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[Wrensong]

Just agreed with lovely GP to change new conti Utrogestan/Estradot regime from Utrogestan 28/28 to 25/28 as, 31 days into trial, body seems to be trying to have a bleed & dreaded palpitations are back.  Other post-meno bleeds throughout 18 months on Evorel Conti, but scanned (lining well within limits) & scoped & all OK, though repeat investigations looming if latest bleed continues/ recurs.  Recent smear normal.  Long term hypothyroid, recent TFT perfect.

Now 4+ years post-meno, mid-50s, on 3rd HRT: Estradot is 75mcg & Utrogestan 100mg orally at night.  Previously, Evorel Conti 18 mths but night sweats etc persisted so more oestrogen advised.  Mild osteopenia just diagnosed.

So, question 1) Has anyone else had palpitations on oral Utrogestan & transdermal Oestradiol and if so, did these resolve or did you have to stop the regime?  Had similar palps for several years in peri, thoroughly investigated & found to be harmless ectopics.  Not panicking they're back, but these are a nuisance I'd hoped was behind me. 

GP says expect migraine during 3 days off Utrogestan.  Had classical migraine (aura, headache, the works) from age 18 to final period, but not a single one in 4 1/2 years since.  YAAAAAAAY!!!  Still get ocular migraine from time to time (aura + odd bits & pieces, but NO headache).

Question 2): have any of you who are migraineurs found a 25/28 day cycle with Utrogestan brings on migraine?  If so was this only during first months?

[Hurdity]

Hi Wrensong

I know your questions are very specific so I can't really help with these - sorry!

However I do get migraines from time to time - and these only started in late reproductive stage and I didn't know they were migraines until several years later as they are the classic type. I always used to get them just before period, and then when I started HRT, sometimes on the progesterone part and often on withdrawal. I first used Cyclogest pessaries which were very high dose and since using utrogestan I don't seem to get migraines from progesterone withdrawal at all - although get them randomly for other reasons but pretty infrequently now - probably every 6 weeks or so (or couple of months?). I use a higher dose of utrogestan than you do - 200 mg x 12 days ( although a couple of days I take 100mg to ease the withdrawal) and I take these  vaginally which gives a higher dose. You may well not notice the 3 days withdrawal each month so let's hope for the best. The other thing is the metabolic byproducts from oral use cause more side effects than from vaginal use so this might affect the likelihood of migraine on withdrawal  - to do with GABA receptors and maybe allopregnanolone (?) or similar compound from metabolism (sorry a bit hazy on this and don't have time to look it up!).

The other thing is you might find continued spotting on the regime you are using as you are on a higher dose of oestrogen - but depending on how well you absorb the utrogestan. You might end up preferring a longer cycle - although perhpas on 75 mcg you might not be able to go much longer - and also this would need a higher dose of Utrogestan.

Sorry can't help with the palps - I do get them occasionally but ignore them!

Hope this helps a little

Hurdity x

[Wrensong]

Hi Hurdity,

thanks for the thoughtful reply.  So sorry you also have to contend with these horrible headaches & their baggage.  I remembered from some of your earlier posts that you too are a migraineur.  Interesting that you used to have some on withdrawal from Cyclogest, as I think this is what my GP is expecting for me.  I never noticed a pattern relating to menstrual cycle with those I had in reproductive years (ie migraine with aura) - I think they were more or less random.  After the first one at 18 which scared me witless because of the impaired vision in aura, I never saw a GP about them as I was lucky not to have more than, probably at most, one every six weeks, so didn't learn about them in depth, though did read up on possible dietary triggers. 

Please don't take this as gospel as memory not my strong point, but did a very quick Google yesterday and was surprised to learn that those with aura are not thought to be "menstrual", which I took to mean are unrelated to cycle in any way.  Yet mine were always with aura but did stop after last period, except for the ocular variant, which lacking the debilitating headache, I didn't realise for some time, were also a form of migraine until a Neuro confirmed this. 

Ah, the vaginal route - yes!  Had agreed with Gynae to start this way as she warned orally would exacerbate IBS-C, so tried vaginally a year ago, but stopped after just 3 days as the palpitations came back with a vengeance.  The capsules also irritated the area (Vagifem not 100% effective) and didn't think it practical to use that route on a conti basis.  The sequi method is something I had hoped to avoid, but may eventually have to go that way if spotting/bleeding doesn't settle on conti. 

Had the most horrific sweats last night and no sleep after about 3am - 2nd night without Utro - right back to pattern of pre-HRT, so wondering if I am one of those queer birds who is better on prog than off.
 
I always read your posts with interest and in awe of your knowledge!  In fact, I think you were the first to make me sit up & take note about the benefits of HRT while I was still too scared to take the plunge, yours the first mention I read of Utro & the first to recommend the Gynae I later sought out.

[Hurdity]

Thanks for your kind words Wrensong - but I am very aware of how much I don't know and how superficial my knowledge is! Women are always asking questions on here and talking about various hormones and their effects at different stages and the endocrinology and biochemistry is complex - I will glance through lots of papers gathering nuggets here and there and then not be able to remember where I've read them to back up what I say - and I have  so many bookmarks - it takes forever to look at which one is which!!!

Yes vaginal progesterone is not an ideal regime for those who want to indulge in regular bedroom activities  . I do think cyclical HRT rather than continuous is the way to go for maximum feel good - but the cycle length is crucial for this.

I would never call myself a "migraineur" - had never heard of this term until recently. I really only get them now and again and wouldn't label myself as such, and also do not get aura - which is why I didn't know they were migraines for several years. Those who get them regularly or have done - as you have - well it's a different matter and you have my sympathies - because I have to write off most of the three days mine last but I can't imagine what it must be like to suffer them frequently. I can still function but feel rubbish and can't do anything productive. Glad I have retired now as would have to work while having them sometimes!

You might still be experiencing progesterone withdrawal - but strange it manifests as increased might sweats 

I hope you feel better soon and enjoy the dawn chorus if you happen to be awake then

Hurdity x

[Wrensong]

Regular bedroom activities - hahaha, that would please hubby!  These have been less frequent post-menopause, but I am working on it    The higher oestrogen & Vagifem now up to 3 a week does seem to help with preparing the way.  However, have long deferred starting T as all signs were I was not absorbing the Oestrogen from The Evorel too well.  Had learned on MM that ensuring good oestrogen levels first was important

That your migraines take 3 days at a time out of your life is dreadful.  I was luckier in that mine were only usually debilitating for 24 hours, though the after-effects lingered for a day or so, but from the onset of the visual impairment of aura I needed to get to bed in a quiet, darkened room asap to get through the quickly following nausea/vomiting & the worst of the headache which I found impossible to function with.  I admire anyone who can carry on with life on during a full migraine as right from the start, I was always rendered helpless by these.  When I later started to get ocular migraine (aura but no, or minimal headache) I didn't know it was possible to have migraine without headache & though the aura was similar to those I'd had with classical migraine, so many weird things happen with hypothyroidism I wasn't sure it wasn't just another odd consequence of that!

Congrats on the retirement btw - I remember reading this was on the agenda for you & seeing fewer of your posts recently, began to worry you were considering retiring from MM as well!

The Utrogestan withdrawal has been a bit rough - horrible, tense-feeling fight or flight type reaction, body threatening to panic & intense, long-lasting night sweats with familiar racing heart that won't be calmed by breathing exercises etc.  I think being hypothyroid doesn't help with the vasomotor symptoms - we have a tendency to faulty thermoregulation & I've found night sweats to be hellish and so long-lasting they have wrecked sleep right from the start of peri.  Have to decide today whether to go back to Evorel Conti or restart Utrogestan tonight.  Leaning towards the Evorel, but won't go into reasons here as they are many.

I'm usually awake waiting for the dawn chorus to start and breathe a sigh of relief when it does, as this means the long hours spent tossing & turning trying to get back to sleep are coming to an end!  We have lovely birds visit the garden every day and watching their activities can be a lot of fun, though hubby is less amused with their fence painting efforts, which he thinks spoil the effects of his!

[Elizabethrose]

Hello Wrensong

Welcome to MM, lovely to have you here and so glad to read that the site has been so useful to you.

I'm so sorry you've had such a hard time, boy you've had to juggle so much.  I've no experience or knowledge of thyroid problems but as you seem to be aware, loads of history with managing migraine. Thank goodness they've calmed for you post-meno, at least that's one less thing to have to manage.

My mother suffered with the occasional migraine with aura through her life but they never appeared linked to her hormones. After she hit meno like you she had a year or two of silent migraine. She was a medic so knew what was happening but I think for many people they can be terribly frightening. Most people associate the aura as only being ocular disturbance, but it is frequently so much more and can manifest itself in very peculiar ways.

So little is still understood about migraine, there is still so much to discover. I pray that there will be significant advances in migraine study in time for my daughter to hit peri. Her hormone struggle is even greater than mine. I've taken part in a few studies over the years and it does now appear to be something that is beginning to be taken seriously.

As far as I am aware, it is common for migraineurs to have a mix of migraine with and without aura and that this can evolve with time. I have always struggled with headache, had them as a child but just managed them when necessary. I had my first visual aura in my 30s but my pure menstrual migraine kicked in hard at the very beginning of my peri, about 16 years ago. They were always a mix of common and classic migraine but I definitely found them much worse when accompanied by an aura, particularly the facial tingling/numbness, when that occurred I knew I was in trouble.

I have been repeatedly reassured that all would calm if I went into a natural menopause and that seems now to be happening. This is something that I celebrate every single day upon waking. Like you I also recently read something about classic migraine not necessarily being improved with meno, which rather put the fear of God into me. Trouble is Wrensong, the migraine mechanism is still not fully understood and beliefs are often misreported as facts.

The specialists I saw tried to treat my migs with HRT, specifically Oestrogel and Crinone. It was felt that I should not take anything orally and they felt that gel would be easier to manipulate. I can't answer your query re your HRT as I'm afraid I wasn't successful using it and it had to be stopped after a number of routes were tried.

I get the occasional palpitation, which I tend to ignore but have noticed over the past few months, a feeling of pressure in my chest when the adrenalin surge hits just before a flush. Again, I tend to ignore it and just use it as a warning signal for the imminent flush.

I'm sorry your sleep is so disturbed, this seems to be such a common problem but for you exacerbated by the thyroid. A double whammy!! I know it goes against popular belief but there has been an improvement in my flushes since using Vagifem, docs think it's because I'm so sensitive to hormone change. Either way I'm making the most of it. I‘m taking Vagifem every other night at the moment but every time I try to use fewer the flushes kick back in so I'm sticking with it.

I'm sorry I was unable to answer your questions but hopefully someone with a similar experience will pop in soon.

I wish you well Wrensong x

[babyjane]

Elizabethrose my flushes started to calm down when I started to use Vagifem too, unless they were naturally sorting themselves out anyway.  I will never know but one way or another they have never been as bad since I have used the VF    I also use one every other night.

[Elizabethrose]

Babyjane, that's really interesting. I was speaking with my GP about it who has a specialism in hormones/HRT/gynae and she is not at all surprised. As we all know, women all react in our own individual ways. As she said, I've never followed the guide books in my reactions so far, so they'd not be surprised by anything! Apparently I'm not a freak, I'm special she said!  Incidentally, even with a starting dose of one pump of Oestrogel, within hours I had the mother of all migraines and breasts that felt like they would explode. You can imagine what I was like by the time I got to 4 pumps.  x

[babyjane]

Elizabethrose I am also hypersensitive to medication.  My mind and body both take an age to adjust, starting on about a quarter of the minimum dose and increasing v-e-r-y s-l-o-w-l-y 

[Elizabethrose]

It doesn't make life easy does it babyjane? I'm super reactive to meds too though not always in a bad way. x

[Wrensong]

Hi Elizabeth Rose & thank you for the lovely long reply.  As a lurker before joining MM (unsure I had anything worthwhile to contribute), I'd read something of your story -  always with a mix of horror and admiration.  You've been through so much with the very frequent migraines, I really don't know how you've coped and remained so positive, but you are an inspiration.  Your knowledge of the condition far outweighs mine, so I've read your posts with interest.  I'm sure this will be a huge help and comfort to your daughter when she herself gets to meno.

I've always had aura with migraine, but the ocular variant that remains post-meno is far easier to live with than the classical.  I've recently read that ocular is a misnomer, but still think of them under this label as the Neuro who diagnosed mine referred to them as such.

Your peri has been so protracted, I do feel for you.  I thought at 7 1/2 years mine was bad enough!  The three years that I was then post-meno before starting HRT were somewhat easier, but I did just want to offer a little encouragement to you in as much as the classical migraine having seemingly stopped with my last period, I hoped the same might apply to other sufferers, assuming they were not lucky enough to be rid of them before this stage.

Like you, I was advised that transdermal HRT was the best option for migraineurs (as well as for reducing other risks), but having had incomplete resolution of symptoms with these & difficulty using the Utrogestan via the lower entrance, I felt a trial of oral Utro was worth the risk.  I've now finished the 3-day withdrawal period during which my GP warned to expect a migraine, but so far, so good!

The palpitations come in lengthy episodes of irregular (ectopic) beats, continually for a couple of hours, then resolve for a few hours before returning.  It can feel very unnerving at this frequency!  This went on for several years in peri & at that time initially freaked me out, coinciding with the worst of other meno symptoms.  Mostly these were worrying because with the thyroid issue it was impossible for anyone to be sure I wasn't being over-treated with thyroxine - palpitations, flushing & night sweats being common to both menopause & having too much thyroxine.

I can absolutely believe your flushing has improved on Vagifem (& the other ladies' reports of same) - this was one of the first things I noticed when I started it 6 months before full HRT & came to look forward to Vagifem night for that very reason.  I also think I remember you getting headaches as a consequence of Vagifem acclimatisation & ?being advised this was unlikely.  Again, the same happened to me, during the initial 2 week loading, when I would get a headache every afternoon, I assumed as the previous night's dose was wearing off.  I think the thyroid issue means those like Babyjane & myself perhaps have more difficulty adjusting to medications, in the same way that many ladies become more sensitive to meds during menopause.  It seems to me that with depletion of gynae hormones, we lose a very effective buffer against all manner of external challenges our bodies were able to manage apparently without noticing beforehand.

I hope your migraine continues to improve and that you will soon be completely free of it and able to enjoy many decades post menopause with the appreciation you already feel as this horrible affliction becomes a thing of the past.  Fingers & everything else crossed for you.

[Elizabethrose]

Thank you so much for your kind words Wrensong, that's very sweet of you but I think in that sort of situation we just have to find a way to get by. Human's are hugely resilient and I learnt many years ago that you can't fight migraine, you just have to close down.

Your palpitations sound horrific, oh my goodness mine are nothing like that. I just get a little pounding or a missed beat occasionally. How difficult for you trying to identify whether it's peri or thyroid. That cannot be easy and I would imagine it's quite scary too.

Your experience with Vagifem is very interesting as well, I have come across a few ladies now suggesting the same. My GP works alongside my specialist and I trust them implicitly. As far as people making negative remarks, I take it with a pinch of salt. I know my body, my specialists know my body and haha, they know I know my body!

Your comment about our hormones acting as a buffer against external challenges makes perfect sense. So many of us here have found allergies and sensitivities have been triggered by peri. It's just the gift that keeps on giving!

Thanks too for your reassurance that the migraines will ease further, it's very kind of you to want to pass on that info. Having a light at the end of the tunnel, in what sometimes feels like a hopeless situation, allows us to stay strong, be positive, to keep going.

You've very clearly spent a long time reading the forum, we're all glad you've decided to muck on in, your contribution will be a valuable one

Hopefully the HRT will supply some much needed relief to you. Fingers crossed that the suggested migs won't strike.

All good wishes to you. x

[Wrensong]

Hi Elizabeth Rose, thank you for the very kind words & good wishes.  Have a fab weekend.

[Cassie]

Hi yes the Utrogestan definitely makes me feel jittery and I also get the bumps and thumps (palpitations) more when using them, as for the insomnia....grrr...

[Wrensong]

Hi Elizabeth Rose, mulling over your last message after logging off, I realised I'd written something ambiguous in the penultimate message and wanted to clarify.  When I wrote " ?being advised this was unlikely" in relation to your reaction to Vagifem use, the question mark was meant to signify that I couldn't remember for sure.  I didn't mean to imply I thought this advice wasn't kindly meant & hope I haven't inadvertently given any offence.