For patients with migraine with aura, which contraception should be avoided?

• A. Estrogen-containing methods
• B. Progestin-only methods
• C. Non-hormonal contraception
• D. Copper IUD

Answer: (A)

Estrogen-containing contraception should be avoided in migraine with aura because estrogen increases the risk of ischemic stroke and thromboembolism in women who have aura with their migraines. Migraine with aura itself is a risk factor for stroke, and adding estrogen-containing hormonal methods amplifies that risk. Safer options include progestin-only contraception (such as the mini-pill, DMPA, LNG-containing IUD, or etonogestrel implant) and non-hormonal methods (eg, copper IUD, condoms, fertility-awareness methods). Copper IUD is a non-hormonal, estrogen-free option that avoids the stroke risk associated with estrogen.