A 38-year-old woman with migraine with aura wants contraception. She is a non-smoker with BP 130/84 mmHg and BMI 26. Which is the SAFEST contraceptive option for her?
- A Combined oral contraceptive pill (COC) with 20 µg ethinylestradiol
- B Contraceptive patch (ethinylestradiol + norelgestromin)
- C Progestogen-only pill (desogestrel 75 µg) ✓
- D Vaginal ring (NuvaRing, ethinylestradiol + etonogestrel)
Correct answer: C. Progestogen-only pill (desogestrel 75 µg)
Explanation
Migraine with aura is an absolute contraindication (WHO MEC Category 4) to all combined hormonal contraceptives (CHC) — COC, patch, and vaginal ring — due to a significantly increased risk of ischaemic stroke. Progestogen-only methods (POP, implant, DMPA, LNG-IUS) are classified as WHO MEC Category 2 (advantages outweigh risks) for migraine with aura. The desogestrel POP (Cerazette) is the progestogen-only pill of choice as it reliably inhibits ovulation.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.