Migraine symptoms can get worse with the increase of estrogen levels, which could happen after starting oral contraceptive pills or post-menopausal hormone supplementation. On the other hand some women may experience an upswing in their headaches due to estrogen withdrawal during the start of menses, "off days" of oral contraceptive pills, or with the onset of menopause. This hormonal sensitivity may explain why migraines worsen around the time of peri-menopause when estrogen levels fluctuate and begin to decline.

Two thirds of women's migraines improve within a couple of years after menopause while 10 percent experience worse headaches. Approximately 25 percent notice no change at all. Hormone replacement therapy is now being selectively offered to women for severe, debilitating hot flashes but because of migraine sufferers' variable reaction to hormones, there's no way of knowing who will respond positively or poorly to menopausal hormonal supplementation.