A 28-year-old with migraine WITH aura requests combined oral contraceptive pills for contraception. The appropriate advice is:

• A COCPs are safe and can be prescribed with adequate monitoring
• B COCPs are WHO MEC Category 4 (unacceptable risk) in migraine with aura ✓
• C COCPs can be used if the aura is purely visual and non-hemisensory
• D Progestogen-only pills are also contraindicated in migraine with aura

Explanation

Migraine with aura is a WHO Medical Eligibility Criteria (MEC) Category 4 contraindication for combined hormonal contraceptives (pill, patch, ring) due to the substantially increased risk of ischaemic stroke when oestrogen is used in this setting. The type of aura (visual vs sensory) does not modify this classification. Progestogen-only pills are WHO MEC Category 2 in migraine with aura (benefits generally outweigh risks), making them a safer alternative.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.