Adjusting hrt dose to prevent migraines

[Juliecloud]

I’m mid 40s. I started getting migraines a few years ago, every month the day before my period was due. They got worse and worse. I was dismissed by the gp several times, being told it was my age. Then I was given anti depressants to stop the migraines, which had no effect.
A few months ago, I was put on hrt patches (oestrogen and progesterone). The first few months were fantastic, no migraines at all. Last month though, I had a headache and a bit of nausea the day before my period, not as bad as a migraine though. This month, I had a full-on migraine again.

I’m going back to the GP soon to discuss it but unfortunately the GP that prescribed the hrt to me has left and it’s only the one that kept prescribing me anti-depressants that is left.
Does anyone know what I should ask for? More oestrogen? More progesterone? More of both?

I'd want the GP to investigate the migraines first, just in case there's a totally unrelated cause.

If they are being caused by a hormone imbalance, you'll likely need more oestrogen, but if you're on a patch that has a fixed dose of oestrogen and progesterone you're probably going to have to change to the 2 separate ingredients to achieve that eg oestrogen patch with higher dose and separate utrogestan tablets.

Hi when you say the day before your period, I assume that's the day before the withdrawal bleed rather than a natural period?

And is it after you have used the last patch with progestogen in it and gone back to the estrogen-only patch?

If so, it's called 'progesterone withdrawal' and the headaches are really well known.

I used to get them with my own periods (for years and years) and just accepted it- they were migraines.

On HRT, I do sometimes get them as well although I'm better with Utrogestan than I was with Norethisterone (which is what is in your patch.)

There isn't a lot you can do to be honest.
My suggestion is that you take some painkillers for headaches as if it's going to happen, for the day or two before the bleed occurs.

Your other option is to change to estrogen gel and utrogestan, or estrogen only patch and Utrogestan BUT I know of women on that who still get migraines before their period.

It's 'one of those things' and no easy answer other than managing it.

It doesn't warrant a trip to the GP as it's really about a side effect of the progesterone 'crash' which can happen as you know with natural periods or HRT.

This month, I’ve not had a period yet and I currently have a migraine and I’m on day 31 of my cycle. I’ve taken migralieve which has helped. Today I switched to a new packet of patches, so I’m currently on the oestrogen only.

Well, that's understandable as you have come to the end of the patches with progesterone.

(You know it's a withdrawal bleed, not a period- sorry, I assume you do know :) )

The fact you have not bled yet is irrelevant. It's what's in the patch ( or not) that is causing the headaches.

I don't know if a patch is a cycle of 28 or 30 days (think it's 28) so that means you are now a few days without progestogen- and it's the withdrawal of that which causes the headaches.

Just tested positive for covid. So headache could be unrelated to hrt.