HRT... Let's start with a disclaimer, shall we? I am not a doctor (but I do like wearing a white coat and a stethoscope and wandering through hospitals - what? it’s fun!) and I haven’t done a lot of general research about this, so what you are about to read is written very much from a partial perspective - mine. And since we are all different, I suggest you gain your own partial perspective on this stuff, which can be *yours* since this is very much not a ‘one size fits all’ situation. Not in the least.
First of all, for me, the last thing a migraineur needs is dosing with oestrogen - just NO. By the time you reach a certain age (whatever that age is, since it does vary, as does the onset of perimenopause) not only will you have plenty in your own life to juggle in general, but you might, like me, already be on medications for this or that. The this or that that I medicate includes chronic migraine and fibromyalgia, and I take several medications daily and really don’t want to take any more.. Did you know that a medication does not have to be ‘about’ hormones or be openly hormonal to be oestrogenic? Neither did I. This last year I have been taking the mood elevator Venlafaxine, and since it appeared to help with the migraines I was advised to ramp it up - only to discover that every time I did that I got a ‘period’ with attendant migraines, and with no added positive effect... aaaand so then I spent the next few months cutting the dose back down again, with even more ‘periods’ and migraines. Such fun.
So lets just say - do your own research and make your own mind up based on whatever baseline horrors you already have in your own life.
Lets get on.
I first wrote about my own experience of menopause and my own strategies for coping in response to a friend posting on facebook about her encroaching insomnia. There is plenty of information available about how to deal with insomnia and I suggest you familiarise yourself with it and make appropriate adjustments if this is a problem for you before you go stark raving mad as a result. What I don’t recommend is listening to Radio 4 on your radio at night. R4 turns into the World Service overnight and is full of heinous doccos about genital mutilation and really horrible ‘Top of the Pops’ type programming. To add insult to injury, once you have stopped floating in and out of consciousness to be met with whatever fresh hell the World Service is serving up and you finally get to sleep, you are woken by the R4 theme tune which is the most unpleasant medley of sea shanties and other horrible jolly tunes from around Britain that you might ever NOT want to hear while you are getting your long awaited short sleep.
One thing which you might like to know, however, is that the 8 hour holy grail is a trumped up concept based entirely around industrialized work schedules. [ https://en.wikipedia.org/wiki/Segmented_sleep ] A sleep habit involving what we might call a ‘disco nap’ would be broken at night for sex, prayers, or even visiting neighbours. Later on another short spell of sleep would be had before rising in the morning. If you actually don’t need 8 hours, don’t take them, and if you are suffering from short night sleeps invest in a regular power nap at your convenience.
The NHS page on menopause doesn’t mention insomnia, but these are the symptoms which they expect HRT to address.
- night sweats
- hot flushes
- vaginal dryness
- loss of sex drive (libido)
- stress incontinence: leaking urine when you cough or sneeze
- thinning of the bones: this can lead to brittle bones (osteoporosis)
(from the NHS page on HRT)
I started getting night sweats a couple of years ago (I am 50 as we speak). What with my already multifarious symptoms I kind of put it down to more fibro crap. I’d wake up with wet hair and a soggy duvet. It’s worth sleeping alone if this is going to be exacerbated by a partner, or if they are in any way irritated with you – their irritation is something you can probably live without. It did pass, though, for me, although I still prefer to sleep alone because of my erratic sleeping habits. I have a bath in the morning anyway, and really, that seems to me to be good enough. That is to say – not worth taking a drug for.
Hot flushes. Hard to say when this started since it overlapped with getting too hot taking the dog out, ending up sweating and then having cold sweat next to my body. By the time I had problem solved the dog walks the spontaneous hot sweats were only an addendum to my problem solving prowess. This is what I did – I bought merino wool thermal vests. These can be worn as a thermal underwear layer or on their own in the summer, since they don’t look particularly like underwear. Obviously they can be worn for exercise as well, and acquired from outlets selling sportswear. Sporty people call underwear the ‘base layer’ so that’s what you’re looking for. Like cashmere, merino wool is excellent at dealing with sweat AND it’s smell. Cotton tops just get wet and stay wet and are horrible. They also have to be washed after one wear. Not the merino or cashmere garment. The fibers wick away the wetness so you stay comfortable, and don’t stink up, so you can wear them for several days. They wear well, too. I bought my black long sleeve ones a few years ago now, and they are still going strong, and I have just bought a cami vest to try out, and if it is good I’ll be getting another couple. Because you don’t need to change them often you don’t need to buy many. Probably literally two would do.
My other thing is that rather than have my hair short I just always have a hair grabby thing handy. If I am hot I put my hair up, if not I let it down. I wash it most days. Evidently ‘late’ middle aged women seem to have taken to having short hair in droves in previous generations. I don’t know why - maybe there’s hair thinning to consider, but It’s up to you, it’s not the LAW.
Be careful if you get vaginal dryness. I haven’t had a problem with this so far, but having worked at Sh! I happen to know that lubricants have different properties so it’s worth getting a bit of advice on which brand to go for. Some people’s bodies are a bit trigger happy with thrush, and I know that some lubricants are more advisable than others for this. You can get a basic one on prescription, but it’s not a medication as such, so has no systemic effect. Also, again be wary of cotton, or even worse, man made fibres. Silk knickers are the most breatheable apparently. Also worth wearing stockings rather than tights if you are a skirt wearer.
Sex drive? Meh – it’s not brilliant, but I’m alright once I get going. Not being very sexually driven is a bit of a relief actually. I wouldn’t medicate for it - as things are right now I like it once I have grumpily acquiesced - and that’s good enough for me and my partner. In any case the female version of Viagra is a massive dose of hormones – which for the migraineur, again a no no. If not feeling terribly proactive about sex is a problem for you then just talk about it with your partner and problem solve it. You don’t have to have the same kind of sex drive or the same kind of sex all your life.
Stress incontinence is not something I have a problem with, but then I’ve never given birth. Kegels (pelvic floor exercises) I guess? And those disposable gussets? Develop a no sense of humour rule? And no sneezing. Definitely no sneezing. If you know you are prone to this why not carry a spare pair of knickers with you to change into? Nobody wants to be stuck with peed on pants but a clean pair doesn’t take up much room, they can even fit in a pocket. Also, this might sound crazy, but make sure you go to the loo properly. Thrush may not have been the bane of my life, but cystitis has been, and it’s remarkable how it can be possible to think you have had a pee, then realize you didn’t do all of it. Might save your bacon for that unexpected moment of hilarity or sneezing!
Brittle bones. This is something women can be prone to. The answer, inasmuch as there is one, is weight bearing exercise. If you want to, or you are too posh to do your own housework then go to the gym. Personally, I’m doing what I can within the limitations of my health conditions. You know what’s weight bearing? Yoga. You don’t need to do the duration of a class every day, but a little down faced dog and some cows and cats and the like keeps a girl limber, and could help with bone density. Because bones don’t have an automatic delivery system in the way of a constant blood supply the only way to top them up is to ‘push’ them. Exercise kills more than one bird per stone, so just work out what it is you LIKE doing and do that. It’ll help with your sleep, too.
That same NHS page also outlines some common side effects of HRT
- fluid retention
- breast tenderness or swelling
depression..so bear that little lot in mind, too, before you bite the magic bullet.***A Word to the WiseI do use one hormone. And it’s a good one. Because of the migraines, and the really AWFULNESS of hormonal ones I have used progesterone based contraception for many years. I have had injections and pills over the years, but eventually I started getting some side effects so I was offered the Mirena coil. I’d never fancied coils much, since I always imagined they would stab you to death from the inside. This despite there NEVER being any headlines about women being stabbed to death by their coils. Regular coils are, again, a no no for the migraineur, since they actually make periods heavier (and with endometriosis in my picture, too, any blood is too much blood, so too much blood is WAY too much blood). The Mirena coil, however, has a tiny release of progesterone which near enough stops periods entirely. This genius piece of engineering is staying in until it is ALL OVER. It’s quite new, and maybe it’s a bit expensive, because it was slightly tricky to get, but you know, they actually use it instead of hysterectomy, so efficacious is it.. And this, bubs, can also be good for seeing off any cheeky little womb cancers that think they might like living in your pouch. If you have endometriosis WHETHER YOU ARE GAY OR STRAIGHT I’d say get one of these bad boys inserted at your earliest convenience. I don’t want to be a scaremonger, but I went to two funerals this year - both lesbians with cancer, and, despite not being a doctor, I suspect at least one of them might have been preventable if the woman in question had considered a coil.So there you have it. Take hormones if you want to, but beware of overdoing the oestrogen. If you are in any doubt about the ramifications of oestrogen on our systems then take a look at the movie Pink Ribbons, Inc.View trailer Here!!!************************************************************