Is now the time to reconsider risks, benefits, and limitations of estrogen preparations as a treatment for menstrually related migraine?
Level 5 - mechanism / opinion, no new human data
Narrative review and expert opinion with no new empirical data or systematic search
PubMed 37038655 · doi:10.1080/14737175.2023.2198705
What was done
The authors conducted a narrative review evaluating the risks, benefits, and limitations of exogenous estrogen preparations, specifically combined hormonal contraception (CHC), for treating menstrually related migraine (MRM) and managing related gynecological comorbidities.
What was found
The abstract reports no numerical data or statistical effect sizes. Qualitatively, estrogen withdrawal during perimenstrual phases or hormone-free intervals is identified as a trigger for MRM. Continuous, extended, or flexible CHC regimens, shorter hormone-free intervals, or perimenstrual estrogen supplementation are noted as potentially beneficial strategies. The authors state that CHC is contraindicated in migraine with aura due to stroke risk, whereas evidence quality regarding risk remains low for women with migraine without aura.
Why it matters
It highlights hormonal manipulation strategies to prevent withdrawal-triggered migraine attacks and calls for evaluating natural estrogens instead of ethinylestradiol to optimize safety.
Limits
The abstract describes a narrative review without original clinical data or systematic quantitative synthesis. No specific sample sizes, effect magnitudes, or numerical safety profiles for stroke risks across different estrogen formulations are reported.
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