Contraception — KFP-style written assessment

KFP 1 (10 marks)

A 31-year-old woman attends for a pill review. She has taken a combined COCP containing drospirenone for two years. Her sister recently had a deep vein thrombosis after surgery. Last month she experienced her first episode of visual aura preceding a unilateral headache. She smokes five cigarettes daily. ^[8]

1. What does the new visual aura change about her eligibility, and why? (4) ^[8]
2. Interpret the family history of VTE in UKMEC terms. (2) ^[8]
3. Name three methods she can safely use instead, with their UKMEC categories. (4) ^{[8] [9]}

Model answers

1. Migraine with aura is UKMEC category 4 for all combined hormonal contraception — the pill must stop. Aura indicates cortical spreading depression with arterial ischaemic stroke risk that oestrogen-containing methods multiply; the restriction follows the aura regardless of headache frequency. ^[8]
2. A family history (sister) of VTE without known thrombophilia is UKMEC category 2 for combined methods — it raises suspicion but does not prohibit; with her other factors it reinforces choosing non-combined methods. ^[8]
3. Progestogen-only pill (category 1–2; Danish data show no increased venous thromboembolism with POPs), etonogestrel implant (no meaningful signal, RR 1.4 CI crossing 1), copper IUD or LNG-IUS (LNG-IUS RR 0.6 versus non-users — no increase). ^{[8] [9]}