Menopause represents a pivotal phase in a woman’s life, typically occurring between the ages of 45 and 55, marked by the cessation of menstrual periods due to declining hormone levels, particularly estrogen and progesterone. For women with migraine, this transition can bring relief as estrogen fluctuations diminish, potentially reducing the frequency and intensity of migraine attacks linked to hormonal changes. However, about one-third of women may continue to experience migraines post-menopause. Hormone Replacement Therapy (HRT), commonly prescribed to alleviate menopausal symptoms, can impact migraine outcomes variably; while some may find relief, others might experience worsened symptoms, necessitating careful consideration and discussion with healthcare providers. Surgical menopause, such as through hysterectomy, shows mixed results in migraine management, underscoring the need for individualized approaches to optimize treatment during this phase of life.
What is menopause?
Menopause is the stage in a woman’s life when her menstrual periods cease due to declining levels of hormones like estrogen and progesterone. It typically occurs between the ages of 45-55, with an average age of 51.
You may experience the following symptoms before and during menopause:
- Periods occurring more or less frequently than usual
- Shorter periods of bleeding
- Skipping one or more periods
- Some symptoms of menopause include hot flashes, night sweats, sleep problems, vaginal dryness, depression, and cognitive issues
The surgical removal of your ovaries and/or uterus is called “surgical menopause” because it involves removing the organs responsible for estrogen production.
How does migraine change during menopause?
The years leading up to menopause can be difficult for women with migraine. Fluctuating estrogen levels during this transition can cause more migraine attacks, particularly for women whose migraine is linked to their menstrual cycle.
The symptoms of menopause (e.g., hot flashes and sleep problems) can also trigger migraine attacks. It can be challenging for both you and your doctor to identify patterns in your migraine as menstrual cycles become less predictable during menopause.
I’ve heard that migraine stops with menopause, but I am through menopause and I still have attacks?
It is estimated that two-thirds of women with migraine will see an improvement, even complete cessation, after natural menopause. For those whose migraine was related to their hormonal cycles, the change of improvement is higher. However, one-third of women may continue to experience migraine post-menopause.
Is it safe to take Hormone Replacement Therapy (HRT) for menopause if I have migraine?
HRT (estrogen replacement) is commonly prescribed to control menopausal symptoms. When it comes to its effect on migraine, there isn’t sufficient research to provide a definitive recommendation. Depending on the dosage and duration of the estrogen replacement, your migraine may improve or worsen.
In general, estrogen-based medications like HRT should be avoided by individuals with a history of migraine with aura and/or heart disease (e.g., heart attack or brain stroke). However, the estrogen dosage in HRT is very low. It’s crucial to discuss this topic with your physician.
If you’ve been prescribed HRT and your migraine has worsened, consult your doctor. They may be able to make recommendations to your HRT prescriber to address this issue or refer you to a headache specialist or gynecologist for further guidance.
I’m experiencing severe hot flashes and disrupted sleep, which seems to be making my migraine worse. What can I do?
Quality sleep is important for migraine management. Medication options are available to alleviate some of the symptoms of menopause. Discussing your options with your family doctor is advisable, as there are various factors to consider in finding the most suitable treatment.
I’ve heard that removing the uterus can improve migraine. Should I consider this option?
While surgical removal of the uterus, known as a hysterectomy, may be necessary for various medical reasons, it should never be done solely to prevent migraine. Currently, there isn’t enough evidence to recommend hysterectomy for migraine treatment. Studies have shown that natural menopause is associated with less frequent migraine compared to surgical menopause. Among women who underwent the surgery, two-thirds reported worsening of migraine, while one-third experienced improvement.
For more information, please see our post on hysterectomy and migraine.
References
- MacGregor EA. Migraine, menopause and hormone replacement therapy. Post reproductive health. 2018;24(1):11-8.
- Allais G, Chairle G, Bergandi F, Benedetto C. Migraine in perimenopausal women. Nuerol Sci. 2017; 36 (Suppl 1):S79-S83.
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