A 29-year-old woman requests combined oral contraceptive pills. Which finding in her history is an ABSOLUTE contraindication (WHO MEC category 4) to starting COCPs?
- A Migraine without aura
- B History of gestational diabetes mellitus
- C Migraine with aura ✓
- D Irregular menstrual cycles
Correct answer: C. Migraine with aura
Explanation
Migraine with aura is WHO MEC category 4 for combined hormonal contraceptives because estrogen further raises ischemic stroke risk in these women. Migraine without aura is only category 2 or 3 depending on age, so it permits use with caution. Prior gestational diabetes and irregular cycles are not contraindications at all. This distinction between aura and non-aura migraine is the single most examined point in COCP eligibility.
Reference: WHO Medical Eligibility Criteria for Contraceptive Use, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.