At 31, can CGRP inhibitors for migraine affect my fertility?

Question

Hello doctor,

I have been suffering from chronic migraines for years, and my neurologist has suggested I start preventive injections like CGRP inhibitors. While I am hopeful they will reduce my migraine attacks, I am worried about their impact on my menstrual cycle and hormones.

I read that some migraine treatments can make periods lighter or heavier, especially injections. I want to balance controlling my migraine and protecting my reproductive health. Also, I am 31 and planning for pregnancy

Do these injections interfere with ovulation or fertility?
Is it safe to continue them while trying to conceive or during pregnancy?
Are there risks of miscarriage, complications in IVF, or harm to the baby if I am on these injections?
Do these treatments affect menopause timing or cause hormonal imbalance in the long run?
Would switching to birth control pills help with both migraines and contraception, or could it worsen my condition?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Calcitonin Gene-Related Peptide (CGRP) inhibitor injections such as Erenumab, Fremanezumab, Galcanezumab, and Eptinezumab work by blocking the CGRP pathway involved in migraine attacks rather than affecting hormones directly. Current evidence suggests that these medicines do not interfere with ovulation, fertility, or menstrual cycles.

These medicines are generally not recommended during pregnancy or breastfeeding because adequate human safety studies are not yet available. If you are planning a pregnancy, most guidelines recommend stopping CGRP inhibitor injections before trying to conceive. Due to their long half-life, some experts suggest a washout period of about 5 to 6 months. At present, there is no evidence showing that these medicines cause miscarriage or reduce IVF success.

CGRP inhibitors do not affect estrogen or progesterone levels and are not associated with hormonal imbalance or early menopause. They are also not known to make menstrual periods heavier or lighter.

Regarding birth control, women who have migraines with aura are usually advised to avoid estrogen-containing contraceptive pills because of the increased risk of stroke. In women with migraine without aura, these pills may sometimes be used, although they can occasionally worsen headaches. Progestin-only pills or nonhormonal contraceptive methods are often considered safer options.

For a 31-year-old woman planning pregnancy, the treatment approach depends on the timeline for conception. Regarding pregnancy planning, you can follow the steps mentioned below.

It may be better to avoid CGRP inhibitor injections.
Consider alternative preventive strategies such as lifestyle modifications, Magnesium, Riboflavin, or medicines considered relatively safer during pregnancy, including Propranolol or Amitriptyline under medical supervision.
If pregnancy is planned several years later, CGRP inhibitors may still be useful for migraine control now, but they should ideally be stopped well before attempting conception.

Feel free to ask further queries.

Thank you.