As a registered dietitian, I’m often asked about the link between menopause and heartburn. Many women are surprised to find themselves experiencing heartburn for the first time during menopause. While it is not commonly associated with menopause, research indicates that women going through the menopausal transition are more than three times more likely to experience heartburn also known as acid reflux. The good news is that there are effective treatments and lifestyle changes to help us mange. Let’s explore the connection between menopause and heart burn, the causes of acid reflux, and the best ways to treat and prevent it. Whether you’re currently experiencing acid reflux or simply want to be prepared, read on to learn more.
Does menopause cause heartburn?
Menopause can cause or worsen heartburn due to hormonal changes that affect the muscles in the digestive tract, including the lower esophageal sphincter (LES). The LES is a circular muscle located at the junction of the esophagus and the stomach. Its job is to ensure that the contents of the stomach stay in the stomach and do not cause irritation or reflux in the esophagus.
When the LES is weakened, stomach acid may flow back up into the esophagus, resulting in heartburn.
What does heartburn feel like?
Heartburn is the burning sensation in the chest or throat that is caused by stomach acid rising into the esophagus. The sensation is often described as a feeling of warmth, heat, or pressure that starts in the upper chest and may spread up to the neck or throat. Some people also experience a sour or bitter taste in the mouth, especially after eating or lying down. The discomfort can be mild to severe and may last for a few minutes or several hours.
Is heartburn dangerous?
Heartburn can be uncomfortable and disruptive to daily life, but it is generally not a serious condition on its own. With some simple changes in lifestyle and if needed, medications, it can be managed. However, if it occurs frequently and is severe, it can lead to a condition called gastroesophageal reflux disease or GERD. GERD can cause damage to the esophagus, produce ulcers, and even lead to esophageal cancer.
When to seek help?
Talk with your doctor if you are experiencing any of the following:
- Frequent heartburn or other symptoms of acid reflux, particularly if they happen more than twice a week.
- Symptoms that persist despite making lifestyle modifications and/or taking over-the-counter medication.
- Difficulty or pain when swallowing, or the sensation of food getting stuck in your throat.
- Unexplained weight loss or difficulty swallowing combined with vomiting or diarrhea.
- Chest pain, especially if accompanied by shortness of breath or pain in your arm or jaw.
- A history of gastrointestinal problems, such as ulcers or stomach surgery.
- A family history of gastrointestinal disorders or cancer.
It is important to note that postmenopausal women on hormone replacement therapy have a much higher risk of developing GERD and Barrett’s esophagus. The risks are over six times greater in women on HRT compared to those not on HRT.
Medications to Treat Menopausal Acid Reflux
If you’re experiencing the occasional bout of acid reflux during menopause, there are several medications that can provide relief.
Antacids such as Maalox, Gaviscon and Tums, work by neutralizing stomach acid, which can quickly reduce symptoms like heartburn and indigestion. They offer fast acting but short-lived relief and are best used for occasional or mild acid reflux symptoms.
H2 blockers such as Pepcid, Zantac, or Tagamet are another type of medication that works by reducing acid production. They block histamine, a chemical in the body that triggers acid production in the stomach. They can be effective for more frequent or severe symptoms; they take longer to kick in (30-60 minutes) but can give relief up to 10 hours or so.
Proton pump inhibitors (PPIs) such as Nexium, Prilosec or Prevacid, also work by drastically reducing the amount of acid your stomach produces. They are more likely to be suggested if you have been diagnosed with GERD. PPIs typically take several days to become effective. It is important to know that PPIs can reduce the absorption of certain nutrients, including calcium, magnesium, and vitamin B12. Talk with your health care provider about the safety of long-term use.
How can I stop heartburn naturally during menopause?
Here are 10 simple lifestyle changes you can try to stop heart burn naturally:
1. Eat small, frequent meals. Eating large meals can put pressure on the stomach and increase the risk of acid reflux. Instead, try eating smaller meals more frequently throughout the day. Eating regularly has also shown to reduce indigestion.
2. Reduce your intake of fatty foods. Fried foods or foods high in fat tend to take longer to digest and can increase the risk of acid reflux.
3. Know your trigger foods. Although there is no concrete evidence linking specific foods to GERD, many people report that certain foods do make their reflux symptoms worse.
Foods that cause heartburn the most include:
- tomatoes and tomato sauces
- citrus fruits
- spicy food
- fizzy drinks
Keeping track in a food diary can be really helpful for identifying you own personal triggers.
4. Try some psyllium. Psyllium(Metamucil), a high-fiber food, can improve gut motility, and potentially lower stomach acidity. In a 2018 trial, 60% of participants experienced symptom relief after taking 1 teaspoon of psyllium husk three times a day- for just 10 days! All the participants had a lower fiber diet to start.
5. Avoid lying down for an hour after eating. Lying down right after eating can increase the risk of acid reflux, so it’s important to stay upright for at least an hour after eating.
Similarly, eating too close to bedtime can increase the risk of acid reflux, so it’s important to avoid eating for at least a few hours before going to bed.
6. Sleep on an Incline. Sleeping flat on your back can increase heartburn symptoms. When you lie flat, your throat and stomach are at the same level, allowing stomach acids to flow up the esophagus more easily. That’s why sleeping with your upper body at a slight incline can help alleviate heartburn and acid reflux symptoms.
Simply stacking pillows may not be enough; consider using a wedge pillow that lifts your upper body. A five- to 15-degree incline can utilize gravity to help reduce heartburn at night.
Another sleeping position to try is sleeping on your left side with your head and shoulders elevated. Sleeping on the left side with your upper body elevated can reduce episodes of acid reflux and heartburn. Again, using a wedge pillow can ensure proper elevation for optimal digestion benefits.
7. Stop Smoking. Smoking is a major risk factor for many health issues, including acid reflux. If you smoke, quitting can improve your overall health and reduce your risk of developing complications from acid reflux. Talk to your doctor about resources and strategies to help you quit smoking, such as nicotine replacement therapy or counseling.
8. Wear loose fitting clothing. Tight clothing, especially around the waist, can put extra pressure on the stomach, potentially pushing acid upwards into the esophagus. By opting for loose-fitting garments, you can avoid unnecessary pressure on the abdomen, allowing for better digestion and reducing the likelihood of acid reflux.
9. Exercise. Exercise can both alleviate and trigger acid reflux. Those exercises that increases abdominal pressure, such as heavy lifting, stomach crunches, or high impact workouts, can worsen reflux. Especially after a meal. You might find it is more comfortable to exercise on an empty stomach. Wait at least two hours after eating to exercise so that food can move from the stomach to the small intestine. When food has left the stomach, there’s less chance of reflux during exercise.
If you feel heartburn during a certain activity, try switching to lower-impact exercises like walking or using an elliptical machine. Once your symptoms improve, you can gradually increase the intensity of your workouts.
10. Manage your stress. Stress can be a contributing factor to heartburn as it can increase the production of stomach acid and slow down the digestive process. When someone is stressed, their body goes into a “fight or flight” response, which can lead to an increase in stomach acid production and cause the muscles in the digestive tract to contract more slowly, leading to acid reflux and heartburn.
Stress reduction techniques such as meditation, yoga, and deep breathing exercises can help improve symptoms of heartburn in some people. Getting enough sleep, and practicing relaxation techniques, can also help reduce the frequency and severity of heartburn symptoms.
Many guidelines do recommend weight loss as part of treatment for acid reflux. And we do know that there is an association between those who live in larger bodies and reflux. But is it really important to remember that association is not the same as causation. There simply are no well-designed studies that have shown that weight loss improves GERD symptoms in the long term. And since long term weight loss is not sustainable for the vast majority it’s unlikely to be helpful here. It’s better to focus on realistically do-able strategies.
I hope you found some information here to help you find some relief.
If you are struggling with heartburn or other menopausal symptoms, don’t suffer in silence. As a dietitian who specializes in midlife nutrition, I’m here to help you. Together, let’s develop a personalized plan to help you thrive in menopause and beyond.