I have noticed a trend in my vestibular therapy practice that is hard to ignore and that is the fact that a large proportion of my patients are perimenopausal women.  Can hormones be to  blame for dizziness and vertigo? The answer is yes, absolutely.  A 2018 Japanese study found that 36 percent of women aged 40-65 struggled with dizziness at least once a week.

Not only do I see an increase in vertigo during peri-menopause, I also see an up-tick in cases around puberty and the pregnancy/post-partum period.  The relationship is not well researched or understood (as are many women's health conditions), but there is some evidence that points to estrogen as being one of the hormones that play a role in the development of vertigo. 

Estrogen levels rise and fall as a part of a woman's menstrual cycle every month.  The key here is that these fluctuations are NORMAL, however the way your body responds to and tolerates these fluctuations differs from person to person.   During times of big hormonal changes such as peri-menopause or pregnancy, larger hormone shifts occur that your body may not be accustomed to. Some women's vestibular systems and nervous systems are more sensitive to these big shifts. 

The vestibular system (inner ear) can be particularly sensitive to LOW estrogen, which naturally occurs right before a menstrual period, during pregnancy and lactation as well as peri-menopause.  There are estrogen receptors in the inner ear, and low estrogen can affect fluid dynamics, blood flow and oxygen supply in the area, therefore impacting the function of the vestibular system.  This can come as mild dizziness, brain fog or even full on vertigo attacks. 

The nervous system (brain and nerves) may also respond to low estrogen. This may show up as increased anxiety, which is known to be at an increased prevelance in peri-menopausal women. Dizziness and vertigo can be symptoms un underlying anxiety disorders in some women. In fact, a large proportion of my patients, female AND male who have vertigo, also experience anxiety.  This relationship between anxiety and vertigo often causes a snowball effect where anxiety increases dizziness symptoms, and increased dizziness causes more anxiety. 

Two of the most common conditions that I treat in the clinic have a surprisingly high incidence in perimenopausal women.  Vestibular migraine and Benign Paroxysmal Positional Vertigo (BPPV).  29% of perimenopausal women experience migraines and the true number is likely higher as many women go undiagnosed.  I will often get women coming in and describing recurrent severe vertigo spells, with nausea ,unsteadiness and light sensitivity that last for a few days, and can take weeks to fully recover from.  They don't experience a headache therefore the thought that it could be migraine related usually doesn't occur to them.  Vestibular migraine does not require a headache to be involved, but often does happen to women who have a history of typical migraines in themselves or a family member.

BPPV on the other hand causes brief vertigo spells that are induced by postural changes such as sitting up from lying or rolling over in bed.  This is due to small calcium carbonate crystals that become dislodged and trapped in the semi-circular canals of the inner ear.   Because lowered estrogen can affect how the inner ear works, perimenopausal women are at an increased risk of developing BPPV.  Decreases in bone mineral density may also contribute to BPPV in aging women as it may cause the crystals to become more fragile.

Vertigo is a symptom. It should not be a diagnosis given to you at a doctors office or in an emergency room. The number of times healthcare professionals have told my patients that they have to live with these symptoms, there is nothing that can be done, is astonishing. There is an underlying condition that is causing it, whether it is vestibular migraine, BPPV, hormonal shifts or another cause. Determining the underlying cause is the first step in getting relief. Enlisting the help of an experienced vestibular therapist can help you get on the right path. Often a Naturopathic Doctor who focuses on women's health will also be essential. We can help you eliminate the vertigo episodes, reduce the amount of recurrences or lift that constant dizziness and brain fog, so that you can get back to being you!

Sources:

Estrogen https://my.clevelandclinic.org/health/body/22353-estrogen

Hultcrantz, M. et. al., Acta Oto-Laryngologica, Estrogen and Hearing: A Summary of Recent Investigations, January 2006. 

Bromberger, J. et. al., Menopause, Does Risk for Anxiety Increase During the Menopausal Transition? Study of Women’s Health Across the Nation, May 2013.

Johns Hopkins Medicine, Vestibular Migraine, 2023.

Mayo Clinic, Benign Paroxysmal Positional Vertigo (BPPV), August 2020. 

Park, JH, et. al., Medical Hypotheses, Vestibular Migraine May be an Important Cause of Dizziness/Vertigo in Perimenopausal Period, November 2010. 

Ogun, O. et. al., Menopause, Menopause and Benign Paroxysmal Positional Vertigo, August 2014.

Jeong, S, et. al., Frontiers in Neurology, Benign Paroxysmal Positional Vertigo Risk Factors Unique to Perimenopausal Women, October 2020. 

Owada, S. et. al., Nihon Jibiinkoka Gakkai Kaiho, Clinical Evaluation of Vertigo in Menopausal Women, May 2012.