You’re Not Imagining It: Menopause Can Cause Nausea

Hot flashes and night sweats get all the attention but there are plenty of less-discussed symptoms of perimenopause and menopause. Including a dodgy stomach.  If you’ve been feeling a little pukey lately, depending on where you are in your transition, perimenopause nausea or menopause nausea could be why.

“No one talks about nausea in perimenopause, and I don’t know why,” says Julie Holland, M.D., a psychiatrist and psychopharmacologist in private practice in New York City and author of Moody Bitches: The Truth About the Drugs You’re Taking, The Sleep You’re Missing, the Sex You’re Not Having, and What’s Really Making You Crazy. 

Nausea is not as common as other menopause symptoms like hot flashes, night sweats, or mood changes, according to the Cleveland Clinic. Although, research suggests that your risk of developing GI issues—including feeling queasy—goes up in perimenopause (3). And several women in the r/Menopause subreddit say they experience the under-discussed symptom.

We’re here to talk about it. But before we dive in, let’s define some terms. Perimenopause is a period of time (the years leading up to menopause); menopause is a moment (12 months after your final period); and post-menopause is the years after that moment. To keep things simple, when we say “menopause,” we’re encompassing the entire menopause transition, or all three of these phases.

About the Experts

Jim Staheli, D.O. is the medical director of Broad Health, and a family medicine doctor in Atlanta, GA. He specializes in hormone health, metabolic and nutritional medicine, anti-aging, and functional medicine.

Julie Holland, M.D., is a psychiatrist and psychopharmacologist in private practice in New York City. She is the author of Moody Bitches: The Truth About the Drugs You’re Taking, The Sleep You’re Missing, the Sex You’re Not Having, and What’s Really Making You Crazy.

Nausea and Menopause

What’s going on in your body to make you feel queasy, and how long does perimenopause nausea last? There are several possible factors at play, says James Staheli, D.O., medical director of Broad Health and a family medicine doctor in Atlanta, GA. These are a few of the biggies:

Lower progesterone

Progesterone levels go down as we get older. “Lower progesterone leads to an increase in bloating, indigestion, and heartburn,” says Staheli, “as well as a decrease in gut motility, digestion, and delayed gastric emptying. All of this can lead to nausea.” 

Lower estrogen

Dropping estrogen levels can also trigger nausea in perimenopause and menopause. “Lower estrogen can lead to an increase in adrenaline, which can also cause nausea,” Staheli notes. 

Hot flashes

Hot flashes (and cold flashes) are the big menopause marquee symptom, and guess what? Because they come out of nowhere, they may make you feel anxious, and that anxiety can lead to feeling nauseated, according to Cleveland Clinic.

Medication

And adding to the joy, medication used to manage hot flashes can sometimes have nausea as a side effect. Hormone changes—just like the ones that send morning sickness into overdrive during pregnancy—can make you feel green. That includes the ones you naturally go through during perimenopause and when you introduce new hormones into your system through hormone therapy.

Don’t give up on HRT just yet. Nausea from hormone therapy should resolve within a few weeks as your body adjusts to treatment. If your queasiness persists on oral hormone therapy, talk to your doctor about other forms of HRT (like topical creams or transdermal patches).

Migraines

Women suffer migraines more than men in general, and they get worse during perimenopause, according to research— over 12% of women in perimenopause get them as compared to 8% for the younger women in a study of over 3500 women (1). Migraines “are often caused by a sudden drop in estrogen, also leading to nausea,” says Staheli. (Frequency of migraines drops off once you’re postmenopausal.)

Stress and our crazy busy lives

Our brain and our gut have always been in communication–think butterflies in your stomach when you’re nervous, or getting physically sick if you see something disgusting or highly emotional. That has to do with the enormous number of nerves in your digestive tract, which have a two-way dialog with your central nervous system.

All that means is when we feel stress, the physical symptoms may show up in our stomachs as nausea. Given all women in their 40s and 50s have going on, who can blame us for being nauseated? We’re the sandwich generation, often dealing with the stress of caring for both parents and children. We may be coping with anxiety related to aging in general, feeling over-tasked and/or under-appreciated at work, worrying about finances in retirement (or whether we can afford to retire at all), or experiencing new marital challenges with an also-aging spouse. We may be having self-esteem issues related to primenopause weight gain and a changing body shape. Not to sound flippant, but there’s a lot to feel nauseated about.

The good news is that it doesn’t last forever. Nausea in perimenopause usually goes away as you age and your hormones level out, says Holland.

More Menopause

Perimenopause Fatigue Is Real. Here’s What to Do About It

What Causes Brain Fog in Menopause—And What Helps? 

Nausea and Hormone Fluctuations

Nausea in menopause can feel just like morning sickness, and just as likely to hit early, when you first wake up. And just like morning sickness during pregnancy, it can come any time of day. This is because the gut has hormone receptors that get triggered when your levels are too high or too low, says Holland. 

“For me, it felt exactly the way morning sickness did,” she says. “And just like when I was pregnant, it helped to eat something as soon as I got up. I was going to yoga, and it was better for me not to puke in down-dog.” 

If you’ve ever been pregnant and experienced morning sickness, you can revisit some of the same strategies that worked for you, like ginger, herbal teas, acupressure bands on your wrists. You can also take comfort that like morning sickness, these symptoms won’t last forever. 

Still, the issue of whether hormone fluctuations in menopause can cause nausea calls for more research. “Nausea and other symptoms of perimenopause are so understudied,” sighs Holland. “And I always ask, ‘Who’s going to pay for this study?’ Clinical research costs money. Way more than you think. And women are under-represented in medical research, in clinical research,” she says. “Most of what we know about the human body and changes over the lifecycle is from studying male animals and male people.”

How Long Does Menopause Nausea Last?

In general, in perimenopause, your cycle becomes erratic. “Expect the unexpected!” Holland says. “If you had PMS when you were younger, you may experience the big-girl version of PMS, with wild mood swings, a changing sex drive, nausea, diarrhea, bloating, and fatigue.” 

Luckily, most of these symptoms are temporary; those wild swings level out, and the body adapts after all the rapid changes and transitions of perimenopause. When you’re post-menopause, that nausea related to swooping and diving hormone levels will almost certainly abate, she says.

Preventing and Treating Nausea

Staheli offers a wide variety of options that could provide perimenopause nausea relief: 

• Eating plant foods containing phytoestrogens, such as walnuts, apples, and soy. Phytoestrogens may affect you in the same way as estrogens in the body.  
• Avoiding spicy foods, alcohol, and caffeine 
• Eating smaller, more frequent meals
• Drinking ginger tea, peppermint tea, or ginger ale 
• Eating peppermint, cinnamon, lemon, or ginger candy 
• Eating sour or lemony foods 
• Experimenting with salty foods, like broth
• Eating fermented foods or trying probiotic supplements to improve digestion
• Reviewing your current medications, HRT protocol, and supplements with your doctor

Holland, a registered prescription prescriber of medical cannabis, also notes, “I’ve found cannabinoids can be very effective with nausea,” she says. It is often prescribed for people undergoing chemo for the same reason. Holland has used it herself, in fact. “It truly helped my nausea in perimenopause.” Talk to a prescriber, as getting the correct strains is important to ease nausea.

When Should You See a Doctor About Nausea in Menopause?

Call 911, says Staheli, if your nausea is accompanied by chest pain, shortness of breath, a recent head injury, severe abdominal pain, vomiting blood, high fever, blurred vision or eye pain, disorientation, or a stiff neck, as, depending on your symptoms, it could be something more serious, including a heart attack, brain bleed, severe concussion, or pancreatitis.

For long-term garden-variety nausea in perimenopause and menopause—especially if it interferes with your daily living (this is true of the other troublesome symptoms of the menopause transition) talk to your doctor about hormone replacement therapy. A major, long-term study of millions of women called The Women’s Health Initiative recently made headlines again for repeated findings that for many women, the risks of HRT are far outweighed by the benefits (2).

Most importantly, be kind to yourself during this transition. “Menopause can be an awkward phase of life, like adolescence. But there’s a lot more space in our culture to talk about fertility coming online than going offline,” says Holland. “At least in adolescence, you get an allowance! An allowance to have pimples and be moody! You get a bit of a pass for the awkwardness of the transition from kid to adult. It’s a bummer that women don’t get as much grace for that transition. That said, I do have friends wearing funky overalls and dying their hair purple. When estrogen goes away, you don’t care as much what other people think of you. That can be super-liberating.”