Acid Reflux and Perimenopause: Causes, Triggers, and Relief
Acid reflux often worsens during perimenopause. Discover why hormonal changes increase heartburn risk and find practical strategies to manage and reduce symptoms.
The Hormonal Link to Acid Reflux
Acid reflux (also called gastro-oesophageal reflux disease or GORD when chronic) occurs when stomach acid flows back into the oesophagus, causing heartburn, a burning sensation in the chest or throat, and sometimes a sour taste. During perimenopause, declining estrogen affects the lower oesophageal sphincter, the muscular valve that normally keeps stomach contents in place. When this valve becomes lax, acid can escape more easily. Progesterone fluctuations also relax smooth muscle, including the sphincter, compounding the problem. Many women who never experienced reflux before find it becoming a regular issue during perimenopause.
Symptoms to Recognise
Classic acid reflux symptoms include a burning feeling behind the breastbone that worsens after eating or when lying down, regurgitation of food or acid into the mouth, a persistent cough, hoarseness, the sensation of a lump in the throat, and bloating. Some women find that perimenopause-related weight gain around the abdomen puts additional pressure on the stomach, worsening reflux. Stress, which tends to increase during perimenopause, also stimulates acid production and delays gastric emptying, making symptoms more likely after tense or difficult days.
Dietary Triggers and What to Avoid
Certain foods are well-established triggers for acid reflux. These include fatty or fried foods, citrus fruits and juices, tomato-based sauces, chocolate, peppermint, coffee, alcohol, and spicy foods. Late-night eating is a particular problem: going to bed within two to three hours of a meal significantly increases reflux risk. Carbonated drinks increase stomach pressure. Eating larger meals stretches the stomach and increases the likelihood of acid escaping. Switching to smaller, more frequent meals eaten slowly tends to reduce symptom frequency for many women.
Lifestyle Adjustments That Help
Elevating the head of the bed by 15 to 20 centimetres (using blocks or a wedge pillow, not just extra pillows) reduces night-time reflux significantly. Sleeping on the left side also helps, as this position positions the stomach below the oesophagus. Wearing loose-fitting clothing rather than waistbands that compress the abdomen reduces pressure after meals. Losing even a small amount of weight if you are carrying extra around the middle can make a noticeable difference. Stopping smoking, if applicable, is one of the most effective steps, as smoking weakens the lower oesophageal sphincter.
Medication and Natural Options
Over-the-counter antacids provide short-term relief by neutralising stomach acid. H2 blockers such as ranitidine or famotidine reduce acid production for several hours. Proton pump inhibitors (PPIs) like omeprazole are the most effective medication for frequent or severe reflux and can be prescribed by your GP for regular use. Long-term PPI use should be monitored, as it can affect magnesium absorption and gut microbiome diversity. Some women find relief from slippery elm, aloe vera juice, or chewing sugar-free gum (which stimulates saliva and helps neutralise acid), though these have less clinical evidence behind them.
When to Seek Medical Help
Occasional heartburn is common and manageable, but persistent or worsening symptoms require medical attention. See your GP if reflux is occurring more than twice a week, if symptoms are not controlled by over-the-counter remedies, or if you experience difficulty swallowing, unintentional weight loss, or vomiting. These can indicate complications including oesophagitis or Barrett's oesophagus, a precancerous change in the oesophageal lining. An endoscopy may be recommended to assess the oesophagus directly. Do not dismiss acid reflux as a minor inconvenience if it is affecting your sleep, eating, or quality of life.
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