Will a hysterectomy cure my Migraines?

Did you know there is a way to "try out" a complete hysterectomy (removal of ovaries and uterus) before committing permanently to this irreversible procedure?

Patients often assume that their menstrual Migraines will go away if they stop menstruating. Some doctors will even encourage their Migraineurs to try a hysterectomy. Patients have that belief reinforced when they become pregnant and their Migraines lessen or stop altogether. Many go on birth control pills and see a reduction in their Migraine attacks, and research tells us that women in menopause suffer less frequent Migraine attacks as well.

1 + 1 + 1 + 1 does not always equal 4 in this case.

A WEGO Health activist named Laura recently asked here if being "put into menopause" might help her. Since I do have some personal experience with this, I thought I'd address it in my blog.

Hysterectomies are irreversible. They are probably done more frequently than necessary. I'll leave that discussion for someone else to tackle, but my own experience was enlightening.

I tried out a hysterectomy before committing to it. Not exactly a test-drive, but as close as you can come to one without actually undergoing the procedure. The trial involves a class of drugs that temporarily shuts down your reproductive hormones.

I am blessed with a physician who is tops in his field and knew to offer me this option, as I felt rather attached to my reproductive system and was reluctant to allow someone to take it from me. In my medical conundrum of problems, I was also desperate for options.

The drug I tried is called Zoladex (Goserelin). It is routinely used for many things, including the treatment of cancers that are sensitive to sex hormones such as prostate and breast. It helps to thin the uterine lining in those with this precancerous condition as well. It is helpful for many who suffer endometriosis and fibroid tumors of the uterus. Goserelin is also used for chemical castration.

Zoladex is given as a small implant in the fat under the skin, usually in your abdomen. Short acting goserelin lasts about a month. Long acting goserelin lasts about 3 months. Therapy may be repeated as long as you and your doctor agree that the benefits outweigh potential risks. High or low metabolism may affect how your body uses the drug, and therefore how often it needs to be given. Insurance usually pays for goserelin treatment.

How is it given? Goserelin will be administered in your doctor's office. An ice pack is placed to numb the area below the belly button. Placement is alternated from right side to left each time the drug is given. A nurse uses a syringe and needle to properly place it. If the area is adequately numbed, the placement is not terribly uncomfortable, but not all doctors know to use this technique so you may have to ask for it. The needle is large enough to carry the drug which looks like a grain of rice. A band-aid is placed over the site, and your journey has begun. There may be some bruising, but not always.

The drug works on the pituitary gland in your brain that acts as a thermostat to your endocrine system. It is a synthetic form of a hormone that naturally occurs in your body called luteinizing-hormone releasing hormone (LHRH). The natural form is produced by the hypothalamus in the brain, telling the pituitary gland to secrete gonadotropins which in turn direct hormone and sperm or egg production by the ovaries and testes.

Goserelin works by binding to the receptors in the pituitary, which causes an initial flare of increased hormones. The response of the body to the flare is to shut down the hormones responsible for egg and sperm production. This process takes around 2-3 weeks.

For those sensitive to estrogen peaks, another drug can be given to counteract the effects of the initial flare, and should be considered.

Those whose Migraines are triggered by lowered levels of estrogen will usually have an initially good response - feeling better than usual - followed by Migraine attacks that can vary from mild and infrequent, to severe and chronic. Add-back therapy, in which a small amount of hormones are replaced via medicine, can help those in this category. Patches are often recommended because the consistent levels are easier to maintain.

Patients whose Migraines are triggered by fluctuations in sex hormones may have to take the drug for a longer period of time before seeing a positive response.

Those suffering central sensitization as a result of chronic pain, may need more time for those symptoms to slowly disappear.

You should talk to your doctor about potential side-effects and contraindications. Side effects vary, but male and female patients commonly suffer menopause symptoms which come on suddenly and very strongly. Lack of sex hormones has been implicated in other conditions such as heart disease. Add-back therapy may work to relieve many of these symptoms, but doctors often must be creative, treating individual side-effects separately. Add-back therapy has its own set of contraindications and side effects, including returned Migraine attacks. My suggestion: Spend several months before treatment getting your bones prepared. Watch your nutrition carefully. Supplement well with at least calcium, magnesium and vitamin D and get a baseline DEXA scan so you can monitor your bone status. If necessary, consider early treatment for bone density issues.

As to my own response, I initially felt much better, but a few days after the implant I walked into a room with a flickering fluorescent light that triggered back-to-back attacks for the next 9-10 months. Add-back therapy was helpful, but I had hoped Zoladex would allow me enough time for my reproductive condition to heal. My body wasn't metabolizing the medicine appropriately however, and the implants were wearing off too soon, causing fluctuations that triggered yet more attacks. I dried up everywhere, had severe bone pain and osteoporosis, and felt exhausted. I couldn't stick it out long enough. My last 3 month implant wore off in May/June. The repro condition quickly returned as I began cycling again. I consented to surgery in August, knowing that I had tried everything possible before giving in to a surgery I dreaded.

My experience with hysterectomy induced menopause has been very similar to Zoladex, but without the constant worry and watching of a pre-cancerous reproductive condition. It was the right decision for me, it just didn't help my particular Migraine situation.

There are other drugs that can be given to patients as a hysterectomy 'trial', but this type of drug has the cleanest record of side effects for most women, so far. That said, none of these drugs should be considered lightly. Have patience and research this treatment thoroughly. Talk with your doctor and your family candidly and over time about the pro's and con's of this kind of life-changing therapy. It will not only change your life for better or worse, but your family's as well. Choose wisely...

If you're interested in asking me more questions about my personal experience with the injections or surgery, feel free to write. Remember however, there is no cure for Migraine...