What is menopause?
This is the time in a woman’s life where her periods stop as the levels of hormones including estrogen and progesterone goes down.
Menopause typically occurs between the age of 45-55. On average, the age of menopause is 51 years.
You may experience the following symptoms before and during menopause:
- Periods occur more often or less often than usual.
- Shorter periods of bleeding.
- Skipping 1 or more periods
- Some symptoms of menopause include: hot flashes, night sweats, sleep problems, vaginal dryness, depression, and trouble thinking.
If you have had your ovaries and/or uterus removed, this is called “Surgical Menopause” since your estrogen factory (i.e. the ovaries) were removed through surgery.
How can my migraines change during the time around menopause?
The years before menopause can be difficult for women with migraine [1]. During this transition, your estrogen levels go up and down in an unpredictable manner. In women who find that their migraines are connected to their periods, these unpredictable fluctuations in estrogen can cause more migraines.
The symptoms of menopause (ex: hot flashes, sleep problems) can also trigger migraines. It can be difficult for both you and your doctor to find a pattern to your migraines during menopause as your periods lose their predictability.
I heard that migraine stops with menopause, but I am through menopause and I still have them.
It is estimated that 2/3 women with migraine will see an improvement (even an almost complete stop) after non-surgical menopause. If migraine were clearly related to hormonal cycles, the chance of improvement is higher. But 1/3 will still have migraine.
Is it safe to take Hormone Replacement Therapy (HRT) for menopause if I have migraines?
HRT (estrogen replacement) is commonly prescribed to control menopausal symptoms. When it comes to its effect on migraine, there is not a lot of research for a definitive recommendation. Depending on the dose and duration of the estrogen replacement, your migraine may improve or get worse.
In general, estrogen-based medications (like HRT) should be avoided in people with a history of migraine with aura [2] and/or heart disease such as heart attack or brain stroke, but the dose of estrogen in HRT is very low. This is an important topic to discuss with your physician.
If you were prescribed HRT and your migraine has worsened, consult with your doctor. They may be able to make recommendations to your HRT prescriber to help with this. If needed, your doctor may refer you to a headache specialist or gynecologist for further advice.
I have terrible hot flashes and my sleep is disrupted. This seems to make my migraines worse. What can I do?
You are right: good quality sleep is important for migraine control. There are medication options to help with treating some of the symptoms of menopause, which you can discuss your family doctor. There are many factors to consider.
I heard that if the uterus is removed, migraines can get better. Should I consider this option?
Surgical removal of the uterus, also called hysterectomy, may be necessary for some women for several reasons. However, you should never have it done for the sole reason of preventing migraines. At this point, there is not enough evidence to make recommendations regarding surgical removal of the uterus for migraine treatment. Several studies showed that natural menopause is associated with less frequent migraine as compared with menopause due to surgical procedure. Among women who had surgery, 2/3 reported worsening of migraine and 1/3 improved.
REFERENCES
1. MacGregor EA. Migraine, menopause and hormone replacement therapy. Post reproductive health. 2018;24(1):11-8.
2. Allais G, Chairle G, Bergandi F, Benedetto C. Migraine in perimenopausal women. Nuerol Sci. 2017; 36 (Suppl 1):S79-S83.
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