For those who have not experienced a migraine, perhaps it would seem just another headache. But for someone like me who has suffered through migraines that will last over a week even with medication, I can definitely tell you that it's much more. The ache is not confined to the head; it's the whole experience. Nausea, sensitivity to light, and throbs so bad it makes simple tasks unbearable. It also comes with an emotional burden—the loneliness and frustration are pretty unbearable. Through the years, realizing how hormones are also implicated in triggering and exacerbating my migraines has helped change the game in my dealing with these episodes.

What are Hormonal Migraines?

Hormonal migraines are caused by fluctuations in estrogen and progesterone, the two main female hormones. These hormones are essential for the reproductive system, regulating menstrual cycles and pregnancy. They also have an effect on brain chemicals, such as serotonin and dopamine, which affect mood and pain perception. When hormone levels fluctuate, such as during menstruation, pregnancy, or menopause, they can destabilize the pathways in the brain, causing migraines.

According to Dr. Shivananda Pai, Consultant Neurology, migraines are more than a neurological disorder. "Migraines represent a complex interplay of genetic, environmental, and hormonal factors. In women, hormonal fluctuations are a critical trigger that amplifies sensitivity to pain," he explains. Hormonal headaches are particularly challenging because they are influenced by multiple life stages, from puberty to post-menopause. Common causes include:

• Menstrual periods: Estrogen levels significantly drop just before menstruation often triggers a migraine.
• Pregnancy: Hormones can act to relieve symptoms or aggravate them during different times of pregnancy.
• Menopause: The hormonal fluctuation during menopause can intensify a migraine, while some women tend to find relief.
• Hormonal therapies: Birth control and HRT tend to level off hormone balances in some individuals but will exacerbate a migraine in others.

Complex Role of Hormones in Women’s Neurological Health

Estrogen and Neurological Health

Estrogen, often called the "hormone of femininity", does more than regulate reproductive functions. It is a powerful influencer of brain health. Estrogen modulates the activity of neurotransmitters like serotonin, which regulates mood and pain perception, and dopamine, associated with reward and pleasure.

During stages of hormonal stability, like in pregnancy's latter months, women may have fewer migraines because of the steady elevation of estrogen. However, a sudden downfall in estrogen destabilizes these chemicals in the brain, sending a heightened sensitivity for migraine triggers.

Menstrual Migraines

The most common form of hormonal migraines is menstrual migraines, which occur in response to the steep decline in estrogen levels just before menstruation. These are typically more intense and less responsive to standard treatment. The timing of these migraines provides clear evidence of the role hormones play in neurological health.

Pregnancy and Hormonal Shifts

Pregnancy is a rollercoaster of hormones. Although many women experience relief from migraines as a result of the constantly elevated levels of estrogen, some women, particularly in the first trimester, worsen. This individual variability is a characteristic of hormonal migraine triggers.

Hormonal Therapies and Management of Migraine

Hormonal treatments, such as oral contraceptives and HRT, have had mixed reviews regarding their use in managing migraine. Some women fare better with the stabilization the treatment provides, whereas others suffer worsening symptoms. This will depend on the nature and dose of the hormones used.

Post-Menopause: Migraine Remission or Continued Struggles?

For most women, menopause brings relief from their migraines. The decline in frequency and severity often accompanies stability in hormone levels. Even so, the susceptibility remains with some towards other forms of triggers including stress and sleep deprivation, not to forget diet-related factors and continues the saga of migraines well after the menopausal stages.

Effect on Neurological Health Due to Hormonal Changes

The relationship of hormones to neurological health goes beyond migraines. Hormonal changes have profound effects on a woman's brain in general.

Mood Disorders: Estrogen helps stabilize mood by regulating serotonin. Its decline at menopause increases the risk of mood swings and depression.

Neurodegenerative Diseases: Estrogen is neuroprotective, stimulating the growth and repair of brain cells. Its absence in post-menopausal women has been associated with an increased risk of Alzheimer's disease and cognitive decline.

Multiple Sclerosis (MS): Hormonal cycles may affect the course of MS, a disease that occurs more frequently in women than in men. Estrogen's anti-inflammatory effects provide transient protection during pregnancy, reducing relapse rates in women with MS.

"The intricate interplay between hormones and neurological health underscores the need for gender-specific treatment approaches," says Dr. Pai.

Managing Hormonal Migraines: Practical Strategies

While hormonal changes are inevitable, several strategies can help manage migraines effectively:

1. Tracking Your Cycle

Understanding your menstrual cycle can help identify patterns and predict when migraines might occur. This knowledge allows for preventive measures, such as scheduling medications or adjusting lifestyle habits.

2. Consulting Specialists

Working with a neurologist or gynecologist can help develop a personalized treatment plan. Options might include hormonal therapies, triptans, or preventive medications tailored to your specific needs.

3. Adopting a Healthy Lifestyle

A well-balanced diet, regular exercise, and stress management are all integral parts of managing migraines. For instance, magnesium-rich foods and hydration can help reduce the frequency and severity of attacks.

4. Exploring Preventive Therapies

For people with severe or frequent migraines, preventive medications, such as beta-blockers or CGRP inhibitors, may be prescribed. These medications stabilize brain activity and therefore reduce the chances of migraine during hormonal fluctuations.

5. Mind-Body Techniques

Techniques like yoga, meditation, and biofeedback can enhance wellness and reduce the debilitating effects of stress-one of the most common migraine triggers.

Research that was once in its embryonic stage continues to shed more light on the role of hormones in migraines and other neurological conditions. Further breakthroughs in genetic testing might enable doctors to predict, at least in a way, how an individual would react to hormonal therapies. The importance of gender-specific approaches is gradually being realized, which involves differentiating between the plight of women with migraines from others.

As Dr. Pai puts it, "Empowering women with knowledge about the hormonal underpinnings of migraines can lead to better, more personalized care. With the right strategies, migraines can be effectively managed, allowing women to lead fuller, healthier lives.

Migraines are not headaches; they are a complex neurological condition that deeply impacts the lives of millions of women. Understanding the role of hormones in triggering and exacerbating migraines is a vital step toward better management and relief.

Awareness, proactive care, and advances in medical research can help women regain their lives from the grip of hormonal migraines. Whether tracking cycles, adopting healthier habits, or seeking tailored medical care, every step taken toward understanding and managing migraines is a step toward empowerment.

Dr Shivananda Pai is a Consultant Neurology at KMC Hospital Dr B R Ambedkar Circle in Mangalore, India.

Brandes JL. The Influence of Estrogen on Migraine: A Systematic Review. JAMA. 2006;295(15):1824–1830. doi:10.1001/jama.295.15.1824

Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012 Apr;13(3):177-89. doi: 10.1007/s10194-012-0424-y. Epub 2012 Feb 26. PMID: 22367631; PMCID: PMC3311830.

India has a physical inactivity problem that is contributing to a growing burden of joint and musculoskeletal disorders among its working-age population. Close to half of Indian adults were insufficiently active in 2022, according to a Lancet study, and among women, that figure climbed to 57%. Behind those numbers is a generation whose muscles have quietly stopped supporting their joints and whose weight has quietly started punishing them for it.

Why do Indians struggle with weak, ageing knees?

In an interview with Health and Me, Dr Deepak Gautam, Sr. Consultant Orthopaedic & Robotic Joint Replacement Surgeon, Apollo Hospitals, Navi Mumbai, explained how a patient's knees can start ageing faster than their actual biological age.

Young Indians broadly assume joint problems are inherited with age. Clinical practice keeps demonstrating that they are earned much earlier, through years of small daily choices that never feel consequential until they are. The best time to address this is before a patient ever needs to describe where it hurts.

The knee absorbs roughly four times a person's body weight with every step. Add excess weight over several years, and that force erodes cartilage far ahead of schedule. Obesity also drives systemic inflammation through the release of molecules from fat tissue, which attack joint cells independently of any mechanical load. Patients frequently describe their pain as having an insidious onset and, at times, being sudden. Clinically, joint degeneration develops gradually over many years before symptoms become apparent.

Read more: Feeling Weak In Your Knees? Here Are Tips To Maintain Them As You Age

What are the consequences of weak knees?

Muscle weakness makes that threshold arrive sooner. The quadriceps and core do the work of absorbing shock and stabilising the joint under load. Sedentary work strips that capacity away gradually, and screen time beyond three hours a day has been directly linked to weight gain and metabolic deterioration. For a large portion of India's urban workforce, three hours of daily screen exposure is where the morning starts.

None of this stays contained to the joints. Around one in five Indian adults is already managing several chronic conditions at once, and 45.4% of Indians with coronary heart disease remain physically inactive. Musculoskeletal decline and cardiovascular disease tend to share the same lifestyle roots and reinforce each other. Globally, inactivity rates are still climbing and are expected to reach 35% by 2030, up from 31% in 2022.

When should you take action?

Once cartilage degeneration starts, it is very difficult to reverse the process. We can, however, retard the progression of the disease or prevent it from occurring in the first place. That single fact should change how people think about when to seek help. By the time climbing stairs or a regular walk in the market or garden becomes painful, the window for conservative management has already narrowed.

Waiting for symptoms is the wrong strategy. People with sedentary work patterns, weight above the healthy range, or significant screen exposure should have their joint mobility, gait, and muscle strength assessed before pain enters the picture at all. Resistance training twice a week, clinician-guided weight management, and dietary changes that dial down chronic inflammation are not complicated prescriptions. They are what separates someone who stays mobile in their forties from someone who is discussing surgical options.

Many couples are battling infertility and are keen on opting for ARTs to conceive and fulfill the dream of parenthood. However, the country continues reeling under severe heatwave conditions. Currently, a large number of couples who are planning fertility treatments are becoming stressed regarding how heatwaves can impact IVF procedures and even the success rates. Patients frequently ask fertility consultants whether extreme outdoor heat can affect the IVF laboratory environment, embryos, sperm samples, or even egg quality. However, there is no need to panic, as labs are designed to function even under highly controlled conditions throughout the year, and it is possible for couples to conceive successfully.

In an interaction with Health and Me, Dr. Aswati Nair, Fertility Specialist, Nova IVF Fertility, Rajouri Garden, Delhi, spoke about how extreme temperatures can affect the IVF process and what the consequent impact is on the outcome.

Read more: Heatwaves And Toxic Air Create A Growing Health Crisis In Delhi

Does a heatwave affect the IVF lab?

Usually, all the IVF labs have Air Handling Units (AHUs), which maintain the internal condition of the lab throughout the year at the same condition and temperature, and all the parameters are maintained throughout the year with the help of this equipment and gadgets. So, the internal environment of the lab does not get affected by an external heatwave. Understand that the temperature-sensitive procedures that are carried out inside the IVF lab, such as handling eggs, sperm, and embryos, are performed in a controlled setting and are monitored constantly. Hence, external heatwaves do not directly impact the IVF lab environment or the development of embryos. But only from the patient's perspective; they need to be hydrated and careful when there is scorching heat outside.

Too much heat can lead to dehydration, weakness, fatigue, dizziness, and stress, which can impact the patient’s health during fertility treatment. Women undergoing IVF cycles are put on hormonal medications, and staying hydrated is necessary for everyone. It is the need of the hour for the patients to take charge of their well-being right away!

Read more: Heatwave In India: Temperatures Continuously Rising; Stay Hydrated, Says PM Modi

Precautions to take

The precautions that patients can take are to stay well-hydrated and adhere to a balanced diet with lots of fruits and seasonal fruits like watermelon and muskmelon, which can improve hydration. They can have coconut and lemon water and avoid beverages, carbonated drinks, caffeine, and alcohol. They can follow these crucial tips to stay healthy during the heatwave. Patients should be sure to follow the guidelines given by the fertility consultant.

Even if the heatwaves can lead to discomfort, it doesn’t affect the functioning of modern IVF laboratories. By paying attention to various factors such as hydration, nutrition, and self-care, patients can safely continue their fertility journey even if there is extreme heat outside.

Mrs. Radha Sharma, 78, was brought to the hospital with sudden confusion, irritability, and restlessness. She had no fever, no pain, and no typical urinary complaints. Her family worried it could be dementia or a brain-related issue. However, a simple urine test revealed the real cause— a urinary tract infection (UTI). With timely treatment, fluids, and care, she recovered within a few days. This is a common but often overlooked reality—UTIs in older adults don’t always look like UTIs.

In another case, 72-year-old Mr. Pankaj Verma had repeated UTIs over a year. Each time, antibiotics provided temporary relief, but the infection kept returning. On further testing, doctors found an enlarged prostate that was preventing his bladder from emptying fully. Once this was treated, his infections reduced significantly.

These examples show an important pattern: in the elderly, UTIs are often missed, misunderstood, or keep recurring because the root cause is not addressed.

Why Are UTIs So Common In Older Adults?

As we age, the body goes through changes that make infections like UTIs more likely. In women, menopause leads to a drop in estrogen levels. This weakens the natural lining of the urinary tract, making it easier for bacteria to grow. Women also have a shorter urinary passage, so that bacteria can reach the bladder more easily.

In men, an enlarged prostate is a common issue. It can block the flow of urine, causing some urine to remain in the bladder. This leftover urine becomes a breeding ground for bacteria. Other common reasons include weaker immunity, conditions like diabetes, urinary incontinence, use of catheters, reduced movement, and dependence on caregivers for hygiene.

Symptoms Are Not Always clear

Unlike younger people, elderly individuals may not complain of burning urine or urgency. Instead, the signs can be subtle and confusing, such as:

• Sudden confusion or unusual behavior
• Increased falls
• Weakness or tiredness
• Loss of appetite

These symptoms are often mistaken for ageing or dementia, which can delay treatment.

Men vs Women: What’s the Difference?

UTIs are more common in older women due to hormonal changes and bladder control issues. Many women also experience repeat infections. In men, UTIs are less common but usually more serious. They are often linked to problems like prostate enlargement or urinary blockage, which need proper evaluation. Chronic illnesses play a big role. Diabetes, for example, increases the risk because excess sugar in urine helps bacteria grow. Poor sugar control also weakens the body’s ability to fight infections.

Conditions that affect bladder control, such as stroke or Parkinson’s disease, can also lead to incomplete emptying of the bladder, increasing infection risk.

Diagnosis Needs Careful Attention

Not every bacterium found in urine needs treatment. Many older adults have bacteria in their urine without symptoms—a condition called asymptomatic bacteriuria. Treating this unnecessarily can lead to antibiotic resistance. Doctors usually rely on urine tests, cultures, symptoms, and medical history before deciding on treatment.

Treatment: More Than Just Antibiotics

While antibiotics are important, they are only one part of the solution. Repeated courses without finding the cause often lead to recurring infections.

Treatment should also focus on:

• Drinking enough fluids
• Managing diabetes or other health conditions
• Treating prostate problems in men
• Avoiding unnecessary catheter use
• Reviewing medications that may affect bladder function

Early treatment is crucial. Ignoring symptoms can allow the infection to spread to the kidneys, which can be serious. Recurrent UTIs are common in the elderly. This can happen due to:

• Incomplete treatment
• Underlying problems like prostate enlargement
• Ongoing issues, such as incontinence or catheter use
• Antibiotic resistance

Prevention: Simple But Effective Steps

Preventing UTIs doesn’t always require complex measures. Small daily habits can make a big difference:

• Encourage regular water intake
• Avoid holding urine for long periods
• Maintain proper personal hygiene
• Manage conditions like diabetes well
• Limit catheter use
• Consider probiotics or cranberry products (after medical advice).

Caregivers play a key role in ensuring these habits are followed, especially for elderly individuals who need assistance. Immediate medical attention is needed if there is:

• Fever or chills
• Sudden confusion
• Blood in urine
• Lower back pain

UTIs in the elderly are common but often not straightforward. They may present differently, recur frequently, and require more than just antibiotics. The key is early recognition, identifying the underlying cause, and taking simple preventive steps. With the right care, recurrent UTIs can be reduced—helping older adults live healthier, more comfortable lives.

(By Dr. Sunita Goyal, Senior Consultant – Obstetrician and Gynecologist, Cloudnine Group of Hospitals, Ludhiana)