{"id":7926,"date":"2025-10-09T00:01:11","date_gmt":"2025-10-09T08:01:11","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=7926"},"modified":"2025-10-07T16:04:08","modified_gmt":"2025-10-08T00:04:08","slug":"usmle-step-1-question-of-the-day-contraceptive-pill","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-contraceptive-pill","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Contraceptive pill"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-contraceptive-pill\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-contraceptive-pill\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-contraceptive-pill\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-contraceptive-pill\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-contraceptive-pill\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-contraceptive-pill\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today\u2019s USMLE\u00ae Step 1 question of the day focuses on how a contraceptive pill ingredient works to prevent pregnancy. What\u2019s the answer? Let\u2019s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 25-year-old woman presents to her gynecologist to discuss contraception. After being counseled on the different options, the patient opts for a contraceptive pill. The pill contains an active ingredient contraindicated in individuals with a history of thromboembolism or migraines with aura. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following <em>best characterizes <\/em>this active ingredient in preventing pregnancy?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Thinning of the endometrial lining<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Upregulation of endometrial inflammatory response<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Suppression of ovulation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Stimulation of GnRH release<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Thickening of the cervical mucus<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Suppression of ovulation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Thinning of the endometrial lining<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Progesterone is the component of oral contraceptive pills that prevents endometrial hyperplasia, thereby deterring embryonic implantation. Progesterone also promotes thickening of the cervical mucus, preventing sperm from entering the uterus and fertilizing an egg. However, the contraindications listed in the question stem are more consistent with estrogen, not progesterone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Upregulation of endometrial inflammatory response<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Intrauterine devices work primarily by inducing inflammation of the endometrium. This reaction results in sperm engulfed, immobilized, and destroyed by inflammatory cells. Intrauterine devices are contraindicated in individuals with uterine anomalies (e.g. fibroids), pelvic infection, or abnormal vaginal bleeding. However, they are not contraindicated in individuals with a history of thromboembolism or migraines.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Stimulation of GnRH release<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Estrogen, an active ingredient in oral contraceptive pills, is contraindicated in individuals with a history of thromboembolism or migraines with aura. The exogenous estrogen within the pills will suppress GnRH release from the hypothalamus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Thickening of the cervical mucus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Progesterone is the component of oral contraceptive pills that promotes thickening of the cervical mucus, preventing sperm from entering the uterus and fertilizing an egg. Progesterone also prevents endometrial hyperplasia, thereby deterring embryonic implantation. However, the contraindications listed in the question stem are more consistent with estrogen, not progesterone.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient was likely prescribed a <strong>combined oral contraceptive pill<\/strong>. The medication contains two active ingredients, estrogen and progesterone, which help prevent ovulation.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>estrogen <\/strong>suppresses the release of GnRH from the hypothalamus and the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary. Without these hormones, <strong>follicular development and ovulation<\/strong> are impaired.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>progesterone <\/strong>within combined contraceptives also prevents ovulation via a similar mechanism. Furthermore, progesterone<strong> promotes thickening of the cervical mucus<\/strong>, preventing sperm from entering the uterus and <strong>endometrial hyperplasia<\/strong>, which deters embryonic implantation.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Combined contraceptives are most frequently administered orally. However, they can also be administered via contraceptive <strong>patches <\/strong>and vaginal <strong>rings<\/strong>. Given the presence of estrogen in these medications, they are contraindicated in individuals with conditions including thromboembolism, coronary artery disease, or migraine with aura.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"791\" height=\"353\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_487f15.png\" alt=\"Estrogen &amp; Progestin\n* Decreased secretion of:\n- Hypothalamic GnRH\n- Pituitary FSH (Ovarian follicles do not develop) &amp; LH (Ovulation does not take place)\n*Thinning of endometrial lining\n* Thickening of cervical mucus\" class=\"wp-image-7929\" style=\"width:465px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_487f15.png 791w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_487f15.png?resize=300,134 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_487f15.png?resize=768,343 768w\" sizes=\"auto, (max-width: 791px) 100vw, 791px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Combined contraceptives, which contain estrogen and progesterone, can be administered as a pill, patch, or vaginal ring. The estrogen and progesterone impair follicular development and ovulation.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Read this Osmosis high-yield note:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Estrogens_and_antiestrogens\">Estrogens and antiestrogens<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Burgner, A., Hladunewich, M.A. (2020) Contraception, and CKD. Clinical Journal of the American Society of Nephrology. 15(4), 563-565. Doi: 10.2215\/CJN.09770819.<\/li>\n\n\n\n<li>Callahan, T., Caughey, A.B. (2013) Blueprints obstetrics &amp; gynecology (6th ed.). Philadelphia, PA: Lippincott Williams &amp; Wilkins. ISBN: 978-1451117028.<\/li>\n\n\n\n<li>Cooper, D.B., Mahdy, H. (2021) \u201cOral contraceptive pills\u201d. StatPearls [Internet]. Web Address: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK430882\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK430882\/<\/a>.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png?w=700\" alt=\"\" class=\"wp-image-5048\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis from Elsevier today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Learn the pharmacologic actions of contraceptive pill ingredients and important contraindications for safe use in patient care.<\/p>\n","protected":false},"author":204,"featured_media":7928,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[1619,1613,1615,1614,1618,1612,261,1617,1616,664],"class_list":["post-7926","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-birth-control","tag-contraceptive-pills","tag-contraindications","tag-estrogen","tag-migraine-with-aura","tag-ovulation-suppression","tag-pharmacology","tag-progesterone","tag-thromboembolism","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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Understand the significance of emergent laparoscopy to control bleeding and remove damaged tissue.A 28-year-old woman comes to the emergency department for evaluation of right-sided\u2026","rel":"","context":"In &quot;Allopathic Medicine (MD)&quot;","block_context":{"text":"Allopathic Medicine (MD)","link":"https:\/\/www.osmosis.org\/blog\/category\/medicine"},"img":{"alt_text":"USMLE\u00ae Step 2 Question of the Day: Pelvic pain","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T130157.707.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T130157.707.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T130157.707.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-19T130157.707.webp 2x"},"classes":[]},{"id":1000,"url":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-pleomorphic-microcalcifications","url_meta":{"origin":7926,"position":5},"title":"USMLE\u00ae Step 2 Question of the Day: Pleomorphic microcalcifications","author":"Marina Horiates Kerekes, MD &amp; Team","date":"February 7, 2024","format":false,"excerpt":"We're back with a USMLE\u00ae Step 2 CK Question of the Day!\u00a0Today's case involves a 48-year-old woman with no breast symptoms, a history of PCOS, and family history of ovarian cancer presents with mammographic microcalcifications. 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