MIGRAINES AND HEADACHES
Headaches and migraines are not unique to women in Surgical Menopause, but for those who are prone to or have a predisposition to them, navigating Hormone Replacement Therapy (HRT) can have a unique set of concerns.
Understanding Menstrual Migraines
To better understand some of the factors involved in hormone related headaches and migraines, we should first look at menstrual migraines in women who are not in Surgical Menopause.
Women who experience menstrual migraines have a oversensitivity in their brain’s pain around normal fluctuation in hormone levels, in particular the change of estrogen levels in the body. The role of progesterone in regards to menstrual migraines as of yet is unknown. In a person who has hormone related migraines, the worst headache of the month occurs around a woman’s cycle, when the levels of estrogen fluctuate the most.
When a woman undergoes an oophorectomy or a hysterectomy with BSO, the woman’s cycle abruptly ends and thus the changing levels of estrogen and progesterone cease to occur. In theory a woman’s hormonal migraines should improve once in Surgical Menopause, however the sudden dropping off of both estrogen and progesterone due to this surgery can actually lead to more trouble with migraines.
Studies have shown that women who gradually go through natural menopause, slowly decreasing hormones over time, fare far better in the hormonal migraine department than those women who are suddenly thrown into Surgical Menopause. Studies reveal that 2 out of every three woman in natural menopause experience improvement in their hormonal migraines, whereas only one out of every three women in Surgical Menopause experience improvement.
Therefore it is important to understand Surgical Menopause should never be used solely as a treatment for hormonal migraines, but if surgery becomes necessary for another reason such as cancer, large fibroids, or pervasive endometriosis, you should take the time to discuss with your doctor how you will manage your migraines following ovary removal.
Hormonal Migraines and Surgical Menopause
Hormonal migraines in surgical menopause can be related to a couple of things. First, as discussed above, the dramatic decline of hormones caused by ovary removal, and second, the fluctuations of hormones cause by unstable Hormone Replacement Therapy (HRT)
To address the first issue, doctors commonly prescribe HRT to women who suffer from hormonal migraines in an attempt to add back the estrogen and stabilize the dramatic hormonal decline they experience following surgery. Non-oral forms of HRT such as the patch, pellets, and hormonal rings are better options for women who suffer with hormonal migraines as they are thought to be steadier in their release of hormones if a woman is absorbing them correctly.
If a woman in Surgical Menopause has a history of hormonal migraines and is unable to take HRT due to cancer history or endometriosis, then it is recommended that they commence taking an oral migraine preventative prior to surgery. If the woman has already been taking an oral migraine preventative, it is a good idea that they speak with their doctor about upping their dose prior to surgery. A solid option for treatment may be an anti-epileptic, a beta-blocker or a SNRI (serotonin norepinephrine reuptake inhibitor). These medications have the added benefit of lowering vasomotor symptoms such as the dreaded hot flashes in addition to helping to prevent hormonal migraines.
To address the second issue, balance HRT takes time and patience and that can be even more challenging if you are experiencing migraines as the result of hormones not being properly balanced. Please see our section on Adjusting HRT for further information on troubleshooting balancing HRT.
Headaches Due to Low/High Estrogen Levels
Often women experience headaches in Surgical Menopause due to their estrogen levels being either too low or too high due to their Hormone Replacement Therapy (HRT). The question then becomes how you can diagnose if your headache is related to too much or too little estrogen. The first and simplest method is to determine and look out for any other symptoms that accompany being either too low or too high in estrogen. If you are still confused about whether you are too high or too low in estrogen and continue to experience regular headaches, the second line of defense is to have your hormone levels tested by your treating physician. Most frequently the treatment for headaches due to low/high estrogen levels is to increase and decrease your HRT respectively.
Headaches Brought On By Beginning To Take HRT
A slightly different scenario than the one mentioned above is when women experience headaches when they first begin taking HRT or when they experience headaches following taking a new dose of HRT.
In this situation the cause of the headache appears to be related to the surge of estrogen caused by taking a new dose of HRT. Frequently once the hormones have leveled out after a few hours or a few days following the new dose, the headaches will disappear. This is especially true of women who are fresh out of surgery and are adjusting to HRT for the first time, or, on the other hand, if a woman in Surgical Menopause is transitioning to a new medication and their body is still in its initial adjustment period. The key in both these cases is to first allow the body to adjust to the new HRT regiment fully which can take several weeks, and second, to find the most stable delivery form of HRT for your body thus preventing the fluctuations of hormone levels on the HRT.
Estradiol Sensitivity and Headaches
The most commonly prescribed HRT for women in Surgical Menopause is that of estradiol. Estradiol is the active form of estrogen and it is the most powerful of the three estrogens. Women who continue to experience headaches even after trying several forms of HRT containing estradiol may be missing the root cause to their discomfort, the estradiol itself.
Estradiol because it is both active and powerful dumps into the body much quicker and more intensely than the other forms of estrogen such as estrone or estriol. Some women cannot tolerate the strength of estradiol despite its benefits so they are much better served by trying the much gentler estrone or estriol based HRTs or even a synthetic blend of estrogens such as those found in Premarin.