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[RachelT50]

Hello everyone,

I have read this forum for a while now and found it so useful that I thought it would be the right thing to join!

I am 50 and my periods started going all over the place from about 48 onwards (I have kept a record of all my cycles for the past 18 years, specifically so I could track my descent into the menopause!!) plus night sweats started to happen, brain fog and going right off sex with a vengeance!  Covid lockdowns didn't help and I finally got access to help in Feb this year, speaking to the Menopause Clinic lady at our GP.  She immediately put me on Elleste Duet 2mg tablets - I had nausea and a few headaches but my periods became regular again and it was a relief to feel 'stabilised' for want of a better word.  I did feel very anxious though and after 3 months she put me on Femoston 2/10 tablets. 

I have suffered from migraines since the age of 11, but had largely got on top of them by being really strict in terms of diet, exercise (I cycle 10 miles 3 x a week, walk every day & do pilates), hardly drink any caffeine and about 1 unit of alcohol a month!  However, since starting Femoston I have had a 3 day migraine every month as I near the end of the red tablets.  I have a really responsible job and this is making life impossible.  Thing is, do I persevere or should I look at quitting HRT when I get to the end of this pack of tablets?  My periods are all over the place again, I have had 34, 18, 37 day cycles recently.

I'd rather have night sweats than migraines.  I was surprised that I was put on the strongest dose of each tablet when I am still clearly in perimenopause.  I wouldn't do anything without chatting to my lady first, but I wonder if I should come off the tablets and then maybe try gel patches or something which is a bit more flexible than a tablet every day.  All thoughts welcome and it's lovely to be able to share this stuff!

[Limpy]

Hi RachelT50,

Welcome to MM 

It would probably be better to be on a transdermal route for getting HRT i.e. patches or gels.
I started HRT at 52 when I was actually post menopause and had a history of migraines.
My GP was fine about HRT as long as it was patches. I am still using them now at 64.

[RachelT50]

Hi Limpy!  Thanks so much for your reply, that is really helpful to know.  I am also learning how long HRT treatments are used - a real eye opener!

[Nicodemus]

Yes it's a bit weird they didn't go for patches straight away. I also have a history of migraines and was put on patches because of this.

If it doesn't improve after switching to patches it could be worth looking into magnesium supplements as they supposedly help prevent migraine, I'm researching this myself at the moment but haven't started them yet so can't recommend any particular one. It sounds like you're doing all the recommended things for migraines by avoiding caffeine and regular exercise etc.

[Wrensong]

Hi RachelT50    Another migraineur here (classical with aura since age 18, developed ocular in my 30s & then vestibular postmenopause).  I agree with the others that transdermal methods are the type usually recommended for anyone with a migraine history.  I didn't start HRT until a few years postmenopause & now on transdermal, thankfully no longer have classical migraines, touch wood, though have had episodes of the other 2 variants, the latter both on & off HRT.  While trying to find my best HRT fit I stopped a trial of oral HRT (Femoston Conti) a couple of years ago as I began to have frequent headaches & was keen to avoid a return to full blown migraine.  I find the gradual release of patches works better for symptom relief than the once a day methods such as gel or spray.

No time to write more this morning but maybe have a look at the following links when you have time.  The extract in quotations by Prof Anne MacGregor is from the first link.

Mary G is very knowledgeable on this topic so hopefully she'll be along later too.

I hope you manage to get on top of it as migraines are truly awful & very debilitating. 

https://migrainetrust.org/news/migraine-and-perimenopause/

"If you are considering HRT to manage menopause symptoms, either during perimenopause or post menopause, it is important to use a form that minimises hormone fluctuations as much as possible. Hence we recommend transdermal body identical oestrogen, that is oestrogen patches, gel or spray, which can provide stable hormone levels as the hormone is absorbed directly into the blood stream through the skin. Transdermal oestrogen can also safely be used by women who have migraine aura."

https://www.nationalmigrainecentre.org.uk/understanding-migraine/factsheets-and-resources/migraine-menopause-and-hrt/

https://thebms.org.uk/publications/tools-for-clinicians/migraine-and-hrt/

https://www.menopause.org.au/images/stories/infosheets/docs/AMS_Migraine_headaches_menopause_and_MHT_HRT.pdf

[RachelT50]

Hi RachelT50    Another migraineur here (classical with aura since age 18, developed ocular in my 30s & then vestibular postmenopause).  I agree with the others that transdermal methods are the type usually recommended for anyone with a migraine history.  I didn't start HRT until a few years postmenopause & now on transdermal, thankfully no longer have classical migraines, touch wood, though have had episodes of the other 2 variants, the latter both on & off HRT.  While trying to find my best HRT fit I stopped a trial of oral HRT (Femoston Conti) a couple of years ago as I began to have frequent headaches & was keen to avoid a return to full blown migraine.  I find the gradual release of patches works better for symptom relief than the once a day methods such as gel or spray.

No time to write more this morning but maybe have a look at the following links when you have time.  The extract in quotations by Prof Anne MacGregor is from the first link.

Mary G is very knowledgeable on this topic so hopefully she'll be along later too.

I hope you manage to get on top of it as migraines are truly awful & very debilitating. 

https://migrainetrust.org/news/migraine-and-perimenopause/

"If you are considering HRT to manage menopause symptoms, either during perimenopause or post menopause, it is important to use a form that minimises hormone fluctuations as much as possible. Hence we recommend transdermal body identical oestrogen, that is oestrogen patches, gel or spray, which can provide stable hormone levels as the hormone is absorbed directly into the blood stream through the skin. Transdermal oestrogen can also safely be used by women who have migraine aura."

https://www.nationalmigrainecentre.org.uk/understanding-migraine/factsheets-and-resources/migraine-menopause-and-hrt/

https://thebms.org.uk/publications/tools-for-clinicians/migraine-and-hrt/

https://www.menopause.org.au/images/stories/infosheets/docs/AMS_Migraine_headaches_menopause_and_MHT_HRT.pdf

Thanks so much Wrensong!  This is all very helpful.  Having chatted to a few friends I am surprised that I was put on HRT tablets immediately and the highest dose.  The lady I speak to at our GP is very much billed as a menopause specialist, but does seem to be very wedded to tablets being the answer.  She reacted with shock when I said Elleste wasn't really working for me, she said something along the lines of, 'oh well it does work for the majority of women' - which made me feel like a failure, but also annoyed because, come on, we're all different and there is no way we can control what does and does not work for us..!

I will call her once I get towards the end of this pack of tablets, as I am wary of upsetting my system.  But I cannot have a 3-day migraine every month.  I take rizatriptan and have got through more prescriptions in the past six months than I have for years!

[Wrensong]

You're most welcome Rachel & you're certainly not a failure, oral HRT should just not really have been prescribed in the first instance to someone with a migraine history, but your GP specialist must not have been aware of that.  When I took Femoston it was because I was struggling to get good enough symptom relief with transdermal methods, but please don't be put off by that as there are other complications in my case & most women do well once they find a good fit.  I asked to start the Femoston trial fully aware that it could be problematic for my migraine, but by then I'd been round the block a few times & had had good reason to research HRT, whereas anyone new to it can't be expected to.  I'm afraid many GPs are still learning, even those with a special interest in menopause.

Like you, I've felt I'd failed, having been told at 2 different Menopause Clinics that Utrogestan is the form of progesterone most women feel really well on, whereas it's the worst of the lot for me & makes me very unwell indeed (not as a migraine trigger, but for other reasons).  We are all bafflingly different in our combination, duration & severity of symptoms & in our responses to HRT, as you'll see if you have time to read around on the forum.

I understand your reasoning about seeing out this current cycle of HRT, but yes, do ask to try a different method when you can, as you absolutely can't go on with 3-day migraines on a frequent basis.  Please bear in mind though, that in perimenopause things can be a bit trickier to manage as we still have significant amounts of our own hormones crashing around erratically in the background.  The relative instability of sequential HRT compared with continuous methods in which we take the same hormone combination every day, may also be a complicating factor for you.  I'm sorry, I don't know whether the red tablets you mention are oestradiol alone or the oestradiol-dydrogesterone combination, as it was Femoston Conti I took, so same dose of both hormones every day.  Prof MacGregor (1st link I posted earlier) suggests a Mirena IUD for the progestogen component of HRT in perimenopause, as this is a continuous release method that can be combined with any of the various forms of transdermal oestradiol, rather than stopping & starting a progestogen cyclically.  I've never used one personally as I'm progesterone intolerant so need to minimise exposure to all forms of it, but lots of women on here like them.  Hopefully Mary G will be along to give her perspective too.

To give you hope, on a positive note I've not had a single classical migraine since my final period a decade ago & that includes a total of 5+ years on transdermal HRT.  It's also now nearly 2 years since I had either an ocular or vestibular migraine episode, so I very much hope you'll also find migraine is a thing of the past once your own hormones flatline.  And of course that you'll be significantly better on transdermal in the meantime.
Wx

P.S. Sorry Rachel, I've repeatedly come back & edited this post - as I often do - for clarity & completeness as afterthoughts crop up.  I hope it makes sense!

[Mary G]

Thanks Wrensong!

RachelT50, I suffer with silent migraines and can't add much to what Wrensong has said but I do have a question and that is do you ever have migraine with aura?  The reason I ask if because this particular type of migraine can get worse - or even start - at the onset of perimenopause.  Unfortunately, unlike classic migraines that Wrensong mentioned, aura migraines do not always stop once hormones are stable post menopause. 

With all types of migraines, stable, continuous, transdermal forms of HRT are recommended and this type of HRT regime worked well for me until recently when my migraines decided to make a comeback for no apparent reason.   I now have to add migraine preventative medication (amitriptyline)  to my regime as well as propranolol which stops the dreaded postdrome.

On the advice of the specialist, I conducted an experienced where I stopped all HRT for a while to see what happened.   I was not happy about it but went along with it and guess what?   My migraines were even worse but I did take the opportunity to have some baseline hormone blood tests which are useful and obviously, I immediately resumed HRT.

I'm an HRT lifer which is just as well considering the experiment was a massive fail on all fronts.   I'm 61 and 15 years post my menopause.

Please do come back with any questions.

[Wrensong]

Hi Mary G, thanks for posting  , as you have lots of experience with migraines relating to the sex hormone chaos of menopause I hoped you would.

Unfortunately, unlike classic migraines that Wrensong mentioned, aura migraines do not always stop once hormones are stable post menopause. 

Just want to clarify what I mean by the different types of migraine I've had.  Those with severe headache preceded by visual disturbance aura are what the GP who diagnosed my first in late teens termed "classical migraine".  So these do involve aura.  I always have disorienting visual disturbance aura with them, lasting around 15 mins in which I lose quite a lot of the visual field, obscured by bright, moving blindspots, rather like the after image we get from accidentally catching a glimpse of the sun.  This is followed by nausea, vomiting, intolerance of light, sound & any kind of smell - even usually pleasant ones like perfume are nauseating.  Then, such severe headache develops it's impossible to do anything but go to bed with a big bowl (sorry if tmi) & as much light as possible shut out until the nausea & headache pass, usually within 24 hours.  There are lesser after effects for the following day or so, e.g. more than usual tiredness, hyperacusis & tender eye sockets, so that it's painful to move the eyes.

https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/symptoms-causes/syc-20352072

"Migraine with aura (also called classic migraine) is a recurring headache that strikes after or at the same time as sensory disturbances called aura. These disturbances can include flashes of light, blind spots, and other vision changes or tingling in your hand or face."

The last classic migraine I had was shortly before final period a decade ago, but a neurologist has warned that may not be my last, as you also mention can be the case.

In addition to these, in my 30s I developed what a neurologist termed ocular migraine - I think these are what you mean by silent migraine?  I get very similar visual disturbance auras to those I get with classic migraine, but thankfully without the nausea or severe headache.

https://health.clevelandclinic.org/a-migraine-without-pain-yes-it-can-happen-and-its-called-an-ocular-migraine/

"A Migraine Without Pain? Yes, It Can Happen, and It’s Called an Ocular Migraine
These silent migraines come with aura but no ache"

These ocular migraines continued postmenopause, but now 10 years post, thankfully I've not had one for some years. 

The vestibular migraines cause incapacitating loss of balance, nausea, vomiting, extreme dizziness, all lasting hours & sometimes later, mild headache.  There's also that difficult to describe sense of being in an altered state we get with migraine.  Lesser after effects have lasted up to 3 days. These are the latest development, starting 3 or 4 years ago, well postmenopause.  Very debilitating & the less said about them the better!

Wx

[Mary G]

Sorry I got that wrong Wrensong and thanks for the explanation!   

Sadly, the specialist confirmed that unlike migraine without aura, my type of silent migraine does not always improve with age.   That said, it's far less debilitating than the vestibular migraines you describe and for that I am grateful.   

I do hope they subside for you, it's a horrible, affliction.

[Wrensong]

Thanks Mary G & for all your past help with the progesterone intolerance.   I do feel lucky to have been free of the stonking classic migraines for a decade now, but the ocular/silent ones are not without consequence, are they?  I feel for all of us & hope yours will stop altogether in time, or if not, at least diminish in frequency.  As you say, it's a horrible condition.

RachelT50, I hope things improve for you & that you'll let us know how you are at some point if you have time.
Wx

[RachelT50]

Hello helpful ladies!  I just wanted to give an update - I persevered with the Femoston 2/10mg tablets until the migraines were just a regular, terrible part of my month.  I kept a spreadsheet of symptoms as I took the red tablets and then the white ones - the fatigue, aches and also just not feeling like 'me' just tipped me over the edge as well as the migraines. 

So I phoned the HRT lady at the GP and she has now prescribed me patches.  A whole new experience that I will have to go and look up!  I somehow feel happier not being tied to daily tablets any longer.  Here's hoping the patches work and I don't end up in a worse state...!  That's always the risk with this stage of life isn't it, so much guesswork and no two women are the same.

Off to read up on patches now!

[Wrensong]

Hi RachelT50, thank you for the update.  I do hope you'll feel better on the patches, but do bear in mind that if you are still on a sequential regimen in peri you'll not yet have the stability of the same doses of hormones going in each day & that may continue to have a bearing on your migraine susceptibility.  Yes, agreed there can be a lot of trial & error but I try to keep the bigger picture in mind as I'm aiming for optimal health over the long term, as many of us on here are.  Sorry, no time to read back through everything on this thread & can't remember what went before, but I wish you all the best with it.
Wx

[RachelT50]

Thanks so much Wrensong, you are so right.  In fact, I have (for the time being) gone with my gut instinct and have NOT actually started using the patches yet.  I finished a pack of Femoston and have just then left it.  I actually feel really good - I have slept so much better and have not had even a hint of a migraine at the point in my cycle when I was regularly getting them.

For now, at my stage of perimenopause, it appears that HRT is not actually helping me overall.  I am certainly able to focus better at work then I did on the tablets.  It's all about balancing everything and I know for me, I would rather some night sweats than a 3-5 day migraine every month.  I will definitely let you know how I get on and thank you again x