Smoking and combined oral contraceptive (COC) pill as a risk for cardiovascular disease
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- a combined pill containing a low dose of oestrogen (i.e. 30 mcg) is indicated in women who have migraines without auras - this is because the risk of stroke is greater the higher the dose of oestrogen in the combined pill
- a DTB review (1) suggested that low-dose pill can also be given to women who have migraines without auras but have one additional risk factor for stroke - however the review emphasises that these patients must be followed up carefully
- prescribing decisions, with respect to combined hormonal contraception, are made based on the UKMEC criteria below which define migraine with an aura as an absolute contraindication to combined hormonal contraception - see below for further details and guidance with respect to different migraine scenarios
UKMEC Criteria state:
Cardiovascular factors (including migraine) and UKMEC categories (3):
In consideration of UKMEC criteria and combined hormonal contraception (CHC):
Check the summary of product characteristics before prescribing any combined oral contraceptive pill.
Reference:
- (1) Drug and Therapeutics Bulletin (2000), 38 (1), 1-4.
- (2) BNF 7.3
- (3) FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended July 2019)
Related pages
- Migraine and the combined oral contraceptive pill
- Combined oral contraceptive pill
- Oral contraceptives and smoking
- Oral contraceptives and hypertension
- Obesity and combined oral contraceptive
- UKMEC (UK Medical Eligibility for Contraceptive Use) criteria
- General contraindications to combined oral hormonal contraceptive
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