If you’ve started getting heartburn or acid reflux, or existing reflux is worsening during peri-menopause 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 gastro-esophageal reflux disease (GORD). One study of 497 women found that nearly 42 percent of peri-menopausal and 47 percent 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 percent of the peri-menopausal and menopausal women had never been diagnosed with an upper gastro-intestinal disorder such as GORD.(1)
Q: Why do so many women experience acid reflux during peri-menopause and menopause?
A: 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 peri-menopause 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.
Q: Does acid reflux happen more in peri-menopause or post-menopause?
A: It can start at any time, but it’s often worse post-menopause when oestrogen levels are at their lowest. But some women find it starts during peri-menopause when the hormones start to shift and digestion is disrupted.
Q: Does acid reflux happen more in peri-menopause or post-menopause?
A: It can start at any time, but it’s often worse post-menopause when oestrogen levels are at their lowest. But some women find it starts during peri-menopause when the hormones start to shift and digestion is disrupted.
Q: Are there any other factors that can affect reflux at this time?
A: There are several things that can make acid reflux more likely. Here are a few examples:
Weight gain – It is not unusual to gain weight during menopause, and carrying extra weight, especially around your waist, squeezes your stomach, pushing acid up.
Stress & anxiety – Menopausal hormonal shifts can make stress harder to deal with, and stress itself can slow down digestion, making reflux worse.
Dietary changes – If you’re drinking more coffee or wine, eating more processed foods, or snacking late at night, all of these can trigger reflux.
Q: Will acid reflux be improved by HRT, or worsened?
A: The effect of HRT on acid reflux is complex—it depends on the type of oestrogen, dose, and you. 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 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.
Q: Can acid reflux lead to serious health problems if left untreated?
A: 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, it is important to rule out other causes of reflux which 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.
1.The prevalence and pattern of gastroesophageal reflux symptoms in perimenopausal and menopausal women J Am Acad Nurse Pract 2008 May;20(5):266-72