Migraine with aura and POP — DFSRH MCQ

Instant feedback + full explanation. One question, done properly.

HardUKMECMigraine with aura and POPDFSRH

A 29-year-old woman with migraine with aura asks for a desogestrel POP after being advised to stop CHC. She has normal blood pressure and no VTE history. What is the UKMEC category for POP use?

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

Reveal the answer and explanation

Correct answer: E — Classify this as UKMEC category 1

The best answer is “Classify this as UKMEC category 1”. Progestogen-only pills are generally UKMEC 1 for migraine with aura, unlike CHC which is contraindicated. UKMEC 3 or 4 would incorrectly transfer oestrogen-related stroke concern to POP. UKMEC 2 is more cautious than necessary for this scenario. The pearl is that stopping CHC for aura should be paired with safe alternatives rather than contraceptive nihilism. Combined hormonal contraception must be assessed by applying oestrogen-related arterial and venous risk, the exact timing of incorrect use, drug interactions and the need for emergency contraception. A non-oestrogen method may be acceptable even when CHC is not. Missed-use advice depends on whether the hormone-free interval was extended, rather than simply on the number of tablets mentioned.

Reference: CoSRH/FSRH, Combined Hormonal Contraception (January 2019, amended October 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-combined-hormonal-contraception-october-2023.pdf