A 29-year-old woman requests combined oral contraceptive pills. She reports recurrent headaches preceded by flashing zigzag lines and unilateral visual loss lasting about 30 minutes, diagnosed as migraine with aura. Which contraceptive should be avoided in her?
- A Copper intrauterine device
- B Progestogen-only pills
- C Combined oral contraceptive pills ✓
- D Levonorgestrel-releasing intrauterine system
Correct answer: C. Combined oral contraceptive pills
Explanation
Migraine with aura is WHO Medical Eligibility Criteria category 4 for combined hormonal contraceptives because estrogen increases the risk of ischemic stroke in these women. Estrogen-containing methods are therefore absolutely contraindicated. Progestogen-only pills, copper IUD and levonorgestrel IUS carry no such restriction and are all category 1 or 2 for migraine with aura.
Reference: WHO Medical Eligibility Criteria for Contraceptive Use, 5th ed.
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Written and medically reviewed by the StethoPrep medical team.