I want to thank the women of Nebraska, USA, for participating in one of the very few studies looking at the connection between menopause and dizziness. It’s a long way from Nebraska to New Zealand, but I now understand why I had to stop my beloved step-aerobic classes when I went into peri-menopause when the sudden turning and twisting made me feel dizzy and a bit sick. When I mention this in my numerous seminars around the world, I’m amazed at how many women nod and agree!
The Nebraskan study explored the relationship between menopause and dizziness in nearly 1000 women. I had my head in this research because I often receive health screening forms from women who do the MyMT programmes and they ‘tick the box’ that they have experienced dizziness in menopause. I so understand what they are going through! This type of email from Trish, is quite typical.
“I’m feeling really dizzy all the time and my Doctor has done all sorts of tests, but nothing is coming up. Everything’s normal!”
When I receive these responses, I explain that their Doctor may not be looking through the lens of menopause and the loss of oestrogen from our ear canal.
There isn’t a lot of research that has been conducted on mid-life women in menopause, however, we already know that falls and balance problems are the greatest risk for elderly women over the age of 70 years. Our hospitals and rest-homes are full of women who have already had falls, or are at a higher risk of experiencing falls because they feel dizzy.
That’s why I love this study out of Nebraska.
The highest scores for reporting of vertigo (dizziness) problems, [which is medically known as Benign Paroxysmal Positional Vertigo (BPPV)], were reported in women aged between 10-19 years and 40-52 years who reported that they were either in menopause (peri-menopause) or out the other side (post-menopause). BPPV occurs when head position changes (lying down, looking up, or turning over in bed) causing short, recurrent vertigo spells.
What was striking to me was that nearly 50% of the women in the older age group reported that they experienced their first dizziness and balance episodes after menopause and, even more surprising, was that 22% of those who have had their ovaries removed and 32% of women who had a hysterectomy, reported on increasing vertigo episodes. Now that’s a real indication that vertigo and balance has a connection to changing oestrogen levels if ever there was!
So, what’s the connection between menopause, vertigo and oestrogen changes? That’s what I wanted to know – so again thank you to the researchers at the Boys Town National Research Hospital in Omaha, because I learnt about OTOCONIA. This helped me understand why there is the connection between our changing oestrogen levels, our biological ageing and dizziness and balance problems as we go into post-menopause.
Otoconia are bio-crystals which are made from protein and calcium molecules. BPPV is a result of these tiny crystals in your inner ear being out of place. The crystals make you sensitive to gravity and help you to keep your balance when oestrogen is high, but low oestrogen, low calcium and hair loss in your ear canal with ageing, cause these tiny bio-crystals to get out of place. Normally, a jelly-like membrane in your ear keeps the crystals where they belong. This is because your sense of balance relies on a finely tuned system that coordinates sensory information (from nerves throughout your body) and visual information to help you determine the position of your body relative to your surroundings.
The role of oestrogen in all of this, is to ‘couple’ or help this jelly-lie protein substance to adhere and therefore, help to provide a mechanic force to the sensory hair cells in the ear canal.
This process is essential for us to sense linear acceleration and gravity for the purpose of maintaining our balance. In fish, structurally similar bio-crystals called otoliths mediate both balance and hearing. What the Nebraska study (and other studies) have found, is that when there are changing hormone levels (such as in puberty or peri-menopause or when women have their ovaries removed, called an oophorectomy, or they have their uterus removed, called a hysterectomy, then the crystals in the ear shift and move to another part of the ear. Calcium is also involved in this force-coupling action and in menopause, many women experience low calcium levels, which can also exacerbate changes to the ear canal and sensory hair cells. When these lovely bio-crystals are out of place, they make you sensitive to rapid movement and position changes that normally haven’t affected you in the past, sparking the condition of vertigo.
As the Nebraska researchers say,
‘Perimenopausal fluctuations of oestrogen levels, not just low oestrogen levels, may account for the increased BPPV susceptibility of 40-52 year-old women. This is also reflected in the high rate of oophorectomy [removal of ovaries] in these women who likely experienced acute changes in hormone levels. Nevertheless, the higher BPPV prevalence in older women suggests that low oestrogen levels do affect BPPV onset and that BPPV is age-related. It is possible that either a sudden drop or rise in oestrogen would disrupt anion/ion homeostasis as well as affect neuro-sensory function, thereby contributing to the higher BPPV prevalence in menopausal women and even young women entering puberty.’ [p. 5].
This is why BPPV is not only common, but also incapacitating, especially as we go through menopause.
I’ve heard from many women who have to take time off work because of their dizziness. That’s because feeling dizzy can induce nausea, vomiting, balance dysfunction, and as I found myself, especially with skiing which I love to do, it can reduce your confidence in your body coping with whatever activity you are used to doing. Suddenly before you know it, you’re doing less and less activity – and the danger there is that the weight goes on as well. For older post-menopausal women, it can also affect walking and driving. But of course, as orthopedic staff the world over, already know, the greatest risk of feeling dizzy is falling, tripping or sustaining an injury.
Numerous studies indicate that there is a significant female preponderance of balance and dizziness incidents related to post-menopause oestrogen deficiency and if this is you, then please see your medical practitioner or physiotherapist, because there are medical and physiotherapy treatments available as well. This includes learning the Epley Manoevre, which are certain positional changes that assist the crystals in your inner ear to re-align, but please ensure that you go to a trained health professional or Physio who will teach you what to do.
What I also love is that to offset the dizziness and the loss of oestrogen in our ear canal, we can use this knowledge to put into place specific balance exercises and other lifestyle solutions including dietary change as well.
If you are experiencing menopause-related dizziness and loss of confidence in yourself, then here are some of my solutions for you:
- Walk around in bare-feet. Did you know that the balance mechanisms are not only in your ear canal but also in the soles of your feet? When I heard the fabulous New York Podiatrist, Dr Emily Splichal talk at a healthy ageing conference a couple of years ago, she opened up my mind to the possibilities of over-coming balance issues as we go through menopause. As Dr Splichal so rightly reminds us, “The human foot is a masterpiece of engineering and a work of art.” With hundreds of nerve endings in the soles of your feet and because we live in shoes all the time, there is good evidence to show that we have lost our ability to stimulate these precious nerves that help our balance and our gait (walking). When these nerves are not stimulated, we increase our risk of falling and during menopause, over-heating.
2. The old adage of ‘Use it or Lose it’ applies with improving balance. So add some balancing exercises to your day or take a Tai Chi class. Tai Chi is an ancient Chinese practice for improving balance and breathing and is becoming well evidenced in ageing studies. Mind-body exercises, such as tai chi and yoga, have been gaining popularity over the past few decades. This is not surprising, given the increasing number of studies on the positive effects of these gentler forms of exercise—everything from lowering blood pressure and managing depression to building strength and improving balance. There is even evidence that tai chi may help you live a longer, more vital life and I’m excited to teach you some balance and mindfulness techniques. in my brand new 12 week programme called ‘Rebuild My Fitness’. Many women complete this after they do the symptom reduction programmes.
3. Improve your calcium intake with non-dairy alternatives, such as nuts and deep-green vegies. In the MyMT™ food guide and recipe book which is part of the two different MyMT™ programmes, [‘Circuit Breaker’ for thinner/ leaner women and ‘Transform Me’ for overweight women], I teach women how to get their 1200 mg a day of calcium and more importantly, how to balance this vital nutrient up with magnesium, which is also important in menopause because it helps to dilate blood vessels. As we transition through menopause, our blood vessels lose the role of oestrogen which means they become more constricted, which can lead to high blood pressure in post-menopausal women.
When I began to research our menopause transition and all the changes that occur as we go through this natural life event, I realised that mid-life women have been forgotten when it comes to our menopause transition and the specific lifestyle solutions that help us to manage menopause symptoms and/or weight gain naturally. If you are struggling, then when you have time, have a listen to the video below, so you can meet me and see if my 12 week online programmes might be something you want to look into.
Wendy Sweet, [PhD/ NZ Registered Exercise Specialist & Women’s Healthy Ageing Researcher/ Member: Australasian Society of Lifestyle Medicine]