Menopause and Vertigo

Why Do Women Experience Vertigo During Menopause?

By Dr. Jyothi Shenoy

Updated January 2024

Vertigo is one of the most disturbing symptoms that women experience during menopause. It’s often symptomatic of other conditions and may occur due to a combination of factors, including hormonal imbalance, fatigue, ear infection, or metabolic dysfunctions.

Vertigo can significantly interfere with our routine activities and worsen other symptoms they might be experiencing, such as mood swings and anxiety. Understanding why vertigo occurs during menopause transition and how to manage it can help mitigate its impact on daily life.

What is Vertigo?

Vertigo can be understood as a feeling of dizziness or imbalance that a person experiences. It is often characterized by symptoms like lightheadedness, where you feel as if your head has become light like a balloon whose ribbon has been suddenly released.

The sensation of lightheadedness is often accompanied by blurred or clouded vision, a loss of balance, and fainting.

Disequilibrium is another characteristic feature of vertigo that makes you feel as if the floor is tilting, preventing you from maintaining balance. This is often accompanied by unsteadiness, faintness, and spatial disorientation.

A more severe form of vertigo can make you feel as if the room is spinning or that you are being pulled in one direction. It may even cause severe headaches or migraines, ringing in the ears, sweating, and vomiting.

Incidence of Vertigo in Menopausal Women

The incidence of benign paroxysmal positional vertigo (BPPV) is very high in perimenopausal and postmenopausal women. Studies show that African-American women are more likely to suffer from BPPV compared to White women and that the frequency of BPPV is highest among Asian women.

The risk is substantially higher in women in urban areas. It is estimated that nearly 63.4% of women living in urban and suburban areas experience vertigo compared to 33.5% of women living in rural areas.

These numbers point to the need to create awareness about why vertigo occurs and what you can do to ease the symptoms or avoid it from causing severe complications due to a fall or the loss of consciousness.

Factors Influencing The Development Of Vertigo During Menopause

Hormonal changes

During perimenopause, the ovaries’ secretion of estrogen and progesterone begins to decline. These hormones are responsible for the proper functioning of the woman’s reproductive system and the brain, ears, and heart.

The imbalance in the levels of estrogen and progesterone is implicated as a primary cause of vertigo in perimenopausal women.

Ear problems

The brain can sense balance through an ear organ called the otoconia which comprises tiny crystals known as otoliths.

Research studies have revealed that women are likely to experience vertigo when moving or changing position, possibly due to the abnormalities linked to the otoconia.

The studies have suggested a link between reduced estrogen production during menopause and the weakening of the otoconia. This might contribute to ear problems leading to vertigo during menopause.


Degenerative changes occurring in the body due to aging could contribute to the other factors responsible for vertigo.

Some studies have suggested that menopause might trigger epigenetic changes that could speed up the aging process, thus worsening vertigo.

Metabolic dysfunctions

The imbalance in the estrogen levels during menopause can affect insulin secretion in the pancreas, thus preventing an efficient metabolism of carbohydrates.

As a result, the glucose levels in the blood fluctuate, so the body’s cells do not receive a steady supply of fuel. This could lead to fatigue and dizziness, worsening the vertigo risk.

Poor emotional health

Vertigo in perimenopausal and postmenopausal women could be associated with stress and anxiety arising from other symptoms of menopause, such as increased sweating, mood swings, lack of sleep, and hot flashes.

Reduced cardiac efficiency

Hormonal changes during menopause could affect heart function, reducing its ability to pump blood around the body. The deprivation of blood, oxygen and other nutrients to the cells could make women feel lightheaded and dizzy.

Inadequate sleep

Inadequate sleep due to hot flashes, headaches, and sweating can also result in lightheadedness and vertigo.

Women can seek appropriate treatment or try simple exercises to get relief from vertigo. Here are some treatments and exercises you can try to improve your balance and prevent episodes of dizziness.

Treatment of vertigo during menopause


Medications can provide significant relief from vertigo and the accompanying symptoms such as dizziness, nausea, and motion sickness.

Some commonly prescribed medications for managing vertigo include Benzodiazepines, Betahistine, Cinnarizine, Dimenhydrinate, and Meclizine.

If vertigo is caused due to inflammation and infection, your physician may recommend steroids and antibiotics to reduce swelling and clear the infection.

Epley Maneuver

If you experience vertigo from the left ear, follow the steps of Epley Maneuver to relieve the symptoms:

  1. Sit at the edge of your bed and turn your head about 45 degrees to the left.
  2. Then, place a pillow below you so that it will rest between your shoulders and not under your head when you lie down.
  3. Then, lie down quickly on your back, keeping your head on the bed, still keeping it turned at a 45-degree angle. Make sure the pillow is under your shoulders.
  4. Stay in this position for about 30 seconds.
  5. Then, turn your head 90 degrees to the right without raising it and wait 30 seconds.
  6. Slowly turn your body and head to lie on your right side so that you are looking at the floor, and stay in the position for 30 seconds.
  7. Sit up slowly but remain seated on the bed for a few minutes.

Reverse these steps if vertigo comes from your right ear.

Perform this exercise 3 times before bedtime every night until you have had no episode of vertigo for at least 24 hours.

Brandt-Daroff Exercise
  1. Sit in an upright position on your bed.
  2. Then, tilt your head at a 45-degree angle away from the side causing vertigo.
  3. Now, slowly lie down on one side with your nose pointed up.
  4. Stay in the position for 30 seconds. Then, get up slowly to sit on the bed for a few minutes.
  5. Repeat on the other side.

Do these movements 3 to 5 times in each session. Perform 3 sessions of this exercise every day for 2 weeks, or until you do not experience vertigo for at least 2 days.

Lifestyle strategies to reduce vertigo
  • Eat frequent small meals to maintain stable blood sugar levels
  • Stay well hydrated by drinking plenty of water
  • Establish a healthy sleep-wake routine
  • Manage stress through meditation, exercise, and yoga
Vestibular Rehabilitation Therapy

The human vestibular system is a sensory network that supplies the brain with data regarding balance, movement, and the positioning of your head and body relative to the environment around you. For extreme cases of vertigo or disequilibrium that do not resolve in days or weeks, Vestibular Rehabilitation Therapy (VRT), may be helpful.

A movement and exercise-based treatment program designed to improve vestibular adaptation, VRT is not a cure for vertigo; however, when done consistently, it can significantly improve your quality of life.

Here’s how vestibular therapy can help with vertigo:

  1. Improving Balance and Stability: Vestibular therapy involves exercises that train the brain to rely on other senses (like vision and kinesthesia) to compensate for the loss of accuracy in the vestibular system. This can improve balance and stability, reducing the risk of falls.
  2. Reducing Dizziness and Vertigo Symptoms: Specific exercises in VRT can help reduce the intensity and frequency of dizziness and vertigo. These exercises often involve head and body movements that, over time, can lessen the sensitivity of the vestibular system to motion.
  3. Habituation Exercises: Habituation exercises are used to treat symptoms of dizziness that are produced because of self-motion and/or produced by visual stimuli. These exercises involve repeated exposure to specific movements or visual stimuli that provoke dizziness, helping the brain adapt over time.
  4. Gaze Stabilization Exercises: These exercises help improve control of eye movements so vision can be clearer during head movements. This is crucial for tasks that require maintaining focus on a moving or stationary object while the head is moving.
  5. Canalith Repositioning Maneuvers: In cases of BPPV, specific movements known as canalith repositioning maneuvers (like the Epley maneuver) are used to move the dislodged crystals in the inner ear back to their proper position, thereby reducing vertigo.
  6. Improving Overall Fitness and Activity Levels: Vestibular therapy also includes general exercises to improve muscle strength, flexibility, and aerobic conditioning, contributing to overall better physical health, which can indirectly reduce symptoms of vestibular disorders.
  7. Customized to Patient Needs: Vestibular rehabilitation is tailored to the individual’s symptoms and might include a combination of exercises and activities to address their specific issues.
  8. Education and Lifestyle Changes: The therapy often includes education about the vestibular system, how it affects balance and spatial orientation, and guidance on lifestyle changes to manage symptoms better.


Vertigo can contribute to the emotional and physical distress most women experience during menopause. It can also create an adverse impact on their routine activities and put them at risk of falls and injuries.

The use of appropriate medications, Epley Maneuver, Brandt-Daroff Exercise, Vestibular Rehabilitation Therapy, and lifestyle strategies discussed above can help women derive significant relief from vertigo and enable them to perform their activities with better ease.

Dr. Jyothi Shenoy is an integrative physician with more than 20 years of clinical experience. She is an expert in holistic medicine and has expertise in treating acute and chronic health conditions related to menopause transition.