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[patch]

Hi everyone!     New to the forum, though I have been reading here for a few months now. It's absolutely the best, most straight-talking and friendly site out there, and I always seem to end up back here.

I have a question regarding my new patch, Evorel Sequi:

I've only recently been put on HRT by my doc to try to treat migraines which had gone from two weeks a month to 24/7 for about the last three months. At 49, I guess I'm heading into perimenopause, and it has triggered almost constant migraines in me, as I'm predisposed to them anyway.

At first, I was put on Prempak-C, which made a difference to my general wellbeing in terms of feeling livelier, my attention span and general state of mind coming back to what I'd consider normal (??), but within a few weeks I developed increasing nausea, diarrhoea and stomach cramps, until I couldn't stand it and came off them (incidentally, the only thing which helped with nausea? Not nausea tablets, but those little travel-sickness pressure bands which you put around your wrists!).

My doc then put me on a second HRT, which when I read the instructions was actually only for those who no longer had a monthly bleed, so wasn't at all right for me – thanks to this site for helping me spot that; I wouldn't have known the dangers inherent in a non-progestogen patch otherwise! Also, a reminder to everyone to read carefully when you get the instructions; even doctors make mistakes sometimes!

I've now been prescribed Evorel Sequi, and have a question:
I'd like to go immediately over to this patch from the Prempak tabs, rather than wait until I have a bleed at the end of the month (really can't take the incredible nausea!), but the instructions say to wait until my bleed to start the Evorel. I can't come off the Prempac (last time, my withdrawal migraine was so bad that despite taking morphine, I was just sat on the kitchen floor crying!). So what I was wondering was, can I count out the days I am into my Prempak - actually tomorrow will be my first progestogen tablet – and just apply the Evorel patch which is at the equivalent point in my cycle (ie, the first Evorel Conti patch, as it contains progestogen) ?

Thoughts, anyone? It seems logical to me.

Any comments much appreciated   

[Limpy]

Hi Patch

Welcome to the forum.   

It sounds logical to me too, hopefully somebody who knows what they are talking about will be along soon.

[Hurdity]

Hi patch

How old are you and where in meno if you don't mind my asking?

What you suggest does sound logical but of course there is no knowing how you will react.

Changing from a tablet HRT - equine oestrogens - to transdermal estradiol (which is bio-identical) is bound to have some impact on your body which will take time to settle. Also if you go straight onto the combi patch (containing the progestogen) if there are side effects you won't know whether it is due to changing type, or maybe to the progestogen which is also different. Also the dosage of progestogen is theoretically matched to the amount of oestrogen in the preparation you are taking so the progestogen in Evorel (called norethisterone) may not be siffcient to shed all the lining built up during the Prempak.

Having said that norethisterone is a powerful progestogen in helping to keep the uterus lining thin. It does cause headaches in some women too.

Was your dreadful withdrawal migraine after stopping the tablets completely or just coming off the progestogen ones? If that is the case then perhaps I would be inclined to do what you suggest.

So it's as broad as it's long really!

You may still get a headache when you change from the combi patch back to the oestrogen only - which is that classic pmt headache many of us were plagued with during our fertile years. My headaches got worse while peri and became migraines too.

I use micronised progesterone now (Utrogestan) - which is bio-identical - along with Estradot, and rarely get headaches or migrianes and if so they are very mild.

I'm not very good at short answers but hope this helps!

Hurdity x

[patch]

Hi Hurdity - and Limpy!

Thanks for the replies 

Hurdity, many thanks - that was a great answer!  I'm 49 and have been perimenopausal for about a year, I'd say. I still have bleeds, but they're very light and getting further and further apart, though the pre-bleed migraines have become steadily worse to the point of unbearable, though I'm very used to migraines and have had them all my life.

I actually took my first Prempak progesterone pill last night, and it was from the very first pack of Prempak that I've ever taken. I was going to change over to patches at the progesterone point, but chickened out for the very reason you said; that I wouldn't know if it was my first ever dose of *any* progestogen, or the new patch itself that was causing the problem. I only took the Prempak for the first part of the month (16 tabs) prior to that, so I was hoping that my body wasn't that used to the oestrogens, and I was figuring that I would have the effect of the change-over at some point (after my present pack of Prempak is finished) anyway, so why not now, to save a further twelve days of Prempack oestrogen nausea, you know?

Really, norethisterone causes headaches? It's so frustrating, that the recorded reactions of individual HRT types seem so vague! My doc gave me it specifically to treat that!  Then again, when I asked him whether I could swap HRT types mid-packet (picking up with the patch which matched the correct point in my cycle), he told me that he really didn't have the experience or specialist knowledge to answer that. I must admit, I was hoping for a bit more guidance than that!

My full-on withdrawal migraine was from stopping the Prempak entirely for two days, because I coudn't take the nausea/stomach cramps/diarrhoea any more. Then I couldn't take the withdrawal migraine, so went back on them! The migraine went entirely after two days back on the Prempac, but the sickness came back (the sickness went entirely after a single missed Prempack tablet). At that point, I'd only been taking Prempak for a grand total of eight days, but then I do get a migraine at the drop of a hat.

Really, you started to get migraines when perimenopausal? That's tough luck. Good to hear that you're controlling them now - is that entirely, or do you still get the odd breakthrough migraine around your withdrawal bleed?

Good grief, I have so many questions! Hoping that in two years time I'll be one of the old hands who can dole out calm advice and reassurance, but right now I feel like an utter noob (with a headache that could break stone!)

Thanks again for your help 

[Limpy]

Hi Patch

Not sure this headache / migraine thing is entirely clear cut.

I have had migraines all my life, starting from about 5 years old.
They got much worse when I was 18, stayed that way till I was 54.
I was using BCP all the way through till then. The migraines were horrendous in pill free weeks.
I started using Evorel Contil patches when I was 54, the migraines changed to headaches at that point, much easier to cope with, but still there.

This is just a brain dump, not sure it helps

[Hurdity]

Hi patch, Limpy - I agree none of it is clear-cut as we are all different and have and still react differently to hormones - our own or added - all our lives. However the problem with norethisterone is well documented for some women and it is a common side effect.

I am very surprised the doc gave it to you to treat headaches! That would be the last one I would try!! Unfortunately he does not sound clued up at all.

I hardly ever get migraines now thanks - very occasionally when I am on the progesterone or just coming off it, or if I have alchohol (even a small amount) late at night while on it.

Hope you feel better soon

Hurdity x