Migraines - do I medicate or give up HRT all together?

[MaryIngallsRibbons]

Apols for the long post, I wanted to include all the background info at once.

I started on one pump Lenzetto and continuous utrogesten at the end of April. My main symptom has been zero libido, and a few other mild things - dry eyes, achey joints, heavy limbs, mild anxiety but nothing major. I also had very heavy periods which the HRT has really improved. Main reason for starting was to protect bones, heart etc.

At the point of starting I hadn’t had a period for nearly three months and was advised to try continuous as the consistent low dose might help avoid progesterone intolerance which I’d experienced with contraception.

For the first month all was well but by about six weeks in I was getting a lot of bloating and erratic bleeding so switched to sequential which resolved that. However, since then I’ve been experiencing a lot of migraines and feel almost permanently on the edge of a headache. Saw the GP this week and they prescribed beta blockers but I’m not hugely keen on layering on more medication when I didn’t feel a major need to start HRT in the first place.

Please could anyone share their thoughts/experiences? Are the migraines likely to settle at all? What are people’s experiences of using beta blockers to treat? Seems like a big leap to go from no headaches to beta blockers in a few weeks.

As someone who has been suffering much more frequently with (non-menopausal) migraines for the past year, I have been on so many different medications that I might as well have been rattling at various points. I've never been to the GP surgery so frequently in my life.

I would request a blood test. Then you can get straight to the problem, and deal with it, rather than trialling different (potentially lifetime) medications that may not have any effect on treating your migraines.

@TheeNotoriousPIG Can I ask what the blood tests were testing for please? What can they diagnose? Thank you

My GP put me on the mini pill for hormonal migraines which didn’t help, so I swapped to the combined pill which does seem to have helped. My sister is on HRT for migraines but says it’s not helping at all. She’s also on propanol but that’s not helping either. She’s a bit stuck.

At the point of starting I hadn’t had a period for nearly three months and was advised to try continuous as the consistent low dose might help avoid progesterone intolerance which I’d experienced with contraception.

HRT progesterone is nothing like the Pill.
HRT is body identical whereas the Pill is synthetic.

You could try estrogen gel not spray- it's easier to control the dose and it may be you need a higher dose.

Are you using 200mgs utrogestan for 12 days?

Is there any link with starting/ stopping it and migraines?

I've had migraine for life. HRT doesn't affect it like you're finding (used it for around 17 years with a private consultant.)

I get a migraine with progesterone withdrawal- even on a daily basis with continuous so am on sequential.

Does any of this help?

I found sequential utrogestan meant more frequent migraines (15 a month), but continuous use of utrogestan (200mg daily) returned me to my previous baseline of 5 a month.

My GP said it's not uncommon for women with migraine to find continuous utrogestan better.

You might find the continuous use settles down a bit, I found after 4/5 months bleeding tailed off, although I still have a regular menstral cycle it is extremely light, no spotting between periods.

Bloating is still a bit of a thing at times, but I'd rather have that than migraines and menopause symptoms!

Thank you for the replies.

@JinglingSpringbells the first migraine started with the progesterone withdrawal but I have continued to have them when back on it. I’m on my second break (taking 12 days 200mg), will be restarting it soon and monitoring closely for any improvement. I’m really hoping it begins to settle.

I tried increasing to two sprays of Lenzetto but started getting painful joints, excessive tiredness and feeling hot (not hot flushes as such but oddly warm) so dropped back to one after a week, which ended on the Saturday just gone. Haven’t been feeling great today, headache and just a bit foggy. Hoping it’s just settling back to the one pump again.

Honestly, it’s such a minefield. I am trying to limit the changes and stick with one regime to give everything time to adjust but the migraines are really beginning to impact my life and now just feeling a bit rubbish. I just wish there was a reset button that I could push.

@BellsAllTheTime I felt great on the continuous - sleep was amazing. Just a shame it was ruined by the bleeding and bloating. I think I will give it another month and then go back for my follow up appointment and maybe try continuous again if it hasn’t settled.

What blood tests did someone suggest above please? Im under a neurologist for chronic migraines and have had mri and ecg but dont remember any blood tests. No.one has mentioned the HRT I'm on either.
Currently on ajovy injections which aren't working. Im having 15 to 20 migraine days a month.

Not a medical expert but I've had chronic migraine (more then 15 headache days a month) for over 30 years.

HRT isn't recommended for treatment the of migraine and can often make them worse. Although if you need to take it for other reasons then trying different types and adjust dose until things improve seems to be recommended.

Having low vitamin D and B2 won't help, but nothing else in bloodwork will make much of a difference. Neurologist often recommend magnesium supplements and B2 (Riboflavin) often quite a high dose as they do help some people.

How long have you been on ajovy as it can take some months to have it's full effect. There are other alternatives though. Your lucky to have got it as it can be hard to get in some health trusts.

Thanks for reply. All the usual bloods are normal for me then.
I've been on ajovy for a year and a half. I had to do the whole fail on three preventatives first before being allowed to see a neurologist. It took years to get to the point of seeing one. I go back in October so will ask to try something different.
I've been on HRT since surgical menopause. I do need it.
I suspect, like you, I will just have to live with it. I have been for several years now.

I would ask to try Atogapant which is a tablet form of the injections but some people seem to find it more effective.

It's what I'm on and although I still get migraines they are mostly a lot better and easier to treat.

Thank you.
Have you tried botox at all?