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What birth control is best for me if I have migraines with aura?

A progestin-only pill like Norethindrone is a safe birth control option for women who have ever had a migraine with aura. Women who experience migraine with aura are at increased risk of stroke when taking birth control containing estrogen, which is why progestin-only pills are recommended. 

There are some differences between the progestin-only pill (POP) and the combined hormone pill (COC). Here’s what you should know:

  1. There are no “inactive” or “placebo” pills. You must take a pill every day. All POPs contain one type of hormone in the same dose, Norethindrone 0.35mg.
  2. POPs should be taken at the same time each day. When taken on time they’re just as effective as combination pills, but the window of error is narrower for POPs: If you take your POP just three hours late, it is considered a “missed” pill, and you’ll need to use condoms for the next 48 hours.
  3. You can’t choose to skip your period like you can with combination pills, but POPs usually help reduce period pain and the amount of overall bleeding. Some women who use POPs stop having periods entirely, but that doesn’t happen for everyone, and may take up to a year.  However, POPs often cause spotting or irregular bleeding for the first few months—if you stick with your POPs the spotting should stop after three months or so.
  4. Many women find POPs frustrating for the first 1-3 months because of that irregular bleeding, which is totally harmless from a medical perspective but can be annoying. We find that women start to really like POPs at the 4-6 month mark when the irregular bleeding gets better.

Alternately, you can talk with your healthcare provider about other progestin-only or non-hormonal birth control options such as an IUD, Nexplanon implant, or birth control shot. 

If you are not sure if you have ever experienced an aura with your migraines, check out the list below to see you if you have ever experienced any of these symptoms for at least five minutes within the hour before a migraine begins or during a migraine: 

  • Flashing lights or zig zag lines
  • Partial or total loss of vision
  • Vertigo (the room is spinning)
  • Unpleasant smells or tastes
  • Inability to speak clearly or form words
  • Confusing thoughts or experiences
  • Tingling in your face or hands
  • Any other strange occurrence
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