What causes heartburn during menopause and what can you do?

Acid reflux is when the valve at the top of your stomach leaks, allowing acid to travel up your oesophagus and into your throat. It causes heartburn, that burning sensation in your chest. Regular acid reflux is also known as gastroesophageal reflux disease (GERD or GORD).

During perimenopause, or after menopause, you’re three times more likely to have acid reflux than earlier in your life. Scientists believe fluctuating levels of reproductive hormones play a role here but they don’t yet fully understand how this works.

Heartburn and other symptoms of acid reflux are often worse after meals and when you go to bed, and can have a huge impact on your quality of life.

Certain foods can trigger acid reflux, while smoking, stress and being above a healthy weight are also risk factors.

Lifestyle changes, including altering your eating and sleeping habits, can reduce heartburn and other symptoms of acid reflux. There are also medications and over-the-counter products that may help.

Specially designed probiotic supplements like The Better Gut can improve a whole range of perimenopause and menopause symptoms, including some that have an impact on acid reflux and other digestive issues.

You can find out more about these beneficial bacteria here. For regular expert tips on menopause health and nutrition – and 10% off your first The Better Gut order – join our newsletter.

Symptoms of acid reflux

The terms acid reflux and heartburn are often used interchangeably, but heartburn – a burning sensation in the centre of your chest – is actually a symptom of acid reflux.

Heartburn is caused by stomach acid that has leaked through the valve between your stomach and your oesophagus, known as your oesophageal sphincter.

Other symptoms of acid reflux can include:

• a sour taste in your mouth
• a recurring cough or hiccups
• a hoarse or weak voice
• bad breath
• feeling bloated or sick

Symptoms are generally most noticeable after you’ve eaten, when your stomach produces more acid. Lying down or bending over can also make them worse by allowing the acid to travel along your oesophagus.

Menopause, hormones and acid reflux

During perimenopause – the lead up to menopause – reproductive hormones including oestrogen and progesterone fluctuate in complex ways, rising as well as falling, before dropping for good once you pass menopause.

Overall, perimenopausal and menopausal women are around three times more likely to have acid reflux than those who haven’t begun the transition to menopause.

In fact, menopause has been shown to be a greater risk factor for GERD than smoking, drinking or having illnesses like asthma, emphysema or diabetes.

One study found that almost 42% of perimenopausal women and 47% of menopausal women had symptoms.

According to the NHS, increases in both oestrogen and progesterone are associated with worse acid reflux symptoms. However, studies like the one above have shown that symptoms are more severe after menopause, when hormone levels are reduced.

So although scientists believe there’s a link between changing hormone levels and acid reflux, more research is needed before they can say exactly what the relationship is.

Which foods can trigger acid reflux?

Certain foods can make acid reflux worse for some people.

Fatty foods take more time to digest, so they stay in your stomach for longer. That means acid has a greater chance of leaking back into your oesophagus.

Spicy or acidic foods and liquids can add to the acid in your stomach and make heartburn worse.

Alcohol relaxes your oesophageal sphincter, allowing acid to leak out. It also damages the layer of protective mucous in your throat.

Other foods and drinks are known to be common triggers for people with acid reflux too.

Foods and drinks that can trigger acid reflux include:

• spicy foods
• fatty and fried foods
• citrus fruits and juices
• vinegar and sauces like ketchup
• tomatoes
• onions
• peppermint
• chocolate
• coffee
• fizzy drinks
• alcohol

Other causes of acid reflux and heartburn

The following can all increase your risk of developing acid reflux or make your symptoms worse:

• Smoking: Smoking tobacco contributes to acid reflux and heartburn by relaxing your oesophageal sphincter. Smoking also reduces the production of saliva, which normally helps neutralise acid in your oesophagus. Visit the NHS for help with stopping smoking.
• Weight: Being above a healthy weight or having obesity can double your risk of developing acid reflux. Extra fat around your waist can cause your oesophageal sphincter to leak by increasing the pressure inside your stomach. Obesity can also interfere with the release of hormones like oestrogen. See the section below for tips on losing weight healthily.
• Stress: While stress doesn’t necessarily affect the amount of stomach acid you produce or how likely it is to leak, it can increase pain and discomfort by heightening your sensitivity to any acid reflux that does take place. In the next section, we’ll suggest some things you can try to help reduce stress.
• Medical conditions: Certain illnesses, including hiatus hernias, stomach ulcers and bacterial infections can sometimes cause acid reflux or make it worse. However, as we’ll discuss later, some of these can also be the result of acid reflux rather than the cause.
• Medication: Several types of medication, including antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can give you heartburn. However, this is not caused by acid reflux but by irritation of the lining of your oesophagus.

Treatments and remedies for acid reflux

If you’re looking to reduce heartburn and other symptoms of acid reflux, there are lifestyle changes you can make. Over-the-counter products and prescription drugs may also help.

Changing the way you eat

Heartburn and other acid reflux symptoms are often at their worst after meals. But changing the way you eat could improve things.

If there are particular foods or drinks that trigger you symptoms, it’s obviously best to avoid or limit them.

Eating smaller meals more often may also help by reducing the amount of stomach acid you produce.

Try leaving a gap of 3–4 hours between eating and going to bed. Again, this will reduce stomach acid, which is more likely to travel up towards your throat when you’re lying down.

Changing your sleeping position

Studies have shown that certain sleeping positions can reduce the effects of acid reflux at night.

Try elevating the head of your bed by 10–20 cm using wood or bricks. Raising your chest and head above your stomach like this can help prevent acid from rising up into your throat while you sleep.

Don’t try to do this by propping yourself up with pillows as this can actually make your symptoms worse by putting more pressure on your stomach.

Sleeping on your left side as opposed to your right can also help reduce reflux symptoms. Although it doesn’t stop acid travelling up your oesophagus, the reflux clears more quickly, causing less damage and less heartburn pain.

Healthy weight loss

Being above a healthy weight or having obesity are risk factors for acid reflux, as well as a range of other perimenopause and menopause symptoms. Losing weight can help.

If you need to lose weight, try to do it gradually. Follow a nutritious, balanced diet like the Mediterranean diet, including a wide variety of plants, whole grains and healthy fats.

Don’t be tempted to go on a calorie-restricted diet as these are not sustainable and the weight is unlikely to stay off.

Exercising regularly can also support healthy weight loss. However, be aware that intense exercise can sometimes lead to bouts of acid reflux, so always warm up slowly or consider taking antacid medication before a session.

Reducing stress

Stress can make you more sensitive to acid reflux so finding ways to relax may help. Try:

• Exercise: Regular exercise is a great way to reduce the impact of stress. It can also give your mind a break from anxious thoughts – or help you to process them – and boost your mood.
• Mindfulness: Techniques like meditation, yoga or deep breathing exercises can reduce your levels of the stress hormone cortisol and lower your blood pressure.
• Talking: Sharing your thoughts with someone can really help with stress. Try talking to a sympathetic friend, family member or colleague, or consider a talking therapy like cognitive behavioural therapy (CBT).

Medication and supplements

A number of over-the-counter medicines can help with acid reflux and heartburn. These include antacids, which neutralise the acid in your stomach, and alginates, which form a barrier on top of the acid.

These are usually for short-term relief and generally shouldn’t be taken on a regular basis for too long.

If you have heartburn most days and lifestyle changes are not helping, talk to your doctor. They may prescribe drugs called proton pump inhibitors, such as omeprazole and lansoprazole. These reduce the amount of acid your stomach produces.

You should also see your doctor if you have other symptoms along with heartburn, like food getting stuck in your throat, being sick or unexplained weight loss.

Another way to help with perimenopause and menopause symptoms is by taking certain probiotic supplements. Probiotics are friendly bacteria that can have benefits around your body by boosting your gut health.

The Better Gut probiotic supplements are a specially chosen combination of six strains of bacteria shown to improve a range of menopause complaints. These include symptoms that can have an impact on acid reflux, such as stress and maintaining a healthy weight, as well as related digestive issues like constipation, bloating and irritable bowel syndrome.

The Better Gut probiotics can also help with:

• hot flashes and night sweats
• brain fog and mental fatigue 
• sleep quality
• vaginal health 
• risk of osteoporosis
• inflammation and immune function

To find out more about how these beneficial bacteria can help you, visit the website.

For regular expert tips on menopause health and nutrition – and 10% off your first The Better Gut order – join our newsletter.

Does HRT help with acid reflux?

Scientists have linked hormone changes during perimenopause and menopause to an increased risk of acid reflux, so you might expect hormone replacement therapy (HRT) to help.

But according to the research so far, that’s not the case. Large-scale studies have shown that although both perimenopausal and menopausal women are at greater risk of developing GERD and acid reflux, HRT doesn’t improve things.

In fact, women who have been through menopause are more likely to have GERD if they are on HRT.

However, that doesn’t mean that low levels of oestrogen or other hormones reduce acid reflux – menopausal women who aren’t on HRT are still more likely to have symptoms than perimenopausal women, who have higher levels of these reproductive hormones.

This is another reminder that when it comes to the relationship between hormone changes and acid reflux in women, there’s a lot scientists still don’t understand.

Does menopause heartburn go away?

Whether or not it’s a symptom of menopause, if you regularly get acid reflux or heartburn it’s unlikely to go away on its own.

Women who have been through menopause are actually more likely to have these symptoms than perimenopausal women, so if you’re suffering it’s important to try some of the lifestyle changes or products that could help. If things don’t improve you should talk to your doctor.

Why acid reflux can be serious

If you get acid reflux, you’ll know that it can be very painful. And if it happens on a regular basis it can have a huge impact on your quality of life.

But over time acid reflux can also lead to other health issues, including an increased risk of:

• ulcers in the oesophagus
• Barrett’s oesophagus, where damaged cells grow abnormally
• oesophageal cancer

If you think you may have symptoms of any of these conditions, you should talk to your doctor. But it’s also important to remember that most people with acid reflux don’t develop these conditions.

Summary

Acid reflux is when the your oesophageal sphincter – the valve at the top of your stomach – allows acid to leak into your oesophagus. One of the main symptoms of acid reflux is the pain of heartburn.

Acid reflux is very common among perimenopausal and menopausal women. This may be linked to changes in the levels of their reproductive hormones but more research is needed.

Heartburn and other acid reflux symptoms are often worse after you eat or when you’re lying down. They can also be triggered by particular foods and drinks, including fatty or spicy foods or alcohol.

Smoking, being above a healthy weight, stress and certain medical conditions and medications can contribute to acid too.

Menopausal acid reflux is unlikely to get better on its own but lifestyle changes, including eating smaller meals, not eating too close to bedtime, changing your sleeping position, losing weight and reducing stress may improve symptoms.

Hormone replacement therapy does not seem to make a difference to acid reflux or heartburn but certain prescription medicines and over-the-counter products may help.

The strains of bacteria in The Better Gut probiotic supplements have been shown to improve a wide range of menopause symptoms, including digestive issues, stress and anxiety, and hot flashes and night sweats.

Get 10% off your first order here.