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[FlowerPot]

I'm 53 and have had hormonal migraines for about 20 years, always starting on first day of my period (sometimes mid-cycle also) and lasting 3 days during which time I'm down and out and in severe pain for most of the time.
That was bad enough but at least I had some idea of when I was going to get them. Since entering peri they've become much more frequent with no way of knowing when they will strike and are really affecting my life. Apart from the total misery of lying in bed for 2 days feeling like your head is going to burst with the pain, I'm leaving a trail of let-down friends, missed appointments and even had to cancel a holiday because I couldn't get out of bed never mind onto a plane.

Last year I decided to try HRT to see if that would help. Menopause consultant put me on Oestrogel and continuous Utrogestan with the aim of suppressing my cycle to help with those around my period. It didn't change the frequency but it definitely seemed to lessen the intensity for most of last year. The problem is they've now come back to how they were before and I'm migraine free today for the first time since last Sun - it's been a hellish week and I just feel at the end of my tether.

What has prompted me to post, apart from just letting it out (sorry about that!) is that I'm convinced that it is not low oestrogen itself that causes my migraines but the sudden drop down to low that triggers them. Everything I've read and the timing of them in my cycle over the years points to that. So having one pump of oestrogel might ensure a steady daily dose but does not stop the sudden drop that triggers them as my body is still producing its own and natural fluctuations are still happening. So it makes the higher and lower levels higher than they would be but the difference between the two remains the same.

I know there are many ladies on here who have the experience and knowledge of HRT that you just can't seem to find on Google - or even in the medical profession! So I wanted to ask if anyone knows whether there is a level of oestrogen HRT that you can take that might stop your body making 'extra' so the sudden drops won't happen?
It's hard to word what I mean correctly but say if I upped my dose to a higher level, might that make it more stable?

[Banjo1973]

Hi Flowerpot,

I know nothing about migraines, but I could rant for hours about how betrayed I feel by 'new' Oestrogel. I had been really happy on the old stuff, the new stuff just isn't the same and I nose-dived. Eventually I switched (to Sandrena) I instantly improved - but it's taken a long time to feel properly good again. All my Oestrogel friends happily switched over and are happy. All except for the one who like you suffers from migraines. She moved to Evorel patches and is largely migraine free and feels great again. (The same thing happened to a poster here)

Sorry if this is no use to you, but it might be worth considering Evorel patches.

Good luck x

[Mary G]

It could be that this duff Oestrogel problem has set off your migraines because the dose is not stable or just too weak.

I have silent migraines (aura without pain) but the cause is very similar to your painful migraines.  They invariably get worse at the onset of the menopause because of plummeting progesterone, wildly fluctuating oestrogen and low levels of both.  It's complex and there is a lot involved but unstable/low hormones set off a whole load of things like low seratonin, high blood pressure which affect migraines.

You need a continuous, stable dose of oestrogen and progesterone and you need to avoid bleed breaks because that sets off migraines.  You will also need to keep your oestrogen levels quite high ie somewhere in the 500s of even 700s to override your own cycle - this can also be achieved with the contraceptive pill.  Because of the high dose of oestrogen needed, you might find a Mirena coil more stable and suitable for the progesterone component.

You might also need to add in a migraine preventative.  Proprananol is the first line of defence followed by antidepressants and calcium channel blockers.

I hope that helps.

[FlowerPot]

Thank you both for you replies and helpful advice 

Although I have noticed the difference in the oestrogel in the new bottle, I don't think the timing is right for that to be the cause.

Mary I know you have a lot of knowledge and experience re migraines and I value your advice.
I'm very interested in what you say about a high level of oestrogen overriding my own cycle because I was wondering if that might be so. I didn't know if your body would recognise and respond according to the existing levels of oestrogen or whether it would just carry on producing regardless?

I tried propanolol for a year but it made no difference and I've tried many other things such as botox, supplements, acupuncture, massage etc. The best result I had was 13 weeks migraine free when I started magnesium but the migraines soon found a way round that!

[shrosphirelass]

I was exactly like you Flowerpot, regular headaches around my period which got worse when Peri. I went on HRT at 57 still having regular periods and things did improve slightly but not substantially.  I'm sure my headaches have been caused by drops in oestrogen. I really wanted to change to a conti regime to get an even amount of hormones. At 59 this was agreed and my headaches did improve markedly. However, I experienced lots of bleeding which may have been because I was still peri and my own hormones were overriding the HRT.  This bleeding was nearly always accompanied by headaches, so must have been due to changes in hormones.

I'm guessing I'm menopausal now at 62 but the bleeding accompanying headaches continued so I was advised to change to a Mirena to stop the bleeding. I did this 6 weeks ago and fingers crossed the bleeding has stopped (for now) and the headaches are much improved.

I really don't know how to achieve a stable level of hormones before menopause is reached. My mother had exactly the same pattern of migraines which stopped all together when she reached menopause.

[Mary G]

Flowerpot, first of all, I think you need to try to override your cycle either with the contraceptive pill or high doses of oestrogen.  If you type it into the search bar on here, there is a lot of information on that.

If that doesn't work and the migraines still persist, the next port of call is propranolol.  You said you tried it before but at what dose?  It needs to be high for migraine prevention and you can go as high as 320mg per day - I take 200mg.  If that doesn't work, the next step is to add in an antidepressant like amitriptyline or nortriptyline.  Next step after that is to add a calcium channel blocker.  This is the set procedure recommended by hormonal migraine specialists but hopefully you can control your migraines via hormone manipulation.  Once post menopause, you should be able to reduce your oestrogen dose and continue with a lower dose, continuous combined regime.

Unfortunately migraines are difficult to treat and you have to throw the kitchen sink at them!