obesity and combined oral contraceptive (COC) pill and risk of cardiovascular disease

• 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)

Last edited 06/2020