Hormonal changes across a woman's life shape migraine patterns

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About two-thirds of women with migraine experience attacks in association with their menstrual period, driven largely by the rate of estrogen decline in the late luteal phase — the days just before menstruation when estrogen falls most sharply. Brian Grosberg explains that it is not the low estrogen level itself but the speed of the drop that appears to be the distinguishing factor in women who get these attacks. Migraine also tends to fluctuate at other hormonal milestones: puberty, pregnancy, lactation, perimenopause, and menopause. Roughly two-thirds of women improve after fully transitioning through menopause, but 10–20% continue or worsen. Hormone replacement therapy (HRT) can help some women but worsen others, requiring careful, individualized management — ideally in collaboration between a headache specialist and a gynecologist.