Menopause and Reflux: Understanding the Connection

The Surprising Link Between Menopause and Reflux

Does it seem like you have more reflux now that you’re in menopause (or perimenopause)? It’s likely not just your imagination.

As a woman still riding the menopause rollercoaster, the idea for this article came from my own experience. I’ve had reflux on and off throughout my adult life, but a few months ago, it seemed like my reflux episodes were becoming more frequent. I figured it was just the usual: eating too late at night, having a too-big dinner, etc. Except that, even when I consciously made sure to eat moderately and early, I still frequently had painful reflux—and not just at night, which was new for me. So I looked into it; here’s what I found out. 

Reflux and GERD are more common in menopausal (and perimenopausal) women.

A 2008 study that surveyed nearly 500 women found the prevalence of GERD symptoms in perimenopausal and menopausal women to be high—42% and 47%, respectively. And this, even though 80% of the women in that study had never been diagnosed with an upper gastrointestinal disorder. 

A recent population-based study found that post-menopausal women were “3.5 times more likely to have GERD” than premenopausal women. They also found that menopause was a bigger risk factor for GERD than smoking, alcohol consumption, and diabetes, among others. Clearly, there is some connection between menopausal status, reflux, and GERD symptoms, but more study is needed. 

What causes increased reflux during menopause?

A few possible causes have been put forth, but given that there have not been a lot of studies on the topic, answers are far from definitive. According to researchers, these look like likely causes: 

• Hormone levels: In the previously mentioned 2008 study, researchers concluded their findings were “strongly suggestive of a hormonal link” between perimenopause and menopause and increasing GERD symptoms. Both estrogen and progesterone can impact the lower esophageal sphincter (LES) in ways that allow stomach acids to come back up. In perimenopause, estrogen levels fluctuate, often higher than usual, while progesterone decreases. This situation promotes reflux and GERD symptoms.  

• Certain medications: Taking medications becomes more common as we age, and as it turns out, several of them also increase the risk of reflux symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are most commonly used in older people and are known for being GI-unfriendly. One-third of people who take NSAIDs develop reflux and GERD symptoms. But other medications, such as aspirin, certain blood pressure drugs, osteoporosis drugs, and some medicines for anxiety and depression, can also trigger reflux symptoms.

• Weight increase: People who are overweight or have obesity are more likely to experience reflux. Lower estrogen levels in the later stages of menopause foster weight gain, presumably due to its impact on other hormones that control fullness and appetite. Disrupted sleep, common in perimenopause and menopause, is clearly associated with weight gain.

Does hormone therapy play a role in increased reflux with menopause?

There is debate over whether hormone therapy (either progesterone only or a combination of estrogen/progesterone) during perimenopause and menopause makes reflux more or less likely.

Typically, women in menopause (especially later menopause) will have lower levels of both estrogen and progesterone, which would decrease reflux symptoms—unless they are taking hormone replacement therapy (HRT), which increases hormone levels. A 2021 study found that in post-menopausal women with a higher risk of GERD than premenopausal women, taking HRT had no impact on that risk.

Bottom line

Realize that much of what happens during the infamous “change of life” is not in your control. Your hormone levels are important, but they’re not the be-all-all for your health status during this time. Your decision regarding hormone replacement therapy involves considerations beyond its potential influence on your GI symptoms and warrants thorough discussion with your doctor. Beyond that, you can focus on taking good care of yourself, including minimizing your risk factors for GERD and acid reflux.   

1. _{Infantino M. (2008). The prevalence and pattern of gastroesophageal reflux symptoms in perimenopausal and menopausal women. Journal of the American Academy of Nurse Practitioners, 20(5), 266–272.}
2. _{Shibli, F., El Mokahal, A., Saleh, S., Fass, R. (2021). Menopause is an important risk factor for GERD and its complications in women. American Journal of Gastroenterology 116, S168-S169.}
3. _{Prior, J., Hitchcock, C. (2011). The endocrinology of perimenopause: need for a paradigm shift. Front. Biosci. (Schol Ed) 3(2), 474–486.}
4. _{Tai, F. W. D., & McAlindon, M. E. (2021). Non-steroidal anti-inflammatory drugs and the gastrointestinal tract. Clinical medicine (London, England), 21(2), 131–134.}
5. _{Lizcano, F., & Guzmán, G. (2014). Estrogen Deficiency and the Origin of Obesity during Menopause. BioMed research international, 2014, 757461.}
6. _{Fenton A. (2021). Weight, Shape, and Body Composition Changes at Menopause. Journal of mid-life health, 12(3), 187–192.}