How Hormones Influence GERD and Ways to Manage Symptoms

Gastroesophageal reflux disease (GERD) is a prevalent condition affecting many people in the United States. It is estimated to affect about 20% of the population, with women being slightly more affected than men. 

GERD occurs when acidic stomach contents get regurgitated back or refluxed back up into the esophagus, leading to a burning sensation in the chest. Other symptoms could include chest pain, chronic cough, sore throat, asthma, and dental erosions. Chronic GERD can lead to abnormal cells in the esophagus called Barrett’s esophagus, which can then increase the risk of esophageal cancer.

While various medications can treat GERD, numerous complementary and alternative therapies may help with less unwanted side effects. This article will primarily explore the potential connection between hormones and GERD.

It is estimated that 30-80% of pregnant women suffer from GERD. While the pressure of the growing baby on the stomach is often cited as a cause, hormonal factors may also play a significant role. Research indicates that, in addition to increased abdominal pressure and obesity, elevated levels of progesterone can reduce the tone or pressure of the lower esophageal sphincter (LES), contributing to GERD symptoms.

The LES is the valve at the bottom of the esophagus that opens and closes; when it functions properly, it prevents stomach contents from flowing back into the esophagus. Various medications can affect the strength of the LES, and both progesterone and estrogen have been linked to changes in their tone and function and are thought to be one potential mechanism of increased GERD symptoms.

A study involving postmenopausal women using hormone replacement therapy (HRT) found that women on estrogen replacement alone had a 41% increased risk of GERD. Progesterone-only therapy was linked to a 39% increased risk, while combined estrogen and progesterone hormone therapy was associated with a 16% increased risk of GERD. Aleem

Fortunately, while using estrogen, progesterone, or a combination (either through HRT or for contraceptive use) can increase the risk of heartburn, the normal fluctuations of these hormones that occur naturally during a woman's menstrual cycle have not been shown to affect the LES function or contribute to GERD symptoms significantly. 

Although some studies show there can be a link between estrogen use and combined oral contraceptive (COC) use and increased GERD symptoms, there is some conflicting data. If you are a woman taking HRT or COC and have started experiencing GERD symptoms, it may be worthwhile to consider whether the added hormones could be influencing the frequency and severity. Have a chat with your healthcare provider about alternatives that you may try.

Lifestyle Modifications for GERD

While these lifestyle modifications may not strengthen the LES, they have been shown to reduce GERD symptoms:

1. Sitting upright after eating or not eating within 4 hours of going to bed
2. Chewing food thoroughly
3. Utilizing digestive bitters or eating bitters with meals to improve stomach acid production
4. Peppermint
5. Consider Mastic gum to aid with GERD symptoms
6. Sleeping on a wedge pillow if nocturnal symptoms are problematic
7. Smoking cessation
8. Reduce or eliminate alcohol consumption

Understanding the connection between hormones and gastroesophageal reflux disease (GERD) is essential for managing this common condition. While hormonal fluctuations can influence the risk of GERD, particularly during pregnancy and with hormone replacement therapy, lifestyle modifications can play a significant role in alleviating symptoms. By adopting healthier habits and consulting with healthcare providers about hormonal therapies, individuals can better navigate their GERD management. Ultimately, awareness of both hormonal impacts and lifestyle choices empowers individuals to take proactive steps toward improving their digestive health and overall well-being.

1. _{Antunes, C., Aleem, A., & Curtis, S. A. (2023, July 3). Gastroesophageal Reflux Disease. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK441938/}
2. _{Kang, A., Khokale, R., Awolumate, O. J., Fayyaz, H., & Cancarevic, I. (2020). Is Estrogen a Curse or a Blessing in Disguise? Role of Estrogen in Gastroesophageal Reflux Disease. Cureus, 12(10), e11180. 10.7759/cureus.11180}
3. _{Salamon, M., & Golen, T. (2023, October 1). Hormone therapy linked to higher risks of GERD. Harvard Health. Retrieved September 18, 2024, from https://www.health.harvard.edu/womens-health/hormone-therapy-linked-to-higher-risks-of-gerd}
4. _{Van Thiel, D. H., Gavaler, J. S., & Stremple, J. (1976). Lower Esophageal Sphincter Pressure in Women Using Sequential Oral Contraceptives. Gastroenterology, 71(2), 232-234. https://www.gastrojournal.org/article/S0016-5085(76)80193-X/pdf/}