Contraception for patients with migraine with Aura

[Hiker12]

Hi, I have issues with migraine with aura. So my GP put me on a progesterone-only pill, it's been five months and I'm still having multiple periods a month and I've only had a six day window not bleeding so far.

I want to try a different contraceptive method but I'm afraid I'll just react in the same way. What shall I do?

[KirstyC90]

I get migraine with aura but not on contraception. I would definitely head back to the doctor for more advice and tell them what’s going on x

[Hidden]

Dear Hiker12,

There are still a few choices left for women suffering from migraine with aura if they don't tolerate the progesterone only pill:

1. Copper coil- very effective, associated with heavier periods and no effect on migraine

2. IUS (Intrauterine system, e.g. Mirena, Jaydess, Kyleena)- very effective and lasting up to 5 years, lighter or no periods, some spotting initially

3. Implant & DepoProvera- progesterone implant or injection; duration 3mths to 3 years, spotting initially.

The copper IUD is safe. Both 2 and 3 are classed as 'UKMEC 2' by the Faculty of Sexual and Reproductive Health, meaning their advantages outweigh the theoretical risks (for people with migraine & aura).

I would certainly go back to your family planning doctor/nurse to discuss these remaining options. If you've never been pregnant, I might suggest the Jaydess or Kyleena IUS. They are physically smaller than Mirena or the copper coil and associated with lighter periods, although you may initially experience a period of spotting lasting 3-6 months while the endometrial lining thins. Theoretically, the levonorgestrel in the IUS has only a local effect on the endometrium. Hence my recommendation for option 2 over option 3.

The technical blurb from FSRH is here: guidelines.co.uk/womens-hea...

Rgds,

Adhari

[Hiker12 in reply to Hidden]

Thank you! I think I’m going to talk about the implant with my doctor x

[saj01]

Hi... The side effects of the progesterone only do vary.. from small bleeds to what you're experiencing.

You don't say whether you already had the migraines and that can sometimes be hormone related, especially if they occur around the time of your period. Is that's what's happening?

I'm inclined to lean towards not taking any oral contraception at all, but to try the coil., reason being if you go for an injection type and it doesn't suit you... you're going to be stuck with it until it wears off.

There are some drawbacks with the coil , initially it may cause some discomfort but that should settle down. You will find your periods are heavier and your cycle will take a while to regulate itself, but it's certainly worth a try.