In which situation should estrogen-progestin contraceptives be avoided?

Estrogen-progestin contraceptives are best avoided in women who experience migraines with aura due to the increased risk of stroke associated with estrogen use in this population. Migraines with aura signify a neurological symptom that can precede a migraine attack, and these symptoms may indicate underlying vascular changes in the brain. The addition of estrogen can heighten the risk of vascular events, including thrombosis and stroke, particularly in women with a predisposition to migraines with aura.

In contrast, women with regular migraines, migraines without aura, or those with no headache history do not face the same level of risk when using estrogen-progestin contraceptives. In fact, some studies suggest that women with migraines without aura may actually benefit from hormonal contraceptives, as they do not carry the same vascular risks. Therefore, avoiding estrogen-progestin contraceptives in the context of migraines with aura is crucial for ensuring patient safety.