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[Bluebirdie]

Hi. My GP just started me on Femoston six weeks ago. I've been getting on well with it...

Since the HRT the sweats, sleeplessness and itching all drastically reduced.

But I had some visual disturbances, which my GP thinks might be a 'silent' or opthalmic migraine but is sending me for non urgent MRI to rule out TIA. My BP was up in the surgery but I was quite stressed!

I am generally quite stressed as just started new difficult job managing 45 people. I can't afford to be sleepless and forgetful again!!

By the way, I had one incident of the visual disturbances well BEFORE I started HRT also but during this perimenopausal period...

No history of migraine or family history, although I do have mild eyesocket headaches that I've put down to sinuses!

So. Any ideas? I'm quite miserable about the idea of stopping the HRT so soon after starting when it was so helpful. Would it be worth me trying to find out other approaches (patches? Different types?) Or does anyone know how I could find out more about what might be going on with the aura symptoms?

Thanks x

[Hurdity]

Hi Bluebirdie

Do these occurrences (visual disturbances) happen at a particular stage in your HRT cycle - or previously at a particular point in your menstrual cycle before you started HRT? This could help to indicate whether they are hormonally induced - ie as a result of the rise or fall in one of the hormones - oestrogen or progesterone? Migraines are not a contra-indication to HRT and if migraines do occur then transdermal HRT ( patch or gel) is recommended. It would be good to know firstly if there is a pattern and then you might want to think about using progesterone rather than a synthetic type. Mary G also suffers from silent migraines in her case brought on by synthetic progestogens, and she might see this and respond. In your case this may not be the cause as you had them before - but they could due to the drop in progesterone or ostrogen?

Obviously important to be checked out to be on the safe side - but if all is found to be well then no reason not to continue with transdermal HRT.

Hurdity x

[Bluebirdie]

Thanks for the reply.

It has literally only happened twice. Once well before I started HRT (months, maybe even a year before...?) and then this week, just two short episodes of 20 mins within 12 hours of each other.

So I couldn't identify a pattern at all, although this latest occurrence happened mid cycle just after restarting the progesterone tablets.

Really helpful to read your comments. I think I might try to get weight and BP down, get the MRI done and hopefully ruling out anything more sinister and then collect information to present to my GP.

If you, or anyone, know where I can find robust info and data on migraine and hrt I'd be grateful to be pointed in that direction.

Thanks again.

[Hurdity]

Hi there - I'm not an expert but there is a lot of information out there - eg National Migraine Centre, Migraine Trust:

http://www.nationalmigrainecentre.org.uk/migraine-and-headaches/migraine-and-headache-factsheets/migraine-menopause-and-hrt/
https://www.migrainetrust.org/about-migraine/trigger-factors/menopause-and-midlife/
https://www.menopause.org.au/hp/information-sheets/560-migraine-headaches-menopause-and-mht-hrt
This one's about 10 years old I think:
http://srh.bmj.com/content/familyplanning/33/4/245.full.pdf

Here's an up to date review:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548761/

One on migraine and oestrogen:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102139/

I haven't read any of these but hopefully there is some information in there which is helpful?

Great idea to get weight and BP down - that's the most important step you can take in terms of health!

Do let us know of any further developments and how you are

Hurdity x

[Mary G]

Bluebirdie, I'm sorry to hear about this but it sounds to me like a classic case of silent migraine.  My story is very similar to yours and I had my first migraine pre-menopause BUT importantly, I had a Mirena coil at the time which contains synthetic progesterone which explains a lot. 

There are many migraine triggers and you will not necessarily be the same as me but in my case, silent migraines are caused by low oestrogen in conjunction with all forms of synthetic progesterone and even Utrogestan (micronised progesterone) in high doses so I have to keep it to an absolute minimum.  To cut a very long story short, following various consultations with specialists, it would seem that I was able to tolerate synthetic progesterone pre-menopause but once my oestrogen levels fell too low, I could not 'fight off' the effects of synthetic progesterone hence the migraines - unfortunately progesterone does change the way your brain receptors work.  So I now have to keep my oestrogen levels high (late 700s minimum) keep away from synthetic progesterone altogether and only take the barest minimum Utrogestan - Professor Studd recommended a hysterectomy which I am considering.  I have regular scans and very luckily, I get good thinning and clearance from a very low dose.  Interestingly, I didn't ever have any problems with my own progesterone (no PMS) although I never really got on with the synthetics in the coil or the pill. 

As long as you don't have any other health issues, you don't need to ditch HRT because of silent migraines, you just need to reduce your progesterone intake and have regular uterine scans.  Assuming all is well with the MRI scan which I am sure it will be, you might want to consider Oestrogel for the oestogen (you rub it on your skin) and 7 days of vaginal Utrogestan every month along with annual uterine scans to make sure everything is OK.  This is the only HRT regime that has worked for me so far and I can honestly say that during the oestrogen only period I feel completely back to normal with no menopause symptoms whatsoever so I obviously need the high dose of oestrogen. 

I hope that gives you something to think about!  The one episode you had prior to starting HRT could be because of low oestrogen, were you using a contraceptive containing progesterone at the time?