Menopause and dizziness: why it happens and what you can do

Most people have experienced a surge of dizziness at one point or another — have you ever stood up too quickly and suddenly felt light-headed and woozy? But in your mid 40s, you may have that sensation more and more often. That’s because dizziness and vertigo in menopause is surprisingly common. While it may be triggered by those infamous hormone shifts, there are many other potential causes too. Read on to find out what menopause dizziness may feel like, common contributors to feeling sick and dizzy during menopause, when to seek treatment, and different approaches for relief.

Dizziness can refer to many different sensations, but it’s often defined as feeling lightheaded, faint, or unsteady. Vertigo is one type of dizziness and is characterized by a false sensation of motion, almost like the room is spinning around you.

Dizziness is commonly associated with menopause as a result of changing hormone levels. Fluctuating hormones can affect more things than you think, including your inner ear function. Your inner ear is essential to your sense of balance, which is why this can lead to dizziness or even vertigo. 

Non-menopause causes of dizziness 

While it can be more common during perimenopause and menopause, dizziness may also stem from factors completely unrelated to menopause. These include:

• Alcohol

• Dehydration

• Certain foods

• Excessive tiredness

• Stress and anxiety

Other potential causes of dizziness can include:

• High blood pressure: This can reduce blood flow to your brain, which may cause lightheadedness.

• Anemia: This is a condition in which your body doesn’t have enough red blood cells to circulate oxygen around your body. Iron-deficiency anemia can make you feel dizzy and lightheaded.

• Benign paroxysmal positional vertigo (BPPV): Most common in older adults, this occurs when tiny crystals within your inner ear (called canaliths) shift out of place. Certain head movements may trigger symptoms.

• Migraines: These could impact balance and cause vertigo.

• Ear infections: If your inner ear gets inflamed, it can affect balance. 

Dizziness can also occur as a side effect of certain medications.

How clinicians distinguish dizziness from vertigo

While dizziness may be associated with being lightheaded or unsteady, vertigo is the feeling of motion and spinning. Vertigo is two to three times more common in women than men.

Your clinician may ask you questions about what you were doing when you first experienced the sensation. For example, if it was brought on by a change of position or if you’re experiencing any accompanying symptoms like nausea or head pain.

Try to give your clinician clear descriptions of your symptoms so they can narrow down potential causes and determine the best next steps.

From hormonal fluctuations to anxiety, there are many reasons why you may experience dizziness during perimenopause and menopause.

Hormonal fluctuations

The onset of menopause is marked by a decline in estrogen levels, which can disturb the delicate vestibular system of the inner ear. The vestibular system is essential to balance and spatial orientation, which is why hormonal changes may contribute to dizziness and vertigo symptoms. 

Estrogen also plays a role in various physiological systems involved in dizziness, including your neurosensory function and how you interact with the space around you. And then there’s the fact that as you go through menopause, your body may have a harder time regulating blood sugar levels, which in turn may cause you to feel dizzy. Here’s a look at some of the other factors:

Sleep disruption

Sleep issues are synonymous with the menopausal transition. In fact, up to 70% of women report sleep disturbances during this time frame. Low estrogen levels may make it harder to fall asleep, and cause lower quality sleep, so you may not feel as rested when you wake up. Plus, night sweats (intense hot flashes that wake you up) contribute to sleep disturbances. Fatigue and dizziness episodes can sometimes be related, so extreme tiredness may contribute to feelings of dizziness in menopause. 

Anxiety and stress 

The menopause transition can be a worrying time — after all, your body is going through significant change and there’s a lot to take in and wrap your head around. If your anxiety escalates to the point where you aren’t breathing normally, you can start to feel dizzy. Anxiety may also cause you to feel emotionally unsteady. This can also have a cyclic effect, where the dizziness you feel intensifies any anxiety.

Inner ear issues

Benign paroxysmal positional vertigo (BPPV) is a common cause of recurrent vertigo. With this inner ear problem, changes in head position cause a feeling of spinning. You’re more likely to experience this as you age. The reduction of estrogen associated with the menopause transition may increase the risk of BPPV. This may be partially due to decreased activation of estrogen receptors in the inner ear. Low vitamin D may also be a risk factor for BPPV in postmenopausal women. 

Migraines

Migraines are often associated with dizziness. Some women report migraines during the early stages of menopause as a result of hormone fluctuations. The varying estrogen levels during perimenopause may be a trigger — even if you’ve never experienced migraines before. 

In fact, there is a particular type of migraine called vestibular migraine. It is particularly associated with the menopausal transition and research shows that menopause is one of the key features that distinguishes vestibular migraines from other types. If you’re experiencing new or worsening dizziness during perimenopause, especially if you have a history of migraines or motion sickness, it might be a vestibular migraine.

Anemia from heavy bleeding

While the menopause transition is associated with irregular cycles and eventually the cessation of periods, some women experience heavy menstrual bleeding during perimenopause. This can lead to an iron deficiency, which can make you feel dizzy.

Remember that these are examples of what may be affecting menopausal or perimenopausal dizziness, not a diagnosis. Many other factors may be at play, including diet or medication. It’s important to discuss your symptoms with a clinician so they can guide you.

Common contributors to review with a clinician

Contributors to dizziness in menopause can be grouped into core categories:

• Cardiovascular factors (like blood pressure or heart rhythm)

• Neurologic factors (like migraines or vestibular system — sensory organs in your inner ear that affect your balance)

• Inner ear factors (including BPPV)

• Hematologic factors (including iron levels and anemia)

• Medication and lifestyle (including diet and sleep quality)

Your clinician will review your symptoms to try and determine if your dizziness or vertigo in menopause could be triggered by one of the factors above. This can help them advise on the best course of action.

Sudden dizziness can stem from a variety of different issues, but some need medical assistance. If you experience the following symptoms, seek immediate medical attention:

• Chest pain

• Shortness of breath

• Fainting

• Sudden, severe headache

• New neurological symptoms  

• Vision or hearing loss

• Severe imbalance or falls

• Vomiting 

• Nausea

• Dizziness continues after menopause

• Bleeding after 12 months without a period

As always, any sudden, severe or worsening symptoms should prompt medical advice — or if your menopause dizziness symptoms interfere with daily activities. A clinician can help identity if you have an underlying condition that needs to be treated. Remember, if in doubt, always seek emergency care.

Management of dizziness during menopause largely depends on the cause, so it’s important to inform your clinician and seek medical evaluation for frequent or severe symptoms. In the meantime, these tips may help with safety and comfort if you’re experiencing menopause or perimenopause dizzy spells:

• Sit or lie down. If you experience a dizzy spell, try to lower yourself down safely. Slow position changes may also help to reduce vertigo.

• Keep hydrated. Drink plenty of fluids, particularly water, to stay hydrated.

• Adjust your diet. To help maintain blood sugar levels, opt for small, frequent, healthy meals or snacks. You may also choose to cut down on alcohol and review your caffeine intake.

• Have healthy sleep habits. Sleeping during the menopause transition has its own challenges, but following a consistent routine may help. 

• Practice mindfulness-based stress reduction. The menopause transition can be a worrying time, so taking steps to get on top of your anxiety may help. You might want to experiment with breathing exercises, meditation, or yoga to help manage your stress.

• Work in some balance exercises. Dizziness goes hand-in-hand with feeling unbalanced, so balance exercises (if approved by a clinician) may help to strengthen important muscles.

• Make your home safer. Tidy your space, remove loose wires and rugs, and consider putting support bars in places you may need them. Keep your rooms well-lit to avoid potential hazards if you do feel a little wobbly. 

Safety steps to follow during a dizzy spell

If you experience a spell of dizziness during menopause, try to remain calm and follow these steps:

• Carefully sit or lie down as soon as you feel dizzy.

• Focus your eyes on a stationary point.

• If you have vertigo, it may help to lie with your eyes closed in a dark room.

• Avoid driving or operating any machinery until you feel better.

• Call for help if needed.

Tracking triggers and patterns

When seeking menopause help, having a symptom log can go a long way when explaining how you’re feeling to your clinician. Keep a diary to record when you have dizzy spells, including what you were doing when they started. Your symptom log can include:

• Timings

• Activities

• Food or fluid consumption

• Quality of sleep

• Any other symptoms

Dizziness in menopause can be caused by several things. Your clinician will approach your treatment based on the suspected cause of your perimenopause or menopause dizziness. For example, they may start by reviewing your current medications to see if they could be causing any side effects or if lifestyle adjustments could help. They’ll also need to address any migraine patterns and may speak to you about rehabilitation for any inner-ear conditions that may be causing your symptoms.

During menopause, your vitamin D levels decrease, so your clinician may suggest you take supplements. The reduction of vitamin D in menopause may put you at risk of vertigo reoccurrence because it’s important for the functions of your inner ear that relate to balance. 

Hormone therapy 

If you’re an appropriate candidate, hormone replacement therapy (HRT) may be suggested to help manage vertigo during menopause. HRT may help to prevent formation changes in ear crystals and prevent future vertigo episodes in people with BPPV.

HRT isn’t a suitable option for everyone, so it’s important to speak to your clinician if it’s something you’re considering as part of your menopause care plan. Your healthcare provider will be able to aid you in making a decision based on your symptom severity, personal preference, and individualized risk factors.

Perimenopause is the time before you reach menopause that is often accompanied by irregular menstrual cycles. Some women experience longer gaps between each period, which can cause heavier bleeding when you do have a period. Heavy menstrual bleeding can affect your hydration and iron levels, which may cause you to experience perimenopause dizziness.

Try to keep track of any perimenopause dizzy spells in a symptom log to see if your symptoms change within cycles. Presenting this symptom log to your clinician can also help you to feel confident when discussing your experience with perimenopause and dizziness and deciding on the best menopause treatment plan.

Dizziness and vertigo during perimenopause or menopause can be common, and there are many potential causes and contributors. These can range from hormone fluctuations, cardiovascular factors, and inner ear conditions to lifestyle factors such as sleep quality.

Simple daily habits could help, including staying hydrated, adjusting your diet (when recommended by a healthcare professional), and managing stress and anxiety associated with this stage of your life. 

Work with your clinician to help identify and manage the underlying contributors of your dizziness so you can feel steadier, safer, and supported on your menopause journey.

Find out more about how Weight Watchers can help support you through this stage of life.