What causes menopause dizziness, and how can you manage it?

Menopause is a natural part of ageing that happens when your ovaries stop producing eggs and make less oestrogen, causing your periods to stop. Usually, it happens between the ages of 45 and 55, but it can happen earlier or later.

Many of the symptoms that women are familiar with - hot flushes, vaginal dryness and fatigue, for example - are linked to the hormonal changes taking place in the body. A lot of women also experience dizziness. A Japanese study of women between 40 and 65 who were attending a menopause clinic - found around one third of them felt dizzy at least once a week.

As is the case with other menopausal symptoms, hormonal changes are likely to blame. However, the exact reason why menopause can lead to feeling dizzy is unknown - and there may be several factors at play.

What causes dizziness in menopause?

Changes to the ear

During the menopause, your hormones fluctuate and the changes in oestrogen and progesterone levels are known to affect your inner ear. This can affect your balance, hearing and cause you to feel dizzy¹.

Research suggests that a type of vertigo called benign paroxysmal positional vertigo (BPPV) - a condition which can cause you to feel dizzy or like you’re moving - is more common among women of menopausal age².

Blood sugar

Hormones also play a role in maintaining a healthy blood sugar level - and when you go through the menopause, hormonal changes affect how your body responds to insulin. This makes it more difficult to balance your blood sugar levels, which can make you feel dizzy.

People with diabetes may find it especially hard to manage their blood sugar levels during the menopause. It’s important to speak to your doctor to see if you need to change your blood sugar testing schedule or your medication.

Sleep problems

Exactly what causes sleep problems before and during the menopause isn’t clear, but it’s a common problem. Research suggests hormonal changes, anxiety, stress, low mood and hot flushes may contribute to poor sleep.

In particular, higher levels of the stress hormone cortisol and decreasing levels of oestrogen and progesterone have been linked to sleep disruption³. Studies have also linked poor quality sleep - like struggling to fall asleep or waking up in the night - to feeling dizzy during the day⁴.

Hot flushes

Hot flushes - the sudden feeling of intense heat over your body - are common before and during menopause⁵. Dr Krishna Vakharia, a GP and clinical director of Patient.info, says: “Hot flushes can make you feel hot and faint, which can contribute to dizziness.”

It’s thought that these flushes occur because the lower oestrogen levels cause your body to become very sensitive to minor changes in body temperature. This is because your hypothalamus - the bit of your brain that detects heat and responds accordingly - isn’t being fuelled properly by your oestrogen⁶.

Heart palpitations

Shifting oestrogen levels can affect your heart rate, which can cause palpitations. This can feel like your heart has skipped a beat or is fluttering - but with no pain - and can make some people feel dizzy.

Migraines

Dizziness is a common symptom of migraine, which can be triggered by hormonal changes before and during menopause⁷. There are different types of migraine, but they tend to consist of a very bad headache, usually with a throbbing pain on one side. You may also get dizziness, flashing lights or a tingling feeling.

Patient picks for Menopause and HRT

Women's health

What's behind the HRT shortage in the UK?

Women across the UK are struggling to get hold of their hormone replacement therapy prescriptions due to ongoing manufacturing and supply issues.

by Milly Evans

Women's health

Menopause

The menopause is the time when your ovaries stop working to make an egg each month - it occurs 12 months after your last period. The perimenopause is the time when your periods are getting less regular and you are said to be in the postmenopause when your last period was more than 12 months ago, and this is not due to your periods stopping for another reason such as the use of a contraceptive that stops your periods.

by Dr Hayley Willacy, FRCGP

Tips for coping with dizziness during menopause

Lifestyle changes

Drinking plenty of water and staying hydrated can help with dizziness, as can eating small meals and healthy snacks throughout the day to keep your blood sugar levels stable.

Try to choose foods that won’t cause your blood sugar to spike, like nuts, eggs, avocado, full-fat yoghurt or hummus. Keeping a food diary can help you identify any triggers, for example, if sugary foods increase the likelihood of you developing a migraine.

If you’re struggling with anxiety or low mood, speak to your doctor. You can also self-refer for counselling on the NHS. Regular exercise - like a walk, yoga or gym class - can help you manage stress.

It’s also important not to drive if you feel dizzy. If you feel faint or dizzy, sit down and wait for the feeling to pass.

See your doctor

If you are struggling with menopause symptoms like dizziness, it’s important to speak to your doctor. They may recommend hormone replacement therapy (HRT). Although HRT can increase your risk for certain health conditions, like stroke, heart attack, and breast cancer - depending on the type of HRT, you can weigh up the pros and cons with your doctor. They can also make sure your dizzy spells aren’t caused by anything else.

“You should see your doctor if dizziness is affecting your life, or if you have any faints, falls, or ‘absences’ - where you blank out, lose track of time or experience memory loss,” says Vakharia. These absences can be the sign of a seizure or a problem not related to menopause.

If you have any symptoms that aren’t linked to menopause, such as a seizure, stroke, a high fever, neck stiffness or chest pain, this is a medical emergency and you should call an ambulance.

The signs of a stroke include sudden numbness or weakness in the face, arm or leg - especially on one side of the body - confusion, trouble speaking, dizziness, difficulty understanding speech, sudden vision problems and loss of balance.

Further reading

1. Jeong: Benign paroxysmal positional vertigo risk factors unique to perimenopausal women.

2. Liu et al: Age-related increases in benign paroxysmal positional vertigo are reversed in women taking estrogen replacement therapy: A population-based study in Taiwan.

3. Lee et al: Sleep disorders and menopause.

4. Kim et al: Relationship between sleep quality and dizziness.

5. Owada et al: The relationship between vasomotor symptoms and menopause-associated dizziness.

6. Padilla et al: A neural circuit underlying the generation of hot flushes.

7. Park et al: Vestibular migraine may be an important cause of dizziness/vertigo in perimenopausal period.