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[Mav196]

Hi Ladies
i am looking for your advice before my private gynae appt....I have been suffering unremitting headaches, migraines and dizziness for the last ten months and am now suspecting this is all hormonal.   
 
I am 47 yrs old and 2 yrs ago I began to experience rapid and diffuse eyebrow hair loss and loss of hair on forearms (dermatologist concluded it was probably Alopecia), I was on Cerazette mini pill which i discontinued at the onset of the hair loss.  I also went to an Endocrinologist and she ruled out any underlying thyroid or autoimmune disease.  After 6 months or so the hair loss stopped but it didn't fully regrow. 

Last year out of the blue I was hit with new onset daily headaches, dizziness superimposed with migraine - the worst days over the last 3 months have been on days 2,3,4,5, 10-14, 20-21, 25-26.  Went back to the Endocrinologist and had hormones retested,  said she would struggle to label me perimenopausal based on blood results (see below).

Over the last year my cycle has started to fluctuate to 25, 26 and 27 days but in the last 3 months it has been 27 days each month.  The most recent symptom is extremely debilitating periods - the flow has reduced to only 1-2 days but pelvic pain and bowel discomfort makes me feel faint. I do not have any hot flushes or night sweats.  I also constantly feel foggy headed, like i am not "present" and struggle to concentrate.

I have attended a neurologist and have tried and failed a betablocker, Amitriptyline and most recently Gabapentin, due to awful side effects.  I have been on sick leave from my job for the last 10 months and feel that my life has literally fallen apart.  I struggle through every day and can't remember what normal feels like.

Estradiol - Day 4: 191 (77-921 pmol/l)
Estradiol - Day 15: 454 (139-2382 pmol/l)
Estradiol - Day 20: 907 (77-1145 pmol/l)

Progesterone - Day 4: 1.0 (0.3-0.95 nmol/l)
Progesterone - Day 20: 50.9 (3.8-50.6 nmol/l)

FSH - Day 4: 12.0 (3.03-8.08 IU/L)

LH - Day 4: 3.0 (1.80-11.78 IU/L)

I am based in Ireland and we don't have Menopause Clinics here and it's been a struggle to find a gynae who has experience in dealing with hormonal migraine.  I have read the Treatments section here but am struggling to see which one would be suitable for me given that a) i am still having a regular cycle, b) i won't be able to take oral estrogen due to migraines, c) previous hair loss with progesterone only pill. Gynae might offer transdermal estrogen and the Mirena but I am worried about triggering more hair loss from the progesterone in the coil.

Any advice you could give me would be gratefully appreciated....
Mav

[CLKD]

   can't give advice other than take a list of symptoms and mood to the appt..  Any queries you have, write down so that you don't forget anything.

[Mav196]

Thanks CLKD.....my appt will only be 20mins long so yes that's a good idea to make a list of symptoms - you have given me the idea to give a written list to the gynae - I have so many symptoms that if I tried to tell her them the whole 20 mins would be taken up with that alone 
Thanks for replying and for the hug too
Mav

[DaisyB]

Mav - are you south or north in Ireland? There's loads of info on here specific to your symptoms- hopefully you have found something useful.
How dreadful for you.
You mentioned you have 20 minutes with your gynae ( not a lot of time)! I recently emailed prof studd to enquire about a telephone consultation which I hadn't known was an option.
Perhaps if you are less than satisfied with your gynae appt you could consider contacting one of the specialists frequently mentioned on here?

DaisyB xx

[DaisyB]

A link for you re product developed here in Ireland with that gets continuously good reviews xx


http://m.belfasttelegraph.co.uk/life/features/has-co-down-mans-1699-tonic-boosted-these-womens-locks-35042758.html

[Hurdity]

Hi there Mav196

Having hormonal migraines are not a contra-indication for taking HRT although for those who suffer from migraines transdermal oestrogen is recommended as you have suggested.

It sounds like you are in the very early stages before peri-menopause with your cycle being as it is - as your oestrogen levels are normal, your cycle is pretty regular, you are ovulating and LH is not raised, with FSH only slightly. This is generally classified as the late reproductive stage ie before the ovaries begin to pack up but it is the point at which some hormones begin to become erratic and many women suffer extreme pms including hormonal migraines. This happened with me (the migraines - for the first time at this stage when I had no idea of the stage before peri-menopause).

However if it is the fluctuations that are causing your symptoms then suppression of your cycle may be the best option -  ie some form of contraceptive pill? There is one type called QLAIRA which contains the same oestrogen as HRT and only has two tablet free days - do look it up - but does have variable amounts of oestrogen in it. If your headaches are caused by hormonal fluctuations this may help - and there is another called ZOELY - your specialist would be able to advise on the best option. The Mirena is possible but does not always suppress ovulation so you may still get fluctuations. I can't comment on the hair loss aspects of those two pills.

Yes to taking a list and outlining your history as you have done here.

Good luck with your appointment!

Hurdity x

Oops pressed the wrong button while I was writing and it posted!

[Mav196]

Thanks ladies for your replies, they are much appreciated.
I will consider Prof Studd as an option if this gynae can't help me.

Hurdity thanks for your suggestion about suppressing my cycle as a possible solution. I have considered this too and will be sure to ask the gynae about this. The only problem I can see is that I probably won't be able to take Zoely or Qlaira because it's oral Estrogen and she will probably tell me I can't take that due to migraine. So that leaves Cerazette as an option because it suppresses the cycle but by its action it reduces Estrogen levels to early follicular phase levels for the entire cycle and I am worried that this might then cause me symptoms associated with low Estrogen. Also when I was on Cerazette previously my eyebrow hair dramatically fell out - my then GP suspected that Cerazette caused this but perhaps the gynae will have more insight on this.

It's a total nightmare trying to find a solution given that the drugs the neuro gave me were ineffective. I am so desperate to get well and to be able to function - there has been no respite from this in the last 10 months. I feel that my life is slipping away - family life is non existent and I haven't been at work for all of this time either.

Thanks for your support and understanding
Mav

[Mav196]

Hi ladies
I have a quick question on HRT - am trying to get educated before my gynae appt so please excuse my ignorance as this is all new to me.

 I know that I need Estrogen for some of my symptoms and I understand the various routes for this piece of HRT but my confusion is around the progesterone piece.....In addition to everything else I am suffering from extremely painful periods and am wondering if progesterone via the Mirena is the only way to address this - in other words will progesterone via any route address this particular issue or only via the Mirena?
Thanks for your help
Mav

[Hurdity]

Hi again

If you have a history of migraine with aura then the CCP won't be prescribed - although all the research into VTE risk has been done with the stronger synthetic oestrogens and there are insufficient data for Qlaira ( according to the product info). However if you experienced new onset of hormonal migraines (without aura) this seems to be common around the time of menopause or a few years before. This is what happened with me - except I did not get aura so didn't know they were migraines until a few years ago as I had never suffered them before and mistakenly thought all migraines were preceded by aura and visual disturbances. Hormonal migraines should not be a contra-indication for one of those pills - but that decision and the finer points would need to be left to the experts like your gynae? Something to raise though. I don't know if others on here have experience of this?

Re the Mirena - if you are prescribed this for heavy periods then you won't get the pain associated with the bleeding. Otherwise if you are still peri - you might even get heavier bleeds on HRT (some women do) as your cycles are still pretty regular.

The other option to regulate bleeds is the CCP but have already discussed that.

Sorry this probably isn't much help.... but hope your appt goes well anyway and do report back

Hurdity x

[Mav196]

Thanks again Hurdity for taking the time to respond to me.....you have a wealth of knowledge that is truly invaluable so thanks so much for sharing and it's so helpful in getting me ready for my appt. I think you are right that I am still peri - regular cycle and Estrogen levels are "normal" range so it's the fluctuations that are causing the symptoms - less flow but increasing pelvic pain, bladder discomfort, occasional vaginal stinging, dry mouth, PMS duration increasing, digestion slowing down, permanent headache superimposed with migraine without aura and dizziness. BUT no hot flushes or sweats yet!!

So based on what I have read and what you have said I am thinking that perhaps the solution for me would be the Mirena as progesterone to combat menstrual pain with some add back transdermal Estrogen in low dose to stabilise the fluctuations. Hopefully the gynae will be more concerned with the symptoms than the blood levels and will treat accordingly. Alternatively she might put me on a POP initially with perhaps some vaginal Estrogen to offset the vaginal stinging and bladder discomfort and see how that goes ( and I will just have to hope the POP doesn't trigger hair loss again)

Thanks again
Mav

[Hurdity]

Let us know the outcome and how you get on?

Hurdity x

[Mav196]

Aargh how many more things are going to happen to me. I now have what can only be described as an acne breakout on my face - not pimples but big red painful blind lumps under the skin. I did not have this ever before even as teenager.....i guess this is another symptom of hormone disarray...

Honestly I am on the verge of throwing myself on the floor and bawling like a toddler!!

Bigh sigh....
Mav