Depressed on progesterone does it get better ?

[Vintageroses]

I’ve gone from taking it 12 days a month to continuous. Since starting continuous 2 weeks ago I’ve been bursting into tears left right and centre. Feel very down about myself and paranoid that everyone thinks I’m shit.
i am supposed to be speaking to the doctor in 3 months. Has anyone experienced this and it’s got better ?
I’ve gone on continuous to try to stop migraines.

For those who mentioned Zoely I would like to give a shout-out for this combined pill, which contains body identical estradiol and a really kind progestin, Nomegestrol acetate.

I don't tolerate my own progesterone very well, but have been on Zoely continuously (active pills only) for 5 years now and it has been great.

It doesn't seem to have the same negative effect on mood as other progestogens and is safer than the older ethinylestradiol based pills from the point of view of clots and stroke.

Neurologists are increasingly recognising the value of hormonal stability in migraine and many now consider it better to have someone on a low dose modern oral contraceptive pill continuously if this gets rid of or significantly reduces migraine episodes.

Remember also that all the evidence around aura and stroke came from an era when birth control pills contained a MUCH higher dose of synthetic estrogen, and far more women smoked.

Was always terribly sensitive to all progesterone, my own and in the pill. Wanted to be dead for 2 out of every 4 weeks mood was that low. Went away when I was pregnant and breastfeeding. Came back with a vengeance afterwards. Had a total hysterectomy and oophorectomy to resolve it, and just have add back oestrogen therapy to keep bones etc healthy. No progesterone needed, best thing ever.

Estrogen is a no-go for women over 30 with simple migraine, or at all ages for those who have migraine with aura. You can take the "minipill" because it has no estrogen in it.

@selffellatingouroborosofhate That's incorrect. You might be basing that on outdated info from 30 years ago, and also when HRT was different.

The Migraine Trust has a section on HRT and most HRT is perfectly safe for women with migraine, but it's better to use transdermal types.

I've had migraine since I was 12 and it's never been an issue with HRT ( prescribed for many years by a top menopause consultant.) Used HRT for over 15 years.

@Vintageroses If this has only happened by changing to continuous, is there a reason you can't carry on with sequential? You say your Dr told you to use it daily but if that isn't helping, what's the point?

I have used sequential for years ( over 15) because when I tried continuous I got a daily migraine. I only tried for 3 weeks but it's well recognised as progesterone withdrawal - the slight decline every day was the reason.

I occasionally get a withdrawal migraine on sequential but it's manageable (my migraines don't involve nausea).
I also use Utrogestan vaginally.

I can vouch for it being very helpful for migraines! That's why I went on it, I was having virtually constant migraines and with the mirena, later followed by low dose oestrogen, I barely have any now.

How did you manage to persuade them to do that? I’ve been begging for years

It's very rare indeed for this to happen. It's an extreme way of dealing with PMS and similar etc. Maybe it was done privately?

I'm glad to be corrected, if only because I can now consider HRT for myself.

It's worth looking this up on the Migraine Trust website.

I suspect the info you referred to was on the old types of synthetic estrogens (CEE) used in the US 40 years ago and now not used at all in the UK.

They were possibly associated with strokes but that came from the WHI study (20 years ago) which is a) flawed and not accepted any more and b) used older types of HRT and c) the women in that survey were much older and unhealthy.

No, it was done on the NHS, although I waited 2 years. I'd had successful hormone blocking injections to prove it would work. Couldn't take the pill or other higher strength oestrogen as it spiked my blood pressure. Was already on an anti depressant and an antipsychotic, so no other pharmaceutical options left.

Why did they not just remove your ovaries?
That would have worked without the possible higher risks of a hysterectomy.

It IS very rare.
The only times I've heard of it are when women were suicidal and even then many had to pay for this.

Removing only the ovaries but leaving the uterus condemns the woman to having to use a progestogen for endometrial protection should she take estrogen.

It is the progesterone and synthetic analogues that are generally the problem in PMDD.

Sometimes the uterus is left in but when the indication for oophorectomy is PMDD this is medically very poor practice.

I would love a hysterectomy but am not a surgical candidate.

I think you said you get an aura, which they are very reluctant to give oral estrogen for, but transdermal estrogen is OK.

The increased stroke risk of migraine without aura is really tiny, so much so that they don't really consider it an additional risk factor for the COC or HRT anymore. It's not comparable to migraine with aura, smoking or high blood pressure etc.

But migraine with aura is a little different, so best to avoid oral estrogen.

I was also told in my 20s that I wasn't allowed estrogen, despite never having an aura. I never questioned it again until I was 40 when a migraine specialist neurologist suggested Zoley to manage migraine in perimenopause.

There is just more known about migraine and stroke risk now than there was 20 year ago. Definitely worth reading up on.