Many women in perimenopause and menopause have issues with acid reflux (GERD/GORD). This post will describe what acid reflux is, what causes it and how to reduce symptoms with a focus on food and nutrition.
What is acid reflux?
Acid reflux is the common term for Gasto-esophageal Reflux Disease (GERD or GORD if you use the spelling oesophageal). GERD occurs when stomach contents come up into the esophagus causing a variety of uncomfortable symptoms.
The stomach contains acidic juices that are important for digestion. The stomach lining is designed to withstand the acidic environment. There is a valve (sphincter) between the stomach and the esophagus (the pipe that food travels down when you swallow).
This sphincter stays closed unless food needs to enter the stomach. If the sphincter relaxes when there is no food coming into the stomach, it can allow stomach contents to rise into the esophagus.
The esophagus lining is sensitive to the acidic contents of the stomach and pain or a burning feeling may be felt. Over time, the esophagus can become damaged.
What are the symptoms of acid reflux?
Symptoms vary from person to person however the following are commonly reported:
- Uncomfortable feeling or pain in chest area
- Persistent cough especially at night
- Sour taste in the mouth
- Difficulty swallowing
- Sore throat
Always get symptoms checked by your doctor as many of these symptoms can be due to other medical issues.
What causes acid reflux?
- Esophageal sphincter not working properly which causes stomach contents to come back up the esophagus
- Delayed stomach emptying
- Hiatus hernia
- Stress may increase acid production in the stomach which can exacerbate GERD symptoms
- Some conditions like Type 2 Diabetes
Can menopause cause acid reflux?
There has been limited research into the role of hormonal changes during menopause and its effect on GERD.
We do know that perimenopausal and menopausal women have higher incidence of GERD. Studies have shown that menopausal women were 2.9 to 3.5 times more likely to have GERD symptoms and suggests that there may be a hormonal link.
We also know that estrogen plays a part in gut motility and decreased motility may increase the risk of GERD by delaying stomach emptying.
Interestingly, recent research has revealed that hormonal therapy (HRT) for menopause has been shown to increase incidence of GERD. At the time of writing, the research has been limited and the reasons why this is the case is unknown but it may be due to the fact that estrogen tends to relax the sphincter at the lower part of the esophagus.
It’s important to discuss this with your health care professional as an increased risk of GERD in most cases should not stop you from using HRT.
Damage to the lining of the esophagus appears to be worse in menopausal women with GERD. Estrogen protects the lining of the esophagus so deceased levels at menopause may lead to increased damage from reflux.
Treatment of acid reflux
Treatment options vary and will depend on how severe the symptoms are, how much damage there is to the esophagus and how it is affecting your quality of life.
There are medications that your doctor or pharmacist can prescribe and in severe cases, surgery may be recommended. Consult your health care professional to discuss these options.
Lifestyle changes can be useful in reducing symptoms either on their own (for mild reflux) or as an adjunct to medication.
The following lifestyle changes may be considered for reducing reflux symptoms:
- Quitting smoking
- Reducing stress
- Raising your bed head by 20cm can help if your symptoms are worse at night
- Avoid lying down within 2 hours of eating
Reducing or avoiding foods and drinks that increase your symptoms may help. Common foods and drinks that are reported are:
- Coffee and other caffeine containing drinks
- Spicy foods
- Fried foods
- High fat foods like cream, pastry, fatty meats, butter etc.
- Carbonated drinks like soft drink, soda etc
In addition to what you eat, how and when you eat can be important. Eating large meals can increase the risk of stomach contents moving up into the esophagus. Try eating smaller more frequent meals and snacks instead.
Eating too close to bedtime may also increase symptoms as laying down can also increase the chance of stomach contents getting into the esophagus. Gravity is your friend after meals! Stay upright for about 2 hours after eating and plan your evening meal earlier if possible.
What foods to eat to reduce reflux
Although restricting or avoiding trigger foods can benefit symptoms, research has shown that increasing your intake of certain foods can help treat or prevent GERD.
- Fruit and vegetables: One study found that people who ate more fruit and vegetables had a lower risk of GERD. Choose lower acid fruits like banana, melons and pears if citrus triggers your symptoms.
- Fibre-rich foods like oats, other wholegrains and legumes
- Yoghurt has been reported to be soothing for acid reflux and the probiotics can help restore balance to the gut microorganisms. Read my blog post on Menopause and Gut Health for more information.
- Protein foods like lean poultry, fish, tofu and low fat dairy
- Foods high in omega-3 fats like oily fish, linseeds/flaxseeds and walnuts can help reduce inflammation in the esophagus
Acid reflux (GERD) is a common condition in women at menopause. If not treated, it can cause damage to the esophagus. Treatment options vary depending on the severity of the symptoms and can include medications, lifestyle and dietary changes or even surgery.
Menopause appears to increase the risk of GERD and reduced estrogen levels result in increased damage of the esophagus lining. Our understanding of why GERD is a common problem during this life stage is not well known.
Dietary changes that may alleviate symptoms include reducing foods that trigger symptoms and including more fruit, vegetables, fibre-rich foods, lean protein and omega-3 rich foods can help.