Contraception Journey



Hi @Dr_Paula,

I had 5 - 6 migraines with aura in 2014 and was thus told I couldn’t have the combined pill.

I took the progesterone only pill in 2016 for six months but had to stop taking it due to constant bleeding that didn’t ever subside.

Then, in 2019, I had to take the progesterone only pill while on a course of roaccutane, this was for eight months. I bled for the whole 8 months and stopped the pill as soon as my course of roaccutane ended.

On both occasions, I have given the progesterone only pill time to settle and have still bled constantly. I don’t want to take this pill again.

After having five migraines with aura 6 years ago and none since, am I still not allowed to try the combined pill?

I am obviously very susceptible to prolonged bleeding and would like to avoid ever experiencing this again. Due to my history of constant bleeding, should I be avoiding hormones in birth control altogether? Or will smaller doses work without making me bleed?

What are my options? I am desperate!



Hello @struggling

Many thanks for your question.

The problem with migraine with aura is that it is a sign of disturbance to the blood supply to your brain. In migraine with aura some blood vessels are constricted and the blood in them flows slowly. Blood that flows slowly clots easily and the combined pill increases your risk of clotting. Because a clot in a blood vessel to your brain is such a serious thing - basically, a stroke - the general advice is that it is just not worth the risk. The thing that everyone would be concerned about is that, for whatever reason, you have another migraine with aura and that if you are on the pill you end up with a stroke.

In terms of alternatives. It is very difficult to predict how the other progestagen only methods might affect your bleeding pattern. The fact that you have had prolonged bleeding on the progestagen only pill does not predict your bleeding pattern on the implant, the injectable or the hormone coil. So it would not be unreasonable to try any of these.

Obviously non-hormonal methods are also a possibility - the copper coil, natural cycles or barrier methods.

I hope this is helpful,

Many thanks