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[Me]

Hello all
My 'return to business as usual' cycle has now ended and my last period was so light it hardly got started.  In fact, since then I have had an intense and very fast entry to hot flushes which, are coming thick and fast and cause hideous pain in my head.

Today, I have noticed that another period is coming - just some pink on toilet paper - but I am wondering if the hot flushes are actually pre menstrual rather than peri menopausal or both.

My experience with HRT has always been initally positive (for mood, as I didn't have any other symptoms) but quite quickly becoming intolerable because of bloating and sore, heavy boobs.  It also gave me a 'regular' period (which I've never had) and with it, really awful PMT which, I've also never had.

So I have patches on standby and I put 2 on couple of weeks ago but it didn't make any difference to the hot flushes.  Didn't take them long enough to see if I would get the bloating and heavy boobs.

Anyone else experience premenstrual hot flushes?

[Wrensong]

Yes, long postmenopause now but in the initial months when perimenopause first started I only had symptoms, inc flushes & night sweats, in 2nd half of cycle.  I was not on HRT in peri.  The vasomotor symptoms were always at their very worst in the few days before a bleed & this pattern continued throughout perimenopause however long the cycle & in the last 2 years bleeds were sometimes many months apart.  I always knew when a bleed was coming because of the worsening in vasomotor symptoms & suddenly peeing for England for several days, getting rid of all that fluid that builds when oestrogen has not been adequately balanced by progesterone. 

Progesterone increases core body temperature so we are more prone to overheating when progesterone is high in the luteal phase, so this may be a factor for you.  It's also a diuretic, so probably explained the premenstrual increase in waterworks in my case.

Like you, I never had PMS prior to perimenopause (apart from chronic probs with fibrocystic breasts) & had never really understood what less fortunate women faced each cycle with PMS.  That certainly changed for the worse throughout the dreadful peri years!
Wx

[Me]

Thanks for you reply.
Did you take HRT for the flushes?  Did it work?

I am tempted to reach for the patches but as bad as the hot flushes are, the bloating and spre boobs are probably worse.
My history is that I started HRT on the advice of migraine consultant.  I knew full well that hormones have never had anything to do with my hormones/cycle etc but I tried in order to tick the treatment off my list, in order to qualify for preventive injections.  I tried several horrible drugs which were a waste of time and had hideous side effects.  I'm on the injections now and they have changed my life.

Anyway - back to the hrt:  it did nothing for migraines, as predicted but it did improve my moods which, I thought might have been my one and only perimenopause symptom so I decided to stay on it.  After about 8 months the bloating and massive boobs started.  Over the next couple of years I tried different combos and patches, gels, creams, pills etc but the bloating actually returned even sooner with the other methods. 
I stopped altogether about 6 months ago during which time my periods and cycle suddenly returned, exactly the same as they have always been:  same pattern, same flow etc.  Then about 2 months (cycles ago) the period became so scant that it was hardly there, and at roughly the same time the hot flushes started in earnest.  I have a period again now which is also really light - almost nothing.
So, I am wondering if the bloating was because my oestrogen levels were normal and I just didn't need it.  I'm wondering if the hot flushes are evidence that my oestrogen is low and that I could try it again.  Or is it just premenstrual flushing.
It's not a huge problem but at 52, and becasue kids ar older and migraines are under control I am looking at getting back into regular work and I keep having hot flushes at the most embarrassing moments and I can just see it happening in an interview.  I'm very worried that the hot flushes are here to stay and going to get worse.
 
To add context the bloating was so bad it gave me severe backache and the boobs were so massive my bras no longer fit and I had to sleep in a sports bra becasue letting them 'out' was too painful.

[Wrensong]

Did you take HRT for the flushes?  Did it work?

Because I have a migraine history & a difficult to manage thyroid condition both of which I knew could have been complicated by HRT & my Mum had sadly died of breast cancer, I was hoping to avoid HRT altogether, but my symptoms were so bad in peri that a few years in I was persuaded by a well meaning GP to try HRT.  The product I was started on made symptoms even worse & after a month of that one type he felt that was a long enough trial to know that HRT was not going to be suitable for me & so we stopped it.  This was 15 years ago when many GPs knew very little about HRT as it was rarely prescribed & though I was desperate for symptom relief, in a way I was also relieved to be told it wasn't suitable for me, given my worries about being on HRT. 

I continued to have really troublesome symptoms throughout 7+ years of peri (hellish tbh) but, still worried about HRT & thinking the GP was right that if one type hadn't suited me, none would, I continued without it until 3 years postmenopause when symptoms were still showing no sign of stopping & I was on my knees with it.  I knew I needed do whatever it took to get a better QOL, not only for me but for my long suffering partner.  So, after advice from a couple of consultants about the family history of breast cancer, the thyroid & migraine issues, both of whom felt I was long overdue to give HRT another go & tests showing my oestradiol level was too low to be quantified, I started on it again 3 years postmenopause.  It did help symptoms to some extent, but didn't resolve them completely.  It was a long time before anyone agreed to retest my oestradiol level but when it was finally tested it showed I was getting very poor absorption from the patches (Evorel Conti), explaining the incomplete symptom relief.

Since then I've tried a large range of HRT products, complicated by increasingly extreme progesterone intolerance & the thyroid condition.  Only oral oestrogen proved problematic for the migraine & we are indeed advised to avoid oral oestrogen for that reason, but I was scraping the bottom of the barrel for progestogens & needed to try Dydrogesterone which was only available as part of the Femoston oral range.  HRT at the right dose with consistent absorption does control many of my symptoms pretty well inc daytime flushes, but night time is quite another matter & 11 years postmenopause I'm still really struggling with extreme overheating every night & the consequent insomnia.

I knew full well that hormones have never had anything to do with my hormones/cycle

Did you mean your migraines were not affected by your cycle in fertile years?  And the injections are for migraine & controlling it well?

Which patches have you got & do you take a separate progestogen?  Were you able to work out whether it was the oestrogen or progesterone causing the bloating & sore boobs?  I'm wondering if there's any leeway at all for a better fit, though sounds as though you have tried a fair range already.  In my case, it's oestrogen that causes fluid retention & swollen, painful breasts & progesterone acts as a diuretic to release that stored fluid.  But progesterone can also cause bloating because its smooth muscle relaxant effect can slow the rate at which food moves through the digestive tract.  Progesterone also gives some women breast pain.  If you took HRT cyclically, progesterone for only part of each cycle, hopefully you'll have an idea of which hormone caused which effects with you?

I'm wondering if the hot flushes are evidence that my oestrogen is low

That & your scant bleeds, given your age, do seem suggestive that your oestrogen has been low recently.  But women also flush due to the general hormone chaos at this time of life, so it's not a foolproof sign as you may find you have heavier bleeds yet to come in later cycles.

I understand the worry about looking for work while you are not confident flushing won't occur at interview & many women find stressful situations are a sure trigger for flushes - I certainly do.  But I think our self consciousness about flushes can be out of proportion to any notice others witnessing them may take & if they don't make you feel very unwell, could you try to ignore one if it strikes at interview & bluff your way through?  The only time I flush during the day now tends to be in stressful situations but I've got so used to it over the years that I just carry on & not one person has ever commented on it, though in the loo on the way out of whatever encounter it was, my face is very red so it can't have gone unnoticed!

Sorry, none of this feels as if it gives you much certainty, but I hope comparing notes might enable you to work out what's going on & take a step forward.
Wx

P.S. rereading your original post I see you get headaches with the flushes, so I imagine ignoring them at interview would be difficult?

[Wrensong]

Should have said, I'm sure you know that transdermal HRT is recommended for migraine sufferers as oral gives rise to peaks & troughs in hormone levels that can trigger migraines.  For the same reason we are better avoiding cyclical HRT if possible, so conti HRT with same dose of each hormone every day & using methods that give the greatest stability/consistency - patches rather than once a day oestradiol products such as gel or spray.  You say you have patches at the mo but that you've tried various other methods, so I thought it best to mention that if you try again, patches would probably give the best chance of maintaining good migraine control.

Your situation is quite complicated, with the migraine & the fact that you've tried quite a range of products that caused you intolerable side effects.  Another complicating factor is that we are usually advised that continuous regimens (i.e. the most suitable for migraine stability) should not be used until postmenopause, i.e. at least one year after final period but you are still having natural periods.  I think it's possible you could get agreement to try a continuous regimen with migraine to consider, but this might give rise to breakthrough bleeding.

Sorry for such long posts this evening.  I keep thinking of more after I think I've finished!
Wx

[Me]

Hi Wrensong - your replies have been hugely helpful.
In answer:
Migraines and cyles/hormones etc:  the migraines started when I was in my late teens and then really took off in my late 20s then by my late 40s had morphed into Cluster Headaches for which I was hopitalised three times.  After extensive diary keeping and note taking (as advised by consultants, GPs etc) I could prove that these attacks were totally random with one exception:  alcohol.  I have't had a drop for about 6 yrs or so and before Ajovy injections (just over a year) and during that time it made no difference to my migraines, even without alcohol I still got them but I have always known that alcohol was sometimes a trigger and my tolerance to it got less and less to the point where even a small mouthfull would make my eyes go instantly heavy.
Anyway, I was told to try HRT because of my age and I did so purely to say I had tried it.  Didn't make any difference.  Ajovy has been a game changer for me and although I still sometimes get a migraine or cluster headache, the other drugs I take for an attack like Sumatriptan injectins/tablets - even just good old ibuprofen deal with them very effectively.


Yes - re. the oestrogen levels.  I suppose it's obvious but I am surprised by how quickly it has happened.  I literally had a return to a really normal cycle for about 6 months and then a few weeks ago the next period was almost nothing, then some hot flushes then another 'nothing' period' and more hot flushes.  The other thing that has happened steadily over the past few weeks is weight gain.  I never thought it would happen to me!  I'm small, have always been 8 stone sometimes a bit less.  always exercised and I eat very healthily.  Even though I also have Inflammatory Arthritis I have always found ways around keeping as fit as possible.  Now, I can't even bear to look at the bathroom scales and am in grave danger of not fitting into my clothes any more and I am not eating any more than I usually do. 
There is also another spanner in the works in that I have blood clotting anitbodies and really can't take any oestrogen orally.  This was only discovered a few years ago through rheumatology but I reacted very badly to the combined pill in my 20s.  Tried it twice:  instant headache (not migraine) and I think it caused my usually low blood pressure to go up. Very odd but I assume it had something to do with the antibodies.
I have read that it's the progesterone that causes the sore boobs and bloating, but also that it's the oestrogen.  I have had 3 appointments with HRT specialist who let it slip that progesterone is only prescribed in the UK and in European countries like France women regularly only have estradiol patches or gel.  She told me that the cancer risk to the lining of the womb was miniscule and that obesity, smoking and aclcohol consumption were by far a greater risk.  So...for a short while I just finished up my gel and then got some Evorel 25 patches (estradiol only) but I now can't remember what happened!  I think I went from Sequi to the Evorel25 Estradiol only patch and then still had the sore boobs and then I think I stopped, tried the gel on an ad hoc basis.  Apparently this is also something that European women do, just slap on some gel when they think they need it!
Re reading your replies I am struck by how long this has all been going on for you, although I have read that this can happen.  How have you been managing with the lack of sleep?  Have you just had to get used to it?
thanks again for you replies   x       
Forgot to say that the head pain I get along with the ho flushes is more like my head is in a vice - not like a migraine and passes when the hot flush is gone.                                     
x

[Me]

Forgot to say that the head pain I get along with the ho flushes is more like my head is in a vice - not like a migraine and passes when the hot flush is gone.

[Wrensong]

Hi & thank you for the new info.  Yes my migraines - classic with visual disturbance aura, nausea, vomiting, sensitivity to light, sound, smell & the usual excruciating headache - also started in late teens & continued until around final period, but like yours they were random & didn't seem connected to my menstrual cycle.  I was lucky never to have more than about one every month or so & because I wasn't offered meds for them from the start & didn't know anyone else who had migraine, I didn't realise for many years there was anything that could help them & so managed without.  I also developed ocular migraine approx late 30's - similar aura type but thankfully without headache or most of the other trimmings.  Those did still occur for a while postmenopause, but none for a few years now.  Postmenopause I also started to have vestibular migraines - extreme dizziness & balance probs, intense nausea & the sense of being "migrainous" + slight headache partway through, which I then learnt do sometimes start later in life in those with a prior migraine history  .  Very debilitating & the less said about those the better.  I had just a few episodes of those, both on & off HRT, so they don't seem to have been caused by it.

Your cluster headaches sound horrendous.  How awful to be hospitalised with them.  I am sorry. 

So this latest headache type is new & lasts just for the duration of the flushes.  Are the flushes brief?  Many a day?  Have you had your BP tested recently?  Sorry for all the questions.

Again like you, I'm small & slight, in fact underweight.  I haven't had excess weight gain during menopause, but thankfully was able eventually to make up the stone I lost & couldn't afford to during the horrendous peri years.

I'm sorry you also have inflammatory arthritis to contend with.  You must have had so much pain in your lifetime, bless you.  If you have one inflammatory condition & you're suddenly inexplicably gaining weight, have you been tested for autoimmune thyroid disease?  Not on any drugs that could cause weight gain?

I don't know anything about the blood clotting condition I'm afraid, but with migraine we're advised not to take oral oestrogen anyway.  So presumably you were at some point given the OK for transdermal oestrogen & micronised progesterone?

I have had 3 appointments with HRT specialist who let it slip that progesterone is only prescribed in the UK and in European countries like France women regularly only have estradiol patches or gel.  She told me that the cancer risk to the lining of the womb was miniscule

I'm very surprised to hear that a UK menopause specialist was seemingly endorsing oestrogen-only HRT?  My understanding is that the risk of endometrial cancer increasing over time with unopposed oestrogen is well established.  With an intact uterus you will need progesterone to prevent that happening if you're thinking of taking systemic oestrogen again.
 

Re reading your replies I am struck by how long this has all been going on for you, although I have read that this can happen.  How have you been managing with the lack of sleep?

It's been difficult tbh.  The insomnia long predated menopause.  It's not just the night sweats, there are other factors that have made it difficult for anyone to treat.  I don't like to post about it in detail as I find it embarrassing not to have it sorted by now & it must sound like a sob story  .  The usual advice is take more oestrogen for night sweats & though it helps with other symptoms & improves sleep quality to some extent when I'm getting good absorption, it hasn't got rid of the overheating yet.  Progesterone makes me feel very unwell, very hot & wired, not sedated, so sleep has always been worse on it.  Like a few other progesterone intolerant women on here I was on a long cycle to minimise progesterone exposure prior to hysterectomy.  Yes, as you say, apparently a small percentage of women do go on having vasomotor symptoms for many years, recently I've seen it stated even into their 80s  .  Pretty desperate to avoid that.

There is a member called Mary G whose posts you might want to look up, or perhaps you could PM her.  She knows a lot about migraine & has also posted about suffering really extreme sweats before HRT.
Wx