A 36-year-old woman who smokes 15 cigarettes daily requests contraception. She also suffers from migraine with visual aura. Which method is most appropriate for her?
- A Progestin-only pill ✓
- B Combined oral contraceptive pill containing ethinyl estradiol and drospirenone
- C Combined contraceptive vaginal ring
- D Transdermal combined contraceptive patch
Correct answer: A. Progestin-only pill
Explanation
Migraine with aura is an absolute contraindication to combined estrogen-containing contraceptives because estrogen increases stroke risk, and age above 35 with smoking compounds this vascular risk. All three combined methods, whether pill, ring, or patch, deliver systemic estrogen and are contraindicated. B progestin-only pill avoids estrogen entirely, does not increase thrombotic or stroke risk, and is safe in migraine with aura and in older smokers.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.