Dizziness in Menopause

Dizziness may be more common than you may realise. A study called “Dizziness in peri and postmenopausal women is associated with anxiety”, found that 37% of women in their study. Aged between 40-65 experienced at least weekly bouts of dizziness. But more on this later.

Dizziness is defined as “ an imprecise term which may refer to the sense of spatial disorientation, the motion of an environment or lightheadedness” 

Every woman who experiences dizziness will describe it slightly differently. Some will say they feel like they are spinning others feel that they are still but the world is spinning around them, some feel lightheaded others heavy-headed. She might feel unsteady on their feet and feel like she is going to fall. Others experience a sensation of floating or wooziness. I’ve even had a woman explain her sensation as feeling like she is going to be sucked into a vortex.

These sensations may have a trigger. Some common triggers include sitting or standing up, sudden movements, moving your head or even bending down. Other times it may hit you out of the blue with no noticeable trigger.

Dizziness that is new, severe or prolonged should ALWAYS be followed up with your medical team and a trip to the emergency may be needed.

Some women will have accompanied symptoms like nausea, vomiting, headaches, pain, difficulty breathing, numbness, vision changes, hearing changes, fever, rapid heartbeat, confusion, slurred speech,  seizures and these all require urgent attention.

Keeping in mind I’m a Naturopath and not an ER doctor I don’t see women with serious underlying causes of their dizziness. It is possible that something more sinister is going on and that is why I always check more serious dizziness has been checked out with a doctor. This article is going to focus on the most common causes I see in my clinic coupled with specific research on the causes of dizziness in menopause.

Starting with medication interactions. In most cases, this is interactions between medications and self-prescribed supplements. Remember all supplements have cautions, contraindications and interactions. If you are on prescription medication you really need to check for interactions. In my initial consultation, I double-check all medications and supplements for potential interactions.  Other times it could be that the prescribed medication induces nutritional deficiencies that haven’t been addressed. 

A recent example I have for you is from a beautiful lady who had been on a longstanding potassium product. She loved this product. It previously has made many positive changes for her. But with the introduction of an ACE inhibitor, this started to cause issues. She wasn’t aware of the interaction between the seemingly safe supplement and her new medication. I advised her to stop the potassium and her dizziness went away. 

Blood sugar lows can cause dizziness. This kind of dizziness feels like a jittery / lightheadedness and it may be accompanied by sweating, anxiety and feeling hangry. Better blood sugar balance is the answer here. Upgrading your diet, better management of medication like insulin or considering supplementation like chromium, berberine or inositol may help. Walking after main meals may also be helpful. Don’t overlook this consideration, blood sugar irregularities increase with age and post-menopausal women are at greater risk of diabetes. Read more Blood Sugar, Diabetes and the Menopausal Transition

Dehydration and/ or inadequate electrolytes. This can occur suddenly on a hot day, perhaps post-Bikram yoga workout or the use of a spa or sauna or even just from a hot flush. If you are experiencing hot flushes and dizziness I would highly recommend you consider your electrolyte status. An easy fix could be the addition of a daily dose of electrolytes. I’m a huge fan of electrolytes. Unless you have been told to be on a low salt or low potassium diet it's worth trying a 7-day electrolyte challenge. Document how you feel at the beginning, take a daily dose of electrolytes (I’m talking clean, with no sugars, colours, flavours, or preservatives) and document how you feel after the 7 days. Has your dizziness reduced? Do you have more energy? Less muscle tension or cramps, better clarity of thought, fewer palpitations, fewer flushes and sweating? This is a very common cause in the demographic of women I work with. If you would like more information consider this article Electrolytes

It’s also worth noting that many women who experience hot flushes simultaneously experience nausea, headaches, weakness and dizziness all at the same time. But this is normally short-lived and resolves as the flush ends. In this case, it's a reduction of flushes that we are focusing on.

Anaemia can be another issue. This kind of dizziness is accompanied by a feeling of weakness and fatigue. The wall becomes your supportive friend when you are trying to cross a room. I called this wall hugging. This is more common in perimenopause with heavy menstrual bleeds. Iron overload on the other hand in post-menopausal women can also create the feeling of dizziness. If you haven’t tested your ferritin level recently, get to it. The range of your lab report is not the range I use. In my opinion, anything in the triple digits needs to be addressed. For more information see - Iron and the Menopausal Transition 

Another nutrient involved with dizziness is Vitamin B12. This is a very common nutrient deficiency and it's linked with dizziness, fatigue, brain fog, muscle weakness, and altered peripheral sensations like numbness and pins n needles. This is another blood test I highly recommend but again I don’t like the lab reference ranges. Aim to be at the very top. If you would like to know more about Vitamin B12, you might like to read this article B12 and menopause.

Anxiety and depression are also common causes of dizziness. Remember the study I mentioned in the beginning? They found that anxiety was the sole factor that was independently associated with dizziness. The greater the anxiety the greater the risk of experiencing dizziness. They suggested that psychotherapy such as cognitive behavioural therapy may be effective in improving the sensation of dizziness.

The same study implied that oestrogen fluctuations and deficiency in the menopausal transition might play a role in the development of Benign Paroxysmal Positional Vertigo. This is when a change in position triggers dizziness. A separate animal study quoted in this study found mice with their ovaries removed later developed significant balance issues.

A different study called” Relationship between sleep quality and dizziness” found that sleep disturbances may be related to some vestibular diseases. The vestibular system is the link between your inner ear and your brain, and it is needed for balance. They suggested that women experiencing dizziness have their sleep quality evaluated. They noted that sleep disturbances are associated with emotional stress and anxiety, which is another possible contributor to the sensation of dizziness.

With oestrogen fluctuations in the peri-menopausal stage of the transition, some women will experience migraines. The sensation of Dizziness or lightheadedness accompanies migraines. The goal here would be to address your migraines.

Osteosacopenia is another consideration. This is the reduction of bone and muscle, when this occurs in the lower legs it can increase your risk of developing a sway when you walk and potentiating the sensation of dizziness.

Here are a few other causes of dizziness

• Ear issues. If your dizziness is accompanied by hearing changes it could be Menieres’ disease (which is a fluid build-up in your inner ear) or labyrinthitis (an infection in your inner ear).

• Sinus congestion

• Low blood circulation or a sudden drop in blood pressure (Orthostatic hypotension)

• Liver issues

• Neurological disorders can lead to the progressive loss of balance 

• Fever and Infection

• Injury especially head trauma

• Food intolerances

• Toxicity - have you been exposed to mould, heavy metals, or chemicals?

That was a lot of information we just covered and in case I overwhelmed you let's summarise

1. If your dizziness is new, severe or prolonged start with your GP or ER doctor.

2. If you are on medications or supplements get them checked for interactions. This can be done by your prescribing doctor, pharmacist or other healthcare providers like me.

3. Do some testing but make sure you at least include Vitamin B12, Ferritin, Electrolytes, blood sugar and blood pressure.

4. Drink more water and if relevant include an electrolyte.

5. Consider other causes like anxiety, insomnia, migraines, hot flushes

6. If possible work on your lower leg strength. Can you go for a walk on a good day? Can you start a bone and muscle-building weights program? Oestrostrong is one such example but there are others.

7. Start a dizziness diary, this helps practitioners identify triggers and get to the root cause

8. Don’t give up. There are many different types of practitioners that may be able to provide you with help eg physiotherapy has the Epley's manoeuvre which may benefit some, chiropractors and osteopaths may suggest cranial work or cranial sacral therapy, acupuncture, Bowen therapy and I’m sure there are more manual therapy options.

9. But the last option I want to suggest is that you book an appointment with me and I will hold your hand and walk you through these steps and more. Click here to book your initial consultation 

References:

Dizziness in peri- and postmenopausal women is associated with anxiety: a cross-sectional study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291970/

Relationship between sleep quality and dizziness

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841657/