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Contraception counselling — MCCQE Part 1 MCQ

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EasyPreventive MedicineContraception counsellingMCCQE Part 1

24-year-old woman presents with requesting contraception. She has migraine with aura and smokes occasionally. Which of the following is the most appropriate next step?

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Correct answer: E — Avoid estrogen-containing contraception and discuss progestin-only or non-hormonal options

Avoid estrogen-containing contraception and discuss progestin-only or non-hormonal options is best because migraine with aura increases stroke risk with combined hormonal contraception. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Contraceptive choice should match medical eligibility and patient preference.

Reference: SOGC contraception guideline