Menopause can have surprising effects on digestive health. Digestive problems are incredibly common among women of perimenopausal and menopausal age. A study of 600 women found that almost half experienced at least one digestive symptom, including constipation, stomach pain, and heartburn. The vast majority of these women reported that their symptoms either started or got worse with the onset of menopause or perimenopause.

Heartburn — burning pain in the chest, sour acid in the mouth, coughing, and hoarseness — can be one of the digestive symptoms that comes along with menopause. Fortunately, there are lifestyle changes you can make and treatments that you can take to ease the effects of heartburn.

How Can Menopause Cause Heartburn?

Several factors related to menopause can increase the likelihood of heartburn or make existing symptoms worse. Below are some common causes to be aware of.

Hormone Changes

The hormonal changes of menopause can directly cause heartburn. Lower levels of estrogen can weaken the lower esophageal sphincter (LES). The LES, a valve that regulates the passage of food, sits where the stomach meets the esophagus (the tube that brings food from the mouth to the stomach). Low estrogen can cause the lower esophageal sphincter to lose tone, which can allow acid from the stomach to enter the esophagus, causing heartburn and acid reflux.

The gut microbiome (the ecosystem of microorganisms in your intestines) also changes along with hormone levels during menopause, which could affect how much stomach acid your body makes.

Midlife Changes

Menopause may be making your heartburn worse, but heartburn is also more common in midlife for everybody. As we age, we produce less saliva in our mouths. Saliva helps calm down stomach acid. When there’s less saliva, our stomach acid could cause more irritation, which could lead to heartburn.

The lower esophageal sphincter can get weaker due to aging as well. This weakening can cause stomach acid to escape into the esophagus. In general, your digestive system slows down with age. This means that food sits in the stomach longer and your stomach makes more acid.

You’re also more likely to gain weight as you age. This can apply pressure to your digestive system and push acid up into the stomach and into the esophagus.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) is a treatment that can help reduce certain menopause symptoms, and it can also increase your risk of experiencing heartburn. As mentioned earlier, low estrogen can cause the lower esophageal sphincter to weaken by decreasing tone. Similarly, high estrogen can cause the LES to relax and lead to a backup of stomach acid. Ultimately, both high and low estrogen can cause the LES not to work properly, leading to heartburn.

A study of more than 1 million women found that those who took hormone replacement therapy were 29 percent more likely to develop gastroesophageal reflux disease (GERD), or chronic heartburn. Women who took estrogen alone were the most likely to develop GERD. Interestingly, women who took both estrogen and progesterone were the least likely to get GERD, with only a 16 percent higher risk than women who never took HRT.

Tips for Heartburn Relief

You can treat heartburn with lifestyle changes and medication.

Avoid Triggering Foods

The easiest way to avoid heartburn is to avoid triggering foods. High-fat, high-salt, processed, and spicy foods often trigger heartburn.

Here are some food and beverages that can trigger heartburn:

• Fried foods
• Preserved meats, like bacon and sausage
• Pepper and chilis
• Cheese
• Acidic foods, like tomatoes, citrus fruits, and coffee
• Sodas and other carbonated drinks

Heartburn can be more common at night, as acid from your stomach is more likely to leak through the lower esophageal sphincter when you’re lying down. If you want to eat a type of food that can trigger heartburn, do it earlier in the day.

Alkaline foods can counter the acid in your stomach, which might help with heartburn. These foods include bananas, melons, and nuts. Watery foods can dilute acid, so they might also be helpful. Simply drinking water can help, as can low-sodium broth and herbal tea. Celery, lettuce, cucumber, and melons also contain a lot of water. Sour foods can also help by increasing saliva production and neutralizing stomach acid.

Take Medication

Your healthcare provider may recommend medication that can be used along with lifestyle changes to treat heartburn. The following medications are available to combat heartburn.

Antacids

Antacids are the most well-known treatment for heartburn and are available over the counter. They work quickly to stop heartburn symptoms by neutralizing the acid in your stomach. However, taking antacids for too long can cause acid rebound, in which your body actually produces more acid. Too many antacids can also weaken your bones and cause iron deficiency. If you’re frequently taking antacids for heartburn, talk to your doctor about other options.

H2 Blockers

Your body releases histamine-2 (H2) that attaches to receptors in the lining of your stomach when you eat. This process triggers your stomach to create acid. H2 blockers are medications that block this process from happening so that there’s less acid in the stomach.

Unlike antacids, H2 blockers don’t work right away. They can take about an hour to work. H2 blockers are available over the counter or by prescription.

If you need to take H2 blockers for more than a few weeks, speak with your healthcare provider. H2 blockers can become less effective over time.

Proton Pump Inhibitors

The most powerful stomach acid reducers, proton pump inhibitors, break up the process that creates stomach acid. If you take a proton pump inhibitor for five days, it would eliminate more than 65 percent of your stomach acid.

Even though they’re the most powerful drug against heartburn, proton pump inhibitors don’t treat the symptoms of heartburn right away. It can take up to four days to notice that your heartburn is getting better. They’re more useful if you have chronic heartburn that’s damaging your tissues.

When To Seek Emergency Care

Usually heartburn is painful but not serious. However, heartburn symptoms may be similar to those of a heart attack and it can be difficult to tell which is which. Heart attack symptoms can include:

• Feelings of squeezing or pressure in your chest
• Cold sweat
• Nausea
• Heartburn
• Abdominal pain
• Dizziness
• Shortness of breath

If you’re concerned you’re experiencing heart attack symptoms, seek emergency care right away.