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[Fianna]

Looking for advice please. 7 years post menopause. 54 yrs old

Been on various HRT preparations and doses over last 3 years, all having various side effects including bleeding. Always been on 50mcg estradiol in a patch of some sort up until now which has stopped meno symptoms.

2 months ago had marina fitted to try and stop the bleeding/prog side effects. Gynae suggested oestrogel as easier to play with dose myself. 2 pumps.

Immediately got tinnitus and bad headaches everyday then migraine auras. Improved after 2 weeks or so but didn't go. I know it can take time but 2 or 3 weeks ago I wondered if the estradiol dose wasn't enough to match the prog so I upped to 3 pumps. Headaches seemed better (coincidence? ) but I got Thrush. I know thrush can be caused by both estrogen and the marina. I reduced back to 2 pumps but I'm still struggling to get rid of the thrush.

I've gone from having maybe 2 silent migraines a year to 2 or 3 a week, Headaches, tinnitus.

Mood-wise I feel the best I've been for a couple of years!

Do I risk increasing the oestrogel again to see if it improves migraine?  Or do I reduce? Maybe I absorb it better than in the patches and I'm getting too much? Really want rid of the thrush 😵‍💫

So difficult when I've changed both aspects of HRT.

Thanks for listening x

[Mary G]

Sorry to hear you have migraine auras, I have them too but I've managed to get them under control with the help of hormone manipulation and Verapamil (a calcium channel blocker).

You mentioned that that the auras have got worse since having the Mirena coil and switching to Oestrogel. What type/dose of progesterone did you use before and did you have fewer migraines? 

You have also switched from patches to Oestrogel which is less stable and often more easily absorbed but you might have fewer auras if you split the dose by 12 hours. 

Personally, I don't like patches and didn't get enough oestrogen out of them but if the split Oestrogel dose doesn't reduce the auras, you might have to go back to them. 

[Fianna]

Thanks for replying. I'm already splitting the dose, 1 pump in the morning and 1 in the evening. I've been on evorel 50 with 100mg Utrogestan (couldn't tolerate 200mg), Evorel Combi and most recently Femseven. On all of those I literally only had 1 or 2 migraines a year.

Since moving to coil and oestrogel I have a migraine almost every week and sometimes twice a week.

What do you mean by hormone manipulation?   changing your dose? Do you think it's the oestrogen or progestin causing them?

[bombsh3ll]

Why did you have to change your estradiol formulation just because you got an IUS?

Those with migraines tend to do better with stable estradiol levels rather than the rapid peaks and troughs produced by applying gel.

The patch releases a stable and consistent amount over 24 hours.

I would also treat the thrush aggressively (oral plus topical antifungal agent) and make sure your vagina is adequately estrogenised, ideally via the bloodstream but failing that with topical estrogen.

[Mary G]

Things look clearer now.  If you got in well with Femseven in theory you should have no problem with the Mirena coil because both contain levonorgestrel.  Evorel conti contains norethisterone which is not the best tolerated progesterone in the world but you obviously got on OK with that too.

This would suggest it's the Oestrogel that's setting off the migraine auras which, incidentally, are caused by cortical spreading depression.  There's also a chance the coil is pumping out too much progesterone because it's only just been inserted.  I would go back to the patches and if things improve, that means it's the Oestrogel causing problems but if you have no improvement, it would suggest the coil is pumping out too much progesterone - there's  chart you can locate online that tells you how much progesterone the Mirena pumps out year on year and it reduces quite a lot over a 5 year period.  So if it's the Mirena coil causing the auras, that could stop once it starts reducing the dose.

From what you have said it would seem we suffer from different types of migraine aura.  Mine are brainstem auras that are caused by low oestrogen, high progesterone and all types of hormones instability.  That's why I've had to manipulate my hormones into a stable condition which means never allowing oestrogen to get too low, not overdosing on progesterone and not having bleed breaks. 

Progesterone can be very destabilising so I can't use norethisterone and Utrogestan is very unstable so that's completely out.  I got on fine with the Mirena coil pre menopause but the proverbial really hit the fan once I stopped producing my own hormones  (which protected me from migraines) and the silent migraines started when I was 43.  My migraine sub type starts at menopause and never improves without hormone therapy so I'm on HRT for life.

By the way the Mirena coil can cause thrush type vaginal irritation.  I was constantly having infections and vaginitis which was showing up on smear tests.

I hope that helps.

PS I think you will need something like a 75 or100mcg patch with the coil.

[Fianna]

MaryG , my migraine auras sound like yours, they started soon after my last period. I didn't get on with Norethisterone  - low mood and anxiety- but migraines didn't get worse. What progesterone do you take now that you find keeps you stable? If I request patches they'll put me on 50mg and, as you say, I might need higher to balance the progesterone in the coil. It's difficult not knowing which is causing the problem.

Bombshell, I didn't have to change, the gynae recommended it as it's easier to play around with the dose yourself. I could request patches but I don't know what dose to request as I don't want to increase estrogen if that's causing the thrush. I've taken 2 x oral tablets and 2 x pessaries in the last 2 weeks plus pplyimg cream and eating live yoghurt and kefir daily.

I do have a few Evorel 50 patches left which are a bit out of date but maybe I'll pop one one and see what happens??

[Mary G]

Fianna, I currently use progesterone gel every day (Darstin which is not available in the UK I'm afraid) and 75mcg Cerazette.  I'm still learning about migraines myself and I was about to trial Duphaston (dydrogesterone) but I've realised after much research that my migraine sub type reacts well to suppressed FSH and LH levels so I'm sticking with my current progesterone regime because I don't think dydrogesterone will adequately close down pituitary action. 

I also got on extremely well with compounded progesterone (buccal lozenges) and didn't get one single migraine aura while using it but they can't post to the EU post Brexit so I had to find an alternative.

It's interesting that your auras also started post menopause. Something obviously protects us from these wretched migraine auras pre menopause and I suspect it's progesterone stability and adequate oestrogen.