Migraines caused by hormonal shift at patch change?

[Greigesofa]

I get migraines- not sure if it’s because of the end of the effective patch period, or once I put the new patch on? I also have a terrible memory and sometimes forget to change the patches at the right time, meaning I am guaranteed a migraine?

I am really prone to migraines anyway but hormones definitely seem to affect them. I normally manage to change the patches twice a week as advised, with the help of phone reminders. but I’d like to avoid the migraines just from using the patches as advised, and to understand if it’s the drop in hormones or the increase in hormones that’s causing it.

Is it possible to somehow keep a more consistent level of HRT with using patches- avoiding peaks and drops when changing patches and therefore avoid this migraine trigger?

I changed to daily gel but I definitely do have to set a daily phone reminder.

My HRT is Sandrena sachets.

(I’m on estrogen only though.)

Thanks that’s interesting if the gel gives less of a peak/drop? It sounds like I’m on a higher dose than you for the oestrogen as well maybe, as I have to take progesterone as well as oestrogen. Well, either way, I hope the migraines keep away for you!

(Sorry this is long! I do go on a bit …)

I have oestrogen only gel because I have no uterus (womb) following a hysterectomy.

If you have a uterus, you need progesterone too, to protect yourself from the risk of developing problems. In particular it prevents the uterine lining from over-thickening due to oestrogen, significantly reducing the risk of cancer. There a few options for adding in progesterone - via patch or Mirena, usually.

My dose varies but is currently 1.5mg gel daily, which is roughly equivalent to an Evorel 75 patch. You can get Oestrogel bottles with a pump dispenser too.

I hated the patches. Always peeling off my bum or there was a shortage and pharmacist couldn’t get hold of them, and my GP was awkward about prescribing an alternative and ‘had I tried an anti-depressant?’

Just. Stop. It. I’ve had a total hysterectomy and my ovaries out, doc.

I combine patches with gel, not directly to manage migraine but the migraines have been less since adding gel.

I reckon that might help smooth out the drops a bit?

Can’t comment on the patches etc, but my hormonal migraines have become less severe and less frequent since I started taking magnesium supplements. Might be worth a try, OP

What time of day are you changing the patch OP?

I'm very sensitive to hormone fluctuations and previously had premenstrual migraines. When I started on the patches I changed them every 3.5 days- 9am Monday, 9pm Thursday. The 9pm one gave me a migraine type headache that started between 10 and 11am on the Friday. I think it must have been some imbalance between the peaking patch level (they peak and level off 12 hours after sticking one on) and the micronised progesterone.

I changed the timing to 9am Thursday and no more migraine.

Also rising oestrogen levels cause cortisol to rise as well so if you stick a patch on in the afternoon it could seriously disrupt your sleep as I found out once.

If you're using 2 pumps of gel that's equivalent to a 50mcg patch.
each pump is 0.75mcg.
1 pump is like the lowest 25mcg patch.

I think it's because the level starts to decline towards the end. I've found I'm more likely to get a migraine on that last day, but if I bring it forwards a bit and change the patch after 3 days rather than dragging it out to 3.5 I don't get the migraine.

I wish I had read this yesterday! I forgot to change my patch in the morning so changed it at 8:30pm when I got in and have slept awfully (worse than usual which is saying something!).
Thank you!

I thought of this post too when I woke at 2am today and couldn't get back to sleep! I had, unusually for me, changed the patch late afternoon. It's a helpful explanation. I also tried the 9am Monday, 9pm Thursday routine thinking it would keep it more even, but now I just go with it. I didn't know about the peak and levelling off. Thank you

I've never read anything like this about afternoon applications or rise in cortisol being an issue. I doubt there is a simple correlation. I'd be happy to see some links to HRT and this @Additup if there are some.

If you use a patch, the amount of estrogen in your blood stream should be constant, over 24 hours, unless you are later with the patch by a day or so.

'Late' for gel means more than 24 hours after the previous application.

In fact the BMS suggests splitting the dose of estrogen to morning and evening for women using larger doses.
I have always applied mine am and pm - 1 pump at each time . This is because when I first moved up to 2 pumps from 1, I was experiencing slight nausea like morning sickness.

My GP moved me from gel to patches to try and prevent migraine. It apparently provides a steadier release of hormone instead of daily peaks when you apply the gel and then a slow fade.

This isn't right. It's good you're better on patches but the idea behind levels falling with gel aren't correct. It's a bit of a myth. Some women don't absorb gel well - it depends on skin thickness a lot, whereas patches on the bum are sometimes better for them.
The dose of estrogen is over 24 hours. It doesn't wear off over the day and then need topping up. In fact when women stop any form of HRT they are told to give it 3 months to see how they feel- it takes days/ weeks/ longer for it to impact on how you feel once your blood levels fall.

To be fair it didn't work! Migraines didn't improve on patches. But I have read several times in various places that patches do provide a steadier release and are usually better for migraine sufferers.

It's important to differentiate between the effects of estrogen or progesterone.
It's more common to get migraines when the progesterone levels fall and I'm wondering if @Greigesofa has considered this?

Lower progesterone (before a withdrawal bleed) is known to trigger migraines - it is the same with the Pill which is why some women use the mini pill instead.

I've had migraine all my adult life. I use gel and find it fine. What I do get (and always have even in my 20s, 30s and 40s) was a migraine that developed when progesterone fell, before a period. I still get these on HRT but not every month.

Worth thinking about if it's sequential patches where you're swapping over to the patch with progesterone in. OR poor absorption of micronised progesterone. It can vary a lot depending on if taken with food, no food, how long after eating.

My colleague told me yesterday that there’s some research recently out that suggests patches could be overlapped by about six hours to avoid fluctuations at the lowest point of transdermal delivery and until your new patch delivers a peak dose.

Not sure where it’s published - my GP colleague is doing her menopause diploma at the moment so getting the most up to date guidance and research!

See my understanding was that it was oestrogen dips that triggered migraines. The break in the combined pill definitely triggered migraines in me which did go away, for a while, when I switched to mini pill. But everything I've been told, and read, was that it was the oestrogen falling that was an issue.

There's so much info about there about migraine that conflicts with other info.

I also have a terrible memory and sometimes forget to change the patches at the right time, meaning I am guaranteed a migraine?

If you forget to change the patch then yes, you may get a migraine.
Do you ever forget to take progesterone?
Are you using it on a cycle (12 days a month) or ever day?

Forgetting it or taking it much later can cause migraines.

The bonus of gel is unlike a patch it never runs out.
Using it at the same time every day means there is a constant level in the blood stream. ('Late' application is counted as more than 12 hours after when it should be used.)

But if that was the case, most women would have constant headaches once they were in peri.

It's usually considered that migraines occur when the progesterone falls. I've had that since I was 13 and am now late 60s. I've an 'HRT friend' slightly older and she has the same experience, as we both use sequential HRT still.

Obviously some women may be different!

I can't remember where I read it, but I can promise you I'm not making it up or imagining it 😂

There are graphs available online that show patch absorption by site/strength. The everol 50 shows a gradual increase for the first 12 hours then levelling off before a gradual decline after day 3. As you would expect tbh.

Maybe its not an issue with you because you aren't sensitive to the fluctuating hormone levels. I'm sure lots of women aren't but unfortunately I am so i've read around the subject quite a bit.

I do this and it helped me, except I do 5 hours🙂

I'm not querying the fact the patch runs out but the idea that using estrogen later in the day can disturb sleep. That implies there is a direct link between our own estrogen being higher in the morning and not at night.

I've found the opposite. I've applied 1 pump at bedtime for over 15years.
Maybe that's unique to me.

The BMS has advice online of splitting the dose morning and evening, if it's a high one- eg 4 pumps - which just makes application easier.

Oestrogen is naturally higher in the morning, like many other hormones, eg dhea, cortisol, testosterone) pre menopause and is at it's lowest at night.

Maybe you're just lucky that it doesn't affect you. Also, isn't 1 pump quite a low dose? If you had 2 pumps at bed time, equivalent to a 50 patch you might feel the consequences? Maybe you don't absorb very well transdermally and I do?

We're all so different its difficult to say 🙂

There is scientific info online which says that a normal dose of HRT (the estrogen part) doesn't affect our cortisol levels in terms of lack of sleep, as they are controlled by the hypothalamus, adrenal glands and our circadian rhythm. On the contrary it says that using hrt later in the day can often help sleep.

Everyone is different as you say.

Yeah, this is correct. Both my neurologist, who is a migraine specialist, and my menopause specialist said the same thing - patches are best for migraines because they have a gentler curve with a taper at the start and end over the 3.5 days. My neurologist showed me a graph.

I was also told to use gel at night-time because it would help my sleep - it has done too, but I couldn't say whether that was just because of the extra estrogen in-general or because I've used it at night.

The best I've found is combining patches with daily gel and changing the patch after 3 days, not 3.5. I sleep better and have greatly reduced migraines.