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Menopause and migraines

What is a migraine?

A migraine is a headache that often, but not always causes a severe, often throbbing pain, usually on one side of the head, and that prevents you from doing your normal daily activities. It’s frequently accompanied by nausea or vomiting, as well as sensitivity to light, smell and sounds and can last from several hours to several days.

In some people, migraines may be accompanied by warning symptoms called aura. These may be visual, such as bright or dark spots that affect the field of vision, tingling on one side of the face, or difficulty speaking. Not everyone with migraines experiences aura.

Menopause and migraines

During the perimenopause and menopause, some women notice that their migraines get worse, and others develop them for the first time. These migraines are triggered by fluctuating estrogen levels as well as when levels fall just before a period. When headaches or migraines start for the first time in perimenopause and menopause, it may sometimes be necessary to do some investigations to make sure there’s no other cause.

Other migraines triggers include stress, anxiety, tiredness and lack of sleep all of which are common during the perimenopause and menopause. Sometimes missed meals, alcohol, dehydration and some foods may also trigger a migraine.

Can I have HRT if I have migraines?

Studies  show that people who have migraines, and in particular migraines with aura, may have a very small increased risk of having a stroke. The reason for this isn’t fully understood.

The estrogen in oral (tablet) HRT activates clotting factors in the liver as it’s being metabolised and this may very slightly increase the risk of a blood clot. So women who have migraine with aura are advised not to take oral HRT so as not to further increase the (small) risk of a stroke.

However, transdermal HRT given as a patch, gel or spray through the skin, doesn’t carry this increased risk as it doesn’t activate the clotting factors, so is fine for women with aura.

It’s important to remember, though, that the risk of a stroke from migraine with aura, or from oral HRT is extremely low, and HRT is safe for the majority of women.

And in fact, taking HRT can actually help with migraines during the menopause transition when estrogen levels fluctuate greatly, because it helps to smoothe out the fluctuations!

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You are not alone. As a local example, in Manchester over 46% of council employees are female and over 40 years old. In a CIPD survey (2019) over 30% of women said they were unable to work because of menopausal symptoms.

Only 25% said they could tell their manager the real reason for their absence. The Council account for nearly 7% of all employment in Manchester. They implemented a new Menopause policy in March 2022. CIPD survey | Manchester Council Menopause Policy | CIPD Manchester

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