Migraine and Hysterectomy: Balancing Conflicting Treatment Choices
For years I heard stories from family members that migraine attacks disappeared after menopause. Those stories still give me hope that one day I will be migraine-free. More than once I’ve been tempted to think that a hysterectomy might bring early relief.As I began to learn more about migraine management, I discovered that trying to speed up the process was more likely to worsen migraine. While 67 percent of women see an improvement in migraine after natural menopause, those who undergo surgical menopause are more likely to experience a worsening of migraine attacks. A full 67 percent get worse after their ovaries are removed. Given those odds, I decided long ago that I would resist surgical menopause unless my life depended on it. I wanted to give my body the best chance for post-menopausal migraine improvement by gradually easing into “the change.”
After I turned 40, my periods began getting heavier, more frequent, and more painful. My doctor and I discussed options, but I was busy with work and graduate school, so I put off getting the recommended gynecological check-up. When I finally got around to scheduling that appointment, the news was much more serious. I was diagnosed with adenomyosis (a condition similar to endometriosis in which endometrial tissue grows into the uterine muscle wall) and was strongly urged to have a complete hysterectomy with removal of both ovaries.This news shocked me. I wasn’t emotionally prepared and already knew that surgical menopause could worsen migraine. I’d just started making good progress with my new migraine treatment and didn’t want to risk undoing all that good work. I knew the odds were stacked against me if I followed the gynecologist’s recommendation. Once again, I tried to wait it out for natural menopause.Unfortunately, the pain and heavy periods were doing more than just making me uncomfortable. A routine blood test showed that, despite daily iron supplementation, my hemoglobin levels were below normal. My family doctor reviewed the results with me and insisted that I see the gynecologist again. Worried and frustrated, I made another appointment.
Disagreement with my doctor
The surgeon’s recommendation was the same. He strongly urged me to choose total hysterectomy with bilateral oophorectomy (removal of both ovaries). Had I not been dealing with migraine, his rationale might have made sense. I am only a few years away from the average age of menopause, so I wouldn’t need long-term hormone replacement therapy. He even suggested a 30-day trial of leuprolide (Lupron) to suppress my hormone production to see if that would eliminate any remaining migraine attacks.I really didn’t want to do anything that might jeopardize my migraine treatment progress. That’s when I decided it was time to bring out the research. Supported by scientific studies, I stood my ground, refused Lupron, and insisted that my ovaries remain intact. Although not completely convinced I was right, the surgeon did agree to respect my desire to retain my ovaries unless they posed a threat to my health.
My hysterectomy was successful and my ovaries continue to do their job as nature intended. As my iron levels return to normal, I am enjoying an increase in energy and improved sense of well-being. Best of all, I’ve had no increase in migraine frequency or severity and continue to work with my migraine and headache specialist to reduce the impact of migraine on my life.
Be your own advocate
When treatment recommendations for other conditions are at odds with good migraine management, we need not hesitate to speak up. Advocating for ourselves is simply in our best interests. At times, we can be successful on our own. At other times, we may need to request that our migraine specialist collaborate with our other doctors for the best treatment outcomes.
More helpful information:
1 Marcus DA, Bain PA. The woman’s migraine toolkit: Managing your headaches from puberty to menopause. New York, NY: DiaMedica Pub.; December 14, 2010.
2 Staff MC. Adenomyosis definition. Mayoclinic. April 2015. Accessed February 17, 2017.