Contraception Guidelines for Postpartum Lactating Women with Migraine and Aura

Contraindications and Recommendations

The American Heart Association/American Stroke Association explicitly recommends against using estrogen-containing contraceptives in individuals with migraine with aura 1
Estrogen-containing contraceptives in women with migraine increase ischemic stroke risk with odds ratios ranging from 2.08 to 16.9 3
Migraine with aura independently increases stroke risk 2.5-fold, and this risk is further amplified when combined with estrogen-containing contraceptives 2

Norethindrone or drospirenone-containing progestin-only pills are safe options that carry no increased stroke risk 1, 2
Levonorgestrel IUD is an optimal choice as it provides highly effective contraception without stroke risk 1, 2
Etonogestrel implant provides highly effective contraception without estrogen-related stroke risk 4

Irregular bleeding patterns are common with progestin-only methods and should be discussed upfront with the patient 1
Bleeding can be managed with NSAIDs or short courses of low-dose estrogen if necessary 2
Regular follow-up to monitor changes in migraine pattern or frequency 1
Assess and aggressively manage other stroke risk factors including hypertension and absolutely prohibit tobacco use 2