Yes please! Have had hormonal migraines since age 16, in perimenopause now, still on ECC, headaches are getting more irregular, intense, & frequent. Any thoughts on additional therapies or management?
First of all, thank you so much for your work, knowledge and thoughtfulness in sharing. I'm so grateful to have found you. Perhaps you've shared this previously, so happy to be redirected if so - do you have recommendations about how to evaluate providers? I am not happy with my obgyn and need to start the process of finding a better fit. Thank you!
Thank you!!!!!! I reached out to my gynecologist last week with all the research I had done on MHT not being a contraindication to migraines with aura -- and she still refused. So I'm switching to a new one and hope I can show her this at my appointment in two days.
There are some reasons why we don't recommend MHT for safety reasons, as listed above. And these reasons can be additive. This means that if you have migraines with aura and multiple cardiac risk factors, that is a different discussion. But if there are no other health concerns, maybe take a copy of the Endocrine Society Guidelines to the appointment?
I would love to know more about hormone therapy and mood. I have been taking the pill for 30 years, and it makes me feel emotionally stable. When I have gone off it, my PMS is horrific. In your book you briefly mention that for some women the pill does have this mood effect. I wonder what I should be thinking about as I get closer to menopause. I am 50, with irregular periods, still on the pill. I tried a lower dosage pill byw and after 2 months my mood became very bad. Also when can I stop contraception?
Would love a post about how to talk to MDs that are resistant to treating perimenopause symptoms esp since I’ve been an RN for 25 years, had good resources, and follow you! Some still think period=normal and no period=menopause and there is nothing in between! I recently had a humiliating and demoralizing conversation. I can’t imagine what less knowledgeable or empowered women go through.
Hello from Canada! Love your advice and commentary and appreciate your content. I am 55 years old, hypothyroid but otherwise healthy, and started HRT recently. Within a few days of taking it, had a very strange experience as follows: took estrogen and then the progesterone dose a few hours apart. About 30 minutes later, had slurred slow speech (like I was really drunk) and blurred vision. It passed after about 20 minutes but scared the crap out of me. My gyno told me to stop the HRT immediately. I cannot find any information on this potential side effect, can you point me in any direction for more information?
What about weight gain with HRT? I’ve been on the patch and pill for about a month and a half and my weight has crept up by 4 pounds. I’m not beating myself up over it, because from what I read there might be a slight increase the first few months. Not sure on the logic behind this or if there is any so I would love to hear your thoughts on the matter. I do strength training and HIIT 5-6 days a week, and I feel good and strong in my body right now, but wondering if I need to tweak my programming and nutrition.
As of today the 25,50 and 37.5 patches Estradot as well as the Sandoz (generic) and Climera patches are not available at all here. 100 patches are which means cutting them in half as they are matrixed. Vagifem or premarin cream can be obtained by prescription.
When my reproductive endo started me out on HRT a few years ago - we tried the patch, then oral and now we've gone to injectable to get my estrogren levels to where he wants them. I have PCOS, so "normal" cycles were never a thing - I had really bad cramps from age 15 on (like in bed for 3 days bad); was on oral BCP from 17-40 before coming off after my marriage. A few years after my marriage, started having breakthrough bleeding - like high school all over again, my gyno (at the time) kept upping my progesterone (bio-identical cream that he compounded in house). I finally opted for an ablation - and the surgeon found a fibroid, so we cut that out, did the ablation and I have't bled a day since. Was diagnosed w PCOS and sub-clinical hypothyroidism (75 mg NDT for treatment) about 6 years ago, and have been on estradiol injections, 3mg every 5 days. You often talk about oral and patch options, how common is injectable estradiol for HRT used? Anything I should be extra aware of?
Estradiol injections are no longer recommended for menopause care, so I can't tell you any more about those. The recommendation for menopause is transdermal estradiol, and if, for some reason, that isn't tolerated or doesn't work, then the recommendation is oral therapy. The recommendation is to still use progesterone or progestin to protect the lining of the uterus from the effect of the estrogen.
Is there a study or something I can read explaining why its no longer recommended? I couldn't find anything in my google searching. We have me on progesterone (oral) paired w the injectable estradiol. Because of my PCOS (we assume) we could never get my levels to a level to stop menopause symptoms on oral estradiol (and patch didn't work either).
Many thanks for this article. Pls I thought of using this opportunity of asking this question here. Is there anyone here attending the AAGL (Gynaecology) virtual conference in November. I thought we could pair up cos it’s cheaper if we do. 👍
Estradot 50 is not available here nor in the UK or Australia. The 25 patch issue is now resolved. 100 patches are available here. I read that Bayer will be stopping the production of the estrogen only patch next year. In regards to thyroid requirements, I can not use any form of estrogen without a dose increase of levothyroxine, at least I have that figured out and have an idea what dose I will require. Women on a replacement like myself perhaps have more issues with medications. I also would like to ask (and certainly you do not have to answer) you are presently using estrogen are you intending to stop using it after 5-7 years knowing that any osteo issues, dryness etc will start once you stop?
I’m also curious about Dr. Gunter’s answer regarding stopping. I’m hopeful that in 5-7 years we could have more data, because that’s when I’ll have to make my decision as well.
From what I have read (scholastic journals) and asking other health professionals once estrogen is stopped then the issues of post menopause return never to resolve. Also menopause experts (all that I have encountered) say no interaction with thyroid patches or vaginal preparations) but the studies dating back to 2004 state, not significant, limited or not major changes in thyroid levels (t also depends on replacement of supplement and the person too). I am at 65 and have no problem starting it all over again as there are only two possible reasons for me thyroid too low or estrogen is. I have had a one on one conversation with the past president of the ATA as well he states that all forms of estrogen can impact thyroid levels even if a woman is not on levothyroxine. I have had mixed opinions as well one gyn stated patch one week then add in more, then another said 2-6 weeks yet another said one month or even three. No consistency whatsoever.
Thank you for the information on thyroid and use of MHT . There is a significant amount of conflicting information in recent journals/studies which makes all of it confusing. I am not trying to initiate transdermal estrogen in my 60's I am trying to restart it based on symptoms (hot flashes for sure which are not related to another illness, had every test known to man). I have read that a low dose (25mg) for 2-6 weeks then increase it up to only 50mg patch is advised is this correct? There is a world wide shortage of patches presently is the estrogen gel the best alternative? Thanks
We usually wait 6-8 weeks before increasing the dose. Your doctor will need to guide you on what is best for you. I am not aware of a world wide patch shortage. The only issue I've heard of in North America is a shortage of one name brand, Climara. But it may be regional.
Thanks for this info! On the migraine topic, when contraceptives are contraindicated... Is transdermal estrogen at all effective for helping control menstrual mayhem?
OK, so how worried should I be that I've been on norethindrone/ethinyl estradiol birth control for a couple of decades and I have migraines?? (which I definitely reported to my docs) Gah!
Thanks for this. Unfortunately, it doesn't make me feel too much better, as I have had a handful with aura. Not many, and not for a good 10+ years, but... Sigh.
I used to get the migraines as well when on the pill years ago. Only on it for maybe 7 years but ended up in an ER a couple of times. I never thought that the pill could have been the reason.
Definitely would love a post on migraines and menopause with therapies that can work.
Yes please! Have had hormonal migraines since age 16, in perimenopause now, still on ECC, headaches are getting more irregular, intense, & frequent. Any thoughts on additional therapies or management?
Thank you!
First of all, thank you so much for your work, knowledge and thoughtfulness in sharing. I'm so grateful to have found you. Perhaps you've shared this previously, so happy to be redirected if so - do you have recommendations about how to evaluate providers? I am not happy with my obgyn and need to start the process of finding a better fit. Thank you!
Thank you!!!!!! I reached out to my gynecologist last week with all the research I had done on MHT not being a contraindication to migraines with aura -- and she still refused. So I'm switching to a new one and hope I can show her this at my appointment in two days.
There are some reasons why we don't recommend MHT for safety reasons, as listed above. And these reasons can be additive. This means that if you have migraines with aura and multiple cardiac risk factors, that is a different discussion. But if there are no other health concerns, maybe take a copy of the Endocrine Society Guidelines to the appointment?
I would love to know more about hormone therapy and mood. I have been taking the pill for 30 years, and it makes me feel emotionally stable. When I have gone off it, my PMS is horrific. In your book you briefly mention that for some women the pill does have this mood effect. I wonder what I should be thinking about as I get closer to menopause. I am 50, with irregular periods, still on the pill. I tried a lower dosage pill byw and after 2 months my mood became very bad. Also when can I stop contraception?
Would love a post about how to talk to MDs that are resistant to treating perimenopause symptoms esp since I’ve been an RN for 25 years, had good resources, and follow you! Some still think period=normal and no period=menopause and there is nothing in between! I recently had a humiliating and demoralizing conversation. I can’t imagine what less knowledgeable or empowered women go through.
Hello from Canada! Love your advice and commentary and appreciate your content. I am 55 years old, hypothyroid but otherwise healthy, and started HRT recently. Within a few days of taking it, had a very strange experience as follows: took estrogen and then the progesterone dose a few hours apart. About 30 minutes later, had slurred slow speech (like I was really drunk) and blurred vision. It passed after about 20 minutes but scared the crap out of me. My gyno told me to stop the HRT immediately. I cannot find any information on this potential side effect, can you point me in any direction for more information?
thanks in advance.
What about weight gain with HRT? I’ve been on the patch and pill for about a month and a half and my weight has crept up by 4 pounds. I’m not beating myself up over it, because from what I read there might be a slight increase the first few months. Not sure on the logic behind this or if there is any so I would love to hear your thoughts on the matter. I do strength training and HIIT 5-6 days a week, and I feel good and strong in my body right now, but wondering if I need to tweak my programming and nutrition.
As of today the 25,50 and 37.5 patches Estradot as well as the Sandoz (generic) and Climera patches are not available at all here. 100 patches are which means cutting them in half as they are matrixed. Vagifem or premarin cream can be obtained by prescription.
When my reproductive endo started me out on HRT a few years ago - we tried the patch, then oral and now we've gone to injectable to get my estrogren levels to where he wants them. I have PCOS, so "normal" cycles were never a thing - I had really bad cramps from age 15 on (like in bed for 3 days bad); was on oral BCP from 17-40 before coming off after my marriage. A few years after my marriage, started having breakthrough bleeding - like high school all over again, my gyno (at the time) kept upping my progesterone (bio-identical cream that he compounded in house). I finally opted for an ablation - and the surgeon found a fibroid, so we cut that out, did the ablation and I have't bled a day since. Was diagnosed w PCOS and sub-clinical hypothyroidism (75 mg NDT for treatment) about 6 years ago, and have been on estradiol injections, 3mg every 5 days. You often talk about oral and patch options, how common is injectable estradiol for HRT used? Anything I should be extra aware of?
Estradiol injections are no longer recommended for menopause care, so I can't tell you any more about those. The recommendation for menopause is transdermal estradiol, and if, for some reason, that isn't tolerated or doesn't work, then the recommendation is oral therapy. The recommendation is to still use progesterone or progestin to protect the lining of the uterus from the effect of the estrogen.
Is there a study or something I can read explaining why its no longer recommended? I couldn't find anything in my google searching. We have me on progesterone (oral) paired w the injectable estradiol. Because of my PCOS (we assume) we could never get my levels to a level to stop menopause symptoms on oral estradiol (and patch didn't work either).
We don't manage menopause symptoms based on estrogen levels. Injection therapy hasn't been the standard of care since probably the 1960s.
Many thanks for this article. Pls I thought of using this opportunity of asking this question here. Is there anyone here attending the AAGL (Gynaecology) virtual conference in November. I thought we could pair up cos it’s cheaper if we do. 👍
Estradot 50 is not available here nor in the UK or Australia. The 25 patch issue is now resolved. 100 patches are available here. I read that Bayer will be stopping the production of the estrogen only patch next year. In regards to thyroid requirements, I can not use any form of estrogen without a dose increase of levothyroxine, at least I have that figured out and have an idea what dose I will require. Women on a replacement like myself perhaps have more issues with medications. I also would like to ask (and certainly you do not have to answer) you are presently using estrogen are you intending to stop using it after 5-7 years knowing that any osteo issues, dryness etc will start once you stop?
I’m also curious about Dr. Gunter’s answer regarding stopping. I’m hopeful that in 5-7 years we could have more data, because that’s when I’ll have to make my decision as well.
From what I have read (scholastic journals) and asking other health professionals once estrogen is stopped then the issues of post menopause return never to resolve. Also menopause experts (all that I have encountered) say no interaction with thyroid patches or vaginal preparations) but the studies dating back to 2004 state, not significant, limited or not major changes in thyroid levels (t also depends on replacement of supplement and the person too). I am at 65 and have no problem starting it all over again as there are only two possible reasons for me thyroid too low or estrogen is. I have had a one on one conversation with the past president of the ATA as well he states that all forms of estrogen can impact thyroid levels even if a woman is not on levothyroxine. I have had mixed opinions as well one gyn stated patch one week then add in more, then another said 2-6 weeks yet another said one month or even three. No consistency whatsoever.
Would love a post on what “liver disease” as a contraindication means. Any liver issue at all? Fatty liver? Mildly elevated AST/ALT <100’s? Thanks!!
Thank you for the information on thyroid and use of MHT . There is a significant amount of conflicting information in recent journals/studies which makes all of it confusing. I am not trying to initiate transdermal estrogen in my 60's I am trying to restart it based on symptoms (hot flashes for sure which are not related to another illness, had every test known to man). I have read that a low dose (25mg) for 2-6 weeks then increase it up to only 50mg patch is advised is this correct? There is a world wide shortage of patches presently is the estrogen gel the best alternative? Thanks
We usually wait 6-8 weeks before increasing the dose. Your doctor will need to guide you on what is best for you. I am not aware of a world wide patch shortage. The only issue I've heard of in North America is a shortage of one name brand, Climara. But it may be regional.
Thanks for this info! On the migraine topic, when contraceptives are contraindicated... Is transdermal estrogen at all effective for helping control menstrual mayhem?
OK, so how worried should I be that I've been on norethindrone/ethinyl estradiol birth control for a couple of decades and I have migraines?? (which I definitely reported to my docs) Gah!
It's migraines with aura that estrogen-containing contraception is contraindicated. This link has the information. https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/appendixD.html#mec_neurologic
Thanks for this. Unfortunately, it doesn't make me feel too much better, as I have had a handful with aura. Not many, and not for a good 10+ years, but... Sigh.
I used to get the migraines as well when on the pill years ago. Only on it for maybe 7 years but ended up in an ER a couple of times. I never thought that the pill could have been the reason.
Thank you!