WOMENS-HEALTH Messages for July, 2009: PERIMENOPAUSE: Estradiol patch + Prometrium for menstrually-related migraines in possibly perimenopausal woman

PERIMENOPAUSE: Estradiol patch + Prometrium for menstrually-related migraines in possibly perimenopausal woman

From: K (anonymous@obgyn.net)
Wed, 29 Jul 2009 16:35:37 -0500 (CDT)

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I am 43 years old, primipara at age 38, and have slightly irregular periods, occasional hot flashes that began after delivery, and menstrually-related migraines (since my 20s). My neurologist is willing for me to try monthly estrogen supplementation to prevent the migraines, beginning 2 days before my period and going 5-7 days into my cycle, using an 100 mcg bioidentical estradiol patch. However, because I am not actually menopausal, my primary care doctor wants to add progesterone or progestin. I want the progesterone to be bioidentical because of recent literature reporting different cardiac outcomes following treatment with synthetics (MPA and other progestins) versus progesterone.

We agreed on Prometrium tablets, but are uncertain how much and for how many days I should take them. We have seen different protocols in the literature (and most pertain to menopausal women, while I am premenopausal/ perimenopausal). I will be exposed to only 7-9 days of estradiol supplementation per month, while most postmenopausal women use the estradiol patch continuously. However, these women often use the 50 mcg patch instead of the 100 mcg, but trials show the 50 mcg dose does not help with the migraines, so I have to go with the higher-dose patch.

Since my goal is simply to avoid using unapposed estrogen (re: endometrial hyperplasia), I am unsure if my daily dosage of Prometrium should be 100 or 200 mgs. Also, whether I should I take the Prometrium the first 10 days of my cycle, first 12 days, or less than that. I am not trying to use this as a contraceptive, so I would like the progesterone dose to be as low as possible. If this helps with my hot flashes, it will be a bonus. I hope you can advise us.

--
K. Reed

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