The Use of HRT for Menopausal Women Having Migraines

Menopause is a term used when a woman experiences her last natural period. However, women can experience their periods becoming irregular many years before menopause occurs. They can also suffer with other hormone-related issues during this time, including hot flushes, headaches and migraine. 

In fact, headaches can affect up to 90 per cent of women around this time and tend to get worse in the years leading up to the menopause. Headaches can occur more frequently and can increase in intensity and last for longer. Many women notice an increase in the frequency of headaches linked with their periods.

Along with periods becoming more frequent and erratic, women can experience more migraines. After menopause, migraines tend to become less of an issue, especially for those who notice a strong link between their migraines and hormonal triggers. However, it can take several years post-menopause for hormones to settle before the frequency and intensity of migraines improve. 

It is not unusual for non-hormonal triggers to persist post-menopause. If women are still prone to non-hormonal triggers, migraines attacks can still continue for many years.

How HRT can help reduce migraines

Many women have noticed migraines can be triggered by hot flushes and night sweats. Taking HRT is an effective way of controlling menopausal symptoms such as night sweats and hot flushes. This means that taking HRT can reduce the likelihood of migraines that are triggered by these symptoms.

There are different forms of HRT available and some types can cause hormonal fluctuations that lead to migraines being triggered.  Clinical trials have found this is more likely to occur when taking HRT tablets. For women prone to migraines in need or HRT, it is generally recommended for them to use use estrogen patches or gel instead. This enables women to maintain more stable hormone levels without sharp fluctuations that could trigger migraines.

The dose of estrogen given should be the lowest necessary to control hot flushes and night sweats and this can prove effective in reducing the chances of migraine. However, this isn't an instant remedy for reducing or eliminating migraines as it can take up to three months before the full benefit of HRT is achieved.

Adjusting the dose to find the ideal level also takes time. It is also advised that women use progestogens to protect the womb lining from thickening in response to increased estrogen levels. This doesn't apply to women that have had a hysterectomy.

Migraine aura concerns 

Menopausal women experiencing migraine aura can take HRT. The combined oral contraceptive pill is contraindicated for women with migraine aura. However, because HRT uses natural estrogen that delivers similar levels produced by the body during menstruation, it is far better tolerated by the body and doesn't normally trigger migraines. 

Should a migraine aura worsen or starts when a patient takes HRT for the first time, it can mean the dose is higher than the patient needs. The dose should be just enough to control menopausal symptoms, so will need careful monitoring and adjustment to find the ideal dose. 

PDUK provides professional training courses for healthcare providers and medical practitioners such as nurses, clinicians and allied healthcare workers. We highly recommend the following courses for caring for women around the menopause. 

A144 Menopause management: A guide for healthcare professionals

This is  one day fully interactive online course aimed at primary care nurses, ANPs and other health care practitioners working with women who are going through peri-menopause and approaching menopause. 

The course covers a range of topics including understanding menopause and its impact on women’s health, exploring various treatment options, and developing patient interaction skills. By the end of this course, participants will be confident in counselling women about treatment choices and providing ongoing management of menopause.

A143 Women's health awareness for primary care practitioners

This course is specifically designed for primary care nurses and allied health professionals. The course aims to provide an overview of key women’s health issues, with a focus on menopause, mental health, cardiovascular health, bone health, and cancer prevention.

Through a series of interactive sessions, attendees will gain a deeper understanding of these topics and learn practical strategies for managing and supporting women’s health in their practice. Our expert facilitator will guide participants through each topic, providing the latest research findings and clinical guidelines.

Both courses run from 10:00am- 4:30pm and all course material, evaluations and certificate of attendance are included.