Hello. My gynecologist has suggested that I have a hysterectomy (including my ovaries) because most of my Migraines are triggered by my cycle. My family doctor says that’s a bad idea for two reasons. Her first reason is that she says it’s unlikely to help with my Migraines. Her second reason is that she says hormone replacement therapy is considered risky for people who have Migraine with aura. I have both Migraine with aura and Migraine without aura. My gynecologist says my family doctor is wrong about the risks of hormone replacement therapy. Can you give me any information on these issues? Thank you, Brenda.
Yes, we can give you some information to discuss with your doctors to assist you in making this decision.
Your family doctor is correct that a hysterectomy is unlikely to help you with your Migraines. In fact, it’s more likely to make them worse. Following surgical menopause that occurs as a result of a hysterectomy:
- 33 percent of women find that their Migraines get better;
- 67 percent of women find that their Migraines get worse;
- and a statistically insignificant number of women find that their Migraines don’t change at all.
You can find more information on this in Hysterectomy for Migraine? The Numbers Say No.
There is some data that hormone replacement therapy and hormonal birth control can increase the risk of stroke in women who have Migraine, particularly those who have Migraine with aura. Some doctors feel that it absolutely means no hormonal treatment for women with Migraine with aura. Others consider other risk factors such as age, weight, and whether the woman smokes when making a decision of whether to recommend hormone replacement therapy or hormonal birth control for women who have Migraine with aura.
Another issue we see is that when we see more than one doctor, it’s very helpful for them to consult, especially when they disagree on treatment. The best option would be for them to consult via a conference call that includes you. Also, if their disagreement makes you uncomfortable, there’s nothing wrong with getting a second opinion from another doctor.
Thank you for your question,
Dave Watson and Teri Robert
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Do you have questions about Migraine? Reader questions are answered by UCNS certified Migraine and headache specialist Dr. David Watson, and award-winning patient educator and advocate Teri Robert. Questions may be submitted via our submission form. Accepted questions will be answered by publishing the answers in our Ask the Clinician column. For an overview of how we can help and questions we can and can’t answer, please see Seeking Migraine and Headache Diagnoses and Medical Advice.