If you’ve started getting heartburn or acid reflux, or existing reflux is worsening during perimenopause or menopause, you’re not alone. Research shows that women going through menopause are up to three times more likely than pre-menopausal women to develop gastroesophageal reflux disease (GORD), and several studies suggest that over 40% of women in this stage of life experience symptoms of it. One study of 497 women found that nearly 42% of perimenopausal and 47% of menopausal patients were experiencing upper gastro-intestinal symptoms, and that although the percentage of this group experiencing reflux was higher than for pre-menopausal women, 80% of the perimenopausal and menopausal women had never been diagnosed with an upper gastro-intestinal disorder such as GORD.1 Dr. Katie Hodgkinson explains the connection between acid reflux and menopause.
Hormones oestrogen and progesterone play a key role in digestion, managing inflammation, regulation of the lower oesophageal sphincter (LES), the muscle that keeps stomach acid from flowing back up into your oesophagus, and protection of the mucosa, which lines the stomach. So when oestrogen and progesterone levels decline at perimenopause and menopause, the LES can weaken, the oesophagus can become more sensitive to the acid in the stomach, digestion can slow, causing food to sit in the stomach for longer, and inflammation can increase, which can exacerbate symptoms of GORD or increase the chance of it occurring.
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It can start at any time, but it's often worse during postmenopause when oestrogen levels are at their lowest. However some women find it starts during perimenopause, when the hormones start to shift and digestion is disrupted.
There are several things that can make acid reflux more likely. Here are a few examples:
It depends. Some women find their symptoms ease over time, while others continue to have reflux due to a weakened LES, weight gain, or lifestyle habits. Discover the best and worst foods for acid reflux.
The effect of HRT on acid reflux is complex—it depends on the type of oestrogen, dosage, and the individual. Low oestrogen levels may be a cause of reflux, but too much oestrogen, especially in pill form, can over-relax the LES and over-stimulate the production of more acid.
If you’re prone to reflux but want to try HRT, oestrogen patches, gels, or sprays might be a better option since they have less impact on the LES and acid production. Oestrogen may help to protect the lining of the oesophagus from damage through its effect on reducing inflammation. Progesterone can also help by keeping digestion moving smoothly, which may reduce bloating and discomfort.
Yes, long-term reflux isn't just uncomfortable—it can lead to oesophagitis (inflammation of the oesophagus), Barrett's oesophagus (where the cells lining the oesophagus change, increasing cancer risk), and even tooth damage from years of acid exposure.
Although hormonal changes are likely to be involved in reflux at perimenopause or menopause, it is important to rule out other causes that may need further investigation. If you have new-onset reflux, if it is worsening, or if it is affecting your quality of life, talk to your doctor. Measures such as lifestyle changes, dietary changes, HRT adjustments, or medication may help to improve symptoms.
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