Most people know that perimenopause (the time leading up to menopause) and menopause come with hot flashes. But not everyone’s aware of other menopausal symptoms, such as headaches, anxiety, and nausea.

A study of almost 600 perimenopausal and menopausal women found that nearly all participants had digestive issues. When ThisIsMenopause surveyed a large group of women, they overwhelmingly reported experiencing nausea. As one respondent said, “I have a lot of stomach issues!” Another said, “I wish I had known about feeling sick every day. The cramps and the certain sensitivity to food smells and intense nausea that hits you from nowhere.”

Many body changes caused by menopause can make you feel sick to your stomach. Discover what they are, along with possible treatment options.

Menopause and the Gut

Menopause causes stomach issues because hormonal shifts change the gut biome. The gut biome describes the bacteria that live in your gut. These bacteria have many effects on your body, including the immune system, brain health, and heart health. And because they live in your intestines, any changes in these bacteria can affect your overall digestive health.

Researchers have found that drops in estrogen levels during menopause change both the types and amounts of bacteria in the gut microbiome. Hormonal changes in estrogen and progesterone levels may also affect the protective lining of your digestive system, triggering inflammation and leading to digestive symptoms like nausea.

Additionally, changing hormone levels affect how quickly food moves through your digestive system and disrupt communication between your gut and brain. These shifts in digestion and gut-brain signaling can directly contribute to feelings of nausea.

Other Issues That Cause Nausea

Even when it doesn’t directly affect your gut, menopause can cause and worsen several conditions that have nausea as a symptom.

Hot Flashes

Hot flashes are the best-known symptom of menopause. Together with night sweats, these are called vasomotor symptoms. Most women experience changes in body heat and sweating during a hot flash. But women surveyed by ThisIsMenopause also experience nausea during these hot periods. “The hot flashes make me sick to my stomach,” one said.

Hot flashes make you feel nauseous because changes in estrogen levels affect a part of your brain called the hypothalamus. The hypothalamus regulates body temperature. When it doesn’t get a steady supply of estrogen, it mistakenly thinks that your body is running too hot. To cool you down, the hypothalamus acts in the opposite direction and opens up your blood vessels and sweat glands. This heat release is supposed to cool you down. But because your body temperature is not actually too high, you just feel hot and sweaty for no obvious reason.

This action by the hypothalamus doesn’t just make you red-faced, warm, and sweaty. It can also cause other sensations, like dizziness, a racing heart, and even nausea.

Hot flashes can also feel similar to anxiety or panic attacks. These feelings may trigger nausea right after a hot flash. In addition, the anxiety from hot flashes can lead to worsening anxiety and depression in general.

The most effective treatment for hot flashes is hormone therapy. This treatment replaces the estrogen that your body no longer naturally produces. If you still have a uterus, you will need a progestogen (such as progesterone or a synthetic progestin) along with estrogen. This combination is essential because estrogen alone significantly increases the risk of endometrial cancer (cancer of the lining of the uterus). Antidepressants and other nonhormonal medications can also treat hot flashes, but aren’t as effective as hormone therapy.

Natural treatments and lifestyle changes can limit the effects of hot flashes, including nausea. Making dietary changes, such as cutting back on sugary and spicy foods, may also help. Herbal teas with peppermint, chamomile, or ginger may be soothing as well.

Anxiety and Depression

Anxiety and depression are common during menopause. Hormonal changes during perimenopause and menopause can affect mood and may contribute to anxiety and depression. Menopause can also disrupt sleep, which may make these symptoms worse.

Anxiety and depression can cause emotional symptoms, including worry, restlessness, and irritability. They can also cause physical symptoms, such as muscle tension and heart palpitations. Nausea and other digestive issues may also be symptoms of anxiety and depression.

To treat the nausea caused by menopause-related anxiety and depression, try lifestyle changes that help with relaxation. This may include meditation, gratitude work, and gentle exercise like yoga. Treatments including antidepressants and cognitive behavioral therapy may also help. Some people also find that menopausal hormone therapy (MHT) can help ease anxiety and depression during menopause.

Antidepressants

If you’re taking antidepressants for menopause-related issues, these drugs might be causing nausea as a side effect. Nausea usually shows up right after you start taking an antidepressant. Antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs) are most likely to cause nausea.

You don’t have to give up your antidepressants to stop feeling nauseous. Taking your antidepressant with food can help, as well as drinking plenty of water. Changing your dose might also decrease nausea. Some antidepressant medications have slow-release formulas that make them easier on your stomach. Talk to your healthcare professional if you need a different SNRI formulation to help ease feelings of nausea.

Headaches and Migraine Attacks

Changing hormone levels during menopause can cause headaches and migraine attacks or make them worse. One of the classic symptoms of migraine headaches is nausea and vomiting.

Treatments for migraine pain include triptans and nasal sprays, as well as nonsteroidal anti-inflammatory drugs (NSAIDs). Estrogen supplementation can also help prevent migraine attacks, although if you experience migraine with aura, it is best to talk with your healthcare professional about which hormone therapy formulations may be safest for you.

Treating Nausea

In many cases, treating the underlying cause may help improve nausea. If it’s linked to hot flashes, for instance, taking hormone therapy may help ease your nausea symptoms. You may also benefit from some general nausea self-care tips. These strategies can help you feel less nauseous:

• Eat smaller, more frequent meals.
• Consider eating bland foods that are easier on your stomach.
• Give yourself time to digest before exercising or brushing your teeth.
• Try eating plain crackers or foods made with ginger.

Your healthcare provider may also recommend taking anti-nausea medications. These are also called antiemetic drugs. Ask for a specific recommendation to ensure that the medication won’t interfere with your other therapies.