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Combined hormonal contraception and migraine — DRCOG MCQ

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HardContraceptionCombined hormonal contraception and migraineDRCOG

A 32-year-old receiving treatment for current oestrogen-receptor-positive breast cancer needs highly effective contraception. She prefers a long-acting method and has heavy periods. Which method is safest from a disease-eligibility perspective?

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Correct answer: C — Offer a copper IUD after discussing its possible effect on bleeding

The best answer is “Offer a copper IUD after discussing its possible effect on bleeding”. Current breast cancer makes hormonal contraceptive methods unacceptable under UKMEC because of potential hormone sensitivity. A copper IUD is highly effective and non-hormonal, though her heavy bleeding requires explicit counselling and may affect acceptability. Route or lower systemic exposure does not convert a progestogen method into an unrestricted choice.

Reference: CoSRH, UK Medical Eligibility Criteria for Contraceptive Use 2025: https://www.cosrh.org/Common/Uploaded%20files/documents/UKMEC_2025.pdf