## IUCD Selection in Migraine with Aura **Key Point:** Migraine with aura is a **relative contraindication to estrogen-containing contraceptives** due to increased stroke risk, but **copper IUCDs are safe** because they are non-hormonal. ### Risk in Migraine with Aura - **Migraine with aura** increases baseline stroke risk 2–3 fold - **Estrogen** further increases thrombotic risk (additional 2–4 fold increase) - Combined risk with estrogen-containing methods is **unacceptably high** - **Progestins alone** (including LNG-IUS) are considered **Category 2** (generally acceptable) but copper is **Category 1** (no restriction) ### Why Copper IUCDs Are Preferred | Feature | Copper IUCD | LNG-IUS | Estrogen-containing | |---------|-------------|---------|---------------------| | **Hormonal effect** | None | Progestin only | Estrogen + Progestin | | **Stroke risk** | No increase | Minimal increase | Significant increase | | **WHO Category** | 1 (Unrestricted) | 2 (Generally acceptable) | 3 (Risks outweigh benefits) | | **Migraine with aura** | Safe | Acceptable | Contraindicated | **High-Yield:** **Copper IUCDs are the SAFEST choice for women with migraine with aura** because they are completely non-hormonal and carry no increased thrombotic risk. ### Clinical Pearl - LNG-IUS is **not contraindicated** but is **second-line** in migraine with aura - **Avoid:** Combined oral contraceptives, patches, rings, and injectables containing estrogen - **Progestin-only pills** are an alternative if IUCD not acceptable **Mnemonic:** **"Migraine + Aura = Avoid Estrogen, Choose Copper"**
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