Hysterectomy and Hormonal Migraine
Last updated: March 2023
Migraine can have a wide variety of triggers, from the environment to food to changes in the body. Some people notice that their migraines are triggered by their menstrual cycle, especially by changes in estrogen levels.1
What is the menstrual cycle?
The average menstrual cycle lasts about 28 days. But people can experience their cycle lasting anywhere from 23 to 34 days. The first day of bleeding marks the first day of the cycle. Throughout the 28 days, there are big swings in hormone levels, specifically estrogen and progesterone. Both hormones are made by the ovaries.1
For the first 5 days of your cycle, estrogen is low. It then rises until day 14, or halfway through your period. It then drops for a few days before rising again. For the last few days of your cycle, estrogen levels dramatically drop and stay low. This drop in estrogen triggers the next cycle to start. Some women experience migraine around this time.1
What are the different types of hysterectomies?
There are several types of hysterectomies:2,3
- Total hysterectomy – Removal of the uterus and cervix but not the ovaries. Total hysterectomy is the most common type of hysterectomy.
- Partial hysterectomy – Removal of the uterus but not the cervix. This is also called a supracervical hysterectomy.
- Total hysterectomy with bilateral salpingo-oophorectomy – Removal of the uterus, fallopian tubes (salpingectomy) and ovaries (oophorectomy).
- Radical hysterectomy with bilateral salpingo-oophorectomy – Removal of the uterus, cervix, fallopian tubes, ovaries, the upper part of the vagina, and some surrounding tissue and lymph nodes.
Why would someone have a hysterectomy?
There are many reasons why you may have a hysterectomy. This includes heavy bleeding, growths called fibroids, pelvic organ prolapse, or conditions like cancer. Your doctor will help you decide which type of hysterectomy is best for you according to your health needs.2
How do the ovaries play a role?
Only the ovaries create hormones and affect hormone level changes. The ovaries produce high levels of estrogen until menopause, usually between the ages of 45 and 55. But recent research has shown that the ovaries continue to make low levels of estrogen until 65. This estrogen is very important for bone and heart health.2
Are the ovaries commonly removed?
It is rare to have your ovaries removed before age 65 because estrogen production is so important. But if you are being treated for cancer your doctor may choose to remove your ovaries with your uterus. If this happens before you go into natural menopause, this is called surgical menopause. A total or partial hysterectomy will not affect estrogen levels since the ovaries are not removed during these procedures.2
How does hysterectomy affect migraine?
Since 1974, scientists have been studying the link between estrogen and migraines. Multiple studies have found that low estrogen levels are a significant migraine trigger for many people who have periods. But migraine is very complex and not caused by one thing. Some studies even showed that giving post-menopausal people estrogen increased their chance of migraine.4
Do symptoms improve after surgical menopause?
Many people with hormonal migraines find that they improve after natural menopause. Studies show that those who still experience migraines after natural menopause are not helped by supplemental estrogen. It is likely that estrogen is only one of their migraine triggers. But some people report worsening migraines after surgical menopause.5
Why does ovary removal effect migraine?
Overall, a hysterectomy alone should not affect migraine. But a hysterectomy that includes removal of the ovaries can have an effect on migraine if you have not entered menopause yet. Those people who have their ovaries removed after 65 are unlikely to experience any change in migraine.5
What can you do if you have menstrual migraine?
If you notice that your migraines are more frequent or more intense around certain times of your cycle, it is important to have a plan in place. A period tracking app may be a great place to start. These apps may help you:1
- Keep track of the length of your cycles
- Notify you when your next period will start
- Track other symptoms like migraine
Can hormone replacement therapy help?
Right now, there is not enough evidence to show that supplemental estrogen, known as hormone replacement therapy (HRT), can improve migraine. HRT is also known to have other risks like an increased risk of stroke or heart attack. Migraines are a direct contraindication for taking estrogen. This means your doctor may avoid certain birth control methods if you have migraine.5
There is some research to suggest that progesterone pills could treat migraines by stopping the menstrual cycle. This prevents the changes in hormone levels and is only effective for people who have not gone through menopause. Migraine and hormones are very complex. If you struggle with hormonal migraines, talk to your doctor about what options are best for you.5
Have others downplayed your migraine pain?