Part of Dizziness and BPPV
Is vertigo a symptom of menopause?
Warning signs, and when to get help
Is vertigo a symptom of menopause?
No, not on anything you can go and check. That is not a satisfying answer, and it is the one that leads somewhere.
Start with the list a woman in the UK or anywhere else would look at first. The NHS page on menopause and perimenopause symptoms runs to well over a dozen items. Vertigo is not one of them. The word dizzy appears once on it, inside the description of a hot flush, which it says can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy.
That line does less work than it looks as though it does. A flush that leaves you momentarily swimmy is not the same event as the room spinning when you roll over in bed, and nothing on that page connects the menopause to the second thing.
Absence from a list is not proof that two things are unrelated. It means the connection has not been established, which is a different and more honest claim, and it is the same position our menopause and joints pages take about aching joints: an association in timing, no demonstrated cause. What follows from it is practical rather than philosophical. If your dizziness is new, it is still unexplained, and several of the things it could be are quick to find.
Menopause dizziness: what the NHS actually lists
Worth setting out properly, because the list is the reason so many women arrive here convinced their symptoms belong together.
The NHS names changes to your periods, hot flushes and night sweats, sleep problems, mood swings, low mood or depression, poor memory and brain fog, weight gain, vaginal dryness and irritation, urinary tract infections and incontinence, palpitations, weakening bones, headaches and migraines, muscle aches and joint pains, hair thinning, skin changes, reduced sex drive, and sensitive teeth or painful gums. It also says symptoms may feel worse if you have sleep problems and feel very tired, and it mentions anxiety alongside palpitations.
Now look at that list through the eyes of somebody who feels off. Broken sleep, fog, a heart that announces itself, headaches, aching and exhaustion will between them make anybody feel unsteady, vague and unwell. So the cluster is real and it is recognized. The spinning, or the specific sensation of the floor moving, is the one piece of it that nobody has attached to the hormones.
Two of those items have their own pages here, because they are so often the part that bothers people most. Exhaustion and fog with dizziness are covered in vertigo, tiredness and brain fog, and anxiety in vertigo, stress and anxiety.
Why estrogen gets the blame for the inner ear
Because estrogen gets the blame for most things at this stage of life, and because there is a real experiment behind the idea, done in animals.
Nakata and colleagues removed the ovaries of 8 week old female mice to drop their estrogen, compared them with sham-operated animals, and gave some of the operated mice implants of estradiol or of raloxifene. They then measured the volume of the otoconial layer in the inner ear with micro-CT scanning. The layer was larger in the estrogen-deficient animals than in the controls, and both treatments reduced that difference. The authors propose a route through oxidative stress, state that the mechanism remains unproven, and list their own limits, including doses higher than those used clinically (Nakata and colleagues, 2022).
That is a legitimate piece of laboratory work and it is mice. Removing the ovaries of an eight-week-old mouse is not the menopause, an implant is not a prescription, and a scan of an animal's inner ear is not a woman's symptom.
One sentence from that paper needs flagging, because it is the one most likely to be quoted at you. Its summary opens by saying that BPPV is associated with menopause and osteopenia and that hormone replacement therapy decreases BPPV risk. Those sentences are the authors summarizing other people's work as background, not reporting what their own experiment found. Repeating them as though a mouse study had shown that hormone treatment lowers a woman's risk of vertigo would be a straightforward misreading, and it is not done here. The general position on hormone treatment sits on menopause and joints, and the estrogen and collagen argument is set out on joint pain in the menopause.
What the research does and does not show
The evidence base here is thin, and saying so is more respectful than dressing it up.
The paper you will land on if you search is a narrative review in Cureus, which gathered the literature on menopause and vertigo and included 7 of the 92 articles it identified. It describes a potential link between the onset of menopause and an increased susceptibility to vestibular disturbance, says the interaction between the hormonal and balance systems is still poorly documented, and names the heterogeneity of study designs and the shortage of randomized trials among the limits of the field (Castillo-Bustamante and colleagues, 2024). Its own search excluded articles about vertigo during perimenopause, and articles about hormone replacement therapy, which is worth knowing before anyone quotes it on either. A narrative review makes no measurements of its own, so it tells you what has been written rather than what has been shown, and nothing on this page rests on it.
You will also meet a percentage for how many menopausal women get dizzy. Follow it back and there is no source attached to it on the pages that carry it, so it is not repeated here. A number with no study behind it is worse than no number, because the next person quotes it.
Put the two ends together and the picture is honest enough to work with. There is a mechanism studied in animals, a literature nobody has been able to pool, an overlap in timing that is easy to notice, and no established cause. Compare that with the aching joints question, where there is at least a large pooled count of how many women report pain, which menopause and joints sets out, and you can see why this page is more cautious than that one.
BPPV, bone density and the years after the menopause
One thread does connect this page to the rest of the menopause section, and it is not about what causes the spinning. It is about what the spinning can cost you.
Bone thinning after the menopause is not in doubt, and muscle and bone loss covers it, with the staged training program on osteoporosis. Hold that next to the fact that dizziness makes a fall more likely, and the risk on this page becomes clear. Short-lived spinning set off by a change of head position is not dangerous in itself. What it can do is put you on the floor on the stairs, or on the way to the bathroom at night, at an age when a fall onto an outstretched hand or onto a hip costs more than it used to.
That is why the warning list at the end of this page carries the hip and wrist lines as well as the dizziness ones, and why balance and falls prevention is worth reading alongside it rather than afterward.
What nobody has shown is the other direction. Thin bone has not been established as a cause of positional vertigo in women, and you will not find that claim here.
What else turns up at this age?
Quite a lot, which is the real argument for having your dizziness looked at rather than labeled.
The NHS lists causes of dizziness that owe nothing to hormones, and the overlap with a woman in her forties or fifties is striking once you read them together. A sudden drop in blood pressure when you stand or sit up suddenly. Iron deficiency anemia. Low blood sugar because of diabetes. Dehydration or heat exhaustion.
Then the ones it pairs with a pattern. An inner ear problem, suggested by feeling off balance along with hearing loss or ringing in your ears. Labyrinthitis, suggested by spinning and sickness after a cold or flu. A side effect of a new prescription medicine. Migraine, and stress or anxiety.
Three of those overlaps are worth naming out loud at the appointment.
Changes to your periods are on the NHS menopause symptom list, and iron deficiency anemia is on its dizziness list. Whether the two are connected in your case is a question a blood test answers, so ask for it rather than hoping somebody thinks of it.
Tiredness is the second, and it has its own line in the warning list at the end of this page: tiredness that has run on for weeks, that you cannot account for, or that is getting in the way of your daily life is a question for your doctor in its own right, whatever your hormones are doing.
Headaches and migraines are the third. They are on the menopause list, and migraine is also named as a cause of vertigo, so a change in your migraine pattern is a genuinely relevant thing to report. There is a specific diagnosis in that territory, and it is described on what else vertigo can be rather than here, so there is one proper account of it on this site.
Medicines are worth their own mention because this is the decade when more of them start. Dizziness that began after a new prescription is on the NHS list as a possible side effect, which is a reason to ask, and never a reason to stop or change a prescribed medicine on your own.
Does HRT help vertigo?
Nobody we read has tested that in women, so this page makes no claim in either direction. Not that hormone treatment helps vertigo, not that it prevents positional vertigo, and not that it does nothing.
The sentence circulating to the contrary comes from the background section of the mouse study above, where the authors cite other people for it (Nakata and colleagues, 2022). That is not a finding, and treating it as one is how a woman ends up choosing a prescription on the strength of an experiment in ovariectomized animals.
Hormone treatment is prescribed on your whole picture: your symptoms, your history and your own risks, weighed by somebody who has all three in front of them. That conversation belongs with your own doctor or menopause clinic, and the general position on where it fits and where it does not is on menopause and joints. Nothing here advises for or against it.
Supplements get the same answer and a shorter one. Vitamin D, calcium, collagen powders and the other products marketed for menopause symptoms are not treatments for dizziness on this site, and no dose is given for any of them. If you are asking about bone rather than balance, that is a fair question for your doctor, who can decide whether you need testing at all.
What is worth doing now
Three things, in this order, and none of them involves buying anything.
Get the cause named. Short spells of spinning when you lie down, roll over in bed or look up, or dizziness that keeps coming back, means an appointment with your GP or a physio within a few days so the cause can be confirmed and treated. Take notes with you: what you were doing when it starts, how long one episode lasts, whether the room spins or you sway, whether your hearing has changed, and what is new on your prescription list. How the diagnosis is made, and what the treatment involves, are both on dizziness and BPPV.
Make the house safer while you wait. The NHS advice for vertigo is sensible and free: get out of bed slowly and sit on the edge for a while before standing, turn the light on if you get up at night, sit down straight away when you feel dizzy, move your head slowly through the day, use a walking stick if you are at risk of falling, squat down to pick things up rather than bending over, and do not stretch your neck to reach a high shelf. Do not drive, climb ladders or use machinery while you feel dizzy (NHS dizziness).
Then spend the effort on strength and balance, which is the part that pays at this age whatever the dizziness turns out to be. Start these exercises only after a doctor or vestibular physio has found the cause of your dizziness. New dizziness, or dizziness that has changed, needs checking first.
The graded gaze, balance and walking program for lingering unsteadiness sits on dizziness and BPPV, built on retraining through movement rather than rest (Hall and colleagues, 2022), and your own physio sets what you do. For general strength through the menopause there is the menopause strength plan, and for steadiness and the home side of it, balance and falls prevention. The rest of this section is listed under balance and dizziness.
When dizziness in the menopause needs checking
Call emergency services straight away for any sign of a stroke, even if it goes away: sudden dizziness with unsteadiness or falling over, a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack).
The rest of the list carries its own timings, and they are not interchangeable. Some of those lines mean emergency services now, some mean advice today, one means an appointment within a few days to get the cause of your spinning confirmed, and one means asking your doctor about a falls assessment. That last one is the line most women reading this have not acted on yet.
The overlap that needs naming on its own is the dangerous one. Palpitations are on the NHS list of menopause symptoms, and a racing, pounding, fluttering or irregular heartbeat with dizziness or faintness is on the emergency list here. The same sensation therefore appears on two lists with very different instructions attached, and the stricter one wins every time. A heart rhythm that is not holding is not something to file under the menopause because a web page put palpitations in both places.
The last word is the one this page started with. A new dizziness in the middle of your life is not a hormone symptom until somebody has looked, and the looking is quick. Go and get it done.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: call emergency services straight away for any sign of a stroke, even if it goes away: sudden dizziness with unsteadiness or falling over, a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack).
- Emergency: vertigo or dizziness together with new hearing loss, double vision or loss of vision, trouble speaking, or weakness, numbness or tingling in an arm or leg. Call emergency services or go to an emergency department straight away.
- Emergency: dizziness with a new, severe headache, or a sudden, severe headache that feels unlike anything you have had before. Call emergency services straight away.
- Emergency: a new headache or neck pain, or both, that does not feel like ordinary neck pain. If this is your first bout, judge it by how it behaves rather than by how it compares. Either of the next two is enough on its own. One, it came on suddenly, in a single moment, even if it is not severe and even if it has eased since. Sudden onset counts on its own. Two, nothing you do changes it much: no position or rest makes a real difference, and after the first day or two it has not started to settle. It counts even if you have none of the other emergency signs above, and it matters more if it started after a neck injury or strain, even a minor one, a bout of heavy coughing, or having your neck manipulated. Go to an emergency department straight away, or call emergency services if you cannot get there safely, and do not drive yourself. Do not start these exercises, and do not have any hands-on treatment to your neck, until your neck has been checked. A tear in an artery in the neck can start as pain alone, often on one side, with nothing else to find. If you can find a position that eases it, follow the same day warning sign for this below instead.
- If chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
- Emergency: a racing, pounding, fluttering or irregular heartbeat that does not settle when you rest, or that comes with dizziness, feeling faint or fainting, chest pain or shortness of breath. Call emergency services straight away. If it has already stopped, get medical advice the same day.
- Emergency: you have just fallen and cannot get up, or you think you may have hurt your head, neck, back or hip. Stay where you are, keep warm and call emergency services, or get someone to call for you. If you got up and walked without trouble and only notice pain later, use the same-day lines in this list instead.
- Emergency: you fell and cannot remember the fall or how it happened. Go to an emergency department straight away, and do not drive yourself. You may have blacked out or hit your head without knowing it.
- Emergency: after a fall or a knock, a wrist, hand or arm that has changed shape or sits at an odd angle, that goes numb, tingles or has pins and needles, that turns pale, blue or cold, that has a bone showing through the skin, or that has a cut bleeding heavily. Go to an emergency department straight away, or call emergency services, and do not drive yourself. Do not try to straighten the arm or push the bone back yourself.
Get help today
- Same day: a new headache or neck pain, or both, that does not feel like ordinary neck pain, that started after a neck injury or strain, even a minor one, a bout of heavy coughing, or having your neck manipulated, but that does ease when you change position or rest. Get checked the same day before you start these exercises or have any hands-on treatment to your neck. If nothing you do changes it much any more, or it has not started to settle after a day or two, follow the emergency warning sign for this above.
- Same day: you blacked out or fainted, even for a moment. Get medical advice the same day. Call emergency services instead if the person is not breathing, cannot be woken within 1 minute, has not fully recovered or has trouble speaking or moving, has chest pain or a pounding, fluttering or irregular heartbeat, fainted while exercising or lying down, is shaking or jerking, or was badly hurt.
- Same day: dizziness, lightheadedness, blurred vision or feeling faint when you stand up that is new for you, does not pass within a minute or two, keeps happening, or has made you fall. Sit or lie down, and get medical advice the same day. This can be a drop in blood pressure on standing (postural hypotension), a type of low blood pressure, which the NHS lists among the causes of falls, and your doctor can check it. Tell them about your medicines, because some can cause it. If it does not settle within a few minutes of sitting or lying still, call emergency services. If you faint, use the fainting line above.
- Same day: sudden new dizziness, or feeling faint or unsteady, without any of the stroke signs above. Stop, sit down and get medical advice the same day. If you faint, it does not settle within a few minutes of sitting still, or you cannot stand or walk steadily, call emergency services.
- Same day: dizziness or spinning that has been there all the time for a day or more, rather than coming in short spells when you move your head, without any of the emergency signs above. Get medical advice the same day. If you cannot stand or walk steadily, call emergency services.
- Same day: vertigo with being sick or feeling very sick, a very high temperature, or feeling hot, cold or shivery, without any of the emergency signs above. Get medical advice the same day.
- Same day: you are more short of breath than usual, or short of breath while you are resting or lying down, without any of the emergency signs above. Get medical advice the same day. Call emergency services if you have severe difficulty breathing, are gasping, choking or cannot get your words out, or your lips or skin turn very pale, blue or gray. Breathlessness is not a symptom of the inner ear: the NHS names heart failure and lung conditions among the causes, and it is easy to put down to being run down.
- Same day: after a fall or a knock, a wrist, hand or arm that is very painful, that you cannot use because of the pain, that is badly swollen or bruised, or that is very stiff or hard to move, with no change of shape, no numbness or tingling, no pale, blue or cold skin, no bone showing and no cut that is bleeding heavily. Get it checked the same day at an urgent care center or an emergency department, and do not exercise that arm until it has been seen. A fall onto an outstretched hand often breaks a bone near the wrist, and an X-ray is the only way to be sure.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: after a fall, you are in pain, have hurt yourself or feel unwell, or you were on the floor for an hour or more, without any of the emergency signs above. Get medical advice the same day, even if you managed to get up.
Book an appointment
- Within a few days: short spells of spinning when you lie down, roll over in bed or look up, or dizziness that keeps coming back, without any of the signs above. See your GP or a physio within a few days so the cause can be confirmed and treated.
- Within a few days: you have had a fall, even if you were not hurt, or you keep tripping, stumbling or feeling that your legs might give way. Book an appointment with your doctor within a few days and ask about a falls assessment. Tell them about every fall, even the ones where you were not hurt.
- Routine: you have been tired for a few weeks and you are not sure why, your tiredness is getting in the way of your daily life, or you are tired along with other symptoms such as losing weight without meaning to or a change in your mood. Book an appointment with your doctor about the tiredness itself, say how long it has been there and what else has changed, and let them decide what to test. Tiredness is not a symptom of the inner ear: the NHS names sleep apnea, iron deficiency anemia, diabetes, an overactive thyroid and ME or chronic fatigue syndrome among the conditions behind it, and a blood test settles several of them. Tell your doctor as well if anyone has said you gasp, snort or choke in your sleep. If the tiredness comes with chest pain, feeling faint, or being short of breath while you are resting, use the emergency and same day lines above instead.
Common questions
Is dizziness a symptom of menopause?
Not as a symptom in its own right, on the list most readers would check. The NHS page on menopause and perimenopause symptoms mentions feeling dizzy once, and it does so inside the description of a hot flush, which it says can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy. Vertigo is not named on that page at all. Several of the symptoms it does name can leave you feeling unsteady or unwell in ways that are easy to confuse with a balance problem, including sleep problems, poor memory and brain fog, palpitations, headaches and migraines, and it adds that symptoms may feel worse if you have sleep problems and feel very tired. The practical consequence is the same either way. A new dizziness in your forties or fifties has not been explained by putting the word menopause next to it, and the possible causes include several that one appointment can rule in or out.
Can perimenopause cause vertigo?
Nothing we could read establishes that it does. The strongest honest statement available is that the two overlap in timing, which is the position our menopause and joints pages take about joint pain as well. A narrative review in Cureus gathered the published work on menopause and vertigo, included 7 of the 92 articles it identified, described a potential link between the onset of menopause and increased susceptibility to vestibular disturbance, and said that the interaction between the hormonal and balance systems is still poorly documented (Castillo-Bustamante and colleagues, 2024). A narrative review reports no new measurements of its own, so nothing on this page rests on it. One detail in its method matters for this particular question: it excluded articles focused on vertigo during perimenopause, so even that review is not an answer about the years before your periods stop. The mechanism work that is often quoted alongside it was done in mice, which matters more than it sounds and is covered further down.
What is the treatment for menopause dizziness?
There is no treatment for menopause dizziness, because that is not a diagnosis anybody can treat. What there is treatment for is whatever is actually causing your dizziness, which is why getting it named comes first. If it turns out to be short spells of spinning when you lie down, roll over or look up, that has a specific treatment done or taught by a clinician, and it is set out on dizziness and BPPV. If it is a drop in blood pressure on standing, low iron, a blood sugar problem or a new medicine, those are treated quite differently and your doctor is the route to each. If unsteadiness lingers after the spinning has been dealt with, a graded program of gaze, balance and walking work is the physiotherapy answer, and your own physio sets it. Nothing on this site recommends a supplement, a herbal remedy or a hormone for dizziness.
Does menopause cause dizziness and nausea?
Nausea is not on the NHS menopause symptom list either, so this page cannot tell you the two are connected. Sickness with spinning is a different and much better documented pairing: the NHS pairs feeling off balance or like things are spinning with feeling or being sick in its account of labyrinthitis, and short spells of positional spinning can be intense enough to leave you feeling sick afterward. The combination also has a warning attached that is worth reading properly. Vertigo with being sick or feeling very sick, a very high temperature, or feeling hot, cold or shivery carries a same-day route on the list at the end of this page. So nausea with your dizziness is a reason to get the cause looked at, not a reason to add it to a list of hormone symptoms.
References
- NHS. Menopause and perimenopause symptoms. https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/
- NHS. Dizziness. https://www.nhs.uk/symptoms/dizziness/
- NHS. Vertigo. https://www.nhs.uk/conditions/vertigo/
- Nakata T, Okada M, Nishihara E, et al. Effect of hormonal therapy on the otoconial changes caused by estrogen deficiency. Scientific Reports. 2022;12(1):22596. https://doi.org/10.1038/s41598-022-27240-5
- Castillo-Bustamante M, Celebisoy N, Echavarria LG, et al. Balance in transition: unraveling the link between menopause and vertigo. Cureus. 2024;16(4):e59277. https://doi.org/10.7759/cureus.59277
- Hall CD, Herdman SJ, Whitney SL, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an updated clinical practice guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. Journal of Neurologic Physical Therapy. 2022;46(2):118-177. https://doi.org/10.1097/NPT.0000000000000382
- National Institute for Health and Care Excellence. Falls: assessment and prevention in older people and in people 50 and over at higher risk (NG249). 2025. https://www.nice.org.uk/guidance/ng249
- NHS. Broken arm or wrist. https://www.nhs.uk/conditions/broken-arm-or-wrist/
- NHS. Symptoms of a stroke. https://www.nhs.uk/conditions/stroke/symptoms/
- NHS. Heart palpitations. https://www.nhs.uk/conditions/heart-palpitations/
- NHS. Fainting. https://www.nhs.uk/symptoms/fainting/
- NHS. Chest pain. https://www.nhs.uk/symptoms/chest-pain/
- Rushton A, Carlesso LC, Flynn T, et al. International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: International IFOMPT Cervical Framework. Journal of Orthopaedic and Sports Physical Therapy. 2023;53(1):7-22. https://doi.org/10.2519/jospt.2022.11147
- NHS. Falls. Page last reviewed 06 March 2025. https://www.nhs.uk/conditions/falls/
- NHS. Low blood pressure (hypotension). https://www.nhs.uk/conditions/low-blood-pressure-hypotension/
- NHS. Shortness of breath. Page last reviewed 30 January 2024. https://www.nhs.uk/symptoms/shortness-of-breath/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-18.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.