Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Cherrycrumble on May 10, 2016, 03:39:51 PM
-
Had a doctors appointment yesterday and was hoping to try hrt, but the doctor doesn't think it's a good idea. Because I had awful migraines with aura when i tried the pill and also when pregnant, she said hrt would be a stroke risk. She was lovely and is arranging for me to have CBT to cope with the anxiety symptoms, but feeling completely gutted! Was hoping something would help me feel 'normal' again! :(
-
I'm sorry. I know by the time things get bad enough for me to see a doctor, be it menopause or a sinus infection, I want fast relief. Give the CBT an honest try, and if things don't improve, you could press harder for the hrt. I may be mistaken, but I don't think the hormone amounts in hrt even come close to pregnancy or the pill. Further, if you use a transdermal (patch or gel) I think you can get by with an even lower dose since it doesn't have to be digested. I don't believe hrt is absolutely off the table, but I would try her other suggestions first if she feels it's risky.
-
Cherrycrumble - I forget how old you are and where you are in your meno but if anxiety is your worst symptom and migraines are a big issue then HRT may not be the answer. I assume you have tried ADs/SRRIs or Beta blockers?
Do give CBT a go as it really can help. Also try to build a good routine into your daily life which includes a good walk in the fresh air each day - perhaps try an exercise class or a fun new hobby that can shift your focus. I know it isn't easy as anxiety can be crippling. By seeking help you will be on the way to conquering the anxiety. DG x
-
Hi Cherrycrumble. Has your doc seen the latest advice from the Migraine Trust? https://www.migrainetrust.org/about-migraine/trigger-factors/menopause-and-midlife/
If you really want HRT there seems to be no reason why you can't give it a go. It may take a while to find the one that suits you best but I'm sure there are other members on here who have migraine and are also on HRT.
Taz x :hug:
-
Thanks Lizab, think I was really looking for fast relief or just something to take, but what she said definitely made sense, just a bit deflated. Will definitely give the CBT a good go, I'm quite looking forward to it. I've got to see her again in 4 weeks and she's given me some info to read, but hopefully the cbt will help. :)
-
Hi Dancinggirl, I'm 48 and according to my dr my fsh level suggests I'm menopausal but i'm still having some periods! Anxiety is definitely my worst issue, but unfortunately i can't take beta blockers as i have asthma, otherwise she would have given me them. She said I can have AD's but not sure whether to try them; i've previously resisted taking them as was worried about the side effects, but definitely something to consider. Definitely going to try the cbt. x
Hi Taz2 I don't have migraine at all normally, only when i tried the pill and when pregnant, so only brought on by hormones, I don't have it the rest of the time. She said that because the migraines have aura I'd be at more risk of a stroke. Will have a look through the link, thank you :)
-
Between a rock and a hard place then.
Why can't your GP give you an emergency medication, i.e. Valium [there are others on the market] for an 'as necessary' basis? Is your GP dismissing all BBs?
I have used Rescue Remedy successfully. Deep breathing can help. CBT did nowt for my anxiety as I had my first panic attack aged 3 :-\.
How long do you have to wait for your first appt., maybe your GP could give you emergency med until you get the appt.?
-
Hi CLKD Thanks for your reply. I feel exactly that - between a rock and a hard place. She didn't say anything about valium or emergency meds and she did seem to dismiss all BB's. My mum takes bb's for panic attacks and has got on really well with them, but because of asthma said I couldn't have them. I have bought some Rescue Remedy pastilles today so will give them a try, also bought Kalms (desperation kicked in!) so will give them a try. She said I should hear from CBT within the next 5 days and then I'm not sure how long an appt will be after that. I'm doing deep breathing and a bit of mindfulness and it does help, just get myself so worked up especially at work, i'm not so bad at home.
Think I just expected to breeze into the dr's, get some hrt and all would be fine :)
-
Disappointed too then!
Maybe speak with a Pharmacist about the various types of BBs and asthma connections? and see if there is anything else that can be recommended. They have private rooms these days ;).
Is your asthma generally under 'control'?
-
Thanks CLKD, that's a really good idea about speaking with the pharmacist. My asthma is a bit rubbish at the moment, but it's mostly brought on by allergies, so don't know if that makes a difference. Will definitely ask though as I think they would really help if i could take them. Thank you x
-
If you don't ask you don't get ;-). You could go back to your GP then and re-discuss.
I find that oil seed rape when open as well as willow pollen makes my chest tight.
-
hi cherrycrumble (your name always makes me feel hungry :))
I am using ADs and I had CBT at the start of the year. It was quite helpful on a day to day basis but for me it didn't go deep enough so I am now having psychotherapy. Good luck with the CBT as it is good for coping strategies which I still use from time to time.
-
CLKD - rapeseed gets to me too along with grass pollen and some tree pollen. Food allergies too! I'm an allergy nightmare! ;D
Hi babyjane - think AD's might be my next port of call, but going to investigate a few things that people have mentioned. Hoping the cbt will be some help, hopefully will hear from them this week. :)
-
Hi Cherrycrumble
So sorry to hear you are disappointed with your doc's visit.
However CBT does sound like a good idea as well - and Dancinggirl's ideas re walking, exercuse etc to get the old endorphins going.
Also re the migraine - that link of Taz's is so helpful! Anyway the hormones in the Pill (if it was CCP) are very high doses and synthetic - so much stronger than HRT as Lizab says and in pregnancy oestrogen levels are extremely high.
Transdermal HRT (as it says on the link) is not likely increase your stroke risk and may not even give you migraines. I only started getting migraines (not with aura though) just before peri-menopause and still get them now but have only ever used patch HRT and bio-identical progesterone. Do you also have hot flushes or sweats?
Please ask to be referred to a specialist and I would try to resist ADs for symptoms that are new onset and likely to be hormonal, rather than problems you might have had all your life.
These are the contra-indications for HRT - migrane is not mentioned:
Pregnancy
Undiagnosed abnormal vaginal bleeding
Active or recent blood clot or myocardial infarction (heart attack)
Suspected or active breast or endometrial (womb) cancer
Active liver disease with abnormal liver function tests
Porphyria cutanea tarda
http://www.menopausematters.co.uk/contraindications.php
How often are your periods and how have they been lately?
Hurdity x
-
Don't dismiss anti-depressant medication because some can ease anxiety attacks. Without my ADs I wouldn't be here :-\.
Do you have food allergies or intolerances. Onions make me really ill unless cooked for hours ::). My mouth reacts to jams and sometimes bananas = feels like the tongue/mouth is burning :-\
-
Hi - I was taken off the pill at 49 because 'new rules' had come in that mean you can no longer take COC if you have ever had a migraine with aura. This was after a study which showed there is an increased risk of stroke if you have migraine with aura.
This risk, combined with the (very small, but it is the only risk for a lot of young people) increased risk of stroke of COC, resulted in guidelines that meant you could no longer go on the pill if you have ever had a migraine with aura. There has been a lot of publicity about young girls who die of a stroke shortly after going on the pill which has probably added to this.
The pill is given to healthy people who just want to stop pregnancy, so I guess the risks outweigh the benefits.
http://www.fsrh.org/pdfs/UKMEC2016.pdf (page 71)
COC is a very high dose of progestogen and about 30mg of a synthetic oestrogen (I don't think the actual dose is that high in the low dose pills that have been around for the last 30+ years, but it is one that has a strong effect on the switching off ovulation without breaking down too fast).
The guidelines are not the same with hrt and I have been on that for the last 2 years.
(I have only ever had auras without the 'migraine' since my teens, anyway)
-
Hi Hurdity - think maybe I got too excited about the Dr visit :) I'm definitely going to give the CBT a good go, hoping it will be helpful. I don't do enough exercise so am going to dig the exercise bike out. I walk at the weekends and feel better afterwards. I am having night sweats and skipping some periods, they are a bit erratic. They don't last as long anymore either.
I did talk to the Dr about the transdermal hrt but she still seemed to think they might cause issues. Is it easy to find a specialist, do most hospitals have them? Thanks :)
I'm puzzled about one thing. I had bad migraines with aura with the pill and also with pregnancy with my daughter. But no migraines at all with pregnancy of my son. Is that anything to do with the sex of the child? Does anyone know?
CLKD - yes I do have food allergies - sulphites and dairy, cause me breathing problems. Bit of a nightmare food shopping but have got used to it over the years :). I've found my allergies have got worse during menopause too. X
-
Thanks for that dahliagirl, that's really interesting. Will have a read later. Seems to be lots of confusion, and there's no one that actually specialises in menopause at my surgery, you just see one of the women doctors. She's lovely and really like her as a Dr and she would have been more than willing to give hrt, but the migraine and aura really concerned her. Will have a read of link, thanks :)
-
I think the rather black and white instructions for the pill have probably lead to some confusion with hrt.
HRT is replacement and is supposed to be an improvement for your health. The pill has to be a lot less risk than a possible pregnancy in a healthy person.
Ideally, I would have tried a patch, which seems to be the preferred way, and then come off it if it seemed to cause migraine. My old surgery gave me tablets, and I went with it as it was a chance to try out hrt. My new surgery prefer to keep me on the tablets, so they can move me to continuous hrt with the same progestogen in the future. I dare not mention migraines and rock the boat ::)
-
Hi Cherrycrumble
Your doc should refer you to a menopause clinic if they are unable to provide the specialist advice you need. This is your right. You can say you have researched information about HRT and migraine and you think transdermal HRT is low risk, and therefore you would like to try - whatever you decide - patch or gel combi or separates. If the doc still won't prescribe then this is the point at which a referral should be requested. Unfortunately not every area has one (a menopause clinic) close by and there is generally a wait. My nearest one is nearly 2 hours away but I've been lucky with my docs. Can you try a different doc in the practice?
if you look at the very top menu ( blue writing) click on the "specialists" tab and this will take you to a map so you can see if there are any in your area.
Hurdity x
-
I think I have two triggers for my anxiety. One is hormonal as it seems to come in 4 weekly cycles even though I am now 59 and post menopausal. I am not considering asking to start HRT at this point in my life. The other trigger is deeply ingrained factors from my childhood for which I find ADs and therapy helpful. Sometimes I can go days, or a couple of weeks without any trouble. At this point in my life I think it is what it is and I don't want to add anything else to the mix.
All the best to you cherrycrumble.
-
Cherrycrumble
Just a thought if the Cbt doesn't help, I'm taking the Ad Mitazapine for aniexty and low mood, I have been on them 6 weeks now and can honestly say I've not had any side effects, they are small and can also be broken in half if need be they are taken just before bed time and are brilliant for helping you sleep. I'm taking 15mg but do go up higher in doses 30 then 45.
Ann x
-
When I see your name Cherrycrumble I think of cream ;) - sorry, I digress :whist:
-
Hi Hurdity, I've had a look at clinics and there's one not too far from me. I'm going to see Dr again in a few weeks so will mention maybe being referred as I'm sure it would be better to try hrt under the supervision of a specialist. X
Hi babyjane, I think my anxiety is definitely being caused by hormones, I seem to plummet after my period finishes, but I also have things from my past that I think might be helped by CBT. Thanks :)
Thanks Smokey, I'm a bit of a wuss about taking medicines, so great that you are not having side effects. I think I'm becoming more open to trying AD,s after hearing others experiences. X
CLKD - haha can't beat a bit of cherrycrumble and cream ;)
-
I've never had cherry crumble!!!!! Sounds like a delicious treat! :)
Hurdity x
-
You are missing out hurdity! ;) It's delicious! :)
-
Hi Cherrycrumble
I've just increased the Mitazapine to 11/2 tabs ie 22.5 mg I'm like you a bit apprehensive with taking certain meds nor side effects stil took this dose for two days and then increased again to the 30mg and still no side effects. I shall now stay on this dose now and see. How my moods are, so far so good.
Ann x
-
Hi Cherry Crumble
I have had migraines with aura in the past, as well as a history of strokes at a younger age in my family. However, my doctor let me have HRT (and even a bio identical pill) as she felt the benefits were still greater than the risks. She did stress that transdermal estrogen would be best, as I believe others have suggested.
-
Thanks Smokey, that's interesting to know, I'm such a wuss with tablets in case of side effects. Have felt dreadful, anxiety wise, this week so need to decide which route to go really. Still waiting to be contacted by CBT people, so hopefully will hear early this week. :)
Hi Briony, I'm going to see the doctor again in about 3 weeks, so think I might have to really push for hrt. I don't really have a family history of strokes, I really need to sort something out, can't carry on feeling so bad. Thank you :)
-
Thanks Smokey, that's interesting to know, I'm such a wuss with tablets in case of side effects. Have felt dreadful, anxiety wise, this week so need to decide which route to go really. Still waiting to be contacted by CBT people, so hopefully will hear early this week. :)
Hi Briony, I'm going to see the doctor again in about 3 weeks, so think I might have to really push for hrt. I don't really have a family history of strokes, I really need to sort something out, can't carry on feeling so bad. Thank you :)
I did have to find the 'right' GP. First one (and a locum) both said no way. Third one, who was DRCOG qualified and slightly older, told me of the risks and let me make the decision. Good luck x
-
Hi Cherry Crumble
I've just read your post. I too have very frequent migraine with aura, brought on by perimenopause, and have for the past 14 years. I won't bore you with the detail here but read my first post if you'd like to read my history.
Over the years, many things have been attempted to try to manage/improve my migraine, and both Prof Anne MacGregor and Nick Panay tried to manipulate my hormones with HRT. Clearly HRT can be used by some women in this situation. I also have a family history of stroke with both of my parents.
Both were very well aware of my history and were trying to actually treat my migraine with HRT. Sadly, my body will not tolerate any hormonal manipulation thus the side effects were impossible to live with. All attempts seriously exacerbated my migraine in addition to lots of other unmanageable side effects. I was also never able to take the contraceptive pill and many were tried. My daughter is also unable to take the contraceptive pill because of her migraine with aura.
Both these specialists are London based and of course I don't know where you are. Is it possible for you to find a hormone specialist with an understanding of migraine to try to investigate this further?
Whilst I know that HRT is a life saver for many women, if I'm honest I would not try HRT again, it was disastrous for me. I am trying very hard to manage 'cold turkey' but I am inordinately lucky in that I've never been affected by mood changes.
I'm sorry, I'm away at the moment so I can't detail what was tried. Do ask though if you'd like any more detail.
I wish you well.
-
Thanks Elizabethrose, think I need to see the doctor again, and push this. I think her concerns are that I don't suffer with migraine usually, only when I take hormones (the pill) and when I was pregnant. She says it's a progesterone problem, and it seems to be synthetic and natural that both cause it. But surely I'm just bringing my levels back up again, so i wouldn't be having excessive amounts. To be honest, I'm a bit confused with it all, not really sure what to do. I'm waiting for CBT to try to help me manage the anxiety side of it, so might see how I go with that. x
-
Cherrycrumble, if you think it would help, you could cite my case to your GP. I have to take HRT to avoid getting silent migraine (aura without headache) which is the complete opposite of what she is saying. The only trigger in my case is synthetic progesterone in conjunction with very low levels of oestrogen. Therefore I have to seriously limit my Utrogestan intake and keep my oestrogen levels high.
It is extremely shortsighted to deny you HRT because you might then go on to develop other health problems that are caused by years of oestrogen deprivation. You just need the right type of HRT at the right dose and don't take too much progesterone.
If you don't get anywhere with the NHS and don't want wait months for an appointment with a menopause clinic/specialist then it might be an idea to consult Professor Studd.
-
Thanks Mary G - have had a look online at Prof Studd and he's not too far from me, but am going to push the doctor first. Have got an appointment with her in 3 weeks. I don't think it's completely out of the question with her, so think I will push it and see what she says. :)
-
Thanks Elizabethrose, think I need to see the doctor again, and push this. I think her concerns are that I don't suffer with migraine usually, only when I take hormones (the pill) and when I was pregnant. She says it's a progesterone problem, and it seems to be synthetic and natural that both cause it. But surely I'm just bringing my levels back up again, so i wouldn't be having excessive amounts. To be honest, I'm a bit confused with it all, not really sure what to do. I'm waiting for CBT to try to help me manage the anxiety side of it, so might see how I go with that. x
Hi again Cherrycrumble - I'm not sure what you mean here about bringing your levels up?
The point about progesterone intolerance is that it means different things to different women.
During the menstrual cycle we only have significant amounts of progesterone during the second half of our menstrual cycle which is probably at its peak at the end of the third and beginning of the 4th week of the cycle. During the first part of the cycle ( from a couple of days into the bleed and for the next fortnight approx) prog levels are very low and negligible - but sufficient - as they also are in post-menopause.
Women who are intolerant of any kind of progesterone suffer side effects for almost all of the second half of the cycle ie pms for two weeks. These women may also suffer during pregnancy when prog levels are very high indeed although this may be attenuated to some extent due to the extremely high levels of oestrogen also circulating. Most women suffer some form of pmt due to progesterone withdrawal - headache (sometimes migraine), tension, irritability etc just before the period starts ie the last couple of days.
Some women are fine with their own prog, but only intolerant to synthetic progestogens, - such as in the Pill (very high doses) or HRT (not quite such high doses), or perhaps only to certain types of progestogen.
Some unfortunate women are very intolerant of both but this is quite rare - and these women benefit from specialist help and a tailored approach to their HRT regime.
If both synthetic and natural prog are causing you problems then you defo should be on the most natural possible ie utrogestan and push for the minimum prescription (fewer days per cycle eg 10 rather than 12 to see how you get on) and regular monitoring ie scan - on NHS.
Hope this helps :)
Hurdity x
-
Hi Hurdity
I'm still confused with all this ;D At the moment I actually feel at my best in the 2nd half of my cycle (if I have one). I feel best in the week before my period is due, and actually feel ok when my period starts. Then when my period finishes is when my anxiety and mood really plummet. What do you think this means?
Definitely intolerant to synthetic progesterone, but dr also thinks intolerant to natural progesterone as I had migraines when I was pregnant too (but only with my daughter, no migraines when pregnant with son!) x
-
Had a doctors appointment yesterday and was hoping to try hrt, but the doctor doesn't think it's a good idea. Because I had awful migraines with aura when i tried the pill and also when pregnant, she said hrt would be a stroke risk. She was lovely and is arranging for me to have CBT to cope with the anxiety symptoms, but feeling completely gutted! Was hoping something would help me feel 'normal' again! :(
I was getting auras as a side effect of the trazodone I was on, I still get them from tiem to time. I got refused patches cos of this but i got doctor currie to write me an email saying patches are better for women with aura migraines, and only one doctor out of three read the email and agreed to the patches for me. It cost me £25 to email Dr Currie but it was worth it, cos I dunno if I would even be alive now if it was not for those little patches that have worked their magic.
I need a massive dose though 1000mcg and I am not even post meno yet.
This may be a good next step to take.
I was taking hrt pills but due to meno induced IBS I was not absorbinh them so even the 2mg femosoton didnt work at all, not one bit.
Good old Doctor Currie, got me to get doctors here to issue my patches and Ive been a lot better since. No more wet bras. I didnt even have seven bras to change daily.
-
Hi Hurdity
I'm still confused with all this ;D At the moment I actually feel at my best in the 2nd half of my cycle (if I have one). I feel best in the week before my period is due, and actually feel ok when my period starts. Then when my period finishes is when my anxiety and mood really plummet. What do you think this means?
Definitely intolerant to synthetic progesterone, but dr also thinks intolerant to natural progesterone as I had migraines when I was pregnant too (but only with my daughter, no migraines when pregnant with son!) x
Cherrycrumble - I have absolutely no idea!!!!! The only thing I can say is that during peri-menopause when hormones are fluctuating madly - then the cycle perhaps is no longer typical so it's anybody's guess how you will feel. If you were intolerant to your own progesterone you would have felt bad during the second half of your cycle throughout your fertile life - but of course during pregnancy levels of both oestrogen and progesterone are extremely high. Sorry I can't be of more help.
Hurdity x