First of all, I want to apologize for formatting as i’m on my phone. 
I’m 9 months into VM and have been having mostly decent days, 80-85% or better. My most bothersome symptoms are the derealization and visual disturbances. This past month i’ve switched to a lower estrogen birth control pill from the one i’ve taken for 10 years, same ingredients, just lower doses.
Today was the first day of my cycle, and so have never felt so crummy! I usually have a menstrual headache, and if i’m super lucky i’ll get a full blown pain migraine. Today I have no pain, however the fatigue is INSANE. Like i’m not tired, but my eyes are so tired! Burning, dry, body feels heavy, feel more lightheaded than usual, dizzier than usual, off balance, the works. The increase in fatigue has me genuinely worried because this is how I felt my first couple mo this with VM and i haven’t had a recurrence since March or so.
I know the answer is obviously that yes, this is normal, and that yes, it’s hormone related and yes, I’ll go back to baseline. But i’m extremely nervous and emotional that THIS is my new “new normal”. Really just looking for some kind words. Hope everyone is well today. 