Medical Matters > Menopause

ME Essential Spring 2020

Question

I’m in my late forties and have had mild to moderate ME/CFS for several years. Over the past few months I’ve been feeling more tired than usual, my concentration has got worse, I often feel hot at night and I have vaginal dryness. Not surprisingly, my doctor has decided that I’m entering the menopause and has recommended HRT – which I’m reluctant to use as I don’t like taking drugs. I’ve also found that what used to be only occasional attacks of migraine have become a much more regular occurrence. Is this unusual? Or can the menopause have an adverse effect on both ME/CFS and migraine-type headaches?

Answer

Research has found that there is an increase in the prevalence of migraine-type headaches during what is called the perimenopause – the time at which the body makes the natural transition into the menopause. And that hormonal factors, especially falling oestrogen levels at the time of the menopause, can effect both the intensity and frequency of migraine attacks. So it’s not surprising to learn that if a woman already suffers from migraine this can get worse around and during the menopause. Because the menopause has a number of symptoms – fatigue, cognitive problems, night sweats, palpitations etc. – which overlap with ME/CFS, the menopause can cause an exacerbation of ME/CFS symptoms.

There is now some good research evidence to indicate that migraine-type headaches are more common in people with ME/CFS. This research is summarised and referenced in the ME Association's ME/CFS/PVFS Clinical and Research Guide (The ‘Purple Book') and in the information leaflets shown below.

As far as treatment of the menopause is concerned, hormone replacement therapy (HRT) has been shown to reduce both the severity and frequency of migraine attacks during the menopause – as well as having beneficial effects on some of the other common menopausal symptoms. The use of a transdermal (skin) patch of oestrogen (which has a lower risk of blood-clotting side-effects) is something that could be considered in a situation like this. For most women under the age of 60, the benefits of HRT outweigh the risks, so I think this is an approach to management that would be worth discussing with your doctor again.

More information

The ME Association has detailed information available to download from the website shop:

MEDICAL DISCLAIMER

Medical Matters is for information purposes only. The answers provided by Dr Shepherd and the ME Association’s other expert advisers should not be construed as medical advice. We recommend that any information you deem relevant is discussed with your GP as soon as possible. It is important to obtain advice from a GP who is in charge of your clinical care, who knows you well, and who can consider other likely causes for symptoms. Seek personalised medical advice whenever a new symptom arises, or an existing symptom worsens. Don't assume that new or worsened symptoms are a result of having ME/CFS.

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