A young woman presenting with severe headacheBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2448 (Published 23 May 2013) Cite this as: BMJ 2013;346:f2448
All rapid responses
Did Maria Stavrou and colleagues advise the 20 year old woman with severe migraines who developed a cerebral infarct to switch to non-hormonal contraception and have her progesterone implant removed?1
Progesterone implants containing 68 mg etonogestrel are a long acting but reversible form of contraception. Progestogen only contraception has a high first year discontinuation rate due to numerous side effects including headaches and migraine, thrombosis, depression, irregular bleeding and increases in breast and cervical cancers.
Severe migraine has been a contraindication for hormone use since the 1960s. Migraine headaches due to oral contraceptives were related to arteriolar overgrowth in the endometrium.2 All hormonal contraceptives marketed since then act predominantly like progesterone. In a 2012 meta-analysis users of an injectable progestin versus non-progestin users had a relative risk of a venous thromboembolic event of 2.67 (1.29 to 5.53).3
Migraine patients also are usually deficient in zinc and magnesium – as are women taking hormones who are also more likely to have toxic metal DNA adducts. Progesterone increases monoamine oxidase in endometrial cells and in platelets.4 Progesterone is also more immunosuppressive than oestrogens increasing the risk of autoimmune clotting diseases such as lupus erythematosus and the antiphospholipid syndrome.5 It is progesterone, and not oestrogen, which immediately increases vascular endothelial growth factor and also tissue factor, the initiator of the extrinsic coagulation pathway. Both increase metastatic breast cancers.6,7
Progesterone based contraception is a very important cause of migraine, thrombosis, depression and invasive cancers whether administered orally or in any other way.
My website www.harmfromhormones.co.uk has 2 summary lectures with pictures of the effects on endometrial and cerebral blood vessels including in a woman with thrombotic stroke and a secondary haemorrhage.
1 Stavrou M, Solomou S. Spooner O, Perry R. Picture Quiz A young woman presenting with severe headache. BMJ 2013;346:f2448
2 Grant ECG. Relation between headaches from oral contraceptives and development of endometrial arterioles. BMJ 1968;3:402-5.
3 Mantha S. Krap R, Raghavan, Terrin N et al. Assessing the risk of venous thromboembolic events in women taking progestin-only contraception: a meta-analysis. BMJ;2012; 345:e4944.
4 Grant EC, Carroll JD, Pryse-Davies J. Monoamine-oxidase and migraine. Lancet 1974: 2:1449.
5 Grant ECG. Systemic lupus erythematosus. Lancet 2001;358:586.
6 Kato S, Pinto M, Carajal A. Progesterone Increases Tissue Factor Gene Expression, Procoagulant Activity, and Invasion in the Breast Cancer Cell Line ZR-75-1. J Clin Endocrinol Metab 2005; 90: 1181–1188.
7 Mirkin S, Wong BC, Archer DF. Effect of 17 beta-estradiol, progesterone, synthetic progestins, tibolone, and tibolone metabolites on vascular endothelial growth factor mRNA in breast cancer cells. Fertil Steril. 2005; 84: 485-91.
Competing interests: No competing interests