It’s a tough reality, but migraines definitely don’t play fair—they hit women way harder than men. If you’ve ever felt that throbbing pain centered over one eye, spreading up into your scalp, you know exactly what I’m talking about. It’s often not just the pain, either; light and noise become your worst enemies, and you might feel nauseated or see weird spots in your vision.

For some, there’s a “warning shot” called an aura—maybe a strange smell or flickering lights in your vision—that lets you know the headache is on its way. Many women describe the onset like a train in the distance: you can feel it coming, and it just gets louder and more intense as it gets closer.

If you notice your migraines ramping up right around your period, you’re not alone. We call these menstrual migraines, and they’re usually triggered by the “hormonal cliff” your body drops off when estrogen and progesterone levels plummet right before your cycle starts.

I actually deal with this myself! Back in college, I’d get these crushing headaches behind my left eye. My eye doctor said my eyes were fine, so I’d just end up stuck in bed if Ibuprofen didn’t kick in fast enough. It wasn’t until I got to medical school that I realized, “Oh, wait—these are migraines!”

If you suffer from migraines without aura and are looking for birth control, there are ways to level out those hormonal fluctuations. Pills like Mircette are great because they include a tiny dose of estrogen during the “placebo week” so your hormones don’t crash so hard.

Similarly, if you’re in perimenopause and things are starting to get unpredictable, a low-dose Hormone Replacement Therapy (HRT) can help keep your levels steady and stop those wild hormonal swings from triggering more migraines.

Now, a quick heads-up: if you’re someone who does experience an aura with your migraines, there’s a slightly higher risk of stroke associated with using traditional estrogen-based birth control such as certain pills, the patch, and the vaginal ring.

Because both migraines with aura and estrogen can independently increase the risk of blood clots, we generally recommend avoiding estrogen-containing pills, patches, or rings if you have aura.

But don’t worry—this doesn’t mean you are out of options for preventing pregnancy or managing your cycle! If you have migraines with aura, the safest path is usually a progestin-only or non-hormonal method. You might consider: 

• The “Mini-Pill”: A progestin-only pill that doesn’t carry the same stroke risk as combination estrogen and progesterone pills.
• Hormonal IUDs (like Mirena or Kyleena): These release a tiny, steady amount of hormone locally in the uterus with very little entering your bloodstream. They are also great for minimizing menstrual flow!
• The Arm Implant (Nexplanon): A highly effective, low-maintenance option that’s progesterone only birth control.
• Non-hormonal IUDs (like the Copper IUD): This avoids hormones altogether if they tend to be your biggest trigger.

As always, keep in mind that everybody is different, so it’s always best to have a candid chat with your doctor to find the right fit for your health and your lifestyle.

I hope that you find this information empowering and encouraging!

~ Dr. Rooney