Hot Flashes and Dizziness: Why Menopause Throws You Off Balance

Hot flashes and night sweats are the most well-known menopause symptoms. But other, less obvious, changes can catch you completely unaware, leaving you wondering how to cope or even whether what you’re experiencing is related to menopause. Dizziness, which often accompanies hot flashes, is one of them.

Even OB-GYNs can fail to connect dizziness to menopause. “Initially, I didn’t think dizziness and menopause were much of an issue. But when I started thinking back, I realized I hear some variant of dizziness [quite often]—either dizzy, lightheaded, feeling faint, weak, ringing in their ears, or feeling woozy,” says Carol Lynn, M.D., an OB-GYN who specializes in menopause management.

One study of over 450 peri- and post-menopausal women found that about 36 percent experience dizziness symptoms at least once a week. ¹

Dissiness may accompany hot flashes or appear on its own, Lynn says. While it’s usually not a sign of a serious health issue, it can disrupt daily life. Fortunately, there are ways to reduce or even resolve menopause dizziness and hot flashes.

About the Experts:

Carol Lynn, M.D., is a board-certified OB-GYN who specializes in menopause management. She is a member of the American Board of Obstetrics & Gynecology and the Menopause Society.

Lauren Whooten, BHSc, MSc, PT, is a vestibular-rehabilitation therapist and an assistant clinical professor at the School of Rehabilitation Science at McMaster University.

Melissa Castillo Bustamante, M.D., is an otolaryngologist, a Harvard University Fellow in otopathology, and the lead researcher of a 2024 study into menopause and vertigo.

Causes of Dizziness and Hot Flashes

Blood vessel dilation and inner ear changes are primary contributors to dizziness and hot flashes during menopause. Other factors—like stress, anemia, blood sugar fluctuations, and certain medications—can heighten your risk.

Hormonal fluctuations

Estrogen helps regulate KNDY neurons in the hypothalamus, a brain region that controls body temperature. As estrogen declines during perimenopause and menopause, these neurons become overstimulated, making the hypothalamus hypersensitive to even small shifts in body temperature. ² This can trigger hot flashes, which can lead to dizziness.

When your temperature rises, blood vessels dilate to release heat, diverting blood from the brain and potentially causing lightheadedness, explains Lynn. When those vessels constrict again to cool you down, sudden changes in blood pressure can add to the dizzying effect.

Estrogen also helps stabilize norepinephrine and serotonin, neurotransmitters involved in temperature regulation. When estrogen declines, these neurotransmitters can fluctuate, disrupting thermoregulation and contributing to hot flashes and subsequent dizziness. ³

“Decreasing progesterone levels can [also impact] the hypothalamus, making it much more sensitive to temperature changes,” Lynn notes.

Inner ear changes

Research in Menopause suggests menopause-related hormone changes can affect the inner ear, leading to benign paroxysmal positional vertigo (BPPV), a condition marked by brief episodes of dizziness, spinning, or lightheadedness. ⁴ Notably, 48 percent of BPPV sufferers experience their first episode after menopause.

Women in perimenopause also might experience dizziness because the inner ear relies on estrogen for optimal function. The inner ear is part of the vestibular system—a sensory system that helps us maintain balance and spatial awareness. ⁵ Low estrogen can affect fluid dynamics and blood flow in the vestibular system, causing anything from mild dizziness to vertigo attacks, says Lauren Whooton, a vestibular-rehabilitation therapist. ⁶

Low progesterone is another cause of dizziness during menopause. “Decreasing progesterone also affects the vestibular system and can increase the chances of vertigo and dizziness,” Lynn says. ⁷ Additionally, low estrogen can impact the otolithic membrane, where calcium crystals help detect head movement, causing these crystals to grow abnormally and trigger menopause dizziness or vertigo, says otolaryngologist Melissa Castillo Bustamante, M.D. ⁸

Migraines

Menopause-related drops in estrogen can also cause dizziness by triggering vestibular migraines—bouts of vertigo marked by nausea, balance issues, and light sensitivity, says Whooton. These migraines happen because of estrogen’s role in the trigeminovascular system, a network of neurons and blood vessels tied to migraine and headache disorders. ⁹

Stress and anxiety

Anxiety, which often ramps up in the menopause transition, may also contribute to BPPV-related dizziness. ^{10 11}

Research in BMC Psychiatry found people with anxiety were 2.2 times more likely to develop BPPV. ¹². Another study found anxiety was the single independent factor most strongly associated with frequent dizziness in perimenopausal and postmenopausal women. ¹³

Several mechanisms may explain the connection between menopause anxiety and dizziness:

• Vasopressin, a hormone released during stressful situations, can cause inner ear fluid buildup, affecting balance.
• Anxiety may activate the body’s inflammatory response, leading to inner ear inflammation and issues like BPPV.
• Stress-induced rapid heartbeat, sweating, and blood pressure changes can also cause dizziness, Lynn explains.

Stress and anxiety can also amplify hot flashes, which can then trigger dizziness. A 2021 paper in PLOS One found that women experiencing stressful events were 21 percent more likely to report vasomotor symptoms. Cortisol, the stress hormone, may mimic or exacerbate the hormonal imbalances behind hot flashes. ¹⁴

Medication

Certain medications often prescribed to women in midlife can contribute to perimenopause dizziness and hot flashes. These include:

• Tricyclic antidepressants. These drugs increase serotonin and norepinephrine levels. High norepinephrine levels have been shown to disrupt the hypothalamus’s ability to regulate body temperature, leading to hot flashes. ^{15 16 17} They can also cause the blood vessels to constrict, which can lead to sudden drops in blood pressure, triggering dizziness. ¹⁸
• Blood pressure medications. Calcium channel blockers affect blood vessel dilation, which can increase blood flow, leading to hot flashes. ¹⁹

Talk to your doctor before making any changes to your medications.

Anemia

Perimenopausal women may experience heavier or longer periods, which can lead to anemia, an iron deficiency.

“Anemia can cause dizziness due to shifts in blood volume to more necessary organs and an overall volume depletion. It can also cause a racing heart, leading to dizziness and lightheadedness, especially if standing up too quickly from a lying or sitting position,” Lynn says. ²⁰

Blood sugar fluctuations

Lower estrogen levels may lead to sharper blood sugar swings during menopause, which can contribute to dizziness and hot flashes. ²¹ Both high and low blood sugar levels can contribute to hot flashes and dizziness, Lynn says. High blood sugar can also damage blood vessels in the inner ear, impacting balance. ²²

Additionally, reduced estrogen may impair the brain’s ability to regulate glucose via the GLUT1 transporter, causing blood flow shifts that can trigger hot flashes, which could then amplify dizziness. ²³

Treatment for Perimenopause Dizziness and Hot Flashes

The best solution for you will depend on what’s causing your symptoms. So it’s important to work with your healthcare provider before deciding on a course of treatment for perimenopause dizziness and hot flashes.

HRT

Hormone replacement therapy (HRT) has been shown to reverse BPPV symptoms like dizziness and improve hot flash severity and frequency in postmenopausal women. ^{24 25}

Low estrogen in particular seems to play a key role in the development of dizziness and hot flashes due to the estrogen receptors in the inner ear and blood vessels, so estrogen-containing HRT can help ease these symptoms, says Lynn. Your doctor may suggest estrogen-alone HRT or combined HRT (which contains estrogen and progesterone).

In a study about BPPV frequency after menopause, researchers found that women taking estrogen-replacement therapy had a significantly lower risk of BPPV than those who weren’t. ²⁶. And there’s a wealth of research showing that HRT can be safe and effective at treating hot flashes and night sweats, calming a crucial part of the hypothalamus’s thermoregulatory response.

One caution: when you first begin taking HRT, it can cause dizziness. This typically goes away as your body adjusts, Lynn says.

Other medications and supplements

• Selective serotonin reuptake inhibitors (SSRIs) may help ease hot flashes and dizziness. One study found fluvoxamine improved dizziness in those with anxiety and depression. ²⁷ Other research has shown that SSRIs can effectively reduce hot flash frequency. ²⁸
• Vitamin D. Deficiency is common in postmenopausal women and linked to BPPV. About 50 to 80 percent of postmenopausal women don’t get enough of the nutrient. ²⁹ There’s also some evidence that correcting a vitamin D shortfall can improve hot flash symptoms, but more research is needed to confirm the link. ³⁰
• Iron. If anemia-related menstrual changes are the cause of perimenopause dizziness, an iron supplement may help.

Lifestyle changes

In addition to HRT and other medications, some simple lifestyle changes can help minimize menopause dizziness and hot flashes.

• Stay well hydrated. Dehydration can cause blood pressure drops that worsen dizziness, Lynn says.
• Eat a balanced diet. Eat small, frequent meals; pair carbs with protein-rich foods; and limit sugar or refined carbs in order to minimize blood sugar swings, since these are known to worsen dizziness and hot flashes. ³¹
• Avoid alcohol, tobacco, and spicy foods. Certain foods can trigger hot flashes and disrupt blood vessel function, Lynn says.
• Manage stress and anxiety: Techniques like mindfulness or therapy can ease both dizziness and hot flashes, Lynn says.
• Consider vestibular rehabilitation therapy. This form of physical therapy can greatly help the brain relearn appropriate balance, correcting dizziness and vertigo, including BPPV, says Castillo Bustamante.

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About the author

Mirel Zaman is a seasoned health journalist with over 15 years of experience reporting on wellness, fitness, nutrition, and healthcare disparities. She's committed to evidence-based reporting and a focus on underrepresented topics including hormone imbalances.

About the reviewer

Dr. Shelly Chvotzkin, D.O., F.A.C.O.O.G., is a physician board certified in obstetrics and gynecology. She is a member of the American College of Osteopathic Obstetricians and Gynecologists (ACOG), the American Osteopathic Association (AOA), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the Menopause Society (formerly known as the North American Menopause Society or NAMS).