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 acheieved.

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 menstration, 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 course for caring for women around the menopause. 

A126 Caring for women around the menopause: Online

This is a four-hour 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 provides a sound grounding in enabling healthcare providers to promote both a healthy menopause and to encourage positive health changes for the future. It is an ideal course for advanced nurse practitioners, practice nurses, first contact nurses, nurse practitioners and allied health professionals.

Participants can expect to gain knowledge and improve skills in the following:

• Appreciate the potential barriers and hurdles for women in accessing advice and support around the menopause.
• Be aware of the other treatment options available for women.
• Be aware of the red flags and when to refer women for more specialist care and treatment. 
• Be more confident in counselling women regarding treatment choices around the menopause.
• Greater awareness around the impact of the menopause on the health and wellbeing of women
• Increased knowledge of the signs and symptoms of the menopause
• Know where to signpost women to up to date information to aid their decision making.
• Understand the risks and benefits of Hormone Replacement Therapy (HRT)

The course runs from 10:00am- 2:00pm and all course material, evaluations and certificate of attendance included.