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[butterfly286]

Hi everyone I'm a newbie
I have been peri- meno since aged 42 I'm now 48! Kind of feel my life stopped at 42! Had a 3 month episode of full blown meno symptoms couple of yrs back GP kept telling it was viral, I had insisted they done my FSh sky high so started on citalapram & everol sequi , managed to come of citalapram was doing ok on everol then had breast tenderness & migranes! GP changed to Femston still migranes all meno symptoms except hot flushes are back full blown! Fealt desperate & paid to see a consultant she has advised me to change to Sandrena 1mg a day with a meareana coil very reluctant to have coil or utrogestron 200mg 7 day b4 period , she said this would make me sleepy!,I'm a staff nurse work nights/ days in same week, need to be alert! She also told me I would be on HRT till I die!!!! Any advise please! X

[Mary G]

Welcome to MM!

Sorry to hear about your migraines, I also started having silent migraines (migraine aura without headache) once my oestrogen levels started dropping.  At the time, I had a Mirena coil and interestingly, never had migraines with the coil until that point.  For that reason, I would not want to risk having another Mirena and it is probably not a good idea for anyone who has migraines to have one fitted although I would try to find out for sure what triggers your migraines.  From what you have said, it does sound like the progesterone part of HRT could be your problem - do you have migraines when on the progesterone part of HRT?  Have you ever had migraines while on the oestrogen only part of HRT?  I also have breast pain when using all types of synthetic progesterone (including the Mirena coil) and if I take Utrogestan orally but not when using it vaginally.

It is worth bearing in mind that all types of progesterone used in HRT (both synthetic and micronised) are nothing like the stuff you produce yourself whereas the oestrogen part is very similar.  I have never heard of anyone who has terrible problems with oestrogen only HRT.

If it turns out to be the progesterone part of HRT that is causing your migraines, the only thing you can really do is take less of it and use Utrogestan vaginally at a lower dose and for less time - it has fewer side effects when used vaginally and it always works better at clearing the lining.  I use 100mg vaginally for 7 days and two pumps of Oestrogel everyday and so far so good.  Obviously there is no guarantee this will work for everyone but it is worth a try.  I consulted a migraine specialist and she suggested that I take 300mg aspirin during the Utrogestan phase and to take vitamin B12 (my levels were low) and magnesium supplements to ensure that I am getting the right amounts every single day. 

If you are getting hot flushes, this would suggest that you are not getting enough oestrogen. 

[Taz2]

Hi butterfly - welcome from me too.

One sentence stands out for me from your post "She also told me I would be on HRT till I die!!!!"  These are words that so many of us on here would love our consultants/GP's to utter. So many of us are told that we are only allowed five years of HRT, or we have to come off at 60 after which we are supposed to just put up with the symptoms. Here's to more enlightened consultants like yours!!

Taz x 

[Dancinggirl]

Hi and welcome to MM butterfly 286
I would have thought your best option would be the Mirena with Oestrogel.  You would get fewer progesterone side effects like the headaches and wouldn't get the sleepiness that is a typical side effect of Utrogestan.
Perhaps try Utrogestan first to see how you feel but then have the Mirena for the convenience and fewer side effects.
Oestrogel is better that Sandrena as it is more flexible for dosage.  DG x

[Hurdity]

Hi butterfly286

  from me too.

Just to say the sleep-inducing effects of utrogestan are generally during the few hours after you take it so if you work nights then take it just before you go to bed/sleep. I can see this would be difficult if your shift pattern keeps changing though as it's best to take the utrogestan at the same time each day approx. I agree that if you are not over sensiitve to progestogens that Mirena might be a better option in your position. Re flexibility of gel - if you decide to use less then you just turn over the top of the gel sachet and hold together with a paper clip - although i haven't seen one of these I imagine it is similar to testosterone gel where one sachet lasts me at least 10 days so I am always using half-opened sachets!

The headaches may well just be part of peri-menopause and the extreme pms many women get at this time - unfortunately HRT is not always able to prevent these. As Mary G says some synthetic progestogens cause  headaches in some women.

Also to correct something Mary G said:

"It is worth bearing in mind that all types of progesterone used in HRT (both synthetic and micronised) are nothing like the stuff you produce yourself whereas the oestrogen part is very similar"

This is wrong. Progesterone - as in micronised progesterone marketed as utrogestan (also as Cyclogest, Crinone and made into progesterone creams is biologically identical to the progesterone that we make in our bodies. The same molecule. This is what bio-identical means. Estradiol is also the same - exactly the same molecule as estradiol we make. Not similar. The same. No-one should be under any illusion about this! They are all synthesised to be bio-identical through chemical processes in a lab/factory from similar molecules found in plants.

Hurdity x

[butterfly286]

Thank you Hurdity,
My migranes have no pattern to then, I can go up to 2 months with out one then have sudden cluster of them- I only have to take urtgesterone 200 mg for 7 days befour my period do you think It will matter If , I took it after a nightshirt a couple of times a week? This may only happen occasionally depending on my off duty- I have a fear that this may completely fatigue me for a week once a month ?

[Dancinggirl]

The problem with Utrogestan is that it does need to be taken at the same time each day or the dose won't be consistent  - if your shifts mean you take it at different times of day this could then result in breakthrough or problematic bleeding. Utrogestan does tend to make one feel sedated for a few hours so this is why you should take it at bedtime.  It does make some women feel sedated though out the day as well, if really sensitive - using it vaginally can reduce side effects but I found it irritated my vaginal area when used this way.
I still think you will be better off with a Mirena as this would eventually result in no bleeds at all (usually a few weeks/months after fitting) and you can then use as little or as much oestrogen as you need to control your meno symptoms.
You may find that your migraines will be better when you have a consistent dose of hormones - are there any triggers for your migraines e.g. poor sleep, certain foods etc? I had terrible headaches lasting days through my peri stage and when I'm not on HRT my headaches are always worse.  DG x