Vertigo can have many causes, which is why an osteopath provides a professional evaluation. Osteopaths apply their diagnostic skills to rule out serious conditions. However, the most frequent type – benign paroxysmal positional vertigo (BPPV) – tends to appear more often in women over 40, peaks during their 60s, and often declines afterwards. Interestingly, this timeline mirrors the menopausal transition, when fluctuating and declining estrogen levels influence several body systems, including bone health, biochemical processes and the vestibular system – the part of the inner ear responsible for balance.
BPPV affects roughly half of people over 65, with women experiencing it about three times more often than men. Research also indicates that women using hormone replacement therapy (HRT) or other estrogen-supportive treatments may encounter fewer vertigo episodes.
Common vertigo symptoms in menopausal women
BPPV causes brief but intense dizzy spells, often triggered by simple movements such as:
- Rolling over in bed
- Looking upward (“Top Shelf Vertigo”)
- Bending forward
- Getting out of bed
- Lying flat
These episodes can last a few seconds to a minute, sometimes making everyday tasks surprisingly challenging.
How hormonal changes trigger vertigo
During menopause, estrogen levels drop, affecting multiple body systems – including the vestibular labyrinth in the temporal bone of the skull. This inner-ear structure helps detect head movement and maintain balance.
Inside the vestibular system are otolith organs, which hold tiny calcium crystals known as otoconia. With age, these crystals can shift out of position, sometimes floating into the inner ear canals and causing BPPV. This explains why head movements – like rolling over or tilting your head back – can suddenly trigger dizziness.
Estrogen is also essential for bone strength and biochemical balance, so its decline can make the otoconia more prone to displacement. Vitamin D deficiency, which is common in menopausal women, can further increase the risk. Spending time in gentle morning or late-afternoon sunlight supports healthy Vitamin D levels and balance.
Lifestyle tips for managing vertigo in menopause
Simple lifestyle changes can help minimise vertigo symptoms:
- Boost Vitamin D through safe sun exposure and diet
- Eat a nutrient-rich diet, especially foods high in healthy fats and fibre
- Maintain a healthy weight and manage stress
Vertigo can recur. If you’ve experienced BPPV before, speak with your osteopath about proactive strategies to reduce the risk of future episodes. While high-impact exercise, swimming, or certain yoga positions may aggravate vertigo, gentle physical activity between episodes can support long-term balance health.
Diagnosis and treatment
If BPPV is diagnosed, an osteopath may perform specialised head maneuvers to guide the dislodged crystals back into place. In many cases, these manoeuvres can provide rapid relief. However, recurrence is common, particularly among women, with studies suggesting around 30% may experience repeat episodes.
After treatment, osteopaths recommend following these guidelines for a week:
- Sleeping with your head slightly elevated
- Avoiding the affected side
- Follow any personalised aftercare instructions
- Yoga, especially inversions
- Swimming
Supplements that may help
- Vitamin D: Supports bone and vestibular health
- Magnesium: May relax muscles and may aid in symptom management
Why menopausal vertigo is often misunderstood
Many women dismiss vertigo as “just dizziness,” but BPPV during menopause has a clear hormonal link. Recognising the connection allows women to seek targeted treatment, improving both safety and quality of life.
This blog has been reproduced with the permission of Dr Alison Linn (Osteopath) at Rozelle Osteopaths.