Migraines and HRT?

[Bimbleberries]

I’m beginning to think I should consider HRT. Symptoms are hot flushes, massive facial sweating, plantar fasciitis, bit of brain fog/word finding/memory issues, probably a few other symptoms that I don’t realise are related. Am fairly overweight but trying to exercise a bit more, but tiredness and muscle/feet pains make it hard.

The biggest long term thing I want is to help prevent dementia above all else; I know research around dementia is mixed, which worries me that HRT could make the risk worse, too. I have a huge family history of it. And then also bone health - have recently broken bone but had a dexa scan that says average for age, but I know that there is some family risk of this too.

So both for current symptoms and potential future benefit, I wonder if it’s something I should be taking.

But, I don’t know if I’m really suitable, because of migraine and high blood pressure. Hypertension is well controlled with tablets. Used to get migraines (with and without aura) but the aura/hormonal ones pretty much stopped the last 10 years or so, until I had one last month. So I don’t know if that is a problem or not.

My GP will probably offer a phone appointment, and I get fairly flustered, so I want to be prepared with what I need to ask. She is very exact about following whatever NHS guidelines are, prescribing as little as possible, keen on ‘seeing how it goes’ for months before doing anything, so I am possibly going to have to be proactive. But I don’t want to push for something that isn’t right for me, either. I’ve no need for contraception, and don’t want to be talked into that, or anti-depressants.

I’m 52, very irregular periods for the past 18 months or so, last one was before Christmas, so i’m not sure if they’ve really stopped yet or not. Doesn’t the dose/type depend on this? So I need to know what to say. Does HRT mean I’ll start a bleed/period again while I’m on it?

Anyone with any experience with HRT who has had migraines before, whether or not any longer? Do you feel it’s risky, even if you don’t have them any more? Any ideas what type/dose/combination I’d be likely to be prescribed, or should ask for? I don’t really know much about the different types, but I’m thinking that I’d prefer a patch to the gel, if I get the choice. But I know that if the guidelines say you have to try the gel first or whatever is cheapest, my GP will likely insist on that.
thanks for any advice

I am not on any hrt (yet) but do have consultant appointments for migraine. I asked about it as have chronic migraine with aura. He said HRT is fine, I think patches/gels etc rather than oral medication.

thank you, that's good to know that it might be fine. I would prefer some kind of patch/gel instead of oral medication but I thought that I might need tablets as part of the combination if I'm still having periods, so maybe I will just need to wait until I know for sure it's been a year.

I see a neurologist for my migraine and he said I would be unable to take it.
As it happens, I would rather not take it, so I wasn't upset by the news.

You need both estrogen and progesterone whether your periods have stopped or not. The only women who don't use progesterone are if they have had a hysterectomy.

You don't need to wait for periods to stop before using HRT.

Your main options are

Oestrogen gel + micronised progesterone (Utrogestan)
Oestrogen gel +Mirena coil

Patches
Oestrogen +Norethisterone

As you are still having periods, which ever type you use (other than the Mirena coil) you will use estrogen every day and progesterone for 12 days a month.

If this is patches, half the patches have only estrogen and the other half have both hormones.

Your GP shouldn't be making a decision on cost and TBH it's up to you to say which you prefer.

I wonder how up to date he is?

The Migraine Trust says it's fine. It's on their website.

I get occasional migraine and it's never been an issue- been on HRT for years under a top consultant.

[[https://migrainetrust.org/live-with-migraine/self-management/migraine-and-hormones/

Info here on HRT and migraine

@Fuctifin0 Do you think your neuro is behind the times and only thinks that tablets are what women use? They have a slightly higher risk of blood clots, so anyone with migraine is advised to use other types.

I was suffering really badly with migraine with aura, 4 or so episodes a day, saw Neuro for a routine checkup as I thought the symptoms were down to my MS, he said straight away, given my age, due to hormones etc migraine with aura saw GP given patches 3 mths ago, made a huge difference only experience migraine with aura a couple of days each month now, less hot flushes, skin and nails better.

@JinglingSpringbells no, I think he's shit hot on migraines.
He got me from 8 - 10 migraines a month to 1 or 2 a year. I am pretty sure he knows his stuff and of course he has my complete medical history to base his opinion on.

Why should you not take HET with migraines?

thanks all, that's encouraging that it might be possible.

I've not been under a neuro or consultant or anything for them as they have not been that bad. They are either headache/nausea but no aura (triggered mainly by weather changes, which still happen occasionally), or visual aura without headache (possibly hormonal; haven't happened for 10 years until last month) - I did wonder if they had started again because of drop in hormones, so it's interesting that some people have had an improvement with HRT.

I'd like to think that my GP would just go with what I'd prefer, but if there is anything in the guidelines that say things have to be tried in a certain order, she will go for that, or at least strongly recommend it, so I want to be sure what I want. Definitely no coil. So if I want patches, then it's oestrogen patches + Norethisterone - are they both patches? Does the brand of patch matter - should I be asking for anything in particular? I hear about various shortages of all this stuff, so not sure whether I have much choice in the matter! If they start me bleeding again, then how will I ever know if I've finished having periods for a year? I expect I have stopped now, only a few over the past 18 months and no signs of anything since November. But I don't know for sure that there won't be another!

I hope the risk isn't higher. I hear enough about the risks of HRT as it is, and it's the longer term link to dementia that I'm most concerned about, whether it might help or hinder, as I've read conflicting stuff. But I'd also be quite glad to get rid of the hot flushes and plantar fasciitis! I could live with those if I had to though. And I expect I have other symptoms that I haven't connected to menopause, so it might help those. But if the risk with migraine is a problem, I don't want to think I've brought it on myself by not being able to cope with hot flashes that aren't that bad!!

I think there was thought to be a risk for clots with people who have migraines and high blood pressure. Maybe this isn't so much the case with non-oral medication though. But i think that was the reasoning and I certainly remember hearing in the past that migraine meant you wouldn't be able to take it. My migraines are very rare though, so I didn't know if it would apply to me, though I do also have high blood pressure, and that in itself might be enough to make it unsuitable!

I have had chronic migraines in the past and migraines all my life - no issue with starting HRT 18m ago (gel and Mirena). My migraines are mainly hormonal now - three to four days a month, much less bad than they used to be due to propanalol and triptans. There was no issue about starting HRT at all but I was prescribed by a specialist GP at my practice whose expertise is in this area.

@Bimbleberries What you heard was possibly out of date. A lot has changed with the advice on HRT since the negative reports 20 years ago when the type of estrogen used was different in tablets. Yes, tablet forms are not advised but that applies generally because the safer options are better for all women.

High BP has to be controlled if on HRT, so if you are not on medication your GP would suggest you try lifestyle measures first (changes to diet, losing weight if necessary, and exercise) and getting your BP down either that way or with meds.

I'm on HRT but might be getting off it due to high blood pressure.

I have never been able to take hormonal contraceptive.
Maybe I am a special case 🙃

My high blood pressure is controlled with medication now. I am trying to lose weight, but painful feet make exercise difficult, and I've falled off the diet bandwagon but really need to get back on it now. I don't want to do anything that adds extra risk of strokes or clots or anything though, but maybe patches are OK. Might be an idea to wait a bit before seeing the GP though to see if I can get back on a healthier diet and exercise first I guess.

So I can get patches that are both oestrogen and progesterone combined then? Is this a particular brand that does that, and is it one of the hard-to-get ones at the moment? I don't want a coil and have no need for contraception.

On the other hand, I wonder if I start HRT, am I just postponing the symptoms until I stop taking it - at which point I’ll end up with the hot flushes and joint pains and so on, at a time when it might be even harder to cope with them than now (when they are really not very bad compared to what I read many women go through). I wonder if I should just get through it now (on the assumption that some of the symptoms then improve with time, which might be an erroneous assumption!).

I've been reading more about the progesterone now - so there are two types, micronised progesterone and synthetic progestogen, and the first type is available through tablets alongside the patch and the second via combined patches? The first type is more similar to natural hormones and fewer risks, but more complicated to remember to take; the second is synthetic but available in combined patches (though only with medium dose oestrogen). Does that sound right?

I'm sure my GP would start on the lowest dose of oestrogen, which means that if I want patches, I would then also have to have a separate tablet for the progesterone at night. Then if I needed to increase the dose, I could have higher dose patches, and at that point, could switch to combined patches for both?

And if I start taking it now, I won't actually know when I've been period-free for a year, so they'll wait til I'm 54 to switch to a continuous rather than cyclical regimen.
Hope I've got all that right. I'd not been sure it would even be possible given history of migraine and hypertension, even if they are now controlled, so I've not looked into the details too much before.

Still not sure if just postponing the symptoms for 10 years or whatever is a good idea, especially as some days I hardly notice the hot flushes, only a few times a day really, so I probably could cope with them. The plantar fasciitis and muscle aches would be nice to get rid of, if they turn out to be related, though, as well as possible longer term protection against other conditions. But it's not like the current symptoms are really bad or anything.
I suppose this is not the week to be trying to phone the GP anyway, with all the strikes elsewhere that will be keeping them busy.

[[https://www.menopausematters.co.uk/perimeno.php You can find all the types here.

I think we've already covered the 'Can I have HRT because of migraine and high BP'.

The answer is Yes.

Another point, your GP is supposed to act in accordance with your preferences. You come over in your posts as if you are expecting some kind of battle or being 'told what you can have' rather than it being a mutual agreement on what may suit you best. NICE guidance on menopause and HRT says that doctors discuss the risks and the woman makes the decision (within the boundaries of what is safe for her.)

No one can decide what is best for you! HRT is not a one-way street. You can try it, come off it, go back on it....whatever you want.

Although you shouldn't have to, you can also think about seeing a private doctor (GP or a consultant) if you feel your own GP is putting up barriers or isn't willing to treat you as an equal in the decision-making.

I’ve had migraines with aura since puberty. They were all hormone related, ie a couple of days before period. They carried on haphazardly when peri menopausal and periods were irregular.

I had very bad hot sweats so started HRT. Tablets where you switch halfway through.

I had the worst and longest migraines of my life at the two week switchover. (4 migraines over 6days).

I ended up seeing a specialist who said it wasn’t the hormones per se, but the change,the rise and fall, of the hormones I was very sensitive to.

I was prescribed a very low dose Evorel patch and a progesterone mini pill to take continuously.

HRT helped with the sweats, and though I still got the odd migraine,it wasn’t as bad.

yes, thanks, I have been reassured by the fact that it seems possible to take HRT with migraine and hypertension now, which is why I'm trying to understand the various sorts. I've been very unaware until now really, because I'd assumed that it wasn't something I'd be likely to get, so I'm only now looking into it and it's a lot to take in at first. I'm trying to get my head around what I'm likely to need. The sites are helpful but they often assume that you know which names are tablets vs patches etc, or that one is a tablet and the other a gel or patch or whatever. So I am looking up what is what and trying to find out any advantages/disadvantages of different types or brands etc. It sounds like combined patches are less easy to change the dose, so I'm guessing would not be prescribed to start with.

I don't know what my GP will be like. I find phone appointments difficult at the best of times, and in the past, she has always been very much 'wait and see' about things, and very keen on doing things exactly as the guidelines say, and if they say to try a certain thing first, she will do that, unless you have very strong reasons to try to say why you'd like something else or that you've already done something. The surgery still isn't booking face to face appointments to start with, but an annoying phone triage system where they phone you back at any time of the day, which is very difficult for someone working. However, changing surgeries is also not feasible at this time. So it might be a battle, or it might not be. It could be that they'll be happy to just book me a face to face appointment and she'll discuss it easily with me, but I want to have some idea of how things work in case she doesn't. I know they do tend to be keen on prescribing the lowest cost versions of things unless someone has a particular reason not to.

Yes a one-time appointment with a private doctor wouldl be something I'd consider if needed ,but I'll certainly try my GP first, and see how it goes.

Interesting that you found the switchover between hormones the worst time, @Isheabastard - when I used to get the aura and dizzy migraines, it was often a day or two before my period. I haven't had them for ten years or so until one last month, and very much hope they don't return! I've also got used to almost never having a period now, so the thought of going back to that is a little off-putting. Maybe waiting til I've not had a period for a year, and then starting on the continuous sort, to minimise the ups and downs of hormone levels, might be a thought!

My migraines worsened around peri. It's definitely the fluctuations in levels that can make it worse. I have evorel patches and utrogestan capsules. I found taking the utrogestan 200mg for 12/14 days wasn't great as it causes big fluctuations and therefore migraines, but after switching to 100mg for 25 days then a 3 day break it's much better.

Progesterone seems to be the main thing that's helping my migraines at the moment, and a more constant dose works much better for me. I think it has muscle relaxant properties and is the component that helps sleep the most, which also affects my migraines. All in all it's been fabulous, but took a good 9 months to get my doses and regime right and you do need to allow time to adjust and settle in to any dose changes.

HRT is now covered by an annual prescription charge of around £19 (to you.)
The GP isn't funding it, so it's not relevant.

TBH I'd advise you to be sure in your own mind what you want, because you seem to be saying your GP is quite dogmatic and likely to do what they want rather than what you want.

eg 'I'd like to try HRT please because I have XYZ symptoms. I have read the advice on medical sites [Menopause Matters] and understand that transdermal HRT is best for women with migraine. I'd like to try patches/ gel...' whatever.

If your migraine isn't actually being treated medically by your GP, then it's not worth mentioning unless she tries to push tablet forms.

I have had migraine since I was 12. It was never even raised by my meno consultant and I went straight onto gel anyway. Mine was cyclical migraine- a few days before a period each month (before menopause.)

Thank you. It sounds like there is quite a lot of variations in experience and dose and what is recommended by different doctors. I'm glad to hear that it is working well for you - the fluctuations in levels must be the main issue, and I wouldn't be surprised if that's why I had my first one again last month. Did you get prescribed the constant dose despite still having periods, or were they finished by then?
I'm a little wary about messing around with things if they are only very occasional now, and whether improving the hot flushes and a few other symptoms is enough of a benefit. Of course, if the migraines continue to come back, then that would be a benefit if it did help them.

Yes, that's exactly why I'd like to have a good idea of what I want, and why I'm starting to do some research into this now that I know it isn't necessarily contraindicated in people with migraine/hypertension, depending on who you ask.

I am pretty sure I'd prefer patches to start with, and it sounds like that means an oral progesterone for the lowest dose patches. So that's a start at least.

I have migraine with aura.
I started HRT at 49 whilst still having periods, although fairly irregular. I asked to try continuous progesterone as I had read that it prevents the fluctuations. My GP issued me that, even though normally I would have been given cyclical progesterone.

Since then, I’ve seen a gynae consultant a couple of times, related to testosterone. Each time I’ve checked that it’s okay for me to have continuous progesterone. She has said that cyclical or continuous is fine.

I have oestrogel and utrogestan for the progesterone. I usually take it 25 days at 100mg and then have 3 or d days off, just in case my body wants to have a bleed. In the last 6 months I haven’t had a bleed. It could be my periods have naturally finished.

My migraines are definitely better. Sometimes I still get one with aura, but it is short-lived and I find that if I’m at home and give myself an extra squirt of oestrogel, the extra oestrogen seems to shift it faster than all my migraine medication ever did.