GP says no HRT at 44 with migraine, perimenopause symptoms worsening

[DalmationorLabrador]

My GP is saying I don’t need HRT. Also that HRT may not be suitable for me due to hemiplegic migraines but I’m desperate.

My cycles have shortened in the last 3 years from 35 to 28 days. The GP says that’s normal and they are regular so I don’t need HRT.
My bloods are apparently normal too and don’t indicate I’m anywhere near perimenopause but I’m 44???? My FSH is always 6. Something and the FSH to LH ratio apparently indicates I don’t need HRT.

Im exhausted but don’t sleep well. I’m in a mood all the time and PMT has worsened. I get too hot at night. I have brain fog and feel just not myself and stressed and anxious.

My oestrogen levels are always too high on the day 2/3 bloods so they said again that means I don’t need HRT, I asked about transdermal oestrogen and cyclogest and got told no oestrogen due to stroke risk.

I can’t afford to go private and I really believe I am in perimenopause and that I do need HRT. Do I have to wait till over 45? I’m pretty desperate .

I had the same experience- male doctor! Call the surgery and request a female doctor! I did this and she was amazing, kind & listened! Don't suffer

Thanks I will try I’m just feeing like I don’t even know myself anymore and I’m so sure it’s perimenopause I just want to feel better and not like this !

This.

Defo sounds like perimenopause hun. Trust your gut! Mine started at 40 and no one believed me because 'I was too young'. Also bloods aren't reliable as hormones fluctuate constantly. Do lots of Google research and go in there with a list!! You got this x

The GP actually told me to stop when I queried was my high oestrogen level making FSH lower and it wasn’t a ‘true’ reading he wasn’t happy at all !

Your FSH is still low- mine was 90 + when I was tested and given HRT! (I realise that is very high!)

Hrt made my HM so much worse...it was horrific

It's not always the case that female drs are better. My consultant is male and absolutely wonderful.

@DalmationorLabrador I'd push again for HRT and if your GP won't agree, ask for a referral to a consultant on the basis of using HRT with your migraine.

Also look a the Migraine Trust (online) which has info on HRT. Generally, migraine is not a contraindication.

It's ridiculous that you'd have to wait to 45 because that is a GUIDE (re. blood tests) not mandatory.

@DalmationorLabrador This is a very detailed guide for GPs on prescribing HRT with migraine.

Print it off and take it to your GP?

Basically, it says you can use transdermal HRT.

thebms.org.uk/wp-content/uploads/2026/01/06-NEW-BMS-TfC-Migraine-and-HRT-JAN2026-C.pdf

Oral HRT is contraindicated for migraine, but not transdermal.

But I'd ask for a referral to a specialist because I don't think I'd feel comfortable starting HRT with hemiplegic migraines under a GP who didn't really understand the relationship between HRT & migraine.

IME regular-old bog standard migraine without aura has caused complications with HRT (in that I've had to try lots of different things to manage the menopause symptoms without flaring up the migraine).

HRT does sometimes provoke migraines, especially initially, so if your GP isn't behind you doing it they'll just take you off it again at the first sign something isn't working out, rather than trying to work with you to find a solution.

If it were me, I'd be worried about starting HRT with hemiplegic migraines and inadequate access to support in-place. Either a menopause expert or a migraine expert would be better than the GP.

I think HRT can really improve migraine once it is stabalised though, mine is much better. It's not true that you can't use it at all. My neurologist was the first person who suggested I try HRT. If your GP feels uncomfortable managing a patient with hemiplegic migraines on HRT then fair enough, but they need to refer to someone who doesn't.

Your age and blood tests are pretty irrelevant unless it's determined you've been through early menopause, but for what it's worth, I'm 40, no-one suggests I'm not perimenopausal or don't need HRT. It's been fundamental in managing my rapidly worsening migraine.

Im having the same issue
Im changing doctors

They’re not supposed to judge this on blood tests? They’re supposed to judge it on your symptoms.
id highly recommend the Newson clinic - it’s private so does cost but deffo worth it. You can then go back to your GP for further meds etc.

'It's not always the case that female drs are better. My consultant is male and absolutely wonderful'

Well said. You need an informed GP who is following the guidelines for perimenopause care. Their sex has nothing to do with it

OP, I would ask whether your GP surgery has a women's health / menopause specialist. This person may be a nurse rather than a doctor. Sadly there's no guarantee that they will be fully clued up but it's worth asking. It does sound like you're in peri and hormone blood tests are useless, as you know.

Not necessarily, I saw a female HCP and she was awful to me. So condescending and patronising. Told me to go to Holland & Barrett and take herbal remedies. Saw a private doctor through work, who was willing to prescribe HRT but they aren’t allowed to issue repeat prescriptions. My symptoms have calmed down a bit lately but I’ll look into going private if my symptoms increase again.

I used to get hemiplegic migraines.....until I started HRT! For me the hormone peaks and troughs are smoothed out so no more migraines.

If you can afford it I would recommend going private to get the best advice, Dr Catherine Coward https://myviahealth.co.uk/menopause is really good, she used to work for Newson Health but has now set up a clinic.

I dont know what type of migraines I have, never been tested or properly 'diagnosed', merely that Ive told them I have migraines and am on triptans

But when I got HRT, the doctor gav me a stern warning about me getting more and to be fair I havent done so, so we'll see, its early days. Im on patches

Also what bloods are you getting to show all these results, Ive never been given any tests (albeit they are unreliable as others say). I would love to know what levels of estrogen I have.

My doctor is female and she was useless, didnt know what body identical meant.

I would Def look for a different Dr, sounds like trying hrt could be really helpful.
I have been lucky with my drs, they were all happy to prescribe and increase my hrt whenever I asked.
Playing devil's advocate though at a certain age you do sometimes find yourself putting everything down to menopause. I recently had a flair up of symptoms (insomnia, brain fog, joint pain) I was convinced it was my hormones....eventually I worked out it was actually caused by how I was sleeping!🙄

I have very severe Basilar migraines, I get HRT you can have it but it needs to be transdermal estrogen and ideally with utrogestan if you need progesterone to protect your womb. I took in the guidence from the BMS on migraine someone has posted above and my neurologist was also ok with it. My GP also wrote to a menopause specialist for advice and eventually I got HRT. My migraines actually improved on HRT.

I actually had the opposite. I’m 41 and when I spoke to a young, female doctor she completely dismissed me without hesitation. However a few months later I saw a retired, male doctor who was filling in while they were short staffed and he had no hesitation on putting me on hrt with the long list of very clear symptoms I had.

Don't give up, see another GP, take the print out from the British Menopause Society information about migraines although it doesn't specifically say hemiplegic but do some googling, find information although you shouldn't have to.

If they still say no ask to be referred to a specialist or if you can afford to go private book it. I had to fight a little to get what I wanted HRT wise and it is soul destroying fighting them on it so I understand it is frustrating.

There are two main types: with aura; without aura.

If you just get headache, nausea, light sensitivity etc you have migraine without aura.

If you get a 'predrome' which can be visual disturbances, flashing lights etc which start before the headache and nausea etc, then you have migraine with aura.

There are other types, but they are rare and have specific symptoms with them. People only really get diagnosed with them if they have the specific symptoms beyond migraine with aura.

There's no test for migraine and most people don't get specifically diagnosed. It's only likely to come up with a GP if you need medication to prevent them, or when you want to take contraceptive hormones or HRT. They should ask you at that point if you have ever had a migraine aura, because the aura part is associated with an increased stroke risk, which is contraindicated for oral estrogen therapy.

They should have asked you about an aura when they gave you a triptan though. It's pretty useful to know if you have migraine with aura or not so you can make decisions about hormonal treatments (ie avoid oral estrogen if you get migraine aura).

Being a Migraine suffer myself I've looked into this quite a bit. Listened to an interesting talk by an expert in this area, (unfortunately it's from the Migraine world summit and you wouldn't be able to listen to it now without paying for access). She did say that HRT is really only designed for use if you are no longer having regular cycles and that taking a progesterone only contraception is normally a better option especially for those with Migraine as HRT hasn't been shown to help Migraine and can make it worse in some.

This is what I've done although I can't take HRT anyway due to other medical issues, which was why I was looking for an alternative. Taking the progesterone only pill has certainly helped with thongs like night sweets for me, I feel better on it definitely and I'm older then you.

It will definitely be easier to get a doctor to prescribed it the HRT.

Never been asked about aura and I would say Ive only had 3 migraines with aura, that I can remember. I thought my eyesight had suddenly gone