Acid Reflux and Menopause: A Practical Guide
Do you have a burning in your stomach that’s becoming impossible to ignore?
Do you worry about mealtimes because you’re dreading the reflux that comes after you’re finished?
Are you sick of propping your head up in bed every night?
Trust me, I get it.
Having dealt with acid reflux in both a personal and professional setting I know that heartburn, the acidic taste in your mouth and stomach pain can seriously impact your life.
This practical guide will explain what acid reflux is, why it shouldn’t be ignored and what to do about it. Oh! And, why now in menopause is this happening.
Acid reflux isn’t necessarily a symptom you would associate with menopause but women going through the menopause are almost 3 times more likely to experience reflux than women who aren’t. (1)
So, let’s start to unpack what it is and what you can do about it.
What is Acid Reflux?
Very simply put, the sphincter (ring of muscle surrounding this part of your esophagus which opens and closes) that connects your stomach to your esophagus doesn’t close properly which can allow acid to come back up the esophagus and cause burning, along with other symptoms.
Chronic (long-term) acid reflux is called GERD (or GORD) - gastroesophageal reflux disease.
Although in society we have done a lot to normalize heartburn and acid reflux, it is strongly recommended that you do everything you can to manage the condition.
Why You Want to Make Managing Your Menopausal Acid Reflux and/or GERD a Priority:
Inflammation and damage of the tissue in the esophagus (esophagitis)
Long term acid reflux can cause swallowing issues due to the inflammation
Increased risk of ulcers in the esophagus
Increased risk of barrett’s esophagus if GERD is left untreated - a precancerous condition where the stomach acid can damage the cells and cause them to grow abnormally - it is possible that barrett’s esophagus may also not have any symptoms (2)
Increased risk of esophageal cancer
What Does Perimenopause and Menopause Have to Do With Acid Reflux?
In general, men seem to suffer worse overall with acid reflux (woohoo, women for the win on this one!), but, although there is more research needed to be done with menopause and reflux, we know that fluctuating hormones, particularly estrogen and progesterone do affect the gut. (3)
Women have slower stomach emptying times compared to men, in general, and they are thought to be affected further by the time in a woman's menstrual cycle (although some studies do contradict this).
Slow stomach emptying impacts feelings of satiety and fullness. Very slow stomach emptying can increase the potential for acid reflux.
When estrogen (estradiol) in peri/menopause drops quickly, (remember, it fluctuates a lot, then eventually declines in perimenopause and beyond), the hormone cortisol rises - it too has an impact on how quickly your gut moves food through by, once again, slowing it down. It’s a bit of a mystery why it’s different in peri/menopause, as generally lower estrogen speeds up gut transit, though it could be related to stress and cortisol levels. That said if you are on HRT generally the increased estrogen will cause an increased likelihood of reflux.
Low estrogen levels can also impact acid and bicarbonate (bicarbonate’s job is to neutralize, or counteract, the acid) secretions in the stomach which can contribute to an increase in symptoms of acid reflux.(4) Estrogen is also thought to help bolster and protect the mucosal layer in the stomach and when it declines, so too do its protective qualities (4b).
Looking for more support? Grab my Digestive Issues in Perimenopause (and beyond) Workshop. Put yourself back in the driver’s seat of your gut and “get your life back”.
Medications Commonly Used for Acid Reflux And What They Do:
PPI’s ‘ Proton Pump Inhibitors’:
They prevent certain cells from sending acid into the stomach. Omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole. With common names like Nexium. These work a little slower than H2 blockers but provide a longer, lasting relief so are more commonly used for Chronic GERD/heartburn (5).
H2 Blockers ‘Histamine2- Receptor Antagonists’:
Block a chemical that tells the stomach to produce acid. Common H2 blockers include ranitidine, famotidine, cimetidine and nizatidine. These work more quickly than PPI’s and so are more often used if the heartburn and reflux is too severe for antacids but not bad enough for PPI’s. (6)
Antacids:
Available at most grocery stores and pharmacies, they neutralise the acid in your stomach. Aluminum hydroxide, magnesium carbonate, magnesium trisilicate, magnesium hydroxide, calcium carbonate, sodium bicarbonate.
Commonly seen in store as: Gaviscon, pepto bismol and tums.
Read more about Antacids from the NHS.
Why It’s Recommended to Manage Acid Reflux With Lifestyle Changes, *if Possible*:
As with any medication, there is almost always some risk of side-effects involved, especially if you are taking the medication long-term. It’s also important to remember that there are also serious risks if you don’t take the medication you need.
The risk-benefit see-saw of medication and health conditions are always best left to pharmacists and doctors who are very equipped with their training to help you understand and manage your health conditions.
With regards to PPI’s, although more research is needed, there have been semi-recent concerns, about long term PPI use.
These concerns have included:
Occasional medication interactions (e.g. sometimes with blood thinning medications)
B12 malabsorption (7)
Low magnesium (rare)
Increased risk of hip fractures (of increased importance for perimenopausal, menopausal and post menopausal women).(8,9)
It’s always important to speak with your GP/doctor if your acid reflux is not getting better by taking medication and/or making lifestyle changes.
How to Manage Acid Reflux With Lifestyle Changes:
Regardless of if you’re taking medication for your acid reflux or not, there are some top tips for managing it successfully through some lifestyle changes, they include:
Managing your stress - no matter how zen you think you are, a little improvement in your day to day to bring stress relief can help with your reflux symptoms
Propping your head up in bed at night - grabbing an extra pillow when dealing with nighttime reflux can be helpful
Watching for your own trigger foods (e.g. spicy or acidic foods can sometimes be problematic) - keeping a food-symptom diary can be really eye-opening
Watch the fat amount in your meals and snacks. High fat meals will slow your stomach emptying (also known as ‘gastric emptying’), this can put you at increased likelihood of reflux
Slow your eating down, moderate to fast eating times can cause indigestion
Try having meals at regular intervals: Irregular meals patterns can put you at increased risk for reflux (10)
Quitting smoking - pressure in the esophagus is thought to differ when you smoke, making it more likely for you to experience reflux (11)
Reduce your Alcohol - also an enemy of sleep *quality*, alcohol can affect the esophagus and stomach by abnormal acid secretion and interfering with the mucosa in the stomach (12)
Maintaining a healthy weight - when you’re carrying weight around your mid-section, this creates added pressure on your organs, including the stomach, seek help if needed
Seek personalised advice from a dietitian, registered nutritionist or doctor. As a healthcare professional I can empathise that usually there’s probably not just one challenge you’re dealing with. Whether that be another health challenge or a busy schedule, a personalised plan can help you to see success faster.
It’s important to understand that if your symptoms persist, or get worse, you need to talk with a dietitian or registered nutritionist and doctor/GP as they will likely want to do further tests to rule out any underlying reasons.
Looking for more support? Grab the FREE Ditch Digestive Distress: Gut Control Masterclass. Put yourself back in the driver’s seat of your gut and “get your life back”.
In Summary
Acid reflux, and the symptoms associated such as heartburn and chest pain, regurgitation and acidic aftertaste can seriously impact your life, and your health, in the long term.
Changes in hormones, particularly estrogen, can cause changes in our stomach and esophagus at the time of, and around, menopause.
PPI’s, H2 Blockers and antacids are the most common medications for acid reflux. Lifestyle changes to help successfully manage reflux include, but are not limited to, eating slowly, decreasing alcohol and managing stress.
As always, I recommend working with a dietitian, registered nutritionist or doctor to help build a personalised lifestyle (and potentially medication) plan that’s right for you.
Want to learn more about gut symptoms in perimenopause along with bloating? Download our “Guide to Gut Calm for Bloating” E-book
Looking for more support? Grab my Digestive Issues in Perimenopause (and beyond) Workshop. Put yourself back in the driver’s seat of your gut and “get your life back”.
A Gutsy Menopause is a specialist gut health nutrition clinic run by nutritionist and dietitian, Emily Foster. We offer consultations, workshops and online courses.