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[Trufflecat]

Hi

I am 52.  I have been following posts on here since starting on HRT 4 months ago & am hoping for some advice.
I have had horrendous PMT for 40 years.  Really awful.  DH pointed me at an article by John Studd which let me to approach my GP for HRT, even though I am still having periods (they were getting irregular though).  I have been on Evorel Sequi for 4 months now, which I think should give it time to settle down, yes?  I am used to getting premenstrual headaches, but I think that they have got worse.  I have kept a note of them since starting on the HRT & I have had  a severe headache in week 3 of the first month, week 3 of the second month, week 2 of the third & fourth months.....the latest one lasted for 3 days & was unrelieved even by codeine.  In addition (I am now at the end of week 3) my mood has been really very low for the past few days.  I feel, well, depressed for the want of any better description.  I did start to feel like this last week though & that was when I was on the Oestrogen only patch, so I cannot blame the Progesterone presumably. 
Thank-you if you have trawled through all of that!  Any advice greatly appreciated.

[CLKD]

 

[Briony]

Hi - and welcome

If you have pre menstrual headaches, you may find the Evorel sequential regime doesn't suit you. This is for two reasons: firstly, the progesterone in it is not tolerated by some (many) ladies and secondly, you get quite a 'dip' when you go from one type of patch to the other part way through the month.

You could try by asking your GP for separate oestrogen patches and a bio-identical progesterone like Utrogestan which, especially when taken vaginally, seems to have fewer side effects.

If you still got headaches when you stop the progesterone phase, you might want to consider a more continuous regime (eg 100mg days 1-26 rather than 200mg days for the last 12 days of the month). Others, including Prof Studd, suggest taking even less progesterone in extreme cases eg Utrogestan just on days 1-7 (see his website for info).

Although I still have periods, I didn't like a sequi regime because of the different doses (progesterone withdrawal gave me a headache and low mood) so eventually switched to a low dose contraceptive pill.

I am sure other people will be along soon to give some other suggestions.

Good luck x

[Trufflecat]

Thanks for the welcome and the suggestions. I am going back to see my GP asap, and had considered asking her for a separate progesterone. I did ask for one originally but she said that she couldn't find one! I am a lot better informed after several months of reading posts on here!

[Hurdity]

Hi Trufflecat

  from me too.

Sorry to hear about your headaches.

To add to what Briony said - I was just like you when I first started HRT. I was also given Evorel sequi but my periods were only very occasional so I could have been almost at menopause. However I got bad headaches - which were actually migraines, sometimes on the patch itself ( only the second two weeks) and sometimes got the progesterone withdrawal headaches - which were the same as I got pre-menstrually when fertile. Mine too got much much worse as I headed into peri-menopause - and in fact before my periods even becoame irregular. I had never suffered from migraines before.

I did change to patch oestrogen and separate vaginal progesterone (Cyclogest pessaries - utrogestan wasn't available then) - but still got the withdrawal migraine because it's just like the menstrual cycle. I also had a foggy head and general exhaustion during the progesterone phase too. Once the progesterone has cleared and I was on oestrogen only all was well.

Some like Briony can tolerate the progesterone especially in the lower dose of 100 mg so only get the withdrawal symptoms.

These usually will only last a couple of days but by the time you've got back to normal and had your bleed then it's almost time to start taking them again - so I can see why if you tolerate the prog OK, a longer course of them might be the answer as Briony suggests - not if the prog itself it gives you migraines though!

The different times for getting the headaches could be because this patch is not strong enough to suppress your own cycle so could also be a case of your own homrones breaking through?

If you want to try progesterone you probably need to ask for "micronised progesterone" which is the generic term for Utrogestan. My regular GP couldn't find it when I asked for Utrogestan as she hadn't heard of it but found it under the generic name.

Once I was in my late 50's I went onto a longer cycle - with the OK of gynae GP - to minimise the amount of time on the progesterone - but probably won't work if you are still peri-menopausal due to possible breakthrough bleeding and your own cycle kicking in.

Hope this helps - sorry it was a bit of a ramble!

Hurdity x 

[Trufflecat]

Hi. Thanks. I will explain all that to my GP.