Is it Morning Sickness or Menopause Nausea?

Perimenopause and menopause can come with a wide range of possible symptoms; but nausea isn't often one of them. So, if you've been feeling queasy lately and your periods haven't completely stopped just yet, you might start to wonder: Is this nausea from perimenopause – or could it be morning sickness from a surprise pregnancy?

Chances are that the problem is stemming from menopause-related hormone fluctuations. Here's how to tell what the cause of your nausea during perimenopause may be, and what you can do to feel better.

Is Nausea A Symptom of Menopause?

Transitioning through menopause can potentially cause a woman to feel nauseous, but it's not typical. "Nausea is an uncommon symptom of perimenopause or menopause," says Dr. Rebecca Levy-Gantt, DO and OBGYN.  "Changing hormone levels experienced during this transitional time, however, could be a reason for increased nausea."

While menopause isn't always tied to gastrointestinal symptoms, it's not unusual for a woman to experience symptoms such as mood changes, which can include anxiety. Sometimes the anxiety experienced during menopause is chronic and may be related to stressors or certain life changes that can hit in your 40s or 50s (think divorce, aging parents, or children leaving home). It's also possible that, for some women, hot flashes can trigger short-lived feelings of stress or anxiety¹, perhaps because these symptoms are often uncomfortable or even embarrassing.

In either case, feelings of stress or anxiety can leave you feeling queasy. Stress signals the release of fight-or-flight hormones that can directly impact your digestive system in the form of nausea or abdominal pain. For some, feeling stressed or anxious can even trigger diarrhea or vomiting.²

Heartburn, reflux, or gastroesophageal reflux disease (GERD), which occurs when acid from the stomach backs up and irritates esophagus, is also common in adults; nausea can present as one of the many symptoms of this condition.  While not specific to menopause and common in pregnancy, reflux or GERD can be a very common ailment for adults in general.³

How Does Menopause Nausea Differ from Morning Sickness Nausea?

Nausea that's considered to be a symptom of perimenopause or menopause, is typically tied to feelings of stress or anxiety. In some cases, it's also possible that low levels of the hormone progesterone can slow gastrointestinal (GI) function, leading to bloating and gassiness that could be interpreted as nausea, Dr. Levy-Gantt explains.

Morning sickness that strikes during pregnancy (which can happen at any time of day or night, by the way) may be related to hormone changes, too. But low blood sugar might also be a culprit, experts theorize. The symptom of morning sickness is common, affecting nearly 7 in 10 pregnant women, and it most often occurs in the first three months of pregnancy.⁴

It's not possible to become pregnant once you've officially reached menopause, where your periods have stopped for a full 366 days. But if you're in perimenopause and are still experiencing periods - even sporadic ones - you can become pregnant, Dr. Levy-Gantt points out. So, if you notice that your period is late and you're experiencing symptoms of possible pregnancy, like nausea, tender or swollen breasts, fatigue, or increased urination, it's a good idea to take a pregnancy test and to check in with your healthcare provider.

All this being said, the chances of becoming pregnant during perimenopause are slim, but not zero: A 40-year-old woman's chance of conceiving is less than 5% per menstrual cycle.⁵ And the more sporadic your periods become, the lower the odds, since fewer periods mean that you've been ovulating less often.

Managing Nausea During Menopause

If perimenopause or menopause is bringing on waves of nausea, there are ways to keep your queasiness in check. Some helpful strategies that you can try, include:

• Being active. Regular exercise can help reduce feelings of stress and anxiety, which in turn, may ease nausea. Aim for 30 minutes of moderate activity most days of the week.
• Considering meditation. Just 10 minutes a day is another useful tool for reducing feelings of stress, helping you feel calmer and less anxious.
• Adjusting your diet. If your nausea comes along with gas and bloating, try eating smaller, more frequent meals. Also consider limiting your intake of fatty or greasy foods, which can make stomach discomfort worse.
• Trying peppermint tea. Some research shows that sipping on herbal teas, such as peppermint, can ease feelings of nausea.⁶

If at-home measures aren't doing enough, be sure to talk with your healthcare provider about your symptoms. In some cases, nausea that won't ease up could be a sign of an underlying health problem, so it's a good idea to monitor your symptoms and confirm if your nausea really is menopause related.

If it is, you and your healthcare provider can decide on the best course of action. For nausea that seems tied to hormone fluctuations, stabilizing your hormone levels with hormonal birth control or hormone replacement therapy may be helpful, Dr. Levy-Gantt says. And if you're having trouble managing your stress or anxiety, you might consider meeting with a counselor or therapist.

Resources:

1. https://health.clevelandclinic.org/hot-flashes-and-nausea/
2. https://health.clevelandclinic.org/what-is-stress-nausea-and-how-to-deal-with-it/
3. https://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1
4. https://www.marchofdimes.org/find-support/topics/pregnancy/morning-sickness
5. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/age-and-fertility/
6. https://health.clevelandclinic.org/what-is-stress-nausea-and-how-to-deal-with-it/