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[sonka]

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[Butterfly22]

Hi I'm in the same boat, I've had really bad underlying migraine for the last four days and I'm into week six of a new HRT, I stopped it today and no headache.
I've had every HRT going and happen with elleste duet and another one which the doctor took me off immediately as can be signs that could lead to a stroke.
So I'd stop straight away, I'm back to doctors tomorrow I'll have to try something else. Xx

[Mary G]

sonka, sorry to hear about your migraine, I am a fellow sufferer and it sounds like you have a similar problem to me.  In my case, migraines are caused by synthetic progesterone, nothing else. 

You did mention you had one migraine while you were not taking hormones, how long before this attack had you stopped taking the pill?  Was the attack just before a period?  The reason I ask is that synthetic progesterone take a very long time to leave your system.

It would be a pity to ditch the patch if you are getting on well with it.  Why not carry on with it and see if you have another migraine.  If you do, I would suggest switching to an oestrogen only HRT for most of the time and taking reduced progesterone on a cylical basis.

Sorry I can't be of more help but hope that helps. 

[Butterfly22]

Ive tried every HRT going, I get settled on one then discountined.
I've even tried no HRT but night sweat and hot flushes were bad plus the doctor said as only 43 must take it.
I had the vision go last time and felt sick and sharpe bagging head.
I was on the pill dianettee as got acne off one of the HRT so doctor put me on this to clear my skin, it was the best I felt in years but three months in and every month I got a migraine.
The doctor took me off it even though I was begging her to let me have it.
There are so many to try it's just finding one that suits, maybe you will find even better one xxx

[daisysareyellow]

I am a long time menstrual migraine sufferer. I was not allowed to go on the pill after the birth of my son 23 years ago because of the risks associated with hormones/migraines. I had an IUD inserted instead (non-hormonal). Strokes can be minor or catastrophic. Personally, I would do a lot of research before taking a chance with hormones if you are a migraineur.

[Hurdity]

Hi sonka

Sadly it does say in the product information that sudden onset of migraine type headache is a reason for immediate withdrawal of the HRT.

However in your case and especially as you have had an early menopause and would benefit from HRT for a while longer, I hope the doctor would send you for a referral to asses whether you are indeed at risk or whether this is due to the synthetic progestogen as Mary G suggests.

As you need to take progestogen all the time due to your endometriosis then the only other alternative is oral porogesterone (Utrogestan) which will be absorbed systemically and therefore reach the areas of your body that have endometrial deposits - do you know how widespread they are? It may well be that progesterone does have side effects but maybe fewer than the synthetic progestogens and enabling you to continue with the transdermal oestrogen?

This is what is says on this site about endometriosis:

Endometriosis
There is a small risk of reactivation of endometriosis with HRT use and any recurrence of symptoms should be reported. If a hysterectomy has been performed for endometriosis, the choice of HRT use thereafter should be influenced by the extent of endometriosis at the time of the operation. Since hysterectomy often causes a premature menopause, it is often advised to take HRT until the average age of the menopause; 51 years. HRT after hysterectomy usually consists of estrogen only. However, in the presence of endometriosis, estrogen may cause stimulation of residual deposits and consideration should be given to using continuous combined (estrogen plus daily progestogen) therapy, or tibolone, though little research has been done on the effect of different types and duration of therapy. Medical treatment of endometriosis often involves ovarian suppression which, along with ovarian removal, may increase the risk of osteoporosis.

and this about migraine:

Migraine
Migraine is often triggered by hormonal fluctuations and therefore may occur around the time of a period. Such migraine may improve at the time of the menopause. Some women find that migraine may be triggered by the daily hormone fluctuations which can occur with oral (tablet) HRT so the transdermal (patch or gel) route is usually preferred with a history of migraine.

You have been using transdermal oestrogen which you will see is the safest way to get the oestrogen re migraines.

I do hope you manage to make some progress to alleviate your problems. Do let us know what your GP says and do press for a referral rather than just say goodbye to HRT for ever.

Hurdity x

[Mbrown001]

Elizabethrose, although she hates it, is the forums migraine expert so perhaps ask her for advice.
She is brilliant and so very generous with her time.


It is invaluable to get advice from someone who has been there and owns all the T shirts.

Hopefully she will be along  soon with her words of wisdom.

[Elizabethrose]

Hi Sonka

Mrs Brown is very kind but I'm really not an expert on migraines, just have far too much experience trying to deal with the wretched things for many years.

Few docs have much experience of dealing with either migraine or HRT so it's no surprise that the combination of both freaks them out. I've seen Profs Anne MacGregor and Peter Goadsby for many years and also Nick Panay. All have extensive specialisms in the treatment of hormonally driven migraine. I can pass on to you what I was told.

Firstly let me address the docs concern about migraine and stroke. This subject is hugely contentious as migraine and it's relationship with stroke, particularly ischaemic stroke, is still not terribly well understood. Theories abound and there are many scary headlines but essentially the studies appear to see an increased risk in women in the age group 35-45 with migraine with or without aura, and this is found to be exacerbated by high blood pressure, smoking and the use of the contraceptive pill. This risk is miniscule, however, as a result of these findings the World Health Organization states that oestrogen-containing contraception is an absolute contraindication in all women who have migraines with aura. Read these links to the The Migraine Trust that better explain both stroke risk and migraine, and the use of the contraceptive pill with migraine.
https://www.migrainetrust.org/about-migraine/migraine-what-is-it/stroke-migraine/
https://www.migrainetrust.org/living-with-migraine/coping-managing/contraceptive-pill/

That said, it is believed that Migraine aura is not a contraindication to use of HRT. In contrast to anovulatory doses of synthetic oestrogen used for contraception, HRT uses physiological doses of natural oestrogen. The docs used HRT to try to treat my migraine. In particularly migraine/hormonally sensitive women, it is recommended that gel or patches be used instead of tablets. The results are variable and you can't know whether HRT will help your migraine or exacerbate your migraine unless you try. However, I was told that HRT was more likely to be successful for those whose migraine did not worsen in peri or meno. Women with headache worsening during peri/menopause showed a variable response to HRT.

The effect of HRT on migraine is unpredictable. Some studies appear to show that higher doses of oestrogen replacement therapy may be more likely to lead to the development of aura symptoms; lowering the dosage or switching to another type of oestrogen replacement may lead to an abatement of aura symptoms. Personally, any level of dosage triggered aura, including the minute doses in Vagifem but I am extremely sensitive. If an aura appears for the first time after the start of hormone therapy, oestrogen can be reduced and the HRT route of delivery can be changed. Transdermal oestrogen delivery is recommended, as I mentioned earlier.

Sonka, it's impossible to know what has specifically triggered this mig with aura but I was told the best HRT combination for migraineurs with aura is oestrogel and a vaginal progesterone like Utrogestan but the difficulty with this is that many UK GPs don't know about the vaginal application method of Utrogestan.

I'm sorry I'm sitting in a hosp waiting room at the moment typing on my phone (trying to access stored info) so this may be a little jumbled. Why don't you read the The Migraine Trust links and if necessary print them off and take to your docs. Personally I would continue taking your HRT until you can seek advice. But I'm not your doc! Sometimes it takes a number of triggers to trigger a migraine so it may well have not been the HRT alone.

Don't panic, there is much dramatization in the links between migraine and stroke. There is plenty of accessible information on this subject on the net if you wish to research further. I've just found another link from the national Migraine Centre, which used to be COLMC. They offer calm sensible advice! Have a read.
http://www.nationalmigrainecentre.org.uk/migraine-and-headaches/migraine-and-headache-factsheets/migraine-menopause-and-hrt/

Hope I've been of some use, do ask if I can help further. I'll be home later this evening with more info accessible on my laptop. Hope you find a solution soon, I wish you well x

[Hurdity]

Hi Sonka and sorry I didn't get back to you yesterday – bit busy at the mo' – and also for the lack of detailed explanation - I didn't mean to alarm you at all nor imply anything about stroke risk – and I know this is controversial judging by what I've read. I was reiterating what is recommended in the prescribing information.  Of course also I would never suggest  (and hopefully didn't imply) that women who experience migraines should not take HRT.

Notwithstanding that you experienced a couple of migraines in your 20's while on the pill (but these contain high doses of stronger synthetic oestrogens as well as synthetic progestogens), however, you posted about sudden onset migraine – and this was 10 months after starting the Femseven conti. So rather than worrying that migraines might be a contra-indication to HRT, it was rather – looking at it the other way round – ie what caused the sudden migraine? Do you see what I mean – and I think the advice to stop is really to check out if the doc can find any reason for this sudden onset. Had it occurred within days or weeks of your starting the new HRT – it would have been clear – but personally this being the case, for peace of mind, I would go for a proper check-up with your doctor.

If your doc pronounces you otherwise fit and well and can find no cause for the sudden migraine then no reason not to continue with HRT – but if it is a delayed effect from the continuous synthetic progestogen, then this is more tricky - in terms of finding something to suit you. From what you say you do need sufficient progestogen in your system to prevent growth of the endometrial deposits and I suggested oral progesterone might do this. Vaginal progesterone mainly goes to the uterus but some is also absorbed systemically so it would be a question of which method gave you the highest dose (re the endo).  Most women who use Utrogestan vaginally do not take it on a continuous basis for practical ( and other!) reasons, although of course, it can be taken like this.

If the patches otherwise suit you symptom wise I would be tempted to stay with them rather than change to the gel – but this is a personal choice and depends how your body reacts. Some women absorb gel very well – some too well – and find they get a daily “hit” from the oestrogen peaks but others swear by it!

One other thing occurred to me and is related to my own experience – when I first started HRT I used Evorel sequi patches – and the combi part of the cycle gave me migraines – so I changed type. My doc suggested it could have been due to the (large!) patch coming partially unstuck at times which could lead to falls in oestrogen and the progestogen – triggering a migraine. My view is that they were due to the synthetic progestogen itself. Could this be happening with you – is the patch staying adhered to the skin consistently? Have you used different products on your skin which could have affected absorption? Have you changed where on your body you apply it? I'm clutching at straws here probably – but could be an explanation in the absence of anything else?

I would urge you to ask for a referral to a menopause clinic – but at least start with your GP to discuss the best options for you, given your endometriosis.

I hope this is helpful

Hurdity x

[daisysareyellow]

I think another thing to clarify here is migraine or common headache. I was a bi-monthly menstrual migraineur. I was bedridden for around 8 hours of each migraine which lasted around 36 hours per migraine. It was made very clear to me that I could not use the contraceptive pill due to the risks. My brothers are both doctors and support this. I had an IUD inserted because my doctor would not prescribe the pill. When it was removed, my husband had a vasectomy. I am in perimenopause and my only symptoms are period issues, but if other symptoms arise,  I know I will face the same obstacles in regard to hormone replacement.

[Rosina]

Hi Sonka
I've come to this conversation very late, but I was researching the onset of migraine aura as a side effect of HRT, and came across this forum.  If you're still looking at this site, I'd be really grateful if you could let me know what your GP advised. Have you found an alternative form of HRT which suits you better? I'm worried about telling my GP that I have had migraine aura since using the patches (about 9 months in) as she is very cautious, and may refuse to let me try any other form of HRT.  Currently I am using Evorel Conti patches.

I had an early menopause at 41 and found that the pill, Cileste, was the best treatment for my symptoms.  I stayed on it for 10 years, but at 51 experienced three migraine auras - roughly one a month. I had no previous history of migraine.  After the third one, I told my GP and she was terrified that I might have experienced a stroke and sent me for a full investigation.  After having a brain scan and every other possible test, it was clear that I hadn't had a stroke.  I was advised by a gynaecologist that it would be safe to use HRT patches - combi as I would need progesterone as well as oestrogen - as there was no increased risk of stroke with the transdermal delivery.

I was interested to read Hurdity's posts about the link between synthetic progesterone and migraine. I know that cyclical progesterone would not be suitable for you because of endometriosis, but I wondered whether anyone else had found success with this method in terms of keeping migraine aura at bay?

If anyone has any advice I would be really grateful.

Many thanks indeed.

[Mary G]

Rosina, like you, I didn't have a history of migraines until I reached the menopause.  I had a Mirena coil at the time for contraception purposes and it was only when my oestrogen levels fell that I started having migraine aura without headache. 

It's a difficult one.  You need to know what your personal migraine trigger is and in my case it is the combination of synthetic progesterone and low levels of oestrogen - I didn't have a problem with my own progesterone pre-menopause, only the artificial type used in HRT preparations.  I am in a very difficult situation because I can't tolerate any form of progesterone but need high levels of oestrogen to function normally.  I have been advised to have a hysterectomy but I want to explore all other possibilities before taking that route.

Evorel Conti patches contain norethisterone which is a strong progesterone so perhaps you need to look at other options.  From what you have said, it sounds like your migraine trigger could be falling/low oestrogen levels (possibly caused by constant opposing progesterone) in which case, you need to keep it as stable as possible and not let your oestrogen levels fall too low.  You might need to limit your intake of progesterone and switch to a cyclical regime and take progesterone for 7 days each month and have regular scans to make sure your womb lining is clearing properly.  You could ask if this is possible on the NHS due to your history of migraines.   

I ended up on 2 pumps of Oestrogel every day and 100mg Utrogestan (used vaginally) for 7 days each month and that is the best regime I have come across so far and it does limit the migraines although as I said earlier, I can't really tolerate progesterone at all but you might find this works well for you. 

It might be worth having a good long run on oestrogen only for a few weeks and see if you get any migraines and feel better overall before introducing the progesterone.

[Hurdity]

Hi Rosina

 

The traditional combined contraceptive pills contain high doses both of synthetic oestrogens and progestogens - either of which could have led to your experiencing migraine with aura. Although the CCP does control the cycle and suppress ovulation, I am not sure what happens once you become peri-menopausal - in terms of what your own hormones are doing. However the CCP is not recommended in women over 50 anyway so I expect you would have had to stop it at some point irrespective of your migraines.

I have never experienced migraine with aura - mine are the classic type so I can't comment on that specific question. You haven't said how old you are now and what happened to your periods since you stopped the pill and before starting the Evorel conti? Did you start the patches straight away after stopping the pill and how do you know you are post-menopausal? Presumably you have had no breakthrough bleeding?

For me taking progesterone cyclically is out of the question - I would feel too tired and foggy-headed, I imagine permanently bloated too. The only way to know whether it is the synthetic progestogen causing yours is either to switch to Evorel sequi ( and get a withdrawal bleed every 4 weeks) - and if you still got the migraines with aura you would then need to try something else eg patches and separate progesterone as I use (or gel as Mary G uses). I think it's going to be a process of trial and error to see what suits you best. Also it does partly depend on whether you are truly post-menopause - since if not then your own hormones can cause symptoms when they override the HRT hormones.

Hurdity x