Hi willowrannoch - I am not a doctor or scientist so don't fully understand all these things, however, I do know that FSH is linked to the activity of the ovaries which drive the oestrogen and progesterone production, so is the indicator of where we are in the menopause.
If ‘Hurdity' is around to respond, hopefully she will fill you in more about this, as she has a science background so can give you much more specific answers.
My understanding is that it is the ovaries dying off that results in the loss of oestrogen and progesterone which are the key hormones that result in most of the menopausal symptoms but you are right in thinking there are quite a number of factors involved. It is still a mystery as to why around 50% of women experience far more meno symptoms than the rest and the severity will vary from women to women - there is still much to learn. I am convinced that genetics has a lot to do with it all.
However, I don't think there is the money of the will to research this too deeply as there is no money in it for the pharmaceutical companies!!!! The fact that so many women have to give up work and drastically change their lifestyle in very restrictive ways, during and beyond the menopause, should result in more research but I think it is widely believed by our medical profession that our current HRT treatments are sufficient - unfortunately too many GPs simply put women on antidepressants which is not the correct front line treatment for menopause symptoms !!!! Personally I believe there would be much to gain from finding better and more positive treatments for the, sometimes, awful symptoms so many women experience.
I think you mentioned in your other thread, that you were put on the PCB continuously to help reduce the migraines you suffer with? If this is the case I also assume your migraines were specifically linked to the natural hormone fluctuations during your productive years, so by giving you the PCB continuously this would have prevented the fluctuations, thereby reducing the trigger for the migraines. When you stopped the PCB to have your children did the migraines return? Did you get migraines during your pregnancies - I suffered terrible headaches in my first trimester!
You are clearly peri menopausal and as you will now be experiencing more erratic fluctuations in the hormones, if you are not taking any hormone supplementation then, if your migraines are hormone related, logically your migraines would increase - has this happened? Many women find they develop migraines when they become peri menopausal due to these fluctuations and these often settle once deeper into post menopause - HRT will help these women avoid so many of these headaches.
You were prescribed a sequential HRT because you are peri menopausal, so you could have experienced migraines as the sequential HRT is designed to mimic the natural hormone cycle - sequential HRT is given through the peri and early post meno phase to prevent erratic bleeding from occurring. Transdermal HRT is usually prescribed for women who suffer migraines as the hormones do not go through the digestive systemic, as I believe this can be a migraine trigger. Unfortunately the combined HRT patches are medium dose and this would probably have been too high a dose at this stage in your meno journey.
Had your doctor understood that it was important you have a constant dose of hormones to help prevent the migraines, then they might have suggested having a Mirena fitted, which gives progesterone in lower doses more locally thereby reducing progesterone side effects, and you would then have a daily dose of oestrogen as either gel or patch. If your migraines do return with a vengeance (and they may not if they are not hormone related) and flushes and night sweats become a real problem, then I would suggest you discuss the option of the Mirena as this may give you the hormonal balance you require.
There is treatment to shut down you own hormones completely (Zoladex) but I'm not sure how successful this would be for you - I'm sure this would have been tried if you doctors had thought is appropriate.
I think you are right to have time without hormone supplementation at this stage and concentrate on lifestyle choices to see how things go. You may be surprised and sail through with few problems and your migraines may go away once you are in post meno. Do let us know how you get on. DG x