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Bio-identical Hormones & Migraine

I am tired of women patients and medical colleagues claiming that bio-identical hormones are the kind that have to be made at a “compounding pharmacy” and claiming this type of hormone preparation is the best as it is “natural” and the dose can be tailored to just what a woman needs. Often saliva testing is recommended to check the hormone levels both before prescribing and then during therapy to monitor and then make adjustments to the dose.

I say “Give me a break”! Where is the proof that these products are better (or safer) than bio-identical products that are available by pharmaceutical companies? The term bio-identical has been misinterpreted and misused in recent years. Bio-identical simply refers to the fact that what is being taken is the same as what your own body produces. In the case of hormone therapy for women, we are often referring to estrogen and progesterone when we use the term bio-identical.

Estradiol is the most active and often considered the most important estrogen for women when looking at what our own ovaries produce. During times of estrogen lowering such as menses, post-partum, perimenopause, and menopause, the lower level of estradiol is the main trigger for hormonal migraines that often occur during these times. This level can be raised by giving an estradiol patch such as the Vivelle dot or Climara (name brand estradiol products). This treatment approach is often referred to as “add back estrogen” and is especially ideal when contraception Is not needed or not indicated but a hormonal approach still makes sense given the hormonal trigger for these migraines.

Estradiol comes in patches, gels, sprays and lotions; it can also be inserted as a pellet. These products are all bio-identical and DO NOT NEED TO BE COMPOUNDED OR MADE BY A COMPOUNDING PHARMACY. Since they are made by pharmaceutical companies, they are usually covered by insurance and readily available. As a physician, I know exactly what I am prescribing and can adjust the dose to meet a woman’s needs. There is a lot of flexibility in dosages and preparations. Occasionally, I may order an estradiol level to check a woman’s level if we are unsure whether to go up or down on the dose; however, I usually adjust the dose by how she is feeling and what is happening with her migraines. I order testing by blood and not saliva. I do not feel saliva is a valid measurement of hormone levels and is often hard to interpret. I know many may disagree but that is my opinion. I am also tired of women or compounding pharmacies ordering the saliva testing and then wanting my help in interpreting these results! If a woman or pharmacist orders saliva testing, then let them interpret and figure it out!

Progesterone, also produced by a woman’s own ovaries, is available in a bio-identical product called Prometrium (micronized natural progesterone). It is available as a 100 mg and 200 mg dose and is readily available in pharmacies and usually covered by insurance. I do not see a need for most women to have a compounded progesterone product made up for them. Occasionally, I have women who cannot tolerate Prometrium and we may use a compounded pharmacy to make up a progesterone cream. There are many progesterone creams available over the counter.

Do I ever prescribe a product like Triestrogen/Progesterone or Biestrogen/Progesterone for women in my practice with migraine and hormonal issues? Yes and in a few cases, these women truly feel this is the best way for them to take hormones. I am OK with this but feel it is important to offer these women pharmaceutical bio-identical products such as the Vivelle dot and Prometrium as alternatives to compounded hormones.

I am curious: how many of you feel compounded hormone preparations have worked better for you, including for your migraines, than bio-identical estradiol & progesterone pharmaceutical products like Vivelle dot and Prometrium?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • MissCottonHead
    8 months ago

    “I do not feel saliva is a valid measurement of hormone levels and is often hard to interpret. I know many may disagree but that is my opinion”
    Just because? I personally prefer to study research papers and receiving information from a knowledgable doctor instead of opinions.
    It is generally accepted by now that saliva levels offer a more realistic insight into bio-available levels of compounds than blood tests.

  • jewelbrite
    2 years ago

    I started taking compounded Bioidentical Progesterone. At first it got rid of my migraines and my mind was sharper. I was feeling very edgy and it would relax me. I started sleeping better. I felt amazing. But since the cream was old and expired, my dr. prescribed a new batch from a different compounding pharmacy.
    On the new Progesterone cream, I started to suffer from severe migraines shortly after I applied the cream. I tried reducing the amount but still got migraines. Then I started to suffer from bloating, weight gain, mood swings, irritability as well as the migraines. I was miserable. My mind no longer felt “sharp”; the brain fog returned. So I got off Progesterone completely.

  • genevieveblondin
    4 years ago

    Hi all!

    I was actually recommended this type of Bio Identical HRT today by a naturopathic physician I have started seeing in hopes to reduce my migraine frequency and intensity (and potentially largely reduce my medication intake to treat them!).

    I’m so grateful for this conversation as, I still have to decide whether or not I want to do this. It implies me having my IUD removed which, I’m not 100% comfortable with since my partner and I are not exactly ready to have kids yet.

    My question for you Dr. Hutchinson would be: what are these women patients and medical colleagues basing their claims on? I’m just trying to get both sides of the argument, which, I understand, might be biased here since you have clearly stated that you are against these claims. What is the difference with both and, what’s the debate about.

    Also welcome any feedback or comments!

  • Cclarke
    5 years ago

    I use a combination of retail and compounded. I typically use Prometrium. On occasion, I’ll have a client that for whatever reason will not respond to the Prometrium but will respond to a sublingual compounded Progesterone. I do compound Estradiol and usually am combining either DHEA and or Testosterone depending on lab values. I know there are women that feel the topicals work but in my opinion and experience, the sublingual route offers a better delivery system and treats symptoms much faster.

  • Lori
    6 years ago

    How do I find a doctor in my town of Tulsa that is well versed with hormonal migraines?

  • Nancy Harris Bonk moderator
    6 years ago

    Hi Lori,

    Your best bet is to find a board certified migraine specialist. In this article, there are a few different ways to find one from the Migraine Research Foundation, The National Headache Foundation and the American Headache Society;

    Good luck

  • Barbara Collins
    8 years ago

    Never tried bioidenticals but the theory of lower esterogen being the trigger for migraine is odd to me. When they try increase the dose of estrogen on me, I got severe migraine issues, the worst in years. So why is that?

  • Deborah Easterling
    8 years ago

    I’ve been taking estradiol and prometrium for years (early onset menopause). They work wonderfully and insurance pays for them.

  • Yolanda Hunter Young
    8 years ago

    Over the past 5 years I have done the saliva test and compounded progesterone 3 different times with no relief for my hormonal migraines. The saliva testing is very expensive. I have not tried Prometrium.

  • Patricia Bartoshevich
    8 years ago

    I experienced migraine headaches after surgical menopause. I tried the “bio-identical” hormones and I did find relief. I chose this method because I can get all three hormones combined into one jar (bi-est, progesterone, testosterone). I myself like the progesterone because it helps me sleep better at night and I have read that progesterone counters the negative effects of estrogen. What works for me might not work for another human being. I always try to remember that medicine is a science, but not an exact science.

  • Kelly Schuyler Kerhoulas
    8 years ago

    I am peri-menopausal and see a provider for bio-identical hormone replacement for migraines. She refuses to give me estrogen as she says that I’m in estrogen-overload r/t my labs, so I take prometrium, but this doesn’t help….what do you think?

  • Beth Harville
    6 years ago

    Same here, seeing a bio-indentical hormone specialist for loss of libido and recurring migraines. He has given me prometrium but instead of having headaches several times a months at different times of my cycle I now am having them daily. I think i need estrogen but he won’t give it to me.

  • Janene Zielinski
    8 years ago

    My migraine specialist put me on Angeliq for my early menopause symptoms and hormone triggered migraines. It’s been a couple years. I do get regular blood tests, but am worried about increased stroke and blood clots. Sometimes I wonder about the risks vs. the benefits?

  • Dr Hutchinson author
    8 years ago

    I looked at the wording in the package insert for Vivelle dot brand name and it described the patch as a “multipolymeric adhesive” and there was no mention of the the word Latex. From my experience, very few women have complained of skin sensitivity to the name brand Vivelle dot patches unlike the generic substitutions. The Gabapentin should be compatible with the other medications you are taking but check with your health care provider or pharmacist to be sure. The most common side-effect of Gabapentin is sedation.

  • WildZan
    9 years ago

    Thanks for the reply Dr Hutchinson. Just some clarifying questions if you don’t mind.

    The irritation to the vivelle dot was on a generic, and looked to be related to an emerging allergy to latex. Is the name brand latex free?

    I am currently taking the oral estrace once a day, so I will definately ask my doctor about increasing to twice a day.

    My doctor had actually enrolled in a Gabapentin study for hot flashes, but when I was diagnosed with uveitis I was disqualified from the study. I am still interested in trying it though, or maybe one of the others you mentioned. I am just not sure how they would mix with my other medications. In addition to the estradiol, I take meloxicam for the auto-immune inflamation and imipramine as a migraine prophylactic. Is there a concern with mixing those with any of the medications you mentioned above?

  • Dr Hutchinson author
    9 years ago

    Here are my comments after reading the 2 experiences that WildZan and Julie have reported: I don’t like Premarin which is made from “pregnant mares” as Wildzan is aware. Oral Estrace is estradiol and “bio-identical” but may be better dosed as twice a day as the once a day dosing may not give an even estrogen level over a 24 hour period; the uneven estrogen level could aggravate migraines. As for irritation from the Vivelle patch, I recommend always asking for name-brand. Getting a generic (often larger size) is often more irritating to the skin than the name brand. Even if mild irritation from a name-brand patch such as Vivelle occurs, then spraying with a steroid spray over the skin surface prior to applying the patch can cut down on skin irritation; for this, I often give my patients some samples of a nasal steroid spray such as Flonase or Nasacort. Alternatives to estrogen to help hot flashes and night sweats include Effexor, Prozac and the beta-blockers such as Inderal. The Clonidine patch and Gabapentin have also been found helpful in reducing hot flashes.

  • WildZan
    9 years ago

    I have heard about these bio-identical hormones made at a compounding pharmacy, and had thought about trying them. I am not a typical post-menopausal, because I had a surgical menopause at 35. For a while I was on the typical Premarin, but I got off of it as quickly as I could for two reasons: 1) I am a horse owner and lover, and have worked with too many rescue organizations that deal with discarded mares and foals from PMU farms. 2) My mother had just completed treatment for an estrogen-fed breast cancer and my doctor felt that having me on HRT for more than a few years could be risky.

    The only difficulties I really faced with not being on HRT was hot flashes. Really nasty, severe, miserable hot flashes. The kind that wake you up in the middle of the night dripping sweat, ruin make up in the blink of an eye, and can seriously dampen (literally!) your success at work because it is hard to have your presentation taken seriously when you have sweat rolling down your forehead. I have tried so many different things that people recommended, from black cohosh supplements to phyto-estrogen creams and nothing helped. Which is how I ended up thinking about trying the bio-identicals…

    I tried the Vivelle dot, which worked for about a month, but then I started breaking out from the patches. Currently I am taking Estrace, which does help, but doesn’t stop the flashes completely. I do NOT want to have to start taking Premarin again, what other options do I have?

  • Julie
    9 years ago

    This is a very interesting post to me, as I had saliva testing done by a friend who is a pharmacist whose family owns a compounding pharmacy and has built quite a business in my area specializing in bio-identical HRT. I have been following a treatment plan based on those results for about 6 months. Then just this week I had an appointment with an endocrinologist who felt very similar to you about compounding pharmacies/saliva testing/compounded bio-identical HRT treatments. I will have blood tests in his office next week, after not taking the compounded supplements for a week, so that the endocrinologist can check the accuracy of the saliva tests.

    In my case, I was having severe insomnia and disrupted sleep cycle issues along with chronic, debilitating migraines. Part of what was tested and found to be way out of balance with me were my cortisol levels that assist with regulating my internal clock. I do think that the “medications”–I never know what to call them–that I take from the compounding pharmacy have helped me sleep on a more normal schedule, and resting better has helped my migraines. I don’t wake up with as many migraines now. So–take that for what it’s worth. That’s not really dealing with the estrogen/progesterone question you are talking about. I haven’t been retested (by the pharmacy) so I don’t know if the treatments to bring my elevated estrogen levels down were effective and if that also caused decreased migraines, but I primarily attribute waking up with fewer migraines to sleeping so much better.

    I find it interesting you posted this this week when I had such an interesting conversation with my doctor about this subject. I will be watching to see if anyone else comes along to post their experiences.

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