What do we mean by sore breasts, headaches, and cramps?
I always know when I’m about to get my period because my breasts are lumpy, sore, and very hard — actually painful!WLB Community Member
3 things to know about migraines, headaches, sore breasts, and cramps during perimenopause
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Migraines are likely to increase for those who have had them in the past1,2. By the end of their reproductive life cycle, roughly 40% of women have experienced migraines.3
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Sore breasts or breast tenderness is a symptom that decreases across perimenopause, as you get closer to your final menstrual period. For many the return of sore breasts before your period signals the beginning of perimenopause.
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Like breast tenderness, a return of premenstrual cramps (in the days before your period) or menstrual cramps (with your period) is often the sign of the beginning of hormonal changes.
These data represent the % of respondents reporting each symptom on the Women Living Better Survey. LRS stands for the late reproductive stage and MT for the Menopause Transition. These are two stages on the path to menopause (the final menstrual period).
Headaches
Tension headaches
Migraine headaches
Cramps
Menstrual cramps returned
Menstrual cramps worsen
Sore Breasts
Breast tenderness
Research on sore breasts during the menopause transition
In a study of 24 women, with an average age of 47, who completed daily perimenopause diaries recording symptoms for several months, breast tenderness was seen in the premenstrual window.4 Estrogen causes breast cells to grow and some women experience larger breasts with tenderness when levels are elevated. Clinical evidence from daily diary records suggests that breast tenderness does not occur unless estrogen levels exceed the usual midcycle peak values.5
The good news is that breast tenderness tends to improve as women proceed through the menopausal transition and go from having regular periods to skipping periods.6
Hormones & menstrual cramps
When estrogen levels are high and dropping and progesterone levels are dropping, as in perimenopause, prostaglandins are produced, causing cramps. This higher, dropping estrogen and lower progesterone relationship occurs for many women during adolescence as the menstrual cycle is getting going as well and causes significant cramping.
There can also be anatomic reasons for cramps and bleeding — not atributtable to perimenopause — so cramps are worsening over time, seek care from a gynecologist to have it checked out.
Migraines & other headaches during perimenopause
Estrogen’s tendency to rise and fall more dramatically during perimenopause can cause new or increasing headaches.
People who get migraines are extra sensitive to any hormonal changes so this phase with fluctuating hormones can be a difficult time for migraine-prone women.7
And more good news: Most women will see improvement in their migraines once in menopause.4
A SWAN study demonstrated that in those with migraines, estrogen drops more quickly in the 2nd half of their cycle compared to those without migraine. The timing and rate of estrogen withdrawal before the period may be a signal of vulnerability in those who have migraines.9
Remedies to help with soreness, cramps, migraines, and other headaches
NSAIDs
Such as Advil or Motrin, help to relieve cramps and some of the pain and swelling of sore breasts. As we mentioned on the heavy flow page, the NSAIDs action to reduce prostaglandins also helps to relieve heavy flow. Take NSAIDs with food as they can cause irritation to the stomach lining.
MIGRAINE MEDICATIONS
For some women, NSAIDs may take the edge off of a headache. But for others, a true migraine medication is needed. If you have had migraines previously, you likely have some of these migraine rescue meds. If you are getting really bad headaches for the first time, talk to your healthcare provider about options. Try to track when you are getting headaches relative to your period.
HORMONE THERAPY (HT)
Often used late in the menopausal transition and in the first years of postmenopause to relieve vasomotor symptoms. When HT is used to prevent migraine, it should be administered continuously to prevent sudden estrogen deprivation and the migraine attacks that ensue as a result. Treatment with transdermal patches and estradiol-based gels is preferable to oral formulations as transdermal formulations maintain constant blood hormone levels and avoid changes that may cause migraine.8
REFERENCES
- Allais G, Chiarle G, Bergandi F, Benedetto C. Migraine in perimenopausal women. Neurol Sci. 2015 May; 36 Suppl 1:79-83. doi: 10.1007/s10072-015-2155-8.
- Martin VT, Pavlovic J, Fanning KM, Buse DC, Reed ML, Lipton RB. Perimenopause and Menopause Are Associated With High Frequency Headache in Women With Migraine: Results of the American Migraine Prevalence and Prevention Study. Headache. 2016 Feb; 56(2):292-305. doi: 10.1111/head.12763. Epub 2016 Jan 21.
- Hale GE, Hitchcock CL, Williams LA, Vigna YM, Prior JC. Cyclicity of breast tenderness and night-time vasomotor symptoms in mid-life women: information collected using the Daily Perimenopause Diary. Climacteric. 2003 Jun; 6(2):128-39.
- Faubion SS, Batur P, Calhoun AH. Migraine Throughout the Female Reproductive Life Cycle. Mayo Clin Proc. 2018 May;93(5):639-645. doi: 10.1016/j.mayocp.2017.11.027.
- Prior, JC. “Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause,” , Facts, Views and Vision in ObGyn, 2011, volume 3, number 2, pages 109–120.
- Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol. 2000 Sep;96(3):351-8.
- Ibrahimi K,Couturier EG,MaassenVanDenBrink A. Migraine and perimenopause. Maturitas.2014 Aug;78(4):277-80. doi: 10.1016/j.maturitas.2014.05.018. Epub 2014 Jun 2.
- MacGregor EA. Perimenopausal migraine in women with vasomotor symptoms. Maturitas. 2012 Jan;71(1):79-82. doi: 10.1016/j.maturitas.2011.11.001. Epub 2011 Nov 23.
- Pavlović JM, Allshouse AA, Santoro NF, Crawford SL, Thurston RC, Neal-Perry GS, Lipton RB, Derby CA. Sex hormones in women with and without migraine: Evidence of migraine-specific hormone profiles. Neurology. 2016 Jul 5;87(1):49-56. doi: 10.1212/WNL.0000000000002798. Epub 2016 Jun 1. PMID: 27251885; PMCID: PMC4932235.