Migraine and Multiple Sclerosis Across the Female Reproductive Lifespan: Insights for the Obstetrician-Gynecologist and Neurologists: A narrative review

Migraine and Multiple Sclerosis (MS) are chronic neurological conditions that predominantly affect women, especially during their reproductive years. These disorders are influenced by hormonal fluctuations, particularly estrogen, which plays a crucial role in immune modulation, neuronal excitability, and vascular function.

This review examines the relationship between migraine, MS, and female reproductive health, with a focus on hormonal influences throughout critical life stages: puberty, menstruation, pregnancy, postpartum, and menopause.

The review analyzes the hormonal interactions that impact migraine and MS, emphasizing the role of estrogen in disease modulation across different reproductive stages. Following SANRA guideline an online search was conducted in PubMed, Scopus, WOS, and Embase, the used keywords included: “Migraine,” “multiple sclerosis,” “women,” “hormones,” “estrogen,” “menstrual cycle,” “pregnancy,” “postpartum,” “contraceptives,” “menopause,” “reproductive health,” “obstetrics,” and “gynecology.” The included articles were English peer-reviewed studies from the last 20 years that addressed MS or migrant in women of reproductive age group, we excluded case reports, editorials, and non -relevant studies. The included articles were assessed for quality, clinical relevance, and recency. Extracted data were synthesized to reflect how hormonal changes across diverse women's life cycle influence the disease pattern and management. The key finding was organized thematically and presented to support evidence-based integration into obstetrician-gynecologists' (OB-GYNs) care.

Estrogen withdrawal during the perimenstrual and postpartum periods exacerbates both migraine and MS activity. Stable high estrogen levels during pregnancy provide neuroprotection and reduce MS disease activity. The review also highlights the need for individualized treatment strategies involving contraceptives, hormone replacement therapies (HRT), and assisted reproductive technologies (ART). Menopause leads to increased disease activity in both conditions due to declining estrogen levels.

The current study highlights the integral role of estrogen fluctuation in modulating disease activity in both migraine and MS, with steady hormonal states present a protective effect. it underscores the necessity of a tailored hormone-informed care strategy and multidisciplinary collaboration to enhance women's quality of life as well as neurological and reproductive health.

Despite advances in understanding hormonal modulation of migraine and MS, clinical practice often lacks integrated care strategies, particularly between neurologists and OB-GYNs. Collaborative care is essential for optimizing disease management and reproductive health outcomes. Enhanced awareness, preconception counseling, medication safety assessment, and lifestyle interventions are crucial for supporting women navigating the complex intersection of neurological and reproductive health.