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.

Eli Lilly's experimental weight-loss drug retatrutide, being referred to as ‘Godzilla’, continues to outperform its rivals like Ozempic.

According to a recent head-to-head Phase 3 clinical trial involving adults with type 2 diabetes, it delivered more than twice the average weight loss achieved with Ozempic.

Ozempic Vs Retatrutide

Participants who took the highest dose of retatrutide lost an average of 20.9% of their body weight over 80 weeks, compared to 9.4% among those receiving Ozempic's highest approved dose for type 2 diabetes.

The trial, called TRANSCEND-T2D-2, involved more than 1,000 adults with type 2 diabetes. It compared once-weekly injections of retatrutide at doses of 9 mg and 12 mg with semaglutide, the active ingredient in Ozempic, at 2 mg.

At the end of 80 weeks, participants taking retatrutide 9 mg lost an average of 44.3 pounds (20.1 kg), while those receiving the 12 mg dose lost 47.4 pounds (21.5 kg). The Ozempic group lost an average of 20.9 pounds (9.5 kg).

The findings mark the first Phase 3 head-to-head comparison of retatrutide with another medicine in this class.

Also read: ‘Godzilla’ Drug Retatrutide Reverses Sleep Apnea In 1 In 4 Diabetes Patients

Retatrutide Also Improved Blood Sugar

The trial found that retatrutide also resulted in produced greater reductions in HbA1c, a measure of average blood glucose over approximately three months.

At 80 weeks, participants taking either dose of retatrutide recorded an average HbA1c reduction of 2.2%, compared to 1.8 % among those receiving Ozempic.

The experimental drug also resulted in greater improvements in cardiovascular risk factors like non-HDL cholesterol, triglycerides and systolic blood pressure.

Also read: Could GLP-1 Drugs Help Prevent Rupture Of Abdominal Aortic Aneurysm? Study Finds 46% Reduction In Risk

Side Effects Of Retatrutide

The most commonly reported side effects of retatrutide were gastrointestinal symptoms like diarrhoea, nausea, constipation, vomiting and indigestion.

Diarrhoea was reported in 28.3% of participants receiving the 9 mg dose and 32.7% receiving 12 mg, compared to 26.4% in the Ozempic group. Nausea occurred in 21.2%, 23.8% and 21.3% of participants, respectively.

Researchers also reported a higher incidence of dysesthesia, an abnormal sensation that can include tingling, burning or skin sensitivity, among participants taking retatrutide.

Treatment discontinuation because of side effects occurred in 4.8% of the 9 mg group and 7.9% of the 12 mg group, compared to 2.7% of the Ozempic group.

More About Retatrutide

Retatrutide is a once-weekly injectable drug that targets three hormone receptors involved in regulating appetite, blood sugar and metabolism. They are GLP-1, GIP and glucagon.

GLP-1 helps regulate appetite and blood sugar while slowing the process of stomach emptying. GIP also plays a role in glucose regulation and insulin release. Glucagon is involved in controlling blood glucose and energy metabolism.

Ozempic, manufactured by Novo Nordisk, acts on the GLP-1 receptor. Eli Lilly's Mounjaro and Zepbound, which contain tirzepatide, target both GLP-1 and GIP receptors.

Retatrutide remains an investigational drug and has not been approved by the US Food and Drug Administration (FDA) or other regulatory authorities.

Eli Lilly plans to submit the drug for FDA approval in early 2027. The company said detailed results from the trial would be presented at a future medical meeting and published in a peer-reviewed journal.

The hype around GLP-1 weight loss drugs keeps growing due to numerous new benefits as well as side effects that are discovered every other day. A recent study found that the risk of aortic aneurysm rupture is significantly less among GLP-1 users. The study was published in the Journal of Vascular Surgery.

GLP-1 receptor agonists is a a class of medicines that is widely used to treat type 2 diabetes and obesity. Users have reported substantial weight loss results with the help of these medicines like Ozempic, Mounjaro, Zepbound and others.

Now, researchers have found that people with abdominal aortic aneurysms who used GLP-1 drugs had a 46% lower risk of rupture over five years compared with those who did not use these medicines. This means that GLP-1 drugs may also have cardiovascular benefit apart from diabetes and obesity.

The study analysed health records from 123 healthcare organisations in the US. It is based on more than 412,000 people diagnosed with abdominal aortic aneurysms who underwent imaging surveillance every six months.

After matching patients based on factors like age, sex, diabetes, high blood pressure, smoking, heart disease and kidney disease, the researchers compared 13,722 GLP-1 receptor agonist users with an equal number of non-users.

GLP-1 Drugs Linked To Fewer Aortic Aneurysm Ruptures

Also read: ‘Godzilla’ Drug Retatrutide Reverses Sleep Apnea In 1 In 4 Diabetes Patients

After five years, aortic aneurysm rupture was recorded in about 1.6% of people taking GLP-1 drugs, compared to 2.4% of those who were not taking them.

The researchers reported a hazard ratio of 0.538, indicating a 46.2% lower risk of rupture among GLP-1 drug users after adjustment.

The difference was also observed at the two-year mark, when rupture occurred in 1.1% of GLP-1 users compared to 1.8% of non-users.

People taking GLP-1 drugs also had fewer elective aneurysm repairs. At five years, 2.1% of users underwent elective repair compared to 3% of non-users.

The study further found lower rates of major cardiovascular events like heart attacks, strokes and heart failure, as well as lower all-cause mortality among GLP-1 users.

What Is An Abdominal Aortic Aneurysm?

Also read: The Changing Obesity Treatment Landscape: Where Does Bariatric Surgery Fit in the Age of Weight-Loss Drugs?

An abdominal aortic aneurysm (AAA) occurs when a section of the aorta, the body's largest artery, becomes enlarged or bulges due to weakening of its wall. It develops in the part of the aorta that passes through the abdomen.

Many abdominal aortic aneurysms do not cause symptoms and are detected during tests. However, as the aneurysm enlarges, its risk of rupture increases.

A ruptured aneurysm is considered to be a medical emergency as it can cause severe internal bleeding. Symptoms may include sudden, severe abdominal or back pain, dizziness, fainting and a rapid heartbeat.

Smoking, older age, high blood pressure, atherosclerosis and a family history of aneurysms are among the risk factors.

GLP-1 Drugs & Lower Risk Of Aortic Aneurysm Rupture Risk

GLP-1 receptor agonists work by mimicking the naturally occurring GLP-1 hormone. They help regulate blood sugar by stimulating insulin release when glucose levels are high, slowing the emptying of stomach and reducing appetite.

Some of their effects may also impact blood vessel health. Abdominal aortic aneurysms develop through several processes, including inflammation, damage to vascular smooth muscle cells and changes in the proteins that maintain the artery wall.

GLP-1 drugs have shown anti-inflammatory and cardiovascular benefits in older research. The researchers suggest these effects may help explain the lower rates of aneurysm-related complications observed in the study.

The findings are promising but do not conclusively prove that GLP-1 medicines prevent aneurysm rupture. This was a retrospective observational study, meaning researchers examined existing health records rather than randomly assigning patients to receive the drugs.

One important limitation was that aneurysm size was not included among the matching variables. Since aneurysm size is a major determinant of rupture risk, differences between the groups could have impacted the findings.

When a woman misses her period, pregnancy is usually the first thing she thinks about. If that is ruled out, stress, weight changes or a hormonal imbalance may seem like the obvious explanations. But when periods become irregular or stop for several months, there may be more to the story.

In some women, these changes can also signal a risk to bone health. The menstrual cycle is controlled by a complex interaction between the brain and the ovaries. Oestrogen, one of the key hormones involved, is important not only for reproductive health but also for maintaining strong bones. It helps regulate the continuous process of bone breakdown and rebuilding.

When oestrogen levels remain low for a prolonged period, this balance can be disturbed, leading to a reduction in bone mineral density and, in some cases, an increased risk of fractures.

Menstrual health is not just about getting a period every month. It can offer important clues about what is happening elsewhere in the body.

Why Do Periods Sometimes Stop?

Also read: Why Do My Breasts Hurt Right Before My Period?

One possible cause is functional hypothalamic amenorrhoea, a condition in which the brain reduces the hormonal signals that stimulate the ovaries. It may occur when the body is under physical or emotional stress, particularly in the setting of inadequate food intake, rapid weight loss, excessive exercise or a combination of these factors.

In simple terms, the body may not be getting enough energy to support all its normal functions. Reproductive activity can slow down as a result. If this continues, the effects may extend beyond the menstrual cycle.

Low energy availability can affect hormones involved in bone formation and maintenance. Inadequate intake of protein, calcium and vitamin D may further compromise bone health.

The concern is particularly important in adolescents and young women, because these are the years when the body builds much of its peak bone mass. If this process is disrupted, they may not achieve their full bone-strength potential, which can have implications for bone health later in life. It can happen even when a woman is not underweight.

One common misconception is that only very thin women are at risk. In reality, a woman can have a seemingly healthy body weight and still not be eating enough to meet the demands of her daily activity.

A student under academic pressure may skip meals regularly. A working professional may combine long hours with restrictive eating, while a woman who exercises intensively may not increase her food intake to match her energy needs. In such situations, menstrual changes may be one of the first noticeable signs that something is wrong.

Persistent tiredness, declining exercise performance, poor recovery after workouts and recurrent bone or muscle injuries may provide additional clues.

These symptoms are easy to dismiss as the result of a busy lifestyle, but they deserve attention when they occur alongside irregular or absent periods.

Not Every Missed Period Has The Same Cause

Also read: Women With Endometriosis Are Earning Less, Reveals Study

Although inadequate energy intake and prolonged stress can affect menstruation, they are not the only explanations. Pregnancy must first be ruled out. Other possible causes include polycystic ovary syndrome (PCOS), thyroid disorders, raised prolactin levels, premature ovarian insufficiency, chronic illnesses and certain medications.

A woman should seek medical evaluation if her periods stop for three months without an explanation, if her cycles remain persistently irregular, or if menstrual changes are accompanied by significant weight loss, restrictive eating, excessive exercise, bone pain or a stress fracture.

The assessment usually begins with a detailed menstrual history and questions about diet, exercise, weight changes, stress and medication use. Depending on the findings, the doctor may recommend pregnancy testing, blood tests to assess thyroid function and reproductive hormones, prolactin levels and other investigations.

A bone mineral density scan may also be appropriate when periods have been absent for a prolonged period or when additional risk factors for bone loss are present.

Protecting Menstrual Health Also Means Protecting Bone Health

Treatment depends on the underlying cause. When inadequate energy availability is responsible, the priority is to restore a healthy balance between food intake, physical activity and recovery.

This may require nutritional guidance, changes to exercise routines and support for managing psychological stress. A gynaecologist may work with an endocrinologist, dietitian or mental-health professional, depending on the individual’s needs.

Adequate calcium, vitamin D and protein are important for bone health, but supplements alone cannot correct an ongoing energy deficit. Similarly, hormonal medication should not be prescribed simply to produce a period without first understanding why menstruation has stopped.

A menstrual cycle is more than a monthly reproductive event. Persistent changes can provide valuable clues about hormonal function, nutrition and overall health. Paying attention to these changes early can help identify underlying problems and, where necessary, protect bone health for the future.