Nausea: it’s not just for pregnancy. What causes some women to feel nauseated, even to the point of vomiting, during perimenopause and menopause?

It’s not a common occurrence, and even the women who experience it tend to have it a few days a month rather than all the time, but still, it’s unpleasant and disruptive enough for women to want a solution.

So what causes menopausal nausea?

Spoiler alert: there hasn’t been much research on this particular symptom, so the best we have are some educated guesses.  

The most common theory we were able to find points at progesterone deficiency causing nausea in menopause. So if nausea was present during your regular menstrual cycles or during pregnancy, you may find yourself dealing with it again in perimenopause and menopause.

According to Dr. Arianna Staruch, Dean of the School of Naturopathic Medicine at Bastyr University, in menopause, nausea can be due to GERD (gastroesophageal reflux disease) or slow digestion. 

Other causes can include dehydration, particularly if you find yourself nauseated first thing in the morning, and low blood sugar levels, if you haven’t eaten well or enough that day. Fatigue, poor sleep, intense hot flashes, stress, and migraines can also participate in making us feel sick.

How to manage the nausea of menopause

Treatment of the nausea often requires landing on a cause, so the first thing to do might be to check with your doc.

Things to consider:

  1. Are you taking any new medications?
  2. Have you changed your diet in any significant way?
  3. Could you be pregnant? (less likely in perimenopause, but not impossible)
  4. Is there a lot of stress in your life? (new job, money concerns, relationship issues, aging parents)
  5. Could it be something else, like ulcers or diabetes, that may require medical intervention?

Once you’ve eliminated the more dangerous possible causes, there are things you can do to manage, reduce, or maybe even eliminate your nausea.

Track triggers

Is there a pattern to your problem? If you’re still having periods, even irregularly, you might be able to get a clue from tracking your nausea against your cycle. Does it seem to happen a few days ahead of your cycle starting?

Food and drink may also be causing the symptom. Are you drinking enough water? Have you developed a sensitivity that wasn’t present before (many of us find it harder to digest dairy as we age)? Did you have more wine or coffee than usual the day before?

Check your over-the-counter meds: did you take some pain relievers that might cause stomach upset? Are you taking iron or another supplement that might be causing stomach pain?

Is there a potential stressor in your life: a weekly visit or phone call with parents, maybe a regular task that causes stress, or a new concern that’s disrupting your regular sleeping and eating patterns?

Is the nausea related to other menopause symptoms like hot flashes, heart palpitations, anxiety, or insomnia?

Know the timing

When does it strike? First thing in the morning? After a meal? The more information you can uncover about patterns, the better your chances of landing on a cause or avoiding a trigger.

Make choices to feel better

For many, the nausea of diminishing progesterone is a temporary problem, and once your body adapts, you may be able to return to life as usual (ish). But while you have this issue, you may want to make a few adjustments:

  1. Avoid spicy and/or greasy foods. Cut back on sugar or dairy or alcohol, if any of those are related to your stomach upset. Eat smaller, more frequent meals, and take your time while eating. Be sure to drink a lot of water during meals, as that can help with digestion. Don’t skip meals, even if you’re feeling queasy; having no food in your stomach can make matters worse. Just choose something good and bland, like white rice or crackers.
  2. If your issues are due to GERD (which is similar to heartburn), there are lifestyle changes that might help, says Dr. Arianna: "Reducing or eliminating coffee, reducing or eliminating alcohol, not eating a large meal before bed, watching spicy food, chocolate and peppermint." If those changes don't help, she says, you'd be wise to look for another cause for your symptoms.
  3. If the nausea is accompanied by feeling overly full and bloated (and not because you ate too much), you may not be digesting food well, according to Dr. Arianna. "As we get older we may produce less acid and fewer digestive enzymes. Supplementing with digestive enzymes with every meal and using herbal bitters before meals may be helpful. However," she warns, "herbal bitters would not be helpful if you have GERD."
  4. For really bad days, an over-the-counter nausea solution can be a good temporary help (Pepto-Bismol), but don’t become reliant on it. It’s great for treating symptoms, but it doesn’t usually help heal the root cause. Our Director of Health, Dr. Rebecca Dunsmoor-Su, says, "Often the nausea we see in pregnancy is really acid reflux, and it could be the same issue in menopause. So I suggest ginger, and if that doesn't work, a medication like Zantac can help."
  5. Drink fruit teas or peppermint tea. You may want to cut back on caffeine, so why not replace the irritant with something soothing? Just don’t overdo any of it, as too much of anything can cause stomach issues. 
  6. Invest in a yoga class. Stretching, Pilates, tai chi, meditation… all are good for calming our minds which can translate to a calmer tummy. Exercising too much and too hard can cause stomach upset, so maybe swap out the HIIT for a walk in the woods every now and again.
  7. Reduce stress. I know, we laugh too, every time we hear it, because the modern world seems to be built on stress, but honestly, can you find ways to make life easier on yourself? Pack a week’s worth of lunches on Sunday afternoon, delegate a few tasks where you can, learn to say “no” to things you know are going to make life more difficult.
  8. Exercise and sleep. Get enough of both. 30 minutes a day of gentle exercise can actually help calm things down on the inside, especially if your exercise of choice is a walk with friends where there are trees. Trees are really good for us, it turns out, so try and find some to commune with. As for sleep, turn off your screens two hours before bedtime. It’s really hard to unplug, we know, but it’ll pay dividends in better sleep and better health generally.

Like most menopause symptoms, whether or not a woman suffers from it and how much is individual to the woman. But no one needs to suffer debilitating symptoms alone. Talk to your MD or ND to determine why you're feeling nauseated and to discuss solutions for managing the nausea until your body adapts to its new normal.

Are you dealing with menopause nausea? How have you handled it? You can comment here, find us on Facebook or in Midlife & Menopause Solutions, our Facebook group. You can also join us, anonymously, if you prefer, on our community forums. 



Shannon Perry

Shannon is a celebrated author and global educator. Whether she’s interviewing a physician or producing a podcast, her appetite for research, facts, and truth culminates in credible health education and programming that women can rely on. An avid runner, cyclist, and climber, Shannon knows a thing or two about thriving in midlife and lives in Seattle with her cat, dog and boyfriend.


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