HRT, migraines, mounjaro

[myladyjane]

Sorry - v long.

i am 51, started everol sequi 50 about 6 weeks ago and also have on monjaro for the last year.

main hrt symptoms were sleep based, getting a bit more brain fog and a bit low/flat/anxious. My periods went from being very regular to disappearing pretty abruptly a few months ago (hurrah!)

I had tried hrt about 2 years ago but quickly stopped as it made me very sick and massively increased my migraines - my symptoms was really mild tbh and in hindsight a lot of issues were stress related. I made some lifestyle changes, started on a couple of supplements and my migraines all but disappeared.

this time round, it felt a bit more like I was ready for hrt and the improvement in my sleep has been amazing. I have felt a lot more myself pretty quickly and coupled with the weight loss (5 stone done, half a stone to go) was feeling pretty good a lot quicker than I was expecting.

however, migraines are back. They were fine the first month but now in my second week of the oestrogen only patches I’ve had 3 in 3 days. For context prior to the hrt, I had 2 in a year.

i understand that if i am prone to hormone driven migraines, the oestrogen in hrt can be a trigger but transdermal is the best option which I’m on. My gp is already quite nervous because of the monjaro so wants me on patches as I won’t miss a dose of progesterone.

Any ideas? I can’t carry on with the migraines, the monjaro is non negotiable. My symptoms aren’t that bad other than sleep but the hrt has brightened me up and ideally I don’t want to step back.

I am older than you at 57 and was 2 year post menopause and on Mounjaro when I started HRT in January last year.

The BMS guidelines for oral progesterone were not out at that time so I went on oral micronised progesterone (Utrogestan) and have been fine staying on that as my Mounjaro dose has remained low (never went above 3.75mg) and I have no side effects on it.

Once the new guidelines came out I agreed with my Dr if I was planning to increase my Mounjaro dose we would have a conversation first and potentially increase my utrogestan dose.

Depending on where you are with Mounjaro doses (if you have no side effects / don't intend on increasing dose) it might be worth a chat with your Dr to try micronised progesterone instead of synthetic to see if it helps your headaches.

These might be helpful. They are what I looked at at the time when I discussed with my GP Last April/May. Not sure if there has been newer information since.

https://thebms.org.uk/wp-content/uploads/2025/05/23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-E.pdf

https://www.pcwhs.co.uk/_userfiles/pages/files/resources/glp1_contraception_hrt_article.pdf

Personal experience: MJ helped the migraine by removing the hunger trigger
HRT also helped the migraine by removing the hot flushes which also triggered a migraine every time.

However on starting HRT I was advised I'd probably not tolerate cyclical due to migraine being affected by the hormone shifts. So it was either Mirena coil or Utrogestan + minipill.

Thanks for this. It’s tricky - I am on a fairly high dose of the mj but planning to start titrating down soon. I also don’t know if the migraine is a coincidence (I am going through a high stress work period which is somewhat unavoidable at this time of year - I typically crash in Feb). My gp did say she would consider the oral
progesterone (I can be quite progesterone sensitive) if I really didn’t get on with it but I think it’s the oestrogen that triggered the migraines.

i am due to switch to my combined patch tonight and I have a review appointment in a few weeks so a bit more research in the meantime I think.

It is usually the estrogen which triggers migraines, but I found mine improved really significantly when I went from taking utrogestan sequentially to taking it continuously.

It was the starting and stopping progesterone which was stirring them up more than usual. You're getting migraines on day 3 of estrogen only, but you have the estrogen all month - the thing which has changed is you stopped the progesterone, which is a change in hormones.

My migraines are a result of hormone fluctuations, i.e. a change of some kind. A transdermal patch is a really stable form of estrogen, so maybe its starting and stopping progesterone which is causing them. If it was the estrogen, I'd have thought it would cause a problem right up front when you started 6-weeks ago.

I spent months slowly increasing/decreasing estrogen patches to try and control the migraines better, thinking it was the estrogen.

But basically as soon as I kept taking the utrogestan every day my migraines went back to normal (from 15 back down to 5 a month)

People with menstral migraine really just need stable hormone doses. Might be worth trying the progesterone continuously with conti patches instead?

The guidelines are for conti progesterone only post-menopause because of a risk of breakthrough bleeding, but migraine is one of the reasons to use it continuously earlier. I still get periods but am OK on a double dose of daily progesterone.

Many consecutive days of migraines shortly after stopping combined patches is about the pattern I found for my migraines occurring on cyclical HRT. Also a couple of days after starting it, as well as my normal time around my period.

Much sympathy to you, migraine is awful.