thinking about changing birth control is raising my blood pressure
July 29, 2022 8:55 AM   Subscribe

I am a 35-year-old migraineur with now, apparently, high blood pressure. This is a nightmare, as I depend on daily (no placebo) combination birth control pills. Other than never going to the doctor again and just lying on online forms to renew my HBC indefinitely, what options do I have to make sure I continue not having a period?

I have been on hormonal birth control for many years. Without it, I develop lots of (extremely painful!) ovarian cysts, have terrible acne, miserable headaches, depression, and periods that are not just inconvenient and painful but honestly existentially upsetting (I think there's probably some amount of dysphoria there but I don't really feel a need to explore that). I also do not want to get pregnant. I was also told that I "probably" have PCOS and that the HBC is probably addressing the symptoms.

However, I'm now being told that since I have several risk factors, I have to change to some other kind of birth control that isn't going to address all (or maybe any!) of these problems. This is really upsetting. I have been offered the minipill and an IUD.

What options do I have here? Both parents have taken blood pressure medication since they were young adults, so it's genetic and lifestyle changes don't seem to have helped so far. Is there someone out there who will let me take blood pressure meds AND my birth control? Is there some kind of secret option I'm not considering? Right now I am just not doing anything about the blood pressure so a prescription doesn't show up on my health records, but that feels like also a bad idea.

(I know that in theory surgery is an option, but a) I don't really want to have surgery and b) I don't know anyone who's found a doctor willing to do that surgery on a childless and arguably still fertile afab person)
posted by anonymous to Health & Fitness (20 answers total) 3 users marked this as a favorite
 
I've got endometriosis and have a number of very fun symptoms if I don't keep this shit locked down.

The Mirena IUD was effective for me for about 3 years at stopping my periods and keeping most of my symptoms in check. Then I guess there wasn't enough hormone left in it to help me and I started getting breakthrough symptoms. I got it taken out and have been running pill packs back to back for years. I don't know if there's enough hormone in the Mirena to help you, but it did give me a few good years of service.

I'm 36, my blood pressure is fine and I don't smoke, but I've got other health issues requiring drugs and I do basically consider my body a ticking time bomb in re. how long I can continue my birth control without other things being in conflict.

The r/childfree subreddit keeps a list of doctors who will do sterilization and related surgeries on women without being shitty about it. Something to keep in your pocket for a rainy day, perhaps.
posted by phunniemee at 9:05 AM on July 29, 2022 [2 favorites]


I had extremely heavy painful periods only ever diagnosed as 'dysmenorrhea' that also triggered my migraines and the Mirena IUD kept nearly all symptoms at bay for nearly the entire five years I had it in, and only developed some near the end of it's lifecycle. I won't lie though, getting in inserted was very painful. More so than they'll warn you of.
Also if it is "probably PCOS" getting that figured out may help bc HBC isn't the only treatment, and there are other things that go along with it (like insulin resistance) that you may want to know about.*

*source: my spouse has PCOS
posted by wellifyouinsist at 9:20 AM on July 29, 2022 [1 favorite]


Just another datapoint on Mirena, I am on my third one, and my periods dried up almost immediately and I've not had one for going on 15 years. My best friend has the same IUD and has extremely occasional breakthrough bleeding but nothing approaching a full-blown period in years as well.
posted by Medieval Maven at 9:35 AM on July 29, 2022 [5 favorites]


If you do go the IUD route, ask for drugs. You can have them, but they won't be offered to you by default. At your consultation ask for a single dose of a benzo to take before insertion and whatever else they can do for you. It's your right to have pharmaceutical assistance while someone crams a tool through your cervix.
posted by phunniemee at 9:47 AM on July 29, 2022 [8 favorites]


Oh hi, I am very nearly you! Family history of high blood pressure and was told I could no longer be on BCP about 5 years ago after being on continuously for dysmenorrhea/probably endo since I was a teen. First I tried the minipill but it resulted in almost constant periods and a huge amount of stress trying to be sure I took it at exactly the same time each day.

I did the 3-year Skyla IUD for about 4 years and am now 2 years into a 5 year Kyleena. (Kyleena was recommended to me over Mireena as I've never been pregnant and it's a bit smaller.)They're both hormonal IUDs and my only regret is not going straight for the 5 year IUD the first time. I had no periods the whole time I had Skyla, but I did have onset of PMDD in the last year as the hormones started to fade. I don't think it was from Skyla; I think I'd had hormones protecting me from PMDD my whole menstruating life and so never knew until the hormones starting wearing off.

After the first month or two I never had cramps or bleeding with Skyla, I have had cramps and spotting (no real period) with Kyleena since my Covid booster vaccine, but I attribute that to vaccine side effects and not to Kyleena itself.

This is my long-winded vote to talk to your GYN about an IUD over mini-pill. And, on preview, yes ask for drugs! I've had 2 insertions and for my third I will demand to be medicated.
posted by assenav at 9:49 AM on July 29, 2022 [1 favorite]


To piggyback on phunniemee, ask for Misoprostol. It will soften your cervix and helps with insertion.
posted by Medieval Maven at 10:08 AM on July 29, 2022 [5 favorites]


Just FYI on Mirena, continuous pills stopped my period but Mirena did not. I had a regular, consistent period while on it for years. It stops many people’s periods but not all.

I didn’t find it very painful to have placed, but I had a vaginal birth which I think makes a difference.
posted by jeoc at 10:52 AM on July 29, 2022


Another datapoint on IUDs - I’ve had Mirena and a generic whose name I don’t know for over 10 years, no periods. Also nthing phuniemee and Medieval Maven’s suggestions to make a doctor take insertion seriously and support you with pain or anti-anxiety meds - both of mine were put in with nothing but OTC pain meds, and both were worth it! but really difficult to go through.
posted by rrrrrrrrrt at 10:52 AM on July 29, 2022


i am 42 and have heart failure and a history of migraines. i take several blood pressure medications and other heart meds (and many other meds for many other issues as well). i also take hormonal birth control pills continuously (no placebo) with the blessing of my cardiologist because i feel VERY STRONGLY about never ever having a period or becoming pregnant.

who/what type of doc is telling you no HBCP? a lot of doctors just do things by rote without taking the individual patient into consideration. maybe your period problems outweigh the risk of stroke by continuing the pill. maybe adding high blood pressure meds will lower your bp so it's not a problem. i'd push further and maybe ask to see a cardio.
posted by misanthropicsarah at 12:26 PM on July 29, 2022 [2 favorites]


This article from Harvard Medical School outlines birth control options for women with hypertension (high blood pressure). In addition to the ones mentioned, the implant (Nexplanon) may be an option for you.

(On a more personal note, I also have classic migraine along with other risk factors for stroke -- but not hypertension -- and take norethindrone, the mini-pill, to manage my period. It works well but hasn't stopped bleeding entirely. People's responses vary.)

Also, I'd suggest you see another health care provider as well, if that's an option. Ideally, you shouldn't come away from a medical appointment feeling upset and like you need to resort to Ask.me for advice, you know? Best of luck to you in sorting this out!
posted by reren at 12:29 PM on July 29, 2022


I absolutely cannot take HBC for the same reasons, although my blood pressure is actually fine -- my migraine has aura sometimes and that's apparently a big red flag with birth control pills at my age (also much older than you) -- and I was on the minipill for a while. It did NOT stop my period, I found it incredibly persnickety in terms of timing. As in, I'd miss the time to take it by like an hour and I would start spotting. But you can always give it a shot and see if it works before trying something else, you know? I agree that you should talk to someone else about this!

(FWIW, I eventually ended up using a diaphragm like someone from the 70s and I actually love it, but obviously it doesn't do anything about your period.)
posted by Countess Sandwich at 1:05 PM on July 29, 2022


My primary care doctor had me go to an actual gynecologist, for one visit, because of hypertension plus continuous contraceptive pills (which enabled me to avoid menstrual migraines, terrible fibroid side-effects, and other problems). He told me my blood pressure would not go down if I stopped taking the pills, and advised me to just go ahead and take hypertension medication while continuing with the pills. I continued the pills through menopause and got to skip all the horrors of going through menopause with fibroids. Everyone else I know with fibroids suffered horribly with bleeding during menopause, while I had no problems at all.
posted by metonym at 2:40 PM on July 29, 2022


I'm also a migraineur and as my neurologist has been trying different things to get my daily chronic migraines under control, one of the things she's tried is a blood pressure medication called candesartan. I don't know that it makes a lot of difference to my migraines, but it does do good things for my blood pressure (as you would hope). I wonder if you could take the tactic of treating the migraines to continue your HBCP while starting blood pressure medication?

FWIW I also have PCOS and was using HBCP to manage that when I developed high blood pressure and the doc said I had to stop. I am wondering now if that is when my issues with chronic migraine started, though mine are not noticeably worse around my period. Thanks for asking the question and giving me something else to think about!
posted by Athanassiel at 2:55 PM on July 29, 2022


I was pretty grumpy about having to switch off BCP that had worked well for me and onto an IUD and spent ages putting it off. The Mirena was great!! I took two paracetamol minutes before (as I didn’t know for sure it was going in that day) and while it was certainly not comfortable, it was totally fine for me (maybe someone else described it as like a very brief pain like if you hit your thumb with a hammer - but without the lasting pain afterwards). Obviously everyone is different but there were a lot of terrible stories online that put me off.

At risk of truly getting blood pressure on your medical chart, it turns out I have terrible white coat syndrome so my blood pressure reads very high in a doctors office. It may be worth getting a monitor at home to check over time, or also every couple of years, my doctor gets me to do a 24 hour wearable just to reassure what my blood pressure really is.
posted by AnnaRat at 3:21 PM on July 29, 2022


I don't share all your health concerns, but the Mirena reduced my period symptoms in a way no other HBC has. I'm about to get my third. Big fan!
posted by doift at 7:58 PM on July 29, 2022


I don’t know about the high blood pressure, but if you have migraine with aura you might be eligible for a PFO repair (a relatively minor interventional cardiology procedure). If you do have a sizeable PFO and you get it repaired, it would greatly reduce your chance of stroke (which I believe is why hormonal birth control is contraindicated for people with migraines with aura) and also would be likely to make the migraines themselves cease.
posted by cnidaria at 8:37 PM on July 29, 2022


nthing that you demand proper pain medication for an IUD insertion. Docs love to gaslight women about this, and cite the one or two women who experience no pain, but it is excruciating. Yeah softening the cervix is great, and sure, anti-anxiety meds. But the issue is the PAIN, and a painful medical procedure should involve enough pain medication that it doesnt freaking hurt during or after. Everyone should demand this, instead of suffering in silence so maybe they’ll change things eventually.
posted by asimplemouse at 7:55 AM on July 30, 2022 [1 favorite]


People have different side effects from hormonal contraception, and they're quite difficult to predict. A large minority of people will have no periods on progesterone only contraception, such as the minipill, IUD or implant. In your shoes I would try the minipill first, simply because if it doesn't work out in the way you want, it's easy to just stop taking it and try something else.
posted by plonkee at 1:24 PM on July 30, 2022


I have some of the same problems – migraines and acne – and for years being on the pill kept my skin clear and allowed me to skip periods, but after a certain point my migraines got so bad that my doctor told me I couldn't take HBC anymore as it was a stroke risk.

I now use a copper IUD for birth control, and I take Spironolactone for acne, and Endep/Amitryptaline for migraine prevention. Spironolactone is an androgen blocker and a cursory Google suggests it might be useful for PCOS-type symptoms.
posted by RubyScarlet at 12:57 AM on July 31, 2022


My primary care doctor used to write me both prescriptions for high blood pressure medication and nuvaring. She was ok with this as long as my blood pressure was controlled, even if that was with medication. You may have other medical issues that preclude this, though.
posted by Ms Vegetable at 4:51 PM on August 2, 2022


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