​Using Mira Hormone Tracking to Time Frovatriptan for Menstrual Migraine

Mira measures the following hormones -- only Mira Max (E3G + LH + PdG) wands measure all 3:
  • E3G (estrogen metabolite) – rises before ovulation.
  • LH (luteinizing hormone) – spikes just before ovulation.
  • PdG (pregnanediol-3-glucuronide) – rises after ovulation and falls 1–2 days before period.
    The PdG fall is signal that a migraine trigger window is beginning.

Regular Periods - PdG-Only

This protocol helps identify the drop in progesterone (measured as PdG, pregnanediol-3-glucuronide) that occurs 1–2 days before menstruation.

That drop signals the high-risk migraine window to time preventive medication such as frovatriptan more precisely.

💡 1. Which Mira Product to Use
  • Recommended: Mira Confirm Wands – measure PdG only.
  • Alternative: Mira Max Wands (E3G + LH + PdG) – slightly higher cost ($70–90 per 20 tests) but provide the same PdG readings if Confirm wands are unavailable.

🩸 2. When to Start and How to Test
  • Day 1 = the first day of menstrual bleeding. Use this as the reference point for counting cycle days.
  • Determine your usual cycle length.
    • 28-day cycle → begin PdG testing around Day 18.
    • 30-day cycle → start around Day 20.
    • If cycles vary, start testing 10–12 days before the earliest period you usually expect.
  • Use first-morning urine for the most consistent results.
  • Test every two days until your next period begins.
  • Typical use: about 10–12 tests per cycle.
    • Even with every-other-day testing, this number accounts for:
      • The 2-week luteal-phase window (≈ 6–7 tests).
      • A few extra tests if cycles run long or results need repeating.
      • Optional daily testing once PdG starts falling to confirm timing more precisely.
This schedule captures the key hormonal changes while keeping the routine practical.

📉 3. How to Interpret Results
  • PdG remains high and stable through most of the luteal phase.
  • When PdG drops ≥ 40–50 % from prior values (e.g., 15 µg/mL → 7 µg/mL) — or when the Mira app predicts “period tomorrow” — the hormone fall has begun.
  • This drop typically predicts menstruation within 24 hours.

💊 4. When to Start Frovatriptan (or Other Perimenstrual Prophylaxis)
  • On the day PdG drops or when Mira predicts period tomorrow, start frovatriptan 2.5 mg twice daily.
  • Continue twice daily for 5–6 days, through the first few days of bleeding.
  • Record headaches, PdG results, and side-effects in your diary or app.

Mira Max Protocol for Women with Irregular Cycles

Women with irregular or unpredictable periods can’t rely on calendar dates to find the premenstrual hormone drop.

This protocol uses Mira Max wands (which measure estrogen [E3G], luteinizing hormone [LH], and pregnanediol-3-glucuronide [PdG]) to:
  1. Identify ovulation (LH surge),
  2. Confirm luteal PdG rise, and
  3. Detect the PdG drop that occurs 1–2 days before menstruation — the key cue for timing preventive medication such as frovatriptan.

💡 1. Which Mira Product to Use
  • Required: Mira Max Wands (E3G + LH + PdG)
  • After 1–2 mapped cycles, some women with recognizable patterns can switch to Mira Confirm (PdG-only) for maintenance testing.

🩸 2. When to Start and How to Test
  • Day 1 = the first day of menstrual bleeding.
  • Because your cycles vary, you’ll track continuously from the early follicular phase onward.

Step-by-Step
  1. Begin daily testing on Day 8 of each cycle.
    • Early tests detect the E3G rise, which indicates your body is preparing to ovulate.
  2. Continue daily testing until you detect an LH surge (Mira shows a sharp LH peak).
    • Ovulation usually occurs 24–36 hours after that surge.
  3. After the LH surge, switch to every-other-day testing to follow PdG.
    • PdG should rise within 1–2 days and stay high through the luteal phase.
  4. Keep testing until PdG drops ≥ 40–50 % from its plateau value or Mira predicts “period tomorrow.”
    • That drop signals menstruation is imminent (usually within 24 hours).
Typical total: ~18–24 tests per cycle (daily early, then every 2 days).
Once your pattern is known, future cycles may need fewer.

💊 4. When to Start Frovatriptan (or Other Perimenstrual Prophylaxis)
  • On the day PdG drops or when Mira predicts period tomorrow, start frovatriptan 2.5 mg twice daily.
  • Continue twice daily for 5–6 days, through the first few days of bleeding.
  • Record headaches, PdG results, and side-effects in your diary or app.

✅ Summary

For irregular cycles, use Mira Max daily from Day 8 until the LH surge, then every 2 days to follow PdG.

​Start frovatriptan 2.5 mg BID when PdG falls sharply or Mira predicts “period tomorrow,” and continue for 5–6 days.
After 1–2 cycles, you may switch to PdG-only testing once your personal pattern is established.