What's actually happening.
Oestrogen withdrawal is one of the strongest known triggers for migraine. Many women with menstrual migraine see their attacks worsen in perimenopause as cycles become more erratic. Others develop new-onset migraine in their 40s that they have never had before.
The relationship between HRT and migraine is not simple. The wrong type, route, or dose can make migraine worse. The right type can substantially improve it. The conversation needs to be longer than ten minutes.
Common signs
- · Migraine attacks worsening in perimenopause
- · New-onset migraine in your 40s
- · Headaches around the time of your period
- · Increased frequency or severity of episodes
- · Aura symptoms that are new
How I approach this.
I take a full migraine history including pattern, triggers, aura, current treatments, and your wider medical picture. Migraine with aura affects HRT options, particularly the route, and needs careful discussion.
For most women, transdermal HRT (patches, gels, sprays) is preferred because it produces stable oestrogen levels and bypasses first-pass liver metabolism. This is critical when migraine is part of the picture.
Where HRT is not enough or is not appropriate, we will discuss preventive medications, acute treatments, and lifestyle factors. Onward referral to a headache specialist is available when needed.
Ready for a longer conversation about this?
A 45-minute menopause consultation includes full assessment, a written plan, and an HRT prescription if appropriate.