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Migraine with aura and CHC — DFSRH MCQ

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ModerateUKMECMigraine with aura and CHCDFSRH

A 36-year-old woman taking a combined oral contraceptive pill reports a new pattern of unilateral throbbing headaches with flashing zig-zag lines before the pain. She smokes 5 cigarettes daily and has a normal blood pressure. What is the UKMEC category for continuing combined hormonal contraception?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — UKMEC 4

New migraine with aura makes CHC an unacceptable risk and is UKMEC 4. The tempting answer is UKMEC 3 because she smokes, but the aura is the decisive discriminator and carries a higher arterial thrombotic concern. UKMEC 1 and 2 understate the risk, while separating pill from patch is misleading because CHC eligibility applies across combined pill, patch and ring. The teaching point is that aura changes the decision even when blood pressure is normal.

Reference: UKMEC 2025; FSRH Guideline: Combined Hormonal Contraception