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[pinkmarshmallow]

Hi

At the moment I’m on 2mg Sandrena gel daily and on days 15-26 take 200mg Utrogestan tabs orally.  Also 40mg Propranalol when I wake up with these horrible surges and take 30mg Citalopram to help with low mood (which I had before peri started).   I’ve been on this a year now. 

The cortisol surges wake me up every day around 5.30am and start from my feet up through to my chest in waves.  They can be so intense it’s really getting me down.  I’m hating going to sleep as I know I have to wake up to these surges.

My migraines (which I’ve had since puberty) I’m now 53, have got worse from day 20 through to the next cycle day 3.  Can anyone advise me what I can ask my GP when I eventually get an appointment with her?  Previously she hasn’t wanted to give me a thyroid blood test.  I just don’t know where to go from here.  Any advice would be helpful. 

[joziel]

I'm always going to be influenced by my own experiences here, but for me anything to do with cortisol surges at night or insomnia or early waking, has been due to estrogen - too much of it. Other people here have found it to be just not the right dose or type of it, for them, causing this.

I am perhaps a very unusual case as I've had severe high blood pressure caused (we think) by a reaction to estrogen. But along with that came anxiety, early waking, heart palpitations and more. It all got worse when estrogen increased and better when it decreased.

I suspect there are many more women with reactions to estrogen out there, but they just aren't getting recognised by doctors for some reason. They are being prescribed meds to deal, piecemeal, with the symptoms - like your propranolol - instead of trying to work out the root cause.

With your migraines, that would seem to be simpler - as it seems to correlate with when you take your utrogestan. Have you tried taking it vaginally instead of orally? You might not absorb it systemically then. The other option is to try going to a continuous regime, which would see you take utrogestan every day - but only 100mg of it.

[CLKD]

Hello.   Cortisol surges would wake me anytime after 3.00 a.m. and left me terrified.  My GP prescribed a betablocka, the same as you, to take in the evening to ease the early mornings surges.  Does the Citalopram help?

[CLKD]

How much propranolol?  I was on 80mg 3 times a day for a month followed by 40mg twice a day then dropped it down to 20mg at night.

[CherrySG]

Wonder if you'd benefit from a change of antidepressant? I had cortisol surges waking me daily for many years, but citalopram stopped that for me.

Eventually it stopped working although I tried many times as it was something I really relied upon for a decent quality of life.

There are lots of different ADs to try but I'm sure you know that.

[Mary G]

pinkmarshmallow, your migraines sound like the menstrual type ie progesterone withdrawal so if possible, it would be better to avoid a cycle and take 100mg Utrogestan vaginally every other day (as the Newson clinic advocate) and avoid a bleed - I'm assuming you are post menopause.  This equates to a more tolerable 50mg progesterone every day which I find more than enough but it's worth having an annual transvaginal scan to check the womb lining.

I take amiltrypline as a migraine preventative and so far I have not had any side effects.   I started on 10mg daily and now increased to 30mg as recommended by the migraine specialist.  Apparently amiltrypline is the best AD to use for migraine prevention so you might want to give it a try.   If you find you still have morning anxiety/cortisol surges you can increase the dose up to 1mg per kilo of body weight.

[CLKD]

I think the poster takes Citalopram?

   Mary G

[ElkWarning]

I'm always going to be influenced by my own experiences here, but for me anything to do with cortisol surges at night or insomnia or early waking, has been due to estrogen - too much of it. Other people here have found it to be just not the right dose or type of it, for them, causing this.

I am perhaps a very unusual case as I've had severe high blood pressure caused (we think) by a reaction to estrogen. But along with that came anxiety, early waking, heart palpitations and more. It all got worse when estrogen increased and better when it decreased.

I suspect there are many more women with reactions to estrogen out there, but they just aren't getting recognised by doctors for some reason. They are being prescribed meds to deal, piecemeal, with the symptoms - like your propranolol - instead of trying to work out the root cause.

This basically describes my response to the oestrogen element of HRT. For me it ended up creating a medical emergency.

I've found ditching the HRT, spending 3 years in weekly therapy, consulting a herbalist and having regular therapeutic massage sorted the cortisol issue. Sometimes I do still wake at dawn with that shocked back to life feeling, but I can orientate myself and drop back off pretty quickly.

[pinkmarshmallow]

Gosh thanks so much for all of your advice! 

I’m going to try taking Propranalol at night instead of the morning to see if it has any effect on the surges.  If not, then I’ll reduce the Sandrena from 2mg back to 1mg and see if that works. 

I have no idea whether the Citalopram is working, I presume it is helping me.  I’ve had CBT therapy this year and am on the list for another block session in 14 weeks time. 

Regarding my migraines, I’m still getting a withdrawal bleed on day 22 for 4/5 days but I will chat with my Dr about changing Utrogestan to 100mg a day orally or every other day vaginally.  I hadn’t heard of taking it every other day.  Thanks. 

I’ll update you all.  Feel this forum is such a life line x

[CLKD]

Morning.  Don't stop the Citalopram.  If may well be working 'in the background'. 

Let us know how you get on.

[pinkmarshmallow]

No I won’t stop the Citalopram as I could be a blubbering mess again once my 2 Uni kids go off in September!  I’m hoping I’ll get through the whole thing much better than last year.  I blame the perimenopause. 

Anyway, took Propranalol last night - couldn’t get to sleep until at least 1.30am!  Still woke at 5.50am with some surges.  Will stick with it for a week and see.

[Gnatty]

I'm afraid some people don't sleep if they take beta blockers at night time. I'm one of them! You might be the same. Whether it settles down I have no idea.

[CLKD]

Or U may have been waiting to see whether you went to sleep  .  It can have a sedative effect, however my friend becomes hyper and agitated with it!

[Kat36]

I’ll just chip in with my experience of cortisol surges, migraines etc. After many months of trying evorel patch & utrogestan I eventually abandoned it. The further I went up in the dose of estrogen the worse I felt.  I was getting surges, early morning dizzies, daily migraines, bolting up awake in the night. I changed to evorel conti and am getting on much better. I feel much more stable.  I think the thing I’ve learnt the most so far is that when it comes to migraines and other side effects…the most stable, drip feeding type of hrt works well for me. 
How otherwise have you got on with your dose- have you seen the benefits? Have the surges started recently?

[joziel]

That’s interesting as there’s not much difference between Evorel and Evorel Conti except for the progesterone 🤷‍♀️ I’d assume the adhesive in the patch and the estrogen and mechanism of delivery is the same… 🤔