Can perimenopause cause nausea

Can Perimenopause Cause Nausea?

Last modified on July 10th, 2024

Can perimenopause cause nausea, and if so, why?

Perimenopause is overall a challenging time if you’re a woman. It usually starts from your late 30s to early 50s and includes a range of physical and emotional changes you’ll experience.

Among these symptoms can be nausea. Nausea is a common but frequently overlooked issue that has the potential to significantly impact your daily life.

Nausea from perimenopause can range from mildly uncomfortable to debilitating, but you can navigate it when you know what to expect.

The Basics of Perimenopause

The menopausal transition is known as perimenopause, and sometimes, you’ll hear it referred to as early menopause. It’s the time that leads up to menopause, which marks the end of your reproductive years as a woman.

The symptoms of perimenopause start happening because your body’s gradually reducing its production of reproductive hormones—especially estrogen and progesterone. 

The transitional phase can span several years, ending when menopause begins. Menopause is when you’ve not had a period for 12 months in a row.

For women, perimenopause can happen at different times, but on average, it starts in your mid-40s. The symptoms can last a few months up to a decade, but the average length you’ll experience these transitional symptoms is around four years.

Your body’s reproductive system naturally changes as you age. 

Your ovaries gradually produce less progesterone and estrogen, the hormones that regulate the menstrual cycle and maintain reproductive health. The decline in these can lead to the symptoms we associate with menopause and menstrual cycle irregularities.

Specifically, some of the factors contributing to the onset of perimenopause and the associated symptoms include:

  • Your ovaries age as you age. Your number of functional ovary follicles decreases, affecting hormone production and menstrual patterns.
  • Hormone fluctuations. Gradual declines in estrogen and progesterone cause hormonal imbalances, which are responsible for many of the physical and emotional symptoms of perimenopause. These hormone fluctuations can also affect how your body regulates other hormones, furthering your symptoms.
  • Genetics. If you have a mother who experienced either early or late onset perimenopause, you may follow a similar pattern.
  •  Lifestyle and health factors. Things like high stress, medical conditions and smoking can influence when you start to experience perimenopause symptoms and how severe they are. 

Why Do I Feel Nauseous During Perimenopause?

If you’re asking why I feel so ill with perimenopause or if hormonal changes make me nauseous, the answer is yes: perimenopause can cause nausea. 

Not every woman will experience nausea, but it’s a common symptom often linked to underlying factors related to hormone changes.

One of the biggest reasons that perimenopause can cause nausea is because of the fluctuations in estrogen and progesterone. 

When you’re going through perimenopause, your estrogen and progesterone levels go through unpredictable fluctuations. 

In particular, estrogen levels can go up and down unevenly, leading to nausea and other symptoms. Hormonal imbalances have the potential to affect the digestive system, leading to nausea and other types of discomfort.

As estrogen and progesterone levels fluctuate, it can also impact insulin and cortisol levels, impacting blood sugar levels and your stress response, leading to nausea.

Aside from hormone levels, other ways perimenopause causes nausea include:

  • Digestive system changes. The hormonal changes that happen during perimenopause can slow the digestive process, leading to nausea. Your GI tract may also be more sensitive, so you’re more prone to nausea from stress and certain foods.
  • Perimenopause is stressful, and there are psychological effects like higher anxiety levels that can then lead to nausea and other gastrointestinal symptoms. Elevated cortisol because of stress and anxiety can also affect the digestive system, contributing to nausea.
  • Some women experience severe headaches or migraines during perimenopause because of fluctuations in hormones, and those can come with nausea and vomiting. Changes in blood flow and vascular function because of shifting hormones can trigger headaches and nausea associated with them as well.
  • Sleep problems like insomnia and night sweats can lead to fatigue, and that can make nausea during perimenopause worse.

Does Perimenopause Cause Morning Sickness?

I’m currently dealing with perimenopause symptoms, and one of those is nausea, which I feel is much worse in the morning, reminding me of when I was pregnant. 

Overall, the term morning sickness is usually one reserved for pregnancy-related nausea and vomiting, but I did some research and found some women experience a similar type of nausea during perimenopause, although the mechanisms can differ from each other.

The biggest issue leading to perimenopause nausea in the morning is estrogen. The wild fluctuations in estrogen levels cause many symptoms you might be experiencing.

Progesterone is another hormone that decreases during perimenopause. Progesterone calms the GI system and can upset your stomach when it declines. Lower progesterone levels can cause more gastrointestinal motility and sensitivity, contributing to nausea.

As mentioned, perimenopause often leads to elevations in cortisol levels, and cortisol can interact with estrogen and progesterone, further disrupting your hormone balance and causing nausea.

Another issue can be serotonin fluctuations. 

Estrogen helps to regulate serotonin levels. Fluctuations in estrogen during perimenopause can then cause changes in serotonin, which means not only mood swings but potentially nausea. 

There’s a deep connection between our brain and gut, and shifts in serotonin levels are a big reason for nausea that often goes overlooked.

Perimenopause nausea can happen at any time, but some women feel it more intensely in the morning because their stomachs are empty, and they go through hormonal shifts at night.

Serotonin, Perimenopause and Nausea

I’ve talked about the role of hormones in nausea during perimenopause, but because I think it’s a culprit for me, I also wanted to dive a bit more into serotonin.

When you’re going through perimenopause, complex changes in your hormones affect your central nervous system.

Serotonin is a neurotransmitter that regulates mood, appetite, digestion and more. 

It also contributes to our feelings of well-being and happiness.

During perimenopause, levels of estrogen and progesterone fluctuate unpredictably, and this, in turn, influences the production and function of serotonin in your brain.

Specific ways estrogen and hormone levels affect serotonin include:

  • Estrogen influences tryptophan hydroxylase’s activity, an enzyme crucial to serotonin synthesis. High estrogen levels can boost your serotonin production, while lower levels have the opposite effect.
  • Estrogen affects the brain’s serotonin receptors’ density and sensitivity, improving signaling effectiveness or impeding it if estrogen levels drop.
  • Estrogen influences the expression of serotonin transporters. These are responsible for the reabsorption of serotonin after it’s been released. Estrogen, as a result, affects the amount of serotonin available in the brain.

Progesterone affects serotonin because it interacts with GABA receptors. The hormone can increase GABA’s inhibitory effects on the nervous system, indirectly influencing serotonin levels.

Throughout the fluctuation of estrogen and progesterone during perimenopause, the regulation of serotonin is disrupted. This can lead to mood swings, irritability, anxiety, and even depression. Hormonal effects on serotonin can lead to increased sensitivity and declines in emotional stability.

Serotonin is also a precursor to melatonin, so when levels are affected, it can cause insomnia and other sleep disturbances.

Hormonal fluctuations affect the gut-break axis because serotonin is also found in the GI tract, thus the potential for perimenopause nausea.

The chemoreceptor trigger zone, or CTZ, is in the brainstem. It detects toxins in the blood, triggering the vomiting reflex. Serotonin released from the gut can stimulate the CTZ, leading to nausea and vomiting.

Estrogen and progesterone levels can directly and indirectly affect serotonin production, and that can, in turn, cause the nausea you might be experiencing.

Four Supplements to Help with Perimenopause Nausea

Certain supplements like ginger and vitamin B6 can generally be good for nausea. Still, if you’re dealing with an upset stomach because of perimenopause, you might want to try options that target the root causes, including hormonal imbalances and serotonin fluctuations.

 A few options I’ve found helpful in my journey with perimenopause nausea include:

Black Cohosh

Black cohosh has phytoestrogen properties, so it can help balance estrogen levels in the body. Through its stabilizing effects on estrogen, it can indirectly influence serotonin levels, reducing not only nausea but mood swings.

To take black cohosh for perimenopause symptoms, you can try 20 to 40 mg of a standardized extract once or twice a day. If you use a tincture, try 2-4 mL of black cohosh 2-3 times diluted daily in water.

Be mindful of using black cohosh if you have a history of liver disorders or take other medicines.

St. John’s Wort

St. John’s Wort is an herb supplement often used for its antidepressant effects. It can increase the levels of serotonin in your brain by blocking its reuptake, inhibiting nausea from perimenopause and mood swings.

To take St. John’s Wort for perimenopause, 300 mg of a standardized extract 2-3 times a day can work well.

Be careful because it can interact with medications, including antidepressants and birth control pills.


Also known as Vitex, chasteberry is an excellent supplement for perimenopause nausea and symptoms, as well as hormonal balance in general. 

It regulates the production of hormones by acting on the pituitary gland, helping balance progesterone and estrogen. It can reduce symptoms like nausea, which is linked to hormonal fluctuations.

If you try chasteberry, take 400 to 500 mg of standardized extract daily in capsule or tablet form.

Chasteberry can take a few months to show its full effects, so be patient.

Red Clover

Red clover contains isoflavones, phytoestrogens that can mimic estrogen’s effects on the body. It can stabilize serotonin and balance estrogen, reducing nausea and mood swings.

Take 40 to 80 mg of standardized red clover extract 1-2 times daily.

Hormone Replacement Therapy During Menopause

Sometimes, hormone replacement therapy or HRT helps with perimenopause symptoms.

There are different types of HRT, including estrogen therapy, which involves just taking estrogen.

There’s also combined estrogen-progestogen therapy, which involves estrogen and a synthetic form of progesterone.

HRT can stabilize hormone levels and reduce nausea related to hormone fluctuations. HRT can also be very effective in alleviating vasomotor symptoms. These symptoms include hot flashes and night sweats. I can help reduce anxiety and improve mood, and better hormone balance leads to improved sleep quality for many women.

While HRT can provide a lot of relief, there are risks, including a higher likelihood of blood clots, heart disease and stroke, a slight increase in the risk of breast cancer, and a greater risk of endometrial cancer.

Those are some of the key reasons women might opt to try natural supplements for perimenopause symptoms first.

Dealing with Perimenopause Nausea

Navigating perimenopause is tough enough, especially when you’re dealing with symptoms like nausea. When you understand the underlying hormonal changes driving the symptoms, you can work towards finding effective management strategies. Supplements like black cohosh and chasteberry can balance hormones and support serotonin levels, relieving perimenopausal nausea. 

This post contains affiliate links, meaning we may earn a commission if you make a purchase through these links, at no additional cost to you. We only recommend products or services that we trust and believe will add value to our readers. Your support helps keep this website running and allows us to continue providing valuable content. Thank you for your support!"

author avatar
Ashley Sutphin Watkins
Ashley Sutphin Watkins is a graduate of the University of North Carolina at Chapel Hill. She's a medical content writer, journalist and an avid researcher of all things related to health and wellness. Ashley lives near the Smoky Mountains in East Tennessee with her family.
Scroll to Top

Subscribe For News and Updates on Health, Wellness, Vitamins and Supplements