HRT for sufferer of migraine with aura??

[WombatChocolate]

Hi there. I'm 49 and have had erratic periods for about 9 months after always being very regular. Am having hot flushes, anxiety, loss of libido so wanting to look into HRT. Had a chat with GP yesterday after doing some reading.

GP first offered me tablets, but when I said I'd like to try transdermal and use gel for oestrogen they said that would be okay. When I mentioned having migraine with aura, they said they were not sure if they could give it to me so said they would go away and chat with pharmacist.

I understand from reading around, that the lowest possible dose of oestrogen pump is best approach,mbut question is really about the progesterone element.
I had been keen for utrogestan tablets, but as I still have periods, think I'd have to take them for a couple of weeks and then a couple of weeks off. However, my reading suggests varying levels of progesterone usually make aura migraine worse. I can't quite tell from my reading whether the phased approach to utrogestan is okay for migraine with aura suffered or not considered safe.

Does anyone know anything about this please or have experience of HRT with migraine with aura? I'd rather not have the mirena coil if possible but is that the only option?

Thanks for any info or experience you can share.

i have the mirena, with oestrogel and occasionally still get an aura migraine...just the aura, nothing else, but it's 10-15 minutes and passes over without event.

Previously to HRT and when migraines ruled my life....an aura would be about 50-50 aura only (sometimes for ages) or aura and then 24 hours in bed, so a quiet ten minute sit down, eyes closed and a glass of water is very manageable!

Is it falling levels that are associated with more migraines or the other way around?

Laurie, I think it’s fluctuating levels that can make aura migraine worse.

We’re you only offered the mirena or were other options for progesterone given to you too? Many thanks.

If you look up The Migraine Trust they have a section on HRT.
If your migraines are not already linked to your periods, then it might make no difference.

I used to get migraine (not with aura) for a few days before each period when the progesterone dropped.

This sometimes happens now with Utrogestan, although I've found that the longer I've used it ( 8 years) the less it occurs.

The level of progesterone only varies when you stop it, on a cycle.

There is no right and wrong- the only way is to test it out.

Thank you.

I have looked at that site and others too.

As far as I can see, steady, constant levels of progesterone are recommended. So I guess I’m wondering if as someone with a womb who still has periods, Utrogestan taken on and off will cause a problem. What about taking the smaller dose every day? Is that only for women who have finished their periods?

The trouble is, I’m not sure my GP will have the confidence to be flexible with the medication.
In my very short 5 mins first sessions last week, after first offering me a combined tablet, she said I could have Oestogel pump when I asked and said I would prefer transdermal and thought it was recommended for migraine sufferers. She also agreed to Utrogestan, but then said she wanted to check with pharmacist because of migraine with aura. Guess it’s better they check if they don’t know. However, although she was open to hear which HRT I might prefer, the level of knowledge seemed thin.

I’m waiting for a text to confirm if I can have Oestrogel and Utrogestan - I’d said I’d rather not have the Mirena. But there was no info about how to take any of it, just a comment that a prescription would go to the pharmacist. It could be I have a prescription for this stuff following only 5 mins of conversation and to be honest, I drove most of it myself and suggested products. If I’d not done any ore-reading, I think it would have been very disappointing.

I think I will probably ask for another appointment so I can ask Qs about how long to be on it, how best to take it, migrants etc. The trouble is they are so pushed and desperate to move into their next call.

If it is contraindicated for migraine with aura, that will be on the patient leaflet which comes with the Utorgestan, but it's also easily viewed online.

I doubt very much a pharmacist will know any more than what is on the leaflet / online. (You can view it - just type in Utrogestan patient leaflet /info). Pharmacists are not trained in all the nuances of each type of HRT - they just look online.

You can try using it daily and the only downside is it may not control your own cycle enough- so you'd get spotting perhaps or a period anyway. It's worth a try and not 'dangerous' in any way - just 'nuisance value'.

Give it a whirl?

www.medicines.org.uk/emc/product/352/pil

You can view or download all the info on the leaflet here.

Migraine is listed about halfway down (in very small print) where it just says talk to your healthcare provider and be aware if you it (and also lots of other conditions.)

It's not contraindicated and there are no special instructions.

Thank you.
As someone who hasn’t had HRT before or been on the pill, I’m not quite sure what you mean by ‘control your cycle enough’.

Currently I have periods. They have always been regular, but in last 6 months I’ve probably had 2. One was heavier than usual.

With Utrogestan, what kind of bleeding are you supposed to have? What is considered acceptable or normal? How do you know which days to take the Utrogestan and when not to?

Is it the case that as your periods naturally end, the Utrogestan keeps you having them? Is that forever? If so, how do you know when they’ve naturally ended?

Thanks - you can see I’m a newbie to this!

Sure- back to basics! :)

This ought to help- www.menopausematters.co.uk/pdf/HRT-Doses-Sep2021.pdf

In a nutshell

Two types of HRT

1 for women with periods
2 for women whose periods have stopped at least 12 months ago

1 This hrt is taken to mimic a natural cycle, so it's estrogen daily and a progestin 12 - 14 days from the 2nd half of a month. A 'withdrawal bleed' will follow a few days later. It can be light, medium or heavy, depending on your own existing estrogen and the dose you take. It's best to try to schedule the progestin to coincide with your own cycle IF possible (so starting it around day 15 on a 30-day normal cycle.)

2 This is 2 hormones every day- estrogen and a progestin. The daily progestin counteracts the stimulating effects of estrogen on the womb lining, so it doesn't grow or need to be shed each month.

If you were to use (2) and still have natural periods, the amount of progestin in HRT may not stop your lining building up and a period coming (because the amount in the HRT is balanced to work with the estrogen in the HRT, not that AND your own.)

Using (2) you might get erratic spotting or a full period BUT you might not if your own estrogen is already low.

As long as you are using HRT you won't know if your natural periods have stopped. You'd need to stop it for a few months to see.

Most women stop by 54. A few go to 55/56.

Thank you. Very helpful.

@WombatChocolate

Thank you. Very helpful.

Just for info:)

I had been using Utrogestan as (1) for some years then swapped to (2) as I was post menopause (by some many years.)

However, I found I had a daily migraine with it because the level (100mgs) was clearly falling every day before taking the next one, and it was giving me the pre-period migraine I got on my natural cycles.

It may NOT be like that for you at all, but I've continued with cycles (1) for many years now and rarely get a migraine after the 12 days.

Hi,
I am a fellow migriane sufferer. I used to have the full on migraine with aura a lot when younger. They gradually reduced as I got older, and were fairly sporadic, and often without aura. I started Oestrogen gel and utrogestan 200mg on days 15 - 26 (Im 48 and was till having periods, although a bit more irregular)
Initially I had no problems with migraine on this regime. However I wanted to increase the dose of gel as it wasnt fully controlling the peri symptoms so it was increased from 2 to 3 pumps. I then started getting silent migraines (ie just the aura without the following headache and vomiting) So I basically reduced it back down, and then re-increased very very gradually (so 2 pumps plus a tiny dot, 2 1/4, 2 1/2 etc ) over a couple of months. I am now back up to 3 and no migraines or aura, and best of all feel so, so much better from a peri point of view.

Anyway, long waffle but just to say I think it would still be posisble for you to have this regime and I suppose the only way to know how you will be effected is to give it a go?
Good luck

Thank you everyone.

I now have my prescription. I talked through my migraines with GP and that I’d like transdermal oestrogen and also asked if the migraines meant continuous progesterone would help with removing hormonal fluctuations which can be common with cyclical approach - even though I’m 49 and still have irregular previous (1 in last 6 months).

At first mention of migraine with aura, GP said HRT was contraindicated. When I said that the NICE guidelines explicitly say this isn’t the case, we chatted more and after what felt like a genuine conversation, he said a low dose of osetogel (1 squirt) and continuous Utrogestan (1 tablet per night) could be given and he was happy my migraines about concerns about fluctuations if hormones warranted this approach.

I guess all I can do is try and see how I get on.

My feeling is 1 pump per day or oestrogen probably won’t fully sort out meno symptoms. Any thoughts? I assume I’m not supposed to bleed on this continuous regime. If I’m still due to have a last few natural periods, will they still happen if I’m on continuous progesterone or will they be stopped?

I understand there’s a bit if trial and error with all this and it’s good to start on low doses and use the lowest that deals with your symptoms, so just glad to have made a start.

Only rather annoying thing is I’ve been given 90 Utrogestan tablets for 3 months but only 1 pump pack with 64 squirts in it, so that will only last 2 months.

Hey wombat, late to this but I am a migraineur and gel and pill user and I found my migraines didnt get worse, they just changed iyswim. So still the same amount and pretty uncontrolled at times but to sort that I have upped my beta blockers etc.

I’m on 2 pumps oesteogel and 14 day of/on with Utrogestan and haven’t had a migraine since I started 6 months ago. I had previously been on patches but the migraines didn’t stop and I started to get a rash on the progesterone weeks. I take it orally and was prepared to take vaganially but I haven’t had issues at all.

I think my migraines are mostly hormonally, started when I was a teen, almost daily when I was pg, and started to get worse from age 45 onwards.

On side not, I also got sooooo many boxes of Utrogestan and 2 bottles of gel! I thought I’d got the dose wrong because I’ve got enough of it to last me a year.