Menopause isn’t just a shift in a woman’s fertility. As fertility declines, female reproductive hormones, like oestrogen and progesterone, also begin to decline. Women may notice symptoms like mood changes, vaginal dryness, and digestive discomfort.

Heartburn, acid reflux, and indigestion may appear even if they were never a problem before. In fact, around 42% of perimenopausal women and 47% of menopausal women struggle with acid reflux. While symptoms are mostly mild, understanding the condition can help relieve them, and knowing when to visit the doctor.

What Is Acid Reflux and GERD?

Acid reflux occurs when stomach acid flows back into the food pipe (oesophagus). The acid irritates the oesophageal lining, causing the familiar symptoms. These include:

• Heartburn

• Chest discomfort or pain

• Regurgitation

• Throat irritation

Some acid reflux is normal, especially after large meals or fatty foods. However, if acid reflux is repeated and prolonged, it’s known as gastroesophageal reflux disease (GERD). That’s a medical condition requiring treatment.

Why Menopause Can Trigger Acid Reflux

Perimenopause occurs as the number and function of follicles within the ovaries decline. These follicles contain eggs which release hormones such as oestrogen and progesterone. Once the egg supply is depleted, declining oestrogen levels are inevitable.

Oestrogen is responsible for numerous functions within the body. One notable function is its role in digestion and metabolism, influencing how fast the stomach empties, as well as muscle tone. When levels shift during midlife, it can lead to acid reflux.

The Role of Oestrogen in Digestive Health

Oestrogen helps regulate muscle tone and inflammation in the digestive tract. When oestrogen levels decline, the risk of acid reflux can increase through two main mechanisms:

1. Reduced muscle tone. Lower oestrogen levels can weaken the lower oesophageal sphincter (LES), the valve connecting the stomach to the oesophagus. Normally, the LES prevents stomach contents from flowing backward. But when it weakens, pressure inside the stomach can more easily force acid up into the oesophagus.

2. Slower stomach emptying. Hormonal changes can slow stomach emptying and gut motility. If the stomach stays fuller for longer, the pressure inside it increases. Combined with a weaker LES, this increases the likelihood of reflux.

Alongside these mechanisms, declining oestrogen may also increase the sensitivity of the oesophageal lining. As a result, even mild reflux can feel like more intense heartburn.

Why Heartburn Is Common During Perimenopause

Heartburn first begins during perimenopause when oestrogen levels start to decline. While oestrogen is the main factor (as described above), there are several other contributors:

• Weight gain around the abdomen

• Increased stress and sleep disruption

• Changes in diet or alcohol intake

• Slower digestion

Each of these factors either weakens the LES or increases abdominal pressure. But they also present a way to control symptoms. By losing weight, managing stress, or minimising alcohol intake, you can lower your risk of acid reflux, or at least reduce the severity of your symptoms.

Symptoms of Menopause-Related Acid Reflux

For some women, heartburn and menopause go hand-in-hand. But ohers may not experience any acid reflux throughout the change.

If you struggle with menopause-related GERD, you may notice:

• Burning sensations in the chest (heartburn)

• Chest pain or discomfort

• Acid taste in the mouth

• Regurgitation

• Difficulty swallowing

• Chronic cough or throat irritation

• Symptoms that worsen at night or after meals

Remember, perimenopause isn’t a straight line. Hormone levels continue to fluctuate throughout the process, so your symptoms can mirror these hormonal cycles.

How to Manage Acid Reflux During Menopause

Managing acid reflux during menopause consists of two approaches: (1) treating the acid reflux and (2) treating the menopause.

Treating Acid Reflux

You can relieve acid reflux by making lifestyle changes. Some effective techniques include:

• Eat smaller meals

• Avoid trigger foods (spicy, fatty, acidic foods)

• Reduce alcohol and caffeine

• Maintain a healthy weight

• Avoid lying down immediately after eating

• Elevate the head of the bed or use an extra pillow

If that doesn’t work, it’s worth speaking to your doctor. They can prescribe antacids for temporary relief or proton pump inhibitors to reduce your stomach’s production of acid. These medications can help prevent symptoms long term.

Treating Menopause

Menopause is a normal bodily process. Oestrogen levels naturally decline with age as fertility ends. However, hormone replacement therapy (HRT) offers a way to increase levels of oestrogen, reducing the symptoms associated with menopause.

It’s usually not recommended if you’re struggling with acid reflux alone. But if you’re dealing with several symptoms that accompany menopause, HRT can help.

When to See a Doctor

Acid reflux can increase during menopause. It’s not the only cause, however. If you notice any of these red flags, always speak to a doctor:

• Severe or frequent reflux

• Difficulty swallowing

• Unexplained weight loss

• Symptoms not responding to medication

The Functional Gut Clinic offers advanced 24-hour acid reflux testing to accurately measure acid reflux, potentially identifying the true cause of your symptoms. Get in touch with us if you’re struggling with menopause-related acid reflux.

You might want to read the following interesting article: Oesophageal Stricture: Symptoms, Causes & Treatment