From the Guidelines
Hormone replacement therapy (HRT) may worsen retinal migraines in some women, and consideration should be given to changing the dose, route of administration, or regimen if migraine symptoms worsen during HRT. The relationship between retinal migraines and HRT is complex, and estrogen-containing HRT can potentially trigger or worsen migraines due to its effects on blood vessel regulation in the brain and retina 1. For women who experience retinal migraines while on HRT, options include trying lower-dose estrogen formulations or switching to continuous rather than cyclical HRT to avoid hormonal fluctuations.
Key Considerations
- Transdermal estrogen (patches or gels) may be preferable to oral forms as they provide more stable hormone levels, which can help minimize the risk of worsening migraines 1.
- Women with retinal migraines should keep a detailed symptom diary to track their migraines in relation to their HRT regimen, helping to identify patterns and potential triggers.
- If retinal migraines worsen significantly on HRT, the benefits of continuing hormone therapy should be carefully weighed against the impact of these visual disturbances on quality of life, and alternative treatments or adjustments to the HRT regimen should be considered in consultation with a healthcare provider.
Clinical Implications
- The decision to initiate or continue HRT in women with retinal migraines should be made on a case-by-case basis, taking into account the individual's medical history, the severity of their migraines, and the potential benefits and risks of HRT.
- Healthcare providers should closely monitor women with retinal migraines who are using HRT and be prepared to adjust the treatment plan as needed to minimize the risk of worsening migraines and optimize quality of life.