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Additionally, you shouldnt take either type of birth control pill if you: have an inherited blood clotting disorder or a history of blood clots experience migraine with aura have a history of heart attack or a serious heart condition smoke and are over 35 years old have been diagnosed with lupus have diabetes that isnt well managed (complications exist) or have had the condition for more than 20 years You shouldnt use a birth control shot if you: have or have had breast cancer (this also applies to the progestin-only pill) take aminoglutethimide, which is a prescription medication used to treat Cushings syndrome have thinning of the bones or bone fragility have diabetes thats not well managed (complications exist) have a history of stroke have unexplained vaginal bleeding Note that people with numerous risk factors for cardiovascular diseases, such as smoking and diabetes mellitus, may have an increased risk of this disease while taking the shot

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Options for managing tolerance include a brief dose reduction for 4 to 8 weeks ("drug holiday" at a lower dose, not complete cessation), lifestyle optimization to maximize the medication effect, evaluation for other contributing factors (thyroid function, cortisol, sleep quality, medication interactions), and consideration of adding a complementary compound to address specific aspects of the plateau

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However, several indirect mechanisms and associated factors may increase the risk of B12 deficiency in individuals with fatty liver disease