Does Perimenopause Cause Vertigo?

Vertigo and dizziness are common yet frustrating symptoms that many women experience during perimenopause. 

As hormone levels fluctuate, these unsettling sensations can make daily activities feel disorienting and even unsafe. 

If you’ve felt off balance, had dizzy spells or experienced spinning during this phase of life, you’re not alone.

We’ll explore the potential causes of vertigo during perimenopause and the connection between hormonal changes and balance issues. 

We’ll also discuss effective remedies, including supplements and lifestyle changes, that may help alleviate perimenopause dizziness and restore a sense of stability. 

We’ll provide helpful insights into the causes of perimenopause dizziness and how to manage it. 

Short Answer: Does Perimenopause Cause Vertigo?

Yes, perimenopause can cause vertigo due to hormonal fluctuations, particularly the drop in estrogen levels. 

These changes can affect the inner ear and the brain’s balance systems, leading to dizziness and the sensation of spinning. 

However, other factors, including stress, blood pressure fluctuations, and dehydration, can also influence vertigo during perimenopause.

For more information on how perimenopause leads to vertigo and effective ways to manage it, keep reading.

What is Perimenopause?

Perimenopause is the phase of transition before menopause. 

It marks the time when a woman’s body begins to experience hormonal changes that can affect her physical and emotional health. 

This stage typically begins in her 40s, though it can start as early as her mid-30s. On average, perimenopause lasts about 4 to 8 years. 

It ends once a woman has gone 12 consecutive months without having a menstrual period, signaling the start of menopause.

During perimenopause, a woman’s ovaries gradually produce less estrogen, a hormone critical to the menstrual cycle and overall reproductive health. 

In addition to lower estrogen levels, the sensitivity of estrogen receptors may change during perimenopause. 

Some studies suggest that estrogen receptors can become less responsive to the hormone as levels decline, which may affect the body’s ability to respond to estrogen signals. 

This can contribute to imbalances in processes like bone health, cardiovascular health and function, and the regulation of mood and sleep.

This leads to a variety of symptoms, including irregular periods, hot flashes, night sweats, mood swings, sleep disturbances, and changes in libido. 

However, one often overlooked symptom for perimenopausal and menopausal women is dizziness or vertigo, which can be just as disruptive as the more commonly recognized signs of perimenopause.

Hormonal Changes and Their Impact on Balance

Hormonal fluctuations during perimenopause can significantly affect the vestibular system. This is responsible for maintaining balance. 

Estrogen is especially vital for the function of the inner ear and the brain’s processing of balance signals. 

When estrogen levels dip, it can disrupt inner ear fluid balance, leading to dizziness, lightheadedness, or even vertigo.

In addition to estrogen, other hormones such as progesterone and cortisol fluctuate and shift during perimenopause, further contributing to symptoms like dizziness. 

These hormonal shifts can impact blood pressure, circulation, and even hydration levels, all of which influence how the body maintains equilibrium. 

As a result, many women experience unexpected episodes of vertigo or dizziness as their bodies adjust to these changes. 

Does Perimenopause Cause Vertigo?

As touched on, the primary reason for vertigo during perimenopause is the fluctuation of hormones, especially estrogen. It’s a different underlying cause than something like benign paroxysmal positional vertigo, which stems from tiny crystals in the ears causing symptoms.

Estrogen plays an essential role in the function of the inner ear, which is crucial for maintaining balance. 

During perimenopause, as estrogen levels drop, the inner ear may become more sensitive, leading to disturbances in balance. 

This disruption can trigger feelings of dizziness or the sensation of spinning, which is commonly known as vertigo.

The brain also relies on estrogen to process signals related to balance. 

When estrogen levels decline, the brain’s ability to accurately interpret these signals can be compromised, resulting in a sensation of imbalance. 

This is why many women experience unexplained vertigo and dizziness as they transition through perimenopause. 

Vertigo can be a symptom that not only perimenopausal women experience but also can be one of the menopausal symptoms that occur. Even postmenopausal women may continue to experience vertigo attacks.

Other Contributing Factors

While hormonal fluctuations are a significant factor in perimenopause-related vertigo, there are additional factors that can contribute to dizziness during this time.

• Stress and Anxiety: Perimenopause can bring about emotional and psychological changes, including increased levels of stress and anxiety. These emotional factors can lead to symptoms such as dizziness. Anxiety can cause your body to go into “fight or flight” mode, increasing heart rate and affecting the nervous system, which can make balance issues worse.
• Blood Pressure Fluctuations: Hormonal shifts during perimenopause can also impact blood pressure regulation. As a result of these changes, some women experience periods of high blood pressure (hypertension) or low blood pressure (hypotension). Fluctuations in blood pressure can cause lightheadedness or dizziness, especially when standing up quickly, as the body adjusts to changes in circulation.
• Dehydration or Fluid Retention: Hormonal changes in perimenopause can affect fluid balance in the body. Estrogen helps regulate fluid retention, and as levels decrease, women may experience either dehydration or the retention of excess fluid. Both conditions can affect the body’s ability to maintain equilibrium, contributing to dizziness or vertigo. Dehydration, in particular, can lead to a drop in blood volume, causing lightheadedness and balance problems.

How Hormonal Fluctuations Lead to Vertigo

Estrogen, primarily thought of as a female sex hormone, plays a critical role in maintaining balance within the body. 

One of its key functions is to regulate fluid balance in various tissues, including the inner ear, which is responsible for maintaining equilibrium. 

The inner ear contains fluid-filled chambers that help transmit balance signals to the brain. 

When estrogen levels drop during perimenopause, the regulation of these fluids can get disrupted.

As estrogen levels fluctuate or decrease, the fluid balance in the inner ear can become unsteady, leading to disturbances in the vestibular system. 

This system controls our sense of balance, and any disruption in its function can cause dizziness or vertigo. 

The result is that many women going through perimenopause experience a heightened sensitivity to imbalances, leading to symptoms like dizziness, lightheadedness, or the sensation of spinning. 

Essentially, the hormonal shift caused by perimenopause makes it more difficult for the inner ear to maintain normal fluid levels, which can directly affect balance and coordination.

Other Hormonal Imbalances

While estrogen is a primary contributor to balance issues during perimenopause, other hormonal imbalances also play a role in vertigo and dizziness.

• Progesterone works alongside estrogen to regulate the menstrual cycle. It can also influence balance during perimenopause. Progesterone levels naturally decline during this time, and the imbalance between estrogen and progesterone can impact the autonomic nervous system. This system controls bodily functions like heart rate and blood pressure, which can, in turn, affect balance. Fluctuations in progesterone may make women more susceptible to dizziness or lightheadedness, especially if they stand up quickly.
• Cortisol helps the body with its stress response and regulates various functions, including metabolism and immune response. During perimenopause, the body often experiences an increase in cortisol levels due to the physical and emotional stress of hormonal changes. High cortisol levels can contribute to an imbalance in the autonomic nervous system, causing symptoms like dizziness, lightheadedness, and problems maintaining balance.

Together, the imbalances in estrogen, progesterone, and cortisol during perimenopause can create a perfect storm for vertigo and dizziness. 

Supplements for Perimenopause Vertigo Relief

If you’re experiencing vertigo during perimenopause, several supplements may help ease symptoms and restore balance. 

These include herbal remedies, vitamins, and minerals that can address the underlying hormonal and neurological changes contributing to dizziness. 

Here are some of the most beneficial supplements to consider:

Herbal Supplements

• Ginger is recognized for its anti-nausea properties. This makes it a popular remedy for dizziness and vertigo. It improves circulation and reduces the sensation of spinning by calming the stomach and supporting digestive function. Taking ginger as a tea or supplement can alleviate dizziness associated with perimenopause-related balance issues.
• Ginkgo biloba is well-known for its ability to improve circulation, particularly in the brain. Better blood flow can help reduce dizziness and vertigo by ensuring that the brain receives adequate oxygen and nutrients. Ginkgo may also improve cognitive function and relieve dizziness symptoms associated with hormonal fluctuations during perimenopause.
• Black Cohosh is often used to manage menopause symptoms. Black Cohosh helps balance hormones, particularly estrogen, which can be out of sync during perimenopause. By reducing estrogen fluctuations, black cohosh may help alleviate vertigo caused by hormonal imbalances. It has also been shown to ease other perimenopausal symptoms.

Vitamins and Minerals

• Vitamin D is for bone health, immune function, and brain health. Research has shown that low vitamin D levels can contribute to feelings of dizziness and vertigo. Ensuring that you get enough vitamin D, either through sunlight, food, or supplements, can help support brain function and reduce the risk of dizziness during perimenopause.
• Magnesium is a mineral promoting muscle relaxation and nerve function. It is particularly helpful in addressing dizziness related to muscle tension or spasms. Low magnesium levels contribute to feelings of lightheadedness, so supplementing with magnesium can help reduce these symptoms. Magnesium is also useful for calming the nervous system and improving overall balance.
• B vitamins, particularly B6 and B12, support nerve health and function. Hormonal changes during perimenopause can affect nerve function, potentially contributing to vertigo. Supplementing with B6 and B12 can help maintain healthy nerve function, reduce fatigue, and improve balance. These vitamins are often recommended for women experiencing dizziness or brain fog during hormonal shifts.

Other Considerations

• Coenzyme Q10 (CoQ10) is an antioxidant. It supports mitochondrial function. Mitochondrial function is crucial for energy production in the body. Low energy levels can exacerbate dizziness, especially during perimenopause, when fatigue is common. By supporting cellular energy production, CoQ10 may help reduce vertigo and improve overall vitality.
• Omega-3 fatty acids, naturally found in fish oil and certain plant-based sources, are well-known for their anti-inflammatory properties. They promote brain health and improve circulation, which can help alleviate dizziness and vertigo. Omega-3s also support nerve function, which can be especially helpful for managing the neurological changes that occur during perimenopause.

Lifestyle Changes to Manage Vertigo During Perimenopause

While supplements can provide significant relief from vertigo during perimenopause, certain lifestyle changes can also play a role in managing symptoms and improving overall well-being. 

Diet: A Balanced Diet to Support Hormones and Prevent Vertigo Triggers

A well-balanced diet is essential for supporting hormonal health and preventing vertigo triggers. 

During perimenopause, fluctuations in estrogen and other hormones can be exacerbated by poor nutrition, so it’s important to focus on foods that support hormone regulation and brain function. 

Key components of a perimenopause-friendly diet include:

• Healthy Fats: Include sources of omega-3 fatty acids (such as salmon, flaxseeds, and walnuts) to support brain health and reduce inflammation. Healthy fats support hormone production and balance as well.
• Protein: Protein-rich foods like lean meats, legumes, and tofu can support energy levels, stabilize blood sugar, and prevent dizziness associated with fatigue.
• Complex Carbs: Whole grains, fruits, and vegetables provide essential nutrients and fiber, which help stabilize blood sugar levels. Blood sugar fluctuations can contribute to dizziness and vertigo.
• Magnesium-Rich Foods: Magnesium is crucial for muscle relaxation and nerve function. To reduce dizziness, include magnesium-rich foods like spinach, almonds, and avocados.
• Phytoestrogens: Foods like soy, flaxseeds, and chickpeas contain plant-based compounds. These mimic estrogen and may help regulate hormonal fluctuations during perimenopause.

Avoiding highly processed foods, caffeine, and alcohol can also help reduce triggers for dizziness and vertigo. 

These substances can disrupt blood sugar levels and dehydration, both of which contribute to balance issues.

Exercise: Balance Exercises and Stress-Reducing Practices

Regular physical activity is essential for managing vertigo and improving overall health during perimenopause. 

Exercise helps regulate hormones, maintain weight, and reduce stress—all of which can reduce the severity of vertigo. 

Specific exercises can also improve balance, coordination, and strength.

• Simple activities like heel-to-toe walking or tai chi can improve coordination and balance. These exercises strengthen the muscles and help the body maintain equilibrium.
• Yoga is particularly effective for reducing stress and improving flexibility. Certain yoga poses, like Tree Pose and Warrior III, can help with balance. Yoga also helps calm the nervous system, reducing anxiety and tension, which can exacerbate dizziness during perimenopause.
• Regular strength training can improve muscle tone and prevent falls caused by balance issues. It also helps with bone health, which can be compromised during perimenopause.

Exercise improves physical health and supports emotional well-being. It can also lower your levels of stress and anxiety, which often contribute to dizziness.

To help manage vertigo, aim for at least 30 minutes of moderate exercise most days of the week.

Hydration: The Importance of Staying Hydrated

Dehydration can be a major contributor to dizziness and vertigo, especially during perimenopause. 

Hormonal fluctuations affect the body’s ability to retain water, leading to dehydration and fluid imbalances. 

Proper hydration helps maintain healthy blood circulation, supports fluid balance in the inner ear, and ensures adequate body function.

To prevent dizziness related to dehydration, make sure to drink plenty of water throughout the day. 

Try to drink at least eight glasses (64 ounces) of water daily, and consider drinking more if you engage in physical activity or experience hot flashes, which can lead to fluid loss. 

Additionally, avoid excessive consumption of caffeinated beverages or alcohol, which can contribute to dehydration.

Incorporating hydrating foods like cucumbers, watermelon, and celery into your diet can also help you maintain optimal hydration levels and support overall health.

When to Seek Professional Help

While perimenopause-related vertigo can often be managed with supplements and lifestyle changes, it’s important to know when to seek professional help. 

If your dizziness or vertigo persists for an extended period, worsens over time, or interferes with daily activities, talk to a healthcare professional. 

If you experience severe vertigo accompanied by other symptoms like chest pain, difficulty breathing, severe headaches, or vision changes, seek immediate medical attention, as these could indicate more serious conditions unrelated to perimenopause.

A healthcare provider can help determine whether vertigo is caused by perimenopause or an underlying condition that requires different treatment. 

Your doctor might do tests to assess your balance and evaluate other potential causes of dizziness, such as vestibular disorders, ear infections, or cardiovascular issues.

Treatment Options

If medical evaluation confirms that vertigo is related to perimenopause, your healthcare provider may recommend specific treatments or therapies. These might include:

• Vestibular Rehabilitation Therapy (VRT) is a specialized form of physical therapy. It improves balance and reduces dizziness through exercises that train the brain to compensate for balance issues.
• Hormonal Replacement Therapy (HRT): Hormone therapy (estrogen replacement therapy) can help balance estrogen levels and reduce the severity of vertigo symptoms. However, HRT is not suitable for everyone. Talk to a doctor about the risks and benefits of perimenopausal, menopausal and postmenopausal hormone replacement therapy. It may help menopausal vertigo and other symptoms, like the risk of decreased bone mineral density. 
• Medications: Doctors may offer medications to help manage symptoms of vertigo, such as antihistamines or anti-nausea drugs, to reduce dizziness and alleviate discomfort.

Conclusion

Perimenopause can lead to vertigo due to hormonal fluctuations, particularly the decrease in estrogen that affects the inner ear and your brain’s ability to maintain balance. 

However, there are numerous ways to manage and alleviate vertigo, including herbal supplements, vitamins, and minerals that support hormonal balance, as well as lifestyle changes such as exercise, hydration, and a balanced diet.

If vertigo persists or worsens, get medical advice to rule out other causes and explore appropriate treatments. 

Natural remedies paired with healthy lifestyle choices can help improve symptoms, but professional guidance may be necessary to ensure the best possible outcomes.

Additional References, Research and Resources 

Nakata, Takahiro, et al. “Effect of Hormonal Therapy on the Otoconial Changes Caused by Estrogen Deficiency.” Scientific Reports, vol. 12, no. 1, 2022, pp. 1-9, https://doi.org/10.1038/s41598-022-27240-5. Accessed 18 Jan. 2025.

Park, J.H., and E. Viirre. “Vestibular Migraine May Be an Important Cause of Dizziness/Vertigo in Perimenopausal Period.” Medical Hypotheses, vol. 75, no. 5, 2010, pp. 409-414, https://doi.org/10.1016/j.mehy.2009.04.054. Accessed 18 Jan. 2025.

Taavoni, Simin, et al. “Effect of Tribulus Terrestris, Ginger, Saffron, and Cinnamomum on Menopausal Symptoms: A Randomised, Placebo-controlled Clinical Trial.” Przegla̜D Menopauzalny = Menopause Review, vol. 16, no. 1, 2017, p. 19, https://doi.org/10.5114/pm.2017.67366. Accessed 18 Jan. 2025.

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.

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