Can Menopause Trigger or Worsen Acid Reflux?
Are you suddenly experiencing a burning sensation in your chest, difficulty swallowing or regurgitation after eating? Did you have these symptoms before, but they’re now getting worse?
Many menopausal women experience acid reflux, often characterized by frequent heartburn and acid regurgitation. Other women have acid reflux without heartburn. Instead, they have chest pain or difficulty swallowing (1).
It’s common to feel like you have food stuck in your esophagus or a feeling of choking when you’re suffering from acid reflux. Bad breath can also be a symptom (1).
According to a study among 492 women, 42% of menopausal women experience upper gastrointestinal (GI) problems (2).
These problems are common but become difficult to manage when they develop into chronic acid reflux, also known as gastroesophageal reflux disease (GERD).
What Can Cause Acid Reflux During Menopause?
The hormones progesterone and estrogen help control the GI system, and when their levels are low, women can experience a range of digestive issues (2) like reflux, nausea, vomiting, constipation, and diarrhea.
Obesity, smoking, and certain medications can also increase the risk of developing or worsening this condition (1, 3).
Medications that can trigger or worsen GERD include ibuprofen, aspirin, osteoporosis medications, blood pressure medications, anti-anxiety drugs, and antibiotics (4).
What is Heartburn?
Heartburn is the most common symptom of acid reflux, and it’s identified by a burning sensation in the chest. It can happen at any time but is usually worse after eating, especially after large meals or meals high in fat (1).
Medications to Treat Menopausal Acid Reflux
There are many medications, available both over the counter (OCT) and by prescription, to treat this condition, including anti-acids, H2 blockers, and proton pump inhibitors.
The problem with these medications is that while they are very useful for treating reflux a few times a month, they’re not designed for everyday use.
H2 blockers like Zantac, Tagmed and Pepcid reduce the production of stomach acid. Overusing this medication can cause headaches, constipation, and nausea (5.)
Proton pump inhibitors like Prevacid, Prilosec or Nexium work by blocking acid-producing cells in the stomach. They are very effective, but doctors recommend using them for less than 14 days.
Side effects of long-term use include infections, bone fractures, vitamin and mineral deficiencies, and the potential increased risk of stomach cancer (6).
Promotility agents like Reglan work by stimulating the muscles in the gastrointestinal tract (GI), helping to keep the acid in the stomach, and reducing the reflux into the esophagus.
Side effects include drowsiness, fatigue, diarrhea, restlessness, and movement problems (7).
The bottom line is that there is not one perfect medication for acid reflux that works in the long term. Therefore, the key to preventing acid reflux without over-using medication is to modify your nutrition and lifestyle.
Menopause and Acid Reflux Treatments
Achieve and Maintain a Healthy Weight
It is known that obesity increases the risk of developing GERD. A possible explanation is that the extra weight around the belly increases the pressure on the stomach, resulting in acid moving upward into the esophagus.
The good news is that weight loss is an effective treatment (8). Even a modest weight loss helps to improve the symptoms of GERD.
Eat Small, Frequent Meals
Larger meals are likely to stretch the stomach, causing the lower esophageal sphincter (LES) to relax. The LES is a ring between the esophagus and the stomach that keeps the stomach content from traveling upwards. When it loses some of its tightness, it can let stomach fluids move in the wrong direction (9).
Eating small, frequent meals can be easy if you eat a small breakfast, lunch, and dinner, with one snack between breakfast and lunch and one more between lunch and dinner.
Reduce the Total Consumption of Fat
Fried foods and other foods that are high in fat can also cause the LES to relax, enabling acid to travel upwards into the esophagus.
What’s more, fatty foods stay in your stomach longer than other meals. Because fat sits in your stomach for more time, more acid is created, worsening the symptoms.
So, one natural way to improve acid reflux is to reduce the high-fat foods in your diet and instead use a moderate amount of healthy fats for cooking.
Foods that are high in fat:
- French fries
- Fried fish and chicken
- Hamburgers, hot dogs, and other fast foods
- Pizza, lasagna, and other foods made with large amounts of cheese
- High-fat cuts of beef, pork, or lamb
- Bacon and sausages
- Creamy salad dressings
- Latin fried foods like fried plantains, tostones, and yuca frita
- Potato chips
- Cakes, cookies, and muffins
- Ice cream
Sit Straight While Eating, and for an Hour After Eating
When you sit down to eat your meals and to digest them, gravity can help to keep the food in the stomach.
Avoid Eating at Least 2-3 Hours Before Bedtime
The goal is to avoid lying down after a meal because gravity does not help keep the stomach acid down when in this position.
Avoid Foods That Trigger Reflux
Tomatoes and citrus fruits
Fruits high in acid can trigger or worsen symptoms. This includes oranges, limes, lemons, tomato, tomato sauces, and salsas.
Chili peppers frequently cause heartburn because they contain capsaicin, which slows down digestion resulting in an increased risk of experiencing symptoms.
Spicy food can also irritate the esophagus, causing acid reflux (10).
Coffee is well known for irritating the GI system, even when it’s decaffeinated.
If you cannot resist drinking coffee, it can help to limit your intake to a cup or two early in the morning when you are less likely to be lying down.
Be aware that other drinks can also contain caffeine, like tea and sodas.
Carbonated drinks, especially those with caffeine, can irritate the GI tract (11).
For one thing, soda is highly acidic. What’s more, the bubbles put stress on the LES, increasing the risk of acid traveling upwards to the esophagus. Finally, soda can cause burping, which opens the passage from the stomach to the esophagus.
Drinking alcohol can stimulate reflux symptoms by increasing acid secretion, promoting spontaneous LES relaxation, impairing the movement of the esophageal muscles, and reducing the ability of the stomach to pass its contents to the intestines (11).
Even small amounts of alcohol can increase problems with acid reflux.
While eating dark chocolate can have several health benefits, it is also often mentioned as one of the common instigators of GERD symptoms (11).
However, the evidence to back up this claim is not really strong, so it’s worth trying to see how you feel after limiting the amount of chocolate you eat or cutting it out altogether.
Raise the Head of the Bed 6 to 8 Inches
Elevating the head of the bed to a 30-to-45-degree angle can help you prevent stomach acid from rising into your esophagus.
However, extra pillows won’t work; it’s best to elevate the entire head of the bed.
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Smoking can increase the symptoms of reflux because it slows the clearance of the acid in the GI tract and decreases LES pressure. (12)
Exercise 30 Minutes a Day
Mild to moderate exercise, such as walking, yoga, or biking, can reduce the symptoms of gastric reflux (13).
However, intense exercise can make symptoms worse. So, make sure to ease slowly into more strenuous activity.
When planning your exercise, these tips will help avoid triggering acid reflux:
- Avoid exercise within 2 hours of eating
- Drink water while exercising to keep hydrated and help digestion
When to See a Doctor
A gastroenterologist — also known as a GI doctor — is a doctor specialized in the gastrointestinal system. While a general family doctor can give you help for reflux, you might need a more specialized physician if your symptoms are severe or are not improving (14).
You might want to seek medical help if:
- Symptoms last more than two weeks
- Over-the-counter medications are not improving your heartburn
- Heartburn episodes are more frequent or more severe
- Nighttime symptoms are affecting your sleep
- Acid reflux is affecting your life
- You have unexplained weight loss
- Swallowing becomes difficult or painful
- Heartburn is followed by nausea or vomiting
There are many different tactics to naturally reduce acid reflux. However, according to a recent review, there are five dietary and lifestyle modifications that are the most effective: (15)
- Eat a diet rich in whole grains, vegetables, and fruits
- Maintain a healthy body weight
- Stop smoking
- Exercise for 30 minutes a day
- Limit soda, coffee, or tea to 2 cups a day
The goal is to reduce or eliminate your symptoms without the everyday use of medications.
Remember that each person is different and changes in lifestyle and diet will help in different ways. Start making the changes one or two at a time and see how you feel. Let us know if you feel better!
Dr. Su-Nui Escobar, a Registered Dietitian/Nutritionist in Miami, FL, is dedicated to empowering women in perimenopause and menopause to live healthier, more satisfying lives.
With a doctorate in clinical nutrition from the University of North Florida, she has expertise in menopause and weight loss, including the unique challenges faced by those on weight loss medications.
Su-Nui’s passion for her field is evident in her previous role as the Academy of Nutrition and Dietetics spokesperson.