Why Women Get More Migraines Than Men (Episode 456)

Full Transcript: Episode 456

Lisa Hendrickson-Jack: This is the Fertility Friday Podcast, episode number 456.

Welcome to the Fertility Friday Podcast, your source for information about the fertility awareness method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Workbook. I’m a certified fertility awareness educator and holistic reproductive health practitioner with over 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormone health, and optimizing the menstrual cycle without hormones. I have been consistently outspoken about hormonal birth control over the past two decades and its impact on fertility and overall health, because you have the right to know how your body works and how artificial hormones disrupt that natural process. I teach women’s health professionals how to utilize the menstrual cycle as a vital sign in their practices, and I host live coaching programs to help you achieve optimal fertility and health, because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys and a brand new baby girl. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health, and I’m so excited that you’re here with me today.

Today I’m sharing a brand new episode in my FAMM Research Series. As a follow-up to last week’s episode about migraines, today I am going through a review study that addresses migraines in women specifically.

Right off the bat, it’s helpful to know that migraines affect women more than men. So women are disproportionately affected by migraines. Comparatively, women experience migraines at a rate of at least three times as much as men do. So 18 percent of women struggle with migraines compared to only 6 percent of men.

Another interesting thing about migraines is that the onset of migraines in women tends to coincide with menarche. Not necessarily right away, so it’s not to say you have your first period, you have your first migraine that month. But migraines in women tend to start within a year or two of a woman’s first period. And it’s often a lifelong problem, as many of you know who are listening, if you experience migraines yourself. And often the symptoms may worsen for a period of time during the 10 years before menopause. And often, for many women, once they actually hit menopause — so menarche is the word for your first period and menopause is the word for your last period — so when women stop cycling, often many women experience a reduction or cessation of those migraines. And so that gives us a really important piece of information: that migraines are related to our hormones.

And the fact that, as women, we’re more likely to experience migraines compared to men, and that those migraines that we experience tend to be throughout our reproductive years predominantly. To add additional information, up to 43 percent of women will experience at least one migraine in their lifetime. And migraines coincide with menstruation up to 60 percent of the time. So all migraines certainly are not related to your period in the sense that every single migraine you get is not going to be around your period. But to think that up to 60 percent of the time they are related to menstruation, it does give us a pretty significant window into just the basic information that it is related to hormones a lot of the time. So obviously not all of the time, but a lot of the time. And menstrual migraines in particular are most likely to happen during the two days leading up to your period or the first three days of your period. And again, those types of headaches start around when you’re starting to menstruate. So yeah, so right off the bat we know that there is something in particular related to hormones that triggers migraines in women.

So in terms of the hormonal contribution, estrogen fluctuations are often linked to what is happening in women and why they’re experiencing these migraines. When you understand the cycle and what’s happening in the cycle from that basic standpoint of charting, towards the beginning of the cycle, once you are wrapping up your period, that is a time when your estrogen levels start to rise as your follicles are developing in preparation for ovulation. And once you reach ovulation, or just shortly before ovulation, that is when estrogen tends to be highest in the cycle.

And once you ovulate, estrogen levels drop a bit, but they still maintain pretty significant levels throughout the luteal phase. The big difference between the pre-ovulatory period or the pre-ovulatory phase and the post-ovulatory phase or luteal phase is that in the luteal phase we produce significant amounts of progesterone.

So if you think about the timing then of a lot of these migraines happening either before the period or during the first days of the period, that is a time when progesterone is dropping. In a healthy cycle, progesterone would drop fairly gradually. It wouldn’t just drop off a cliff. But for many women, especially women who experience PMS symptoms and women who are experiencing menstrual migraines, they may be — instead of having a gradual drop in progesterone — having a sharp and significant just drop off, like I said, falling off the cliff. And because estrogen levels tend to still be pretty decent during the luteal phase, that sharp drop in progesterone can really exacerbate estrogen-related symptoms. And again, this is something that’s quite consistent that we see in women with PMS. If we look at research on women who are experiencing PMS, they are much more likely to have sharp drops in their progesterone, lower progesterone, or just generally speaking problematic progesterone in the luteal phase. So they’re not seeing typical patterns. They’re seeing atypical or problematic patterns, particularly resulting in like that sharp drop of progesterone. And if you think about this in terms of the cycle, all of this is coinciding with that last week before your period starts or shortly before, a few days before the period is set to start.

The review notes a distinction between premenstrual headaches and menstrual migraines. So premenstrual headaches are happening as you are approaching your period and then tend to actually subside and get better once your period starts, whereas a true menstrual migraine is likely happening during your period while you’re still bleeding. So that’s an interesting distinction. And women who experience severe migraines are likely to have higher peak estrogen levels. So that’s something interesting.

So, you know, what do we do, right? So when I’m taking a look at this review, they’re talking about the conventional ways that migraines are addressed. And it should come as no surprise, especially given the cyclical nature for many women of these migraines — given that it’s happening alongside the cycle and that can be identified — conventional recommendations, so from your medical doctor, from your healthcare professional, are often painkillers and/or hormonal contraceptives. And it’s ironic because when I’m reading the review, they’re saying that the migraines are related to estrogen. They’re saying that women who experience the most severe migraines have higher estrogen levels. And the solution somehow is to give her more estrogen. In the form — and it’s not estrogen, it’s a synthetic estrogen that is not the same as the estrogens that we produce in our body. But it’s really interesting to think that, okay, well, the solution to this problem of estrogen is to give women more estrogen, right?

With that said, I’m sure that some women do find relief, because one of the things — if you’re put on a hormonal contraceptive formulation — then your natural estrogens are suppressed and you’re getting more of a steady dose of the synthetic hormones. So you then get rid of the fluctuations, the cyclical fluctuations. And so many women may find relief because they’re no longer having their natural fluctuations of having the estrogen rise and fall during the cycle. Instead their own natural estrogens are just at this low level, and then they’re getting the synthetic estrogens at a steady dose. But if you think about what that means, it’s just an interesting solution, right? Instead of trying to figure out what’s happening with the woman’s cycle and her hormones and try to identify if there’s a problem — because if you shouldn’t be having these types of symptoms, they are often coinciding with other kind of premenstrual type symptoms, and those premenstrual type symptoms are a sign in many women of a hormonal imbalance. And of course our medical system is not designed to be looking at root cause medicine. Often we’re looking at suppressing symptoms with drugs. And obviously, in the case of menstrual related complaints, the birth control pill and painkillers are pretty much what we’re looking at here. And so, but very interesting that the problem of these estrogen — too much estrogen or estrogen imbalances — is to get more estrogen.

With that said, I think for many of you who’ve been listening to the podcast for a while, or if you’ve read my book The Fifth Vital Sign, it will come as no surprise actually that women who experience severe migraines — and so in particular migraines with aura — the, if any of you have ever experienced a migraine — ironically, the only time I’ve ever experienced a migraine was when I was on hormonal contraceptives — but if you’ve ever experienced a migraine with aura, it really impairs your ability to see. So you’re sensitive to light and you kind of see — it really just affects your vision. I remember I used to see something that kind of looked like it was pixelating. So I’m not describing it very well, but if you’ve experienced it you would know. And it definitely impedes your vision, and it’s a very specific kind of thing, and it’s associated with more severe migraines. But women who do experience migraine with aura have anywhere from a two- to three-fold higher risk of stroke when they are put on hormonal contraceptives.

And so this is something that I’ve certainly talked about many times in the Pill Reality Series. And it’s just terrifying to think that many women are not told this by their healthcare professionals. Many women don’t know. Many women may have even been put on hormonal contraceptives because they were having these recurring migraines with their cycles, to kind of, like I said, level out or significantly suppress their natural hormone production and reduce that kind of cyclical nature of it. But again, a huge, huge risk factor. So the public service announcement out of that is that if you are taking hormonal contraceptives, or you know someone who is, and they had a history of severe migraines, particularly migraines with aura, it is important to know that being on the pill is a risk factor for stroke. It significantly increases that risk factor. So yeah, so that is what conventional medicine has to offer.

So what do we do, right? What do we do if you’re experiencing these cyclical problems? So in last week’s episode, Dr. Mill talked about her approach, which is really focused on balancing hormones. And that is a very similar approach that I teach my FAMM practitioners. The first step is to chart your menstrual cycles and start to learn how to identify if you have hormonal imbalances. Knowing what a normal cycle looks like — a normal cycle falls somewhere between 24 to 35 days. We expect to see your period lasting anywhere from three to seven days; about four to five is average. Leading up to ovulation — ovulation is key in a healthy cycle — and in a healthy cycle obviously ovulation is happening somewhere between cycle days 10 and about day 22. And if you think about it, in order for you to have a cycle that falls within that 24- to 35-day window, ovulation does have to happen at some point in the cycle, so no later really than the 22-ish, in order to maintain that regular cycle length.

And once you’ve ovulated, in a healthy cycle you would expect to then get your period — if you’re not pregnant — within about 12 to 14 days. So the period of time between ovulation and your period, that’s the luteal phase or the post-ovulatory phase. And a 12- to 14-day luteal phase, first and foremost, is a good sign that you have strong, healthy progesterone production. So just the length itself of the luteal phase gives us information as to how strong your progesterone production is.

And as I mentioned, symptoms — PMS symptoms — whether that be depression, anxiety, bloating, food cravings — those are the four main categories of PMS symptoms, and a lot of the different symptoms fall into those categories. If you’re having moderate to severe PMS, sometimes that is a sign in and of itself that the progesterone may not be ideal. And so when having conversations especially about progesterone — I think because I’ve been doing this work and a lot of women, and maybe even yourself, when you start charting your cycles, you notice certain things. Maybe you notice that your mucus production isn’t optimal. Maybe you notice that your luteal phase is only 10 days, or whatever the case. Maybe you notice that you’re spotting for several days before you start your period, which would be another sign potentially of lower progesterone.

And of course, what do I do? What is with this progesterone issue? So I think the first thing to know is that fortunately it is quite common. And I think a lot of us want a quick fix. We want to be able to take a certain supplement or a certain nutrient, which can certainly help. But really and truly, what we want to do is focus on the foundational factors that are needed to support hormonal health. If you’re wanting more on that topic of balancing progesterone and supporting hormone health, then have a look back through the catalog of episodes. Episode 383, I did a whole episode about boosting progesterone.

And so again, it’s interesting because the review mentions estrogen and essentially that the sharp drops and fluctuations in estrogen is being responsible. And I’m talking about progesterone. But often those issues that we’re seeing right before the cycle — when those are happening, it’s often because of the sharp drop in progesterone, which then highlights the issues or highlights the effects of estrogen in the post-ovulatory phase. When you have high, normal, healthy progesterone production, what’s happening is the progesterone is countering some of those effects of estrogen. And maintaining a good hormonal balance is one of the ways that you can reduce significantly those symptoms that you’re experiencing.

So to summarize and bring everything to a close today, menstrual migraines — or migraines in general, I should say — are much more prevalent in women. Women experience migraines at a much higher rate compared to men. And research even shows that the migraines that women experience tend to be more severe than the migraines that men experience. So when they’re looking even at the intensity and severity of the migraine itself, women are experiencing more migraines in general, but the migraines that they’re experiencing tend to be worse than the migraines reported by men.

And this is thought to be related to our hormones, our hormone cycles and fluctuations. And I think one of the key takeaways is that although this is very common and this is the trend and we can see this correlation, just because you’re a woman and you have hormones doesn’t mean that it’s normal to have migraines and for that to be a really severe, kind of crippling aspect of your life. If you are experiencing these types of symptoms, clearly if they are happening in correlation with your cycle, when we think of the menstrual cycle as a vital sign, then that is a sign that we need to do something to improve that hormonal balance.

So I hope this episode has been helpful, just to kind of talk through this whole idea of migraines and the menstrual cycle and how they’re related and where to start. Certainly this podcast isn’t going into every possible solution. There’s a limit to how much we could talk about on air. But hopefully it gives you a starting point and a bit of a deeper understanding as to why these things are related, and also a window into how conventional medicine looks at dealing with it — which arguably is just looking at reducing the symptoms, not necessarily at looking at why it’s happening.

So that may be why, if you’ve been experiencing migraines for a while — the review paper lists migraines as a lifelong issue, and so they’re basically telling you, well, this is just something you’re going to have to live with forever. We’re not really going to look into why it’s happening. You can take the pill. You can take some painkillers. And other than that, you know, good luck. Whereas I think there are better ways to look at this. And obviously there are many women who have experienced improvements by just focusing on the basics to balance hormones. If it’s a hormonal problem, then if we improve the hormonal situation and improve the cycle, then we would expect to see some level of improvement there.

So if you found this episode helpful and you want to share it, the share link is fertilityfriday.com/456. That’s where you’ll find this episode. You’ll find the review study and a few other episodes that I mentioned — the episode on the progesterone, as well as last week’s episode with Dr. Mill. So I’ll link those and other episodes that are related in the show notes page. So again, fertilityfriday.com/456. And I hope you have a wonderful week, weekend, whenever you’re tuning into the show. And of course, as always, until next time, be well and happy charting.