u/ColomarOlivia

This is NOT medical advice and I’m NOT telling anyone to self-medicate. The official guidelines still contraindicate estrogen of any kind at any dose for contraception in migraine with aura. The interesting part of this study is that this is NOT a consensus that “combo methods don’t increase stroke risk” but a strong question mark and a call for risk reassessment in future studies and guidelines, especially with current, modern low, ultra-low dose estrogen and bioidentical estrogen options.

Combined Oral Contraceptives and Stroke Risk in Individuals With Migraine With Aura
Liza R Gibbs et al. Obstet Gynecol. 2026.

Abstract
Objective: To estimate the effect of combined oral contraceptives (COCs) compared with non-estrogen-containing oral contraceptives on the risk of stroke among individuals with migraine with aura.
Methods: Using U.K. primary care medical records with linked hospital data from the Clinical Practice Research Datalink, the authors evaluated the risk of stroke associated with use of COCs, containing estrogen and progestogen, compared with progestogen-only pills (POPs) among individuals with migraine with aura. The study included individuals aged 15-49 years who initiated either contraceptive of interest from 2000 to 2024, with no history of stroke, other thrombotic disease, or menopause at the time of initiation. Risk of ischemic and any stroke was compared after application of treatment and censoring weights using risk differences and ratios from the Kaplan-Meier estimator. Individuals were censored on medication discontinuation in primary analyses.
Results: Among the 12,429 initiators of COCs and 41,984 initiators of POPs included in the study, 1-year risk of ischemic stroke was 17.36 and 17.62 per 100,000 people, respectively. After weighting, the 1-year risk difference for ischemic stroke for COCs compared with POPs was 9.53 per 100,000 people (95% CI, -38.65 to 57.71). For stroke of any type, the risk difference was 3.49 per 100,000 people (95% CI, -45.17 to 52.16). Effects were larger with shorter follow-up periods (3-month ischemic stroke risk difference of 17.62/100,000 people) but were still imprecisely measured. Findings were similar when individuals were not censored at medication discontinuation (ischemic stroke intent-to-treat risk difference of 10.36/100,000 people).
Conclusion: The risk of stroke in this reproductive-age population of individuals with migraine with aura was low overall and similar between users of COCs and POPs.

Source: https://pubmed.ncbi.nlm.nih.gov/42096712/

Anyone with aura migraines and on Nextstellis? Yes I know aura migraines are a contraindication for estrogen however my doctors (gynecologist, neurologist, cardiologist) opened an exception in my case under close supervision because of health issues.

My migraines are strictly hormonal and shut down when my cycles get shut down too but progestin-only birth control drove me into induced menopause, literally. I became hypoestrogenic and needed estrogen replacement (transdermal estradiol) but I didn’t get adapted to any of them (tried a compounded cream, drugstore patch and a drugstore gel). Hated them.

I can’t take synthetic estrogen (ethinylestradiol) because it increases my blood pressure (I don’t have hypertension) while bioidentical estrogen like estetrol doesn’t.

How were your migraines on Nextstellis?

More like curiosity than any other thing: I lost my virginity at 15, I escort since I was 18, I’m 31 now and still do it occasionally. During this life many stuff happened: broken or stuck condoms, received accidental ejaculation (because the condom broke and we only realized in the end) and when I had steady partners I didn’t use condoms for oral sex. Of course after each accident I took PEP and got screened. Statistically speaking, what are the odds I had contact with HIV? I always wonder that.

PS: I already know about herpes, HPV etc and I receive annual follow-ups with a gynecologist and an infectious diseases doctor. I tried to take PrEP twice but I didn’t get adapted to the medicine.

Two HRT regimens failed me, I’m heading to the third one. The migraines are unbearable. The peri symptoms are back. I’m tired. I already cried so much. I see old pictures of myself and I can’t believe I was once like that. I don’t feel like myself anymore. I feel like my old self died. I don’t have energy anymore, no will to live, no sexuality, my whole body hurts, I’m ugly and I started looking old from night to day, I lost friends, potential romantic partners, I can’t get through my college homework and group projects because of migraines, brain fog, joint and body aches. I let people down all the time. I feel like I’m a burden on earth. Please tell me it gets better and it’s just a bad phase. 😭 I can’t take this anymore. I’m surviving on benzodiazepines.

I’m 31 and I was diagnosed with early perimenopause through symptoms + an estradiol test which was almost zero. I was instantly prescribed HRT without other tests. I had recently done abdominal, pelvic ultrasounds, pelvic MRI for endometriosis (negative), thyroid tests (blood tests, ultrasound, Hashimoto’s screening) and even a brain MRI with contrast because of worsening aura and hemiplegic migraines and the gynecologist said “that’s great, so we eliminated all the possible causes for your symptoms and narrowed down the possibilities a lot”. Because of course, at first all doctors thought it was something else (brain tumor, thyroid issues) and not early perimenopause.

However, how do I know if I’m peri or if it’s POI? And what’s the difference between the treatments?

Sorry about my poor English, not my native language.

Thank you.

I’ve been receiving treatment from the same psychiatrist for 11 years now. He gave me his personal number and I never bothered him, only texted him maybe a couple times to make questions about the prescriptions and such.

Recently, I tried suicide. I was in the hospital, in the psychiatric ward for a couple days. I sent him the hospital report. He never answered. My mother sent him and his secretary the hospital report again and asked if I could get an appointment any soon. They never answered. I blocked them and moved on, I don’t want him as my doctor anymore. My mother didn’t block them and they truly never answered her.

Is that normal? Am I right for wanting to switch doctors now? Tbh that made me traumatized, I’ve been hostile against medical teams as in not believing them anymore, not believing they can do something to help me, I became sarcastic and cynical. In my country people who try suicide must receive compulsory medical care so I don’t really have a choice but going to my appointments (it’s not like you’ll get arrested if you don’t but they’ll go after you as in calling you and your family or showing up at your house) and I’m tired and I just wanna blow up that whole place and never show up again.

I don’t feel like medicine could help me anymore (I have psychiatric issues since I was a toddler and now I’m 31) and I truly think of assisted death.

Just telling a win for those who think “I’ll never be able to meditate”.

When I was younger I tried to meditate but I couldn’t because I was extremely harsh on myself. I didn’t know meditation wasn’t about shutting your thoughts completely but just observing them coming and going without judgement or lashing yourself and then turning the attention back to your body and sensations. I thought any intrusive thought during the practice was already a “fail” and I gave up on meditation.

Then I started yoga because my doctors recommended it but I knew it was more than just the asana and I started reading and researching about it. When I noticed, I was meditating without realizing.

Now I’m able to sit down every day before sleep and quietly meditate for at least 15 minutes. I plan on increasing time little by little but for someone who always thought “I’ll never be able to do it”, it’s a win.

Yoga has done great improvements in my body (I have early perimenopause and I started realizing loss of balance and strength at a young age — yoga helped with that so much) and mind and I’m so grateful. I hope it will always be in my life.

Switching from a 0.10 mg estradiol + 0.25 mg estriol compounded cream my doctor had prescribed me to a 0.025 mg estradiol patch. The compounded cream made me feel better from my complaints at first but then after a bit more than a month using the cream I started having extreme pressure headaches, tinnitus, bloating, bloated and sore breasts, bleeding. Are those the signs the estrogen dose is too high? My doctor told me if needed we will go even lower than that, 0.016 mg. She said the dosage doesn’t matter, what matters is symptoms resolution. Recently diagnosed, sorry if the question is silly.

Thank you!

I’m 31. I’m perimenopausal but I still have some ovarian activity (follicles and cysts seen on ultrasound, sometimes increased ovarian size, still have periods even though they started becoming erratic etc) and oscillating estradiol (sometimes normal, sometimes close to zero). That means I still ovulate sometimes and produce my own hormones to an extent however my ovaries are starting to fail. Because of that I’m on Slynd since I need contraception and that’s also the progestogenic component of my HRT.

In my country you can only find bioidentical estradiol in drugstores at doses equal or higher than 50 mcg. I read the pamphlet of all of them and it seems like they’re made to women who are already menopausal or even post-menopausal. That dosage was probably too much for my body on top of my own natural estrogen and I started having hyperestrogenic symptoms and my doctor said I’ll need a lower dose (25 mcg) however that’s only achievable through a compounded cream. I only read awful things about compounded HRT and even doctors saying it’s dangerous and telling women to avoid it.

If I don’t take the HRT I feel awful from hypoestrogenic symptoms, the available dosages make me hyperestrogenic, the only way to get an adequate dosage for my body is through a compounded product.

Anyone on compounded HRT?

Just checking if I’m not alone.

My history: I had Bell’s palsy + other neurological and cardiac side effects (probably autonomic as no structural abnormalities were found but my tilt table test was abnormal) from my first Pfizer shot. I had to be treated by a neuroimmunologist. I took prednisone (started with 60 mg) for almost 1 year (the face paralysis simply wouldn’t go away) + drugs for my blood pressure, heart rate and a diuretic. Suddenly after one year side effects started calming down and I tapered and quit the drugs. Both my neuroimmunologist and infectious diseases doctor told me NOT to take vaccines unless strictly necessary. They even told me not to take the flu vaccine. They told me my immune system created an exaggerated immune response and they can’t guarantee it will happen or won’t happen with other vaccines so in my case benefits vs. risks must be more carefully assessed.

There’s a serious measles outbreak in my city and I had the complete vaccine scheme as a child, 1 booster as a child and one booster as an adult in 2019 (I was 24. I’m 31 now). So 4 MMR shots in total. I asked the family doctor in the hospital near my house and he said “no exceptions, even previously vaccinated people”. However I researched and apparently the basic scheme is considered to offer lifelong maximum protection already, the boosters during outbreaks are to cover 1) people who don’t know if they were vaccinated or not or if they completed the scheme or not and 2) people who didn’t mount a proper immune reaction and having 2 boosters besides the basic scheme would reduce the odds of that being my case. It’s easier to vaccinate everyone instead of checking everybody’s background or if they have antibodies against the virus.

It seems like doctors can’t evaluate my case individually (my personal history of adverse events from a vaccine), that “more careful risks vs. benefits assessment” thing doctors first talked about apparently doesn’t exist and they don’t care if I have something more serious this time in a completely unnecessary way.

Just checking if anyone went through this.

31F. I was overweight when I started fasting and I could do 20, 24 hours easily. Because of obesity I started exercising and started doing well in running. In the end, I became an amateur long distance runner and I’m checked up by a cardiologist and a sports medicine doctor annually. I also acquired the long distance runner body type; extremely lean but with no hypertrophy, low body weight (BMI 19). After that, max I can do regarding fasting is skipping breakfast. Beyond that, I get hypoglycemia (I didn’t know it was hypo until I got my blood sugar tested during one of those episodes). I have palpitations, jitteriness, extreme headaches, cold sweaty extremities, dry mouth, breathlessness, confusion, impeding doom feeling, tachycardia (my heart rate reached 136 during rest). I eat, wait and it goes away. An easy quick fix is sugary stuff. I talked to my doctor and she said IF won’t work well for long distance runners because of low body weight and my reaction is because my body doesn’t have where to get fuel from (fat is gone, muscle is minimal). She recommended me to “eat normally” (from 3 to 3 hours, small meals). Anyone ever went through this? I now rely on just skipping breakfast. Having to eat all the time bothers me and the 1 to 2 large meals a day I used to eat sound more metabolically healthy than snacking from 3 to 3 hours. I have a strong family history of diabetes type 2.

My doctor isn’t even sure it’s Slynd causing this or perimenopause. More likely perimenopause because my (peri) symptoms started BEFORE Slynd and only got worse as the years went by (on Slynd). My estradiol test was almost zero. My doctor told me as Slynd is progestin-only my body was supposed to produce its own estradiol and it wasn’t supposed to be THAT low, even on a progestin-only pill. I’m 31.

My episodes are triggered with estrogen oscillations. I was put on a progestin-only pill that blocks ovulation and reduces your own natural estradiol production. That made my MCAS symptoms MUCH better however didn’t make them go 100% away which is expected because it still allows some oscillation (periods of higher or lower estrogen). But still, it gave me some relief.

However, I went on that pill for MCAS reasons AND weird symptoms that I first thought they were from PCOS (sudden increase in menstrual flow, menstrual irregularities that didn’t exist before, sudden worsening of preexisting aura and hemiplegic migraines). After 2 years those symptoms started getting worse and more obvious (hot flashes, no sex drive, forgetting words, sudden EXTREMELY high cholesterol with no weight, dietary or lifestyle changes, body shape/composition changes including shrinking breasts and loss of roundness on the hips, sudden high blood pressure episodes that would last for a few minutes and go away, sleep disturbances). I quit the pill thinking it was that however it wasn’t. The symptoms didn’t go away for months, they kept going on, actually got worse because of MCAS, I couldn’t deal with all that BS anymore and I went back on the pill.

I went to the a gynecologist who’s specialized in HRT and menopause 3 days ago and told her everything and she was like… “you’re probably entering perimenopause”. And prescribed me transdermal HRT with a very low dose of estradiol (0.10 mg) and estriol (0.25 mg). She kept me on the pill. Yesterday I was already having an MCAS flare because of a sudden estrogen surge (I know when they come because of my skin quality, cervical mucus etc) and I applied the cream and hours later I was feeling worse (?). Increased blood pressure, palpitations, sleepless, wired but tired, you know the drill.

Anyone has experience on HRT?

Thank you.

31F, on Slynd birth control, clonazepam (1.6 mg once at night, currently weaning off it with psychiatric support), HRT (0.10 mg estradiol + 0.25 mg estriol transdermal cream). Aura and hemiplegic migraines diagnosed by a neurologist, improved a lot after Slynd skipping the placebos.

I was kinda baffled at the doctor’s office and I didn’t have much to say from shock. I was still processing it. I didn’t ask her this and I have my next appointment in 40 days. I went home and started googling (yes, I know. It only makes things worse). I read that women who have early perimenopause are at higher risk of cardiovascular disease and osteoporosis. However it wasn’t clear if that’s for women who are on HRT or not. I have health anxiety and this is the news I was DEFINITELY not waiting to get even though everything was so weird in the last couple years I was suspicious perimenopause could be a cause.

Will I be fine on HRT? Is it good that I found out about it early and started HRT early? Does early perimenopause decrease the life expectancy of a woman or increase the risk of early complications?

I’m scared.

Thank you.

31F, on Slynd birth control, clonazepam (1.6 mg once at night, currently weaning off it with psychiatric support), HRT (0.10 mg estradiol + 0.25 mg estriol transdermal cream). Aura and hemiplegic migraines diagnosed by a neurologist, improved a lot after Slynd skipping the placebos.

I was kinda baffled at the doctor’s office and I didn’t have much to say from shock. I was still processing it. I didn’t ask her this and I have my next appointment in 40 days. I went home and started googling (yes, I know. It only makes things worse). I read that women who have early perimenopause are at higher risk of cardiovascular disease and osteoporosis. However it wasn’t clear if that’s for women who are on HRT or not. I have health anxiety and this is the news I was DEFINITELY not waiting to get even though everything was so weird in the last couple years I was suspicious perimenopause could be a cause.

Will I be fine on HRT? Is it good that I found out about it early and started HRT early? Does early perimenopause decrease the life expectancy of a woman or increase the risk of early complications?

I’m scared.

Thank you.

I was diagnosed with perimenopause 2 days ago and I’m only 31. Symptoms have been going on for 2 years now and they reached a point where they became unbearable.

I have aura migraines so I’m terrified of estrogen (BC pills with estrogen gave me awful aura migraines that felt like strokes and high blood pressure) and some of my perimenopause symptoms are cardiovascular (palpitations, chest pain, sudden high blood pressure that resolves after a few minutes, tachycardia, bradycardia — yes, both. Completely irregular heartbeats).

My doctor left me on my progestin-only pill (I have no problems from it as in serious side effects) and prescribed HRT on the smallest dose possible, transdermal lotion, with bioidentical hormones. That means: the safest it can get for a woman with aura migraines and/or cardiovascular risk.

Still, I can’t sleep. I applied the HRT cream for the first time today and I’m already on a doom loop, thinking I’ll have a stroke, high blood pressure peak and die. Or that my next days will be hell with unbearable aura migraines, bedridden.

Btw I went to the psychiatrist today and he tried to calm me down and even prescribed me some meds to help me relax and sleep (another peri issue) but it’s so hard!

Anyone ever been through this situation of health anxiety + going through perimenopause or menopause? This is extremely scary. I’m so glad I have my mom who went through the same to guide me through this and calm me down. It feels like the end of the world.