HRT - migraine & vulvodynia - very nervous

[101trees]

Any help much appreciated!

I'm due to start 50mg oestrogen patches + 100mg of utrogestan daily, as a continuous combined routine.

I'm very early peri, still relatively young (40). But my mum and her mum had their periods just stop dead one day at 42. Mine have been getting shorter and lighter since 2018 when they went from 28 day + 7 bleeding to 21 days + 4 bleeding.

My main reason for wanting to start HRT is the mood aspects. Massive anxiety, PMS low mood, irritability and just general misery really. Secretly hoping it might improve the migraine and vulvodynia, but I note the migraines have got more prolific, but much less severe as my periods have declined.

I'm very very nervous about starting HRT (due to start this week on day 1 of my period), I'm terrified it will make the migraine and vulvodynia worse. I'm also petrified it will turn me into a depressed psychopath as this has been my experience of synthetic progesterone in the past.

Does anyone have any experiences they could share of the first few weeks of starting HRT, especially if they have migraine and/or vulvodynia?

Any experience of using utrogestan daily in early peri? I'm a bit worried about continuous bleeding.

Many thanks!

I started on this combo 6 months ago and it was great. I can't comment on the bleeding as I've had surgery, but my migraines definitely decreased. They've just come back at the point when I think I might be at the bleed point in my cycle, and I've been bumped up to the 75mg patch which I'm hoping will solve it. They had an really good impact on all of my symptoms - itchy skin, flushes, mood, migraines and the dryness. Don't run out and stop taking them is my hard learnt experience.

Honestly, I found them great. Of course they might not work for you but I consider myself a positive story x

Oh that's so great to hear - thank you so much!

I find it really odd that the severity of migraine has got worse as I've entered peri. All I hear is that they get worse... so I worry that adding more hormones will make them worse again

Hi @101trees Can you explain why your doctor has put you on continuous HRT? Assume they have explained the rationale for that?

Usually the regimen you're on is for women over 54 or no periods for 12 months (post menopause.)

You'd usually be on a sequential regimen which mimics a natural cycle where the progesterone is for part of each month.

I've had migraine all my life since I was 12. I've been on sequential HRT for over 15 years and it's not made my migraines worse. In fact I have very few now.

I'll be honest and say I did try continuous (as you're on) for a month (when I was late 50s) and it made my migraines come back daily when the level of progesterone dipped each day.

Not to say you will find that, but there are other ways of using HRT compared to what you're using.

Hi @JinglingSpringbells thanks for getting back to me with that honest response.

The rational was that it would stop the fluctuations when changing from the oestrogen only to the combined with progesterone phase.

That's really interesting that you found it made the migraines worse. I didn't realise the level dropped enough on a daily basis between doses. I assumed it would keep it at a continuous level.

So you didn't find it caused migraines for you when you started the progesterone element?

It's also interesting that the drop in progesterone caused the migraines, I've always been told it was estrogen fluctuations which caused migraines rather than progesterone.

My past experiences with progesterone have all been that they caused severe proflic migraines. Even the mirena coil (tried twice, just to make sure!)

Thanks for you advice !

Just thought- the only other reason I have for the continuous routine was that it won't be a problem because my cycles are still regular, just very short.

I don't know enough to understand why that would be a thing. Whole new, deeply confusing, world.

HRT made my migraines a lot better by stopping the hot flushes - every time I had a hot flush, I got a migraine.

If your vulvodynia is fairly recent, it could well be vaginal atrophy. If you are very nervous of HRT, you could try vaginal oestrogen alone to see if it helps the vaginal symptoms.

Thanks Anna. That's good to hear.

I was actually given vaginal estrogen to try very early on in the vulvodynia situation and it made it significantly worse for some reason. My hospital consultant said that does happen sometimes.

I'm hoping it might help if I try it in a systematic way.

It's all a bit confusing because I had a baby 2 years ago. The vulvodynia started during pregnancy, then got significantly worse following the birth. Something about hormonal fluctuations makes it flare up (still).

I kind of just long for hormonal stability all the time. What is must be to be male...

I assumed they'd said try continuous to stop the fluctuations.

My experience, before HRT, was that I'd often get a migraine the day before my period started (so when progesterone fell right away. In fact it was always a sign that my period was about to start.)

I tried continuous HRT for 3 to 4 weeks and couldn't stand the headache that crept in at the end of each day. Obviously levels do fall, because if you miss a dose at any point, (either sequential or continuous) it can provoke spotting.
I also had spotting every day for those 3 weeks, which is usual when starting continuous, and I was some years post meno then.

Everyone is different so I guess you're just going to have to see how you go.

Fingers crossed!

The dose of progesterone (100mgs) is very low. It may not be enough to control the effects of your own estrogen on your womb lining. Think of it as estrogen is the 'fuel' and progesterone is the fire extinguisher. If the lining is fuelled by estrogen ( your own AND HRT) it can shed spontaneously outside of your predicted cycle.

@JinglingSpringbells oh that's really interesting. I clearly know nothing because I didn't know missing one dose could cause spotting.

I tend to get migraines throughout the week before my period, then one the day after it starts, one after it ends, then more again around ovulation.

I think some months I do not ovulate because the pattern is a little different (and I am extremely irritable)

It's basically anytime there is a change in my hormones, up or down.

The super short cycles (21 days) means I'm basically almost always having a fluctuation these days.

Thanks for your advice, and your well wishing. Its so interesting to hear from someone else who has/had menstrual migraine. You just assume everyone who has it is the same.

I thought 100mg daily worked out the same as 200mg for part of the month? Or is that completely wrong logic there?

sequential is 200mgs x 12 days = 2400
continuous 100 x 30= 3000

However, that's not the point.
Using a lower dose every day may not be enough to control the lining (which builds up with HRT and your own estrogen.)

Women who are post meno don't have much of their own estrogen.
Women like you are still ovulating and will have higher levels.

Thanks, I see where you are coming from there. So continuous causes no bleed when post meno because of the lack of your own estrogen means it is relatively low in comparison to progesterone; but in women who are still ovulating the combination of my own estrogen + HRT may cause lots of bleeding.

Does using a sequential routine stop that from happening? Or you just have a very heavy period when it comes at the end of the cycle?

Or is it that I'd need a higher dose of continuous progesterone?

Sorry for so many questions! Just trying to get it straight in my head.

Really appreciate your help. I feel like I know significantly more now !

https://www.menopausematters.co.uk/postmeno.php Explanation of how continuous works.

Does using a sequential routine stop that from happening? Or you just have a very heavy period when it comes at the end of the cycle?

Bleed varies so you'd have to wait and see. Depends how much estrogen you're producing.

Or is it that I'd need a higher dose of continuous progesterone?

Yes perhaps- maybe 200mgs per day.

Hi OP my hormonal migraine pattern sounds similar to yours (I'd always had a really short period cycle) and definitely getting worse in my 40s. Became totally debilitating.

I put off starting hrt for ages because I didn't like the contraceptive pill (although the contraceptive pill did sort out the migraines it made me feel so awful in other ways). I also didn't experience many other peri symptoms so I was hesitant about risking unwanted side effects unnecessarily.

My Dr suggested a sequential regime as we thought changing estrogen levels was the cause of the headaches. I'm only on the lowest patch - 25- and then progesterone 2 weeks per month. The effect has been brilliant! No bad side effects at all from the estrogen. The progesterone makes me a bit drowsy but it's ok. Migraines are far more manageable. I've only had a handful in the last two months and all were mild. Equally good is that for some reason it doesn't feel like being on the pill did. I don't feel rage or depression. It hasn't destroyed my libido.

Oh that is fantastic to hear. I've been avoiding HRT for that exact reason - that I've always reacted badly to synthetic progesterones, even the marina coil (tried twice, just to make sure).

Do you mind if I ask if it is utrogestan you take?

I collected my prescription today. It's 3 months supply of both. I've been pondering just using them in a continuous regime to see how it goes. I was thinking if I do react badly, it'll be hard to tell if it's to both or just the progesterone if I start both together. 🤔

Thanks very much for sharing, I really appreciate it :-)

Yes, ultrogestan tablets. Approx 2 weeks per month.

i Was similar with migraines as you and was worried about HRT making them worse as I couldn’t tolerate the Pill. However HRT reduced them from monthly to once a year.
Im not on continuous as I’m still bleeding every couple of months.

I started on patches but switched to gel and utrogeston.

I suffered monthly with hormonal migraines and ended up on the continuous pil to help. I then went through a horrendous year of the worst migraines I’d ever experienced, unable to get out of bed, projectile vomiting constantly for 12 hours, intense pain with no hope of medication relief due to the sickness, you get the picture. I started on HRT patches and now it is very rare for me to get a migraine and if I do get one I can get rid of it pretty quickly. I do think it’s the fluctuating hormones that are a trigger.

Thanks so much to everyone who has shared their experiences.

I'm going to try it sequentially to start with and see how I get on with the migraines. It's really encouraging that it's been so successful for so many migraine sufferers.

Really appreciate y'all taking the time to respond