Reproductive hormones influence the epidemiology, pathophysiology, and treatment of migraine. Studies have consistently demonstrated an increased prevalence of migraine among adult women compared with men, with hormonal differences playing an important role in this disparity. Specific hormonal epochs including menarche, infertility treatments, pregnancy, perimenopause, menopause, and gender-affirming hormonal therapy can distinctly influence migraine manifestations and inform treatments. In this chapter, we review the epidemiology of migraine as influenced by sex and distinct hormonal epochs. We will also discuss treatment considerations unique to menstrual migraine, migraine during pregnancy, perimenopause, and gender-affirming hormonal therapy.