A Guide to Migraines and Menopause

8 Informational Steps for Relief

Does Menopause Impact Migraines?

Your guide to Migraines and menopause with 8 informational steps for relief, which will help you understand how migraines and menopause are closely linked. Perimenopausal migraines, where migraine symptoms worsen in the years leading up to the menopause, is often characterised by attacks which occur more often and sometimes also last longer.

In the first stages of menopause, when periods become erratic and more frequent, and so do migraine attacks. Towards the end of the menopause, as periods become less frequent, migraines will also lessen.

For women who have noticed a strong link between migraine and hormonal triggers, post-menopause can be a blessing as migraines are highly likely to improve. This may take two or three years after the last period, as it can take this long for the hormones to settle. Non-hormonal triggers can persist after menopause so if these are important causes for migraines, attacks will continue.

Migraine symptoms in menopause are otherwise like other stages of life and migraine treatment during the menopause will also generally follow the same basic guidelines. https://migrainetrust.org/news/migraine-and-perimenopause/

What Happens During Menopause That Causes Migraines to Worsen?

The primary reason for worsening migraines during menopause is the fluctuation of oestrogen levels. This is also responsible for first worsening of migraines at puberty, as it can take a few years for the hormones to reach the settled pattern of menstrual cycle. From late teens to mid 30’s, most women have a regular pattern of menstrual cycle. For some women, the drop in oestrogen that occurs naturally around menstruation, and which is artificially-induced during the pill-free week of oral contraception, can trigger attacks.

From around the early 40’s, the menstrual cycle can become more erratic, with much more variable fluctuation in oestrogen levels. Periods themselves can be more troublesome, with more pain and heavier bleeding. All these factors can make migraine more likely. As periods lesson, so do the hormonal trigger for migraine, which is why many women find migraines improves after menopause.

Migraine and HRT?

Hormone Replacement Therapy (HRT) should not be used as a treatment for migraines. However, many women notice that a migraine is more likely to occur when they have a bad hot flushes and night sweats. Since HRT is highly effective at controlling these menopause symptoms, it can help reduce the likelihood of a migraine.

Doctors are often asked what form of HRT is used for those that suffer with migraines. Some forms of HRT can create more hormone fluctuations, which can trigger a migraine. This is more likely to occur with HRT tablets and it is recommended that women with migraines who need HRT should use transdermal types, such as oestrogen patches, gels or sprays, as these support stable hormone levels with few fluctuations. Bear in mind that it can take three months before the full benefits are achieved. Some women do need higher doses, but this can usually be reduced once the symptoms settle.

Unless a women has had a hysterectomy, she will also need progestogens to protect the lining of the womb from thickening in response to oestrogen. If this goes unchecked, it can potentially lead to cancers many years later. Women with migraines best tolerate progestogens when combined with oestrogen patches, capsules or micronised progesterone or even the Mirena Intrauterine System.

Can You Use the Mirena Coil with HRT?

The Mirena Intrauterine System (the hormonal coil) can be used for contraception, to control heavy or painful periods, and to act as the progestogen part of HRT. One advantage is that it acts directly on the womb, with little hormone reaching the rest of the body. this means that side effects are usually very few. Another advantage is that if a women has a Mirena coil, it is easy to adjust the dose of oestrogen to suit her needs.

Also, many women find that their periods become noticeably lighter or stop completely while they are using a Mirena coil. So, if migraines were linked to troublesome periods, this can make migraines less likely to occur. https://www.nationalmigrainecentre.org.uk/understanding-migraine/factsheets-and-resources/migraine-menopause-and-hrt/

When Should I Stop Migraine Prevention Treatment Post-Menopause?

The usual recommendation is that the effective dose of medication used for migraine prevention should be continued for around 6 months. The dose should then be slowly reduced, which may be over two or three months. If migraines return after a drop in dose, then the dose should be increased again to effectively control attacks for a further few weeks before trying another dose drop again. This helps find the lowest effective dose to control migraines and enables you to find out how long you need to stay on treatment.

Why Do I Still Get Migraines After Menopause?

Even though your periods have stopped, it can take a few years for the hormone fluctuations to completely settle. This is usually just one or two years, although some women find that they still get hot flushes and migraines ten or more years after the menopause. More often, even when hormonal triggers have settled, non-hormonal ones persist and may even increase post menopause. Chronic medical conditions, while not directly triggering migraines, will make migraines more likely to occur as they lower the migraine threshold.

Maintaining good migraine habits, such as regular meals, regular exercise, a good nights sleep routine, balancing triggers and looking after your general health, are all as important after the menopause as before.

Why Does a Hysterectomy Often Worsen Migraines?

Research consistently shows that a hysterectomy can worsen migraines. This is because the brain controls the menstrual cycle, sending signals to the ovaries to produce oestrogen and progesterone. A hysterectomy disrupts this natural hormone cycle, causing the brain to react as if experiencing an early menopause. Migraine symptoms may worsen temporarily but generally improve within a couple of years. In cases where the ovaries are removed during a hysterectomy, oestrogen replacement therapy can help alleviate menopausal symptoms, including migraines. Even if the ovaries are left intact, hormone levels may still fluctuate, and oestrogen therapy may be beneficial.

Vaginal Oestrogen and Migraines

What to do if it Makes Migraines Worse?

Vaginal oestrogen is useful to help control symptoms of pain and dryness in women who have no problems with hot flushes or sweats, or who still get vaginal symptoms despite using HRT. Therefore, initially, there is a possibility that a rise in oestrogen levels within the blood stream can be measured. Higher levels persist for a couple of weeks and then drop back down. This rise and fall can be sufficient to trigger migraines in susceptible women.

With continued use of vaginal oestrogens, usually only necessary just once or twice a week, oestrogen levels settle and are less likely to trigger migraines. Do not put off trying vaginal oestrogens but do be prepared for an increase in migraines to start with. If migraines do not settle then an alternative treatment needs to be considered, which will depend on what the first symptoms were. If vaginal dryness was the main problem, then a lubricating gel is a non-hormonal alternative. Discover more about menopause and connect with your UK-based menopause coach at https://menopausestudio.co.uk.

For more information on how an online menopause coach can help you, visit https://menopausestudio.co.uk/free-resource-list/menopause-coach-benefits/