- Nausea During Menopause?
- So what causes menopausal nausea?
- How to manage the nausea of menopause
- Track triggers
- Know the timing
- Make choices to feel better
- Are You Pregnant or Starting Menopause? Compare the Symptoms
- Why does menopause trigger nausea?
- Can nausea be a side effect of hormone replacement therapy (HRT)?
- Link between perimenopause and nausea
- Home remedies for nausea and menopause
- Perimenopause: The Ovary’s Frustrating Grand Finale
- Nausea and the menopause
- An introduction to nausea and menopause
- Why does the menopause cause nausea?
- What home remedies are there for nausea?
- I recommend joining our 7 day menopause plan
- Are there herbal remedies to help me?
- What about conventional remedies?
- Introduction to Menopause
- What is menopause?
- When does menopause occur?
- What are the symptoms of menopause?
- What can I do about hot flashes?
- Treatment for menopause
- Are Headaches a Symptom of Menopause?
Nausea During Menopause?
Nausea is not a typical symptom of menopause, and I don’t hear much about it from my patients, though it is more common than previously realized. Unfortunately this area hasn’t been well studied — there are no rigorous studies looking at the frequency of nausea during menopause, and there’s little known about optimal treatments for it. That said, the fact that you have this symptom is something to pay attention to and look into.
There’s a theory that nausea during menopause may be related to progesterone deficiency, so some doctors treat this symptom with progesterone cream or tablets. However, I strongly discourage the use of progesterone for treating this symptom, as it’s been linked to the risk of breast cancer, venous thrombosis, and does have some adverse effects on cholesterol too. I also don’t recommend taking hormone therapy for this symptom alone; only consider it if nausea is accompanied by moderate to severe hot flashes, night sweats, and other symptoms of menopause.
To help relieve your nausea, you can try ginger, ginger ale, herbal teas (some may calm the stomach), and saltine crackers — things that you use in general to treat nausea. There are over-the-counter treatments for nausea (such as Benadryl) that you can take, but ideally you should avoid taking them regularly since all drugs come with risks. Also, you don’t want to get into a situation where you take a drug so frequently that you become dependent on it. Be sure to see your doctor if you’re considering any treatment for your nausea beyond dietary modifications. And if you don’t respond to the treatments and/or your nausea is severe, see your doctor to make sure the symptom isn’t related to a more serious underlying health problem.
Nausea: it’s not just for pregnancy. What causes some women to feel nauseated, even to the point of vomiting, during perimenopause and menopause?
It’s not a common occurrence, and even the women who experience it tend to have it a few days a month rather than all the time, but still, it’s unpleasant and disruptive enough for women to want a solution.
So what causes menopausal nausea?
Spoiler alert: there hasn’t been much research on this particular symptom, so the best we have are some educated guesses.
The most common theory we were able to find points at progesterone deficiency causing nausea in menopause. So if nausea was present during your regular menstrual cycles or during pregnancy, you may find yourself dealing with it again in perimenopause and menopause.
According to Dr. Arianna Staruch, Dean of the School of Naturopathic Medicine at Bastyr University, in menopause, nausea can be due to GERD (gastroesophageal reflux disease) or slow digestion.
Other causes can include dehydration, particularly if you find yourself nauseated first thing in the morning, and low blood sugar levels, if you haven’t eaten well or enough that day. Fatigue, poor sleep, intense hot flashes, stress, and migraines can also participate in making us feel sick.
How to manage the nausea of menopause
Treatment of the nausea often requires landing on a cause, so the first thing to do might be to check with your doc.
Things to consider:
- Are you taking any new medications?
- Have you changed your diet in any significant way?
- Could you be pregnant? (less likely in perimenopause, but not impossible)
- Is there a lot of stress in your life? (new job, money concerns, relationship issues, aging parents)
- Could it be something else, like ulcers or diabetes, that may require medical intervention?
Once you’ve eliminated the more dangerous possible causes, there are things you can do to manage, reduce, or maybe even eliminate your nausea.
Is there a pattern to your problem? If you’re still having periods, even irregularly, you might be able to get a clue from tracking your nausea against your cycle. Does it seem to happen a few days ahead of your cycle starting?
Food and drink may also be causing the symptom. Are you drinking enough water? Have you developed a sensitivity that wasn’t present before (many of us find it harder to digest dairy as we age)? Did you have more wine or coffee than usual the day before?
Check your over-the-counter meds: did you take some pain relievers that might cause stomach upset? Are you taking iron or another supplement that might be causing stomach pain?
Is there a potential stressor in your life: a weekly visit or phone call with parents, maybe a regular task that causes stress, or a new concern that’s disrupting your regular sleeping and eating patterns?
Is the nausea related to other menopause symptoms like hot flashes, heart palpitations, anxiety, or insomnia?
Know the timing
When does it strike? First thing in the morning? After a meal? The more information you can uncover about patterns, the better your chances of landing on a cause or avoiding a trigger.
Make choices to feel better
For many, the nausea of diminishing progesterone is a temporary problem, and once your body adapts, you may be able to return to life as usual (ish). But while you have this issue, you may want to make a few adjustments:
- Avoid spicy and/or greasy foods. Cut back on sugar or dairy or alcohol, if any of those are related to your stomach upset. Eat smaller, more frequent meals, and take your time while eating. Be sure to drink a lot of water during meals, as that can help with digestion. Don’t skip meals, even if you’re feeling queasy; having no food in your stomach can make matters worse. Just choose something good and bland, like white rice or crackers.
- If your issues are due to GERD (which is similar to heartburn), there are lifestyle changes that might help, says Dr. Arianna: “Reducing or eliminating coffee, reducing or eliminating alcohol, not eating a large meal before bed, watching spicy food, chocolate and peppermint.” If those changes don’t help, she says, you’d be wise to look for another cause for your symptoms.
- If the nausea is accompanied by feeling overly full and bloated (and not because you ate too much), you may not be digesting food well, according to Dr. Arianna. “As we get older we may produce less acid and fewer digestive enzymes. Supplementing with digestive enzymes with every meal and using herbal bitters before meals may be helpful. However,” she warns, “herbal bitters would not be helpful if you have GERD.”
- For really bad days, an over-the-counter nausea solution can be a good temporary help (Pepto-Bismol), but don’t become reliant on it. It’s great for treating symptoms, but it doesn’t usually help heal the root cause. Our Director of Health, Dr. Rebecca Dunsmoor-Su, says, “Often the nausea we see in pregnancy is really acid reflux, and it could be the same issue in menopause. So I suggest ginger, and if that doesn’t work, a medication like Zantac can help.”
- Drink fruit teas or peppermint tea. You may want to cut back on caffeine, so why not replace the irritant with something soothing? Just don’t overdo any of it, as too much of anything can cause stomach issues.
- Invest in a yoga class. Stretching, Pilates, tai chi, meditation… all are good for calming our minds which can translate to a calmer tummy. Exercising too much and too hard can cause stomach upset, so maybe swap out the HIIT for a walk in the woods every now and again.
- Reduce stress. I know, we laugh too, every time we hear it, because the modern world seems to be built on stress, but honestly, can you find ways to make life easier on yourself? Pack a week’s worth of lunches on Sunday afternoon, delegate a few tasks where you can, learn to say “no” to things you know are going to make life more difficult.
- Exercise and sleep. Get enough of both. 30 minutes a day of gentle exercise can actually help calm things down on the inside, especially if your exercise of choice is a walk with friends where there are trees. Trees are really good for us, it turns out, so try and find some to commune with. As for sleep, turn off your screens two hours before bedtime. It’s really hard to unplug, we know, but it’ll pay dividends in better sleep and better health generally.
Like most menopause symptoms, whether or not a woman suffers from it and how much is individual to the woman. But no one needs to suffer debilitating symptoms alone. Talk to your MD or ND to determine why you’re feeling nauseated and to discuss solutions for managing the nausea until your body adapts to its new normal.
For more information, you can also test your knowledge and gain some in the process from our quiz on menopause here.
Are you dealing with menopause nausea? How have you handled it? You can comment here, find us on Facebook or in Midlife & Menopause Solutions, our Facebook group. You can also join us, anonymously, if you prefer, on our community forums.
Are You Pregnant or Starting Menopause? Compare the Symptoms
Changes in menstrual cycle
Women who are pregnant or in perimenopause will see shifts in their menstrual cycle because of hormonal changes. A missed period is a tell-tale sign of pregnancy, while irregular periods may mean the onset of menopause.
Signs of irregular menstruation include changes in blood flow, light spotting, and longer or shorter periods. It’s important to remember that irregular periods could indicate another condition. Speak with your doctors about any concerns.
Learn more about conditions that can lead to a missed period “
Fatigue and sleep problems
Fatigue and problems with sleep can occur in pregnancy and during perimenopause. In pregnancy, fatigue is caused by soaring levels of progesterone, which may cause you to become sleepy. In perimenopause, you are more likely to have trouble sleeping and staying asleep, which can cause you to become more tired than normal.
Hormonal changes cause mood swings in pregnancy and during perimenopause. In pregnancy, mood changes may cause you to be unusually emotional and weepy. In perimenopause, these changes may show as moodiness, irritability, or an increased risk of depression.
Headaches appear in both perimenopause and pregnancy. In both cases, headaches are caused by changes in hormones. In menopause, a loss of estrogen can cause headaches. During pregnancy, an increase in hormones may be the cause of increased headaches.
Headaches can also be caused by lack of sleep, stress, and dehydration, among other issues.
Weight gain happens gradually during pregnancy. As your baby grows, so does your belly. It’s recommended that women who are pregnant gain no more than 35 pounds, though your diet and other issues may cause additional weight gain.
During menopause, your metabolism slows down, which makes it harder to maintain a healthy weight. Hormonal changes may also cause you to gain weight around your abdomen.
Read more: Menopause and weight gain “
Problems with peeing
You may find that you are peeing more often during pregnancy. That’s because the increase in blood causes your kidneys to process more fluids, which end up in your bladder.
During menopause, however, loss of tissue tone may cause you to lose control of your bladder. Incontinence can also happen during pregnancy.
Changes to sex drive
Hormonal changes can affect your sex drive both in menopause and pregnancy. You’re more likely to have a low sex drive during menopause. During pregnancy, your libido can increase or decrease.
Bloating and cramping
Your uterus may cramp early in pregnancy. Changes to hormones can also cause bloating.
Bloating and cramping may also occur in perimenopause. In perimenopause, cramping may be a signal that you’re about to start your period.
Read more: Menopause and bloating: What’s the connection? “
Hot flashes and night sweats
Hot flashes and night sweats are commonly associated with menopause, but they may also be early signs of pregnancy.
During a hot flash, you’ll feel a quick rush of heat that can cause you to sweat and your face to become red and flush. You may also sweat excessively during sleep, which can wake you up during the night and lead to fatigue.
The most common menopause symptom may be hot flashes, but many women also experience nausea. In fact, they may not even realize that their nausea may be due to menopause, as this isn’t something discussed as much as other common menopause symptoms.
Nausea is an uncomfortable feeling in the upper stomach. When one is nauseous, they have an intense feeling as if they are going to vomit – and yet most of the time they don’t.
Aside from being a symptom of menopause, nausea could also be a side effect of hormone replacement therapy, which is commonly used to treat menopause.
Why does menopause trigger nausea?
The exact link between menopause and nausea is unclear, but it may be due to hormonal changes. Pregnant women experience morning sickness due to hormone fluctuations, and the same may go for menopause.
Plus, a drop in hormones may result in other gastrointestinal symptoms like bloating, indigestion, and heartburn, which are all other triggers of nausea in menopause.
Nausea may also be worsened by stress and fatigue, which are also common in menopausal women. You may find relief from your nausea by treating and managing your stress and fatigue.
Menopausal hot flashes, causing an intense feeling of burning and rising temperatures followed by shivering and chills, also can bring about nausea.
Can nausea be a side effect of hormone replacement therapy (HRT)?
Hormone replacement therapy is a common treatment for menopause. Women going through menopause see fluctuations and even drops in their hormone levels, and HRT aims to restore some of these hormones. If a woman is already going through harsh symptoms of menopause, she may also experience negative side effects from HRT, including nausea.
HRT can reduce the risk of osteoporosis, colon cancer, and heart disease, but it could increase the risk of blood clots and breast cancer, on the other hand. Before getting on HRT, it’s important that you discuss all the pros and cons with your doctor.
Link between perimenopause and nausea
Perimenopause is the transitional stage leading up to menopause. Extensive research has been done on perimenopause and other common menopause symptoms like insomnia and hot flashes, but little is known about nausea and perimenopause.
Some theories suggest that nausea in perimenopause is brought about by changing hormone levels. Although the research is limited, there are many reports of women complaining of nausea during perimenopause, suggesting a strong association between the two.
Home remedies for nausea and menopause
Although nausea can be a discomforting feeling, there are some home remedies that you can try to help ease nausea along with other menopause symptoms:
- Ensure you eat plenty of nutritious foods
- Partake in regular exercise
- Aim to get a good night’s sleep
- Reduce stress
- Get fresh air
- Drink herbal teas
- Find ways to control your emotions
- Avoid spicy, greasy, and fatty foods
- Control blood sugar levels
- Avoid hot temperatures
- Avoid areas with strong smells
- Avoid coffee, soda, and sugary beverages
- Cut down on your portion sizes during times of nausea – stick with bland foods until the feeling passes
- Stay well hydrated with water
If these home remedies aren’t enough, you may need to speak to your doctor about medical treatments to help you deal with your nausea and other menopause symptoms.
Perimenopause: The Ovary’s Frustrating Grand Finale
Women in midlife increasingly hear the words “estrogen deficiency” spoken as the ultimate in bad news. “Everyone knows” that low estrogen levels cause heart disease, osteoporosis, Alzheimer’s and absent libido. But as Dr. Susan Love (renowned breast surgeon and author of Dr. Susan Love’s Hormone Book) states, “If estrogen deficiency’s a disease, all men have it!” (1).
Our purpose here first is to put women’s midlife concerns into a new and more accurate hormonal picture. Specifically, I’d like to present new information about high estrogen levels in the perimenopause. Not low, not even normal, but estrogen levels that are higher than those of the (sexiest) 20 year old female! Secondly, I’ll discuss how a woman can tell when her estrogen levels are high and out of balance with progesterone, the other important hormone for women. And finally, we’ll review the many ways a woman can help herself through perimenopause, “Estrogen’s storm season!”
What is perimenopause?
Women have often called “menopause” everything they experience during the changing times of midlife, but now that we know about perimenopause, it’s important to use the right names. Menopause means that a year has passed since a woman’s last period. Perimenopause refers to the long and changing time until the end of no flow. The first change may be more PMS, night sweats, a new migraine, or sleep trouble and fatigue. On average the perimenopause lasts several years and commonly lasts six or seven. The good news is that perimenopause ends! I am an expert on the perimenopause primarily because I have now graduated! I survived a rough perimenopause and my own experiences told me that the experts had it all wrong about dropping estrogen!
What’s the evidence that perimenopausal estrogen levels are high?
A dozen or so studies in the last 20 years have set out to measure hormone levels in perimenopausal women. Each study reports the data and summarizes by saying that estrogen levels are dropping. Surprisingly, few bother to mention the high levels they found (2). When all of the studies are put together, and the average perimenopausal estrogen levels are compared with average levels in young women, it is clear that the levels are higher, and significantly so (3).
Let’s consider estrogen levels from 300 Australian perimenopausal women taken during the end of flow (2). The data presented as a scatter plot indicates a wide range of hormone levels. Not only are most of the levels as high or higher than the average end of flow estrogen level for 20-35 year olds but many are even higher than the average mid cycle estrogen levels (peak in the cycle) in 20-35 year olds. Clearly many of these perimenopausal women had very high estrogen levels. But what did the very good scientists say in summary about their data? “Perimenopause is characterized by dropping estrogen and inhibin levels and rising FSH levels” (2).
The study cited above (2) mentioned a strange hormone called ‘inhibin’. I believe it is because inhibin, the normal brake type hormone begins to slack off in its job of keeping the pituitary’s Follicle Stimulating Hormone (FSH) in line, that the perimenopausal ovary goes through its grand finale (4). FSH starts to increase, stimulates several rather than just one follicle (the nest of estrogen producing cells surrounding an egg) and estrogen levels increase and become unpredictable (3).
How can a women know when her estrogen levels are high or out of balance with progesterone?
There are many clues and they differ between women, and in one woman over time. Early in the process of my perimenopause, I dreamed I was going to have a baby and woke thinking I had really lost it! At fifty, with my two children grown, the last thing in the world I wanted was to be pregnant. But after some thought, I began to understand that it was my subconscious self’s way of saying goodbye to the fertile part of my life.
Many of the things I felt in that dream, however, are also high estrogen signs: swollen and tender (sometimes lumpy) breasts, increased vaginal mucous and a heavy pelvic feeling almost like cramps or swelling. High estrogen and progesterone levels in pregnancy are normal and necessary, but in the perimenopause, estrogen is high but progesterone is not. It is this imbalance that can cause significant difficulties for many women.
Dr. Patricia Kaufert, a scientist from Winnipeg who has done one of the best studies about what women experience during perimenopause, found that women were likely to have a flooding menstruation just before their periods changed from regular to skipping(5). But heavy flow, bleeding at shorter intervals than 3 weeks, continual spotting or flow every two weeks, and clotting with cramping are all signs that estrogen is too high and progesterone is too low. Any period is too heavy if you soak more than 16 pads or tampons.
It is normal for the breasts to swell during the week before flow and it is sometimes normal to feel tenderness in the front or nipple area when estrogen hits a high midcycle peak. But swollen breasts most of the time, or front-of-the-breast soreness for more than a couple of days of the month means high estrogen.
During the perimenopause many women occasionally become forgetful and sometimes can’t remember what they were saying. We now know that stress makes for memory problems. And the high estrogen levels of the perimenopause (on top of the necessary stress of moving through this major life change) make cortisol and other stress levels higher. No wonder it feels like PMS-city! One nurse said it very well, “At (peri)menopause life can turn into one long pre-menstrual experience. Hormones slap you up against the doors of your unfinished business” (6).
Are hot flushes (or flashes) from low estrogen?
If periods every month tell a women that her estrogen level is normal, and if hot flushes are caused by low estrogen levels, how come so many perimenopausal women start having hot flushes when periods are perfect? The answer is that the brain has become used to the young normal estrogen levels and when it has been exposed to the high levels during the perimenopause, it rebels when those levels drop, even to what is normal. What happens with a hot flush is like what a drug addict goes through during withdrawal — a major brain discharge of stress and other hormones. It is this hormonal discharge (along with the flush) that causes the anxious feelings, nausea and chest pain as well as the feeling of heat and the sweating that go with them. So if someone tells a women her flushes are in her head just tell them that “darn tootin” they are!
I first twigged that I was perimenopausal when I woke abruptly one dark November morning in 1990 feeling MAD! I looked for a cause — my dog and my partner were sleeping soundly, all was quiet in the house and the neighborhood. But my heart was pounding, my legs wouldn’t lie still and I was ready to do battle. Then I felt a weak and woozy wave of heat and began to sweat. A day later my period started, and I had no more night sweats until the day before my next period. I had learned an important thing — in the early years of perimenopause, night sweats are a clue that your period is coming.
Another new observation is that women who have increased premenstrual symptoms early in the perimenopause are more likely to have a difficult time with hot flushes at the end of the perimenopause and in the early menopause. That information came from the same Australian study we talked about earlier (7). Perimenopausal premenstrual-like symptoms are caused by high estrogen levels. It makes sense that the brain would react when the high levels drop to normal or become normally low in menopause.
What can women do to help themselves through the rough times in the perimenopause?
The first and most important thing is to realize that, ready or not, this is a time of major change — change in body, even change in concept of one’s self (8). A number of years ago I was captured on a National Film Board video “Is it hot in here?” saying I was only 22 times 2 and was looking forward to menopause as a normal phase of life! But, when perimenopause hit me, although my mind said I was okay with it, although I have all the children I ever wanted, and despite my fulfilling job and lots to look forward to, I went through times of real sadness. Losing youth, fertility and even predictable periods is a justifiable reason for feeling blue. It will help women deal with this natural sadness if they can talk with friends, family and perhaps even a counselor about these important and often hidden deep feelings. I also suggest reading a book by Vancouver counselor, Lafern Page, Menopause and Emotions: making sense of feelings when feelings make no sense (8). Your library, book store or health unit can tell you how to get your hands on a copy.
The next and most important thing is for women to take time to care for themselves. A friend of mine and important pioneer in the work of bringing perimenopause information to BC women, retired public health nurse, Pat Chadwick, says the first two letters of the word menopause are ME! That means women need to take time out for exercise, meditation, a cup of coffee with a friend, and to say no to more overtime, or continuing to make their 12 year old’s lunch. I would also urge women to take a multiple vitamin so they have enough vitamin D (especially important because we can’t make enough vitamin D through the slanty northern sunshine exposure we get in B.C. from October through March) and to get at least 1500 mg/day of calcium (which has recently been shown to help with PMS and which also helps sleep, restless legs and other nerve irritability signs).
To help women deal with hot flushes, they can take 400 to 800 IU of vitamin E each day, besides regular exercise, relaxation and slow deep breathing. Recent evidence also says that eating foods made from soy such as soy milk or tofu on a regular basis will decrease hot flushes (9).
Most important is what can women do about periods, flooding, cramps and the risk for anaemia? If a woman is regularly soaking over 12 pads or tampons during her whole period, I suggest she take one green iron tablet (ferrous gluconate) a day. This can be purchased from the drugstore without a prescription (but be sure to tell your doctor what you are doing). For cramps, as well as to decrease heavy flow, ibuprofen (Advil, Motrin or generic) 200 mg, can be used at the first hint of cramps and two or three times a day during flow. This has been shown to decrease the amount of blood loss. If the cramps are really bad, take two tablets initially and take one more each time you start to get the heavy pelvic feeling that cramps are returning.
If taking ibuprofen (and supplementing with iron) doesn’t resolve the perimenopausal flow problems and risk for low blood counts and if bleeding lasts longer than a week or occurs at shorter than 3 week intervals, the family doctor should be seen. Physicians can give you a prescription for progesterone whose job is to prevent estrogen’s over-stimulation of the lining of the uterus. Progesterone can also control and even stop flow. It should be taken days 14 to 27 after the first day of flow. It may be necessary to take high doses for a number of months. Unless both the woman and her doctor decide that at least six months of full or high dose cyclic progesterone hasn’t helped significantly, there is no need for a referral to a gynecologist, an endometrial biopsy, a D & C or a pelvic ultrasound. Like the rest of perimenopause – this will get better!
So, let’s review. We have talked about the perimenopausal puzzle of high rather than low estrogen and the paradox that many believe estrogen treatment will help. Now women will be able to recognize when estrogen is too high and will know that, although it is miserable, it is normal and will pass. They can figure out what is happening both when they get night sweats and when they experience PMS. Most importantly, when flow is abnormal and persists in being so, they can seek cyclic progesterone treatment to help bring their hormones into balance. And if they can’t cope with PMS, sleeplessness and night sweats before their period, they should ask their doctor for the more expensive natural progesterone (Prometrium); 3 capsules at bedtime, days 14-27 of your cycle. My patients have found it made the transition easier.
Most of all, understand that you, like me, can survive the perimenopause!
Finally, as Ursula LeGuin, the science fiction writer says “The woman who is willing to make that change must become pregnant with herself, at last” (10).
- Love S: Doctor Susan Love’s Hormone Book. San Francisco: Random House, New York, 1997; 1-348.
- Burger HG, Dudley EC, Hopper JL, et al: The endocrinology of the menopausal transition: a cross sectional study of a population based sample. J.Clin.Endocr.Metab. 1995; 80: 3537-3545.
- Prior JC: Perimenopause – The complex endocrinology of the menopausal transition. Endocr.Rev. 1998; 19: 397-428.
- Prior, J. C. Perimenopause the Ovary’s Frustrating Grand Finale. A Friend Indeed 15(7), 1-4. 1998.
- Kaufert PA, Gilbert P, Tate R: Defining menopausal status: the impact of longitudinal data. Maturitas 1987; 9: 217-226.
- Kelsea M: Beyond the stethoscope: a nurse practitioner looks at menopause and midlife. In: Women of the 14th Moon: writings on menopause. Sumrall AC, Taylor D, eds. Freedom, California: The Crossing Press, 1991; 268-279.
- Guthrie JR, Dennerstein L, Hopper JL, Burger HG: Hot flushes, menstrual status, and hormone levels in a population based sample of midlife women. Obstetrics and Gynecology 1996; 88: 437-442.
- Page L: Menopause and emotions: making sense of your feelings when your feelings make no sense. Vancouver: Primavera Press, 1994; 1-241.
- Murkies AL, Lombard C, Strauss BJG, Wilcox G, Burger HG, Morton MS: Dietary flour supplementation decreases post-menopausal hot flushes: effect of soy and wheat. Maturitas 1995; 21: 189-195.
- LeGuin UK: The Space Crone. In: Women of the 14th Moon: writings on menopause. Sumrall AC, Taylor D, eds. Freedom, California: The Crossing Press, 1991; 3-6. Copyright Jerilynn C. Prior October, 1998
Nausea and the menopause
An introduction to nausea and menopause
Nausea can be extremely unpleasant, and many people do not realise that it is sometimes a symptom of the menopause. Nausea most often occurs during the peri-menopause, and the symptom is usually at its worst in the morning. It can be accompanied by other PMS-like symptoms.
Nausea can be described as an uncomfortable feeling usually in the upper stomach, characterised by an urge to vomit. Although this feeling usually precedes vomiting, this is not always the case with the menopause.
Nausea may also be a side-effect of HRT. If this is the case, you may want to consider a different type of HRT, or an alternative.
Why does the menopause cause nausea?
Although the exact link between the menopause and nausea is not yet fully understood, it is thought that a change in hormone levels causes the symptom. Similar to pregnancy causing morning sickness, the menopause is a time of your life when your hormones are radically fluctuating, in particular, the hormones oestrogen and progesterone.
It is thought that reduced levels of the hormone progesterone cause gastrointestinal problems such as bloating, indigestion and heartburn, all of which may also lead to nausea.
Additionally, nausea may be caused or worsened by stress or fatigue. Both of these conditions are commonly associated with the menopause. If you are feeling overworked, then looking for ways of improving this may help to lift your feeling of nausea.
Lastly, severe menstrual pain or cramps can give rise to nausea.
What home remedies are there for nausea?
Looking after your digestive system is often the first way to avoid or improve your symptoms of nausea. If you eat fatty, greasy or spicy food you are more likely to feel the after-effects of it. Avoiding eating altogether can also worsen your nausea. Instead, try to eat a small amount of very plain food, such as crackers. It is important not to eat too much, but a little may help to settle your stomach. Making sure that your blood sugar is balanced is important, as low blood sugar may contribute to your symptoms.
Avoid sitting in a hot, stuffy or smelly room, as this will only make you feel even queasier. Try to get some fresh air and breathe deeply, as this will create a rhythmic pattern in the stomach. Unless your nausea is unbearable, then keeping yourself occupied and your mind off the nausea will often help you get through the day.
It’s also important to consider what you drink. Try to avoid tea, coffee, sugary and fizzy drinks.
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Are there herbal remedies to help me?
As the causes of nausea during the menopause can be broad, there are a number of ways to help relieve the symptom.
Most commonly, nausea comes at the early part of the menopause when a woman is still menstruating (more or less) regularly, and accompanied by PMS-like symptoms, such as period pains or bloating. If this is the case, try Agnus castus in the first instance.
TIP: Do not take Agnus castus if you are on hormonal contraceptives as it may not be suitable for you.
If your periods have stopped and you are experiencing nausea because of the menopause, try a supplement containing soya isoflavones.
TIP: Menopause Support contains isoflavones from fermented soya beans, hibiscus and magnesium. It is a general menopause supplement to see you through all points in this stage of your life.
If your nausea is unexplained or does not resolve despite attempts at treating the symptom, seek advice from your doctor in order to rule out other causes other than the menopause.
What about conventional remedies?
If you have not found a combination of home and herbal remedies to be effective, then it may be time to look for a conventional medicine. It is important to consult your doctor, before taking medications, as then you will be able to find the most effective treatment for you. Treatments include antihistamines and steroid treatments.
If your nausea is a side-effect of HRT then you may be able to find an alternative type of treatment. You will need to consult with your doctor to see what is available and suited to you.
Introduction to Menopause
What is menopause?
When a woman permanently stops having menstrual periods, she has reached the stage of life called menopause. Often called the change of life, this stage signals the end of a woman’s ability to have children. Many healthcare providers actually use the term menopause to refer to the period of time when a woman’s hormone levels start to change. Menopause is said to be complete when menstrual periods have ceased for one continuous year.
The transition phase before menopause is often referred to as perimenopause. During this transition time before menopause, the supply of mature eggs in a woman’s ovaries diminishes and ovulation becomes irregular. At the same time, the production of estrogen and progesterone decreases. It is the big drop in estrogen levels that causes most of the symptoms of menopause.
When does menopause occur?
Although the average age of menopause is 51, menopause can actually happen any time from the 30s to the mid-50s or later. Women who smoke and are underweight tend to have an earlier menopause, while women who are overweight often have a later menopause. Generally, a woman tends to have menopause at about the same age as her mother did.
Menopause can also happen for reasons other than natural reasons. These include:
Premature menopause. Premature menopause may happen when there is ovarian failure before the age of 40. It may be associated with smoking, radiation exposure, chemotherapeutic drugs, or surgery that impairs the ovarian blood supply. Premature ovarian failure is also called primary ovarian insufficiency.
Surgical menopause. Surgical menopause may follow the removal of one or both ovaries, or radiation of the pelvis, including the ovaries, in premenopausal women. This results in an abrupt menopause. These women often have more severe menopausal symptoms than if they were to have menopause naturally.
What are the symptoms of menopause?
These are the most common symptoms of menopause. However, each woman may experience symptoms differently. Some have few and less severe symptoms, while others have more frequent and stressful ones. The signs and symptoms of menopause may include:
Hot flashes or flushes are, by far, the most common symptom of menopause. About 75% of all women have these sudden, brief, periodic increases in their body temperature. Usually hot flashes start before a woman’s last period. For 80% of women, hot flashes occur for 2 years or less. A small percentage of women experience hot flashes for more than 2 years. These flashes seem to be directly related to decreasing levels of estrogen. Hot flashes vary in frequency and intensity for each woman.
In addition to the increase in the temperature of the skin, a hot flash may cause an increase in a woman’s heart rate. This causes sudden perspiration as the body tries to reduce its temperature. This symptom may also be accompanied by heart palpitations and dizziness.
Hot flashes that happen at night are called night sweats. A woman may wake up drenched in sweat and have to change her night clothes and sheets.
Vaginal atrophy is the drying and thinning of the tissues of the vagina and urethra. This can lead to pain during sex, as well as vaginitis, cystitis, and urinary tract infections.
Relaxation of the pelvic muscles
Relaxation of the pelvic muscles can lead to urinary incontinence and also increase the risk of the uterus, bladder, urethra, or rectum protruding into the vagina.
Intermittent dizziness, an abnormal sensation, such as numbness, prickling, tingling, and/or heightened sensitivity, cardiac palpitations, and fast heart rhythm may occur as symptoms of menopause.
Changing hormones can cause some women to have an increase in facial hair or a thinning of the hair on the scalp.
While it is commonly thought that mental health may be negatively affected by menopause, several studies have indicated that menopausal women suffer no more anxiety, depression, anger, nervousness, or feelings of stress than women of the same age who are still menstruating. Psychological and emotional symptoms of fatigue, irritability, insomnia, and nervousness may be related to both the lack of estrogen, the stress of aging, and a woman’s changing roles.
What can I do about hot flashes?
Hot flashes occur from a decrease in estrogen levels. In response to this, your glands release higher amounts of other hormones that affect the brain’s thermostat, causing your body temperature to fluctuate. Hormone therapy has been shown to relieve some of the discomfort of hot flashes for many women. However, the decision to start using these hormones should be made only after you and your healthcare provider have evaluated your risk versus benefit ratio.
To learn more about women’s health, and specifically hormone therapy, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the Women’s Health Initiative (WHI) in 1991. The hormone trial had 2 studies: the estrogen-plus-progestin study of women with a uterus and the estrogen-alone study of women without a uterus. Both studies ended early when the research showed that hormone therapy did not help prevent heart disease and it increased risk for some medical problems. Follow-up studies found an increased risk of heart disease in women who took estrogen-plus-progestin therapy, especially those who started hormone therapy more than 10 years after menopause.
The WHI recommends that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It states that hormone therapy should not be taken to prevent heart disease.
These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Although hormone therapy may be effective for the prevention of postmenopausal osteoporosis, it should only be considered for women at significant risk of osteoporosis who cannot take nonestrogen medicines. The FDA recommends that hormone therapy be used at the lowest doses for the shortest time needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their healthcare providers.
Practical suggestions for coping with hot flashes include:
Dress in layers, so that you can remove clothing when a hot flash starts.
Avoid foods and beverages that may cause hot flashes, like spicy foods, alcohol, coffee, tea, and other hot beverages.
Drink a glass of cold water or fruit juice when a hot flash starts.
Reduce your stress level. Stress may worsen hot flashes.
Keep a thermos of ice water or an ice pack next to your bed during the night.
Use cotton sheets, lingerie, and clothing that allow your skin to breathe.
Keep a diary or record of your symptoms to find what might trigger your hot flashes.
Treatment for menopause
Several therapies that help to manage menopause symptoms including:
Hormone therapy (HT)
Hormone therapy (HT) involves the taking a combination of the female hormones estrogen and progesterone during perimenopause and menopause. HT is most commonly prescribed in pill form. However, estrogen can also be given by using skin patches and vaginal creams.
The decision to start using these hormones should be made only after you and your healthcare provider discuss the risks and benefits.
Estrogen therapy (ET)
Estrogen therapy (ET) involves taking estrogen alone, which is no longer being made by the body. ET is often prescribed for women who have had a hysterectomy. Estrogen is prescribed as pills, skin patches, and vaginal creams.
The decision to start using this hormone should be made only after you and your healthcare provider discuss the risks and benefits.
This type of treatment often involves the use of other types of medicines to relieve some of the symptoms associated with menopause.
Estrogen alternatives are the so-called “synthetic estrogens,” like ospemifene, improve symptoms of vaginal atrophy without affecting endometrial cancer risk.
Homeopathy and herbal treatments, often called bioidentical hormones, may offer some relief from some symptoms of menopause. However, there are concerns about potency, safety, purity, and effectiveness.
Are Headaches a Symptom of Menopause?
A number of medications can help treat or even prevent migraines. Some are available over the counter. Others require a doctor’s prescription.
Diet and lifestyle changes can also help to reduce the number of headaches you have or alleviate your symptoms.
What you eat can have a huge impact on your headaches. Keep in mind that what triggers your headaches won’t be the same for someone else. Because of this, you may want to keep a food diary to determine what your headache triggers may be.
When you experience a headache, write down what you ate in the hours before. Over time this may help you find dietary patterns. If a pattern emerges, you should try limiting that item. From there, you can determine if cutting this out of your diet has an effect on your headaches.
Common dietary triggers include:
- alcohol, especially red wine
- aged cheeses, such as Parmesan
- dairy products
Regular physical activity may also help to prevent headaches. Aim for 30 minutes of exercise three to four times each week. Spinning or swimming classes are two great choices. A nice walk outside is easy and accessible, too.
It’s important to go slow in your activity goals. Let your body warm up gradually. Jumping into a high-intensity workout right away could actually trigger a headache.
This is a form of alternative medicine that uses thin needles to stimulate your body’s energy pathways. Acupuncture stems from traditional Chinese medicine and is used to treat various types of pain. Views on its effectiveness are mixed, but you may find that it helps you.
Biofeedback and relaxation therapies are two types of behavioral therapies known to help some people deal with severe headaches. These use different techniques to control how your body physically responds to stress, muscle tension, and even pain.
Cognitive behavioral therapy (CBT) is slightly different. CBT teaches you stress relief techniques, as well as how to better deal with stressors or pain. It’s often recommended that you pair CBT with biofeedback or relaxation therapy for best results.
Certain nutritional supplements have shown some success in limiting headache frequency. Vitamin B-2, butterbur, and magnesium may be your best bets for headache prevention. Vitamin D and Coenzyme Q10 may also be beneficial. You should check with your doctor before adding these to your regimen to make sure you’re not taking any unnecessary risks.