Endometriosis: progestin therapy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Endometriosis: progestin therapy

Sample item

A 27-year-old with confirmed endometriosis and dysmenorrhoea does not want contraceptives containing oestrogen because of migraine with aura. Which medical treatment is appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Dienogest 2 mg daily

Dienogest is a selective progestin that is effective in reducing endometriosis-associated pain and lesion size and has no oestrogenic effects, making it suitable in women who cannot use oestrogen. Irregular spotting is the common side effect. Combined pills are contraindicated with migraine with aura because of stroke risk.

Option by option

  • A. Dienogest 2 mg daily (correct)

    Correct. Dienogest is an oestrogen-free first-line option for endometriosis pain.

  • B. Danazol 800 mg daily as first line

    Danazol has androgenic side effects and is not first line.

  • C. Combined oral contraceptive pill

    Oestrogen-containing pills are contraindicated in migraine with aura.

  • D. No treatment until infertility develops

    Untreated pain is not appropriate in a symptomatic woman.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Dienogest 2 mg daily. Dienogest is a selective progestin that is effective in reducing endometriosis-associated pain and lesion size and has no oestrogenic effects, making it suitable in women who cannot use oestrogen.

Why is "Danazol 800 mg daily as first line" not the answer?

Danazol has androgenic side effects and is not first line.

Why is "Combined oral contraceptive pill" not the answer?

Oestrogen-containing pills are contraindicated in migraine with aura.

Why is "No treatment until infertility develops" not the answer?

Untreated pain is not appropriate in a symptomatic woman.

What concept does this question test?

It tests Endometriosis: progestin therapy in OBG. Irregular spotting is the common side effect. Combined pills are contraindicated with migraine with aura because of stroke risk.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endometriosis: progestin therapy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.