Gastro-oesophageal reflux disease (GORD), commonly known as acid reflux or heartburn, is a chronic condition that affects millions of people worldwide. It occurs when the lower oesophageal sphincter, a muscular valve that separates the oesophagus from the stomach, fails to close properly after swallowing, allowing stomach acid to flow back into the oesophagus. This backflow of acid can cause a burning sensation in the chest, regurgitation, and other unpleasant symptoms.

The Intricate Mechanism of Acid Reflux

The stomach produces hydrochloric acid to aid in the digestion of food. Normally, the sphincter acts as a barrier, preventing this acid from flowing back into the oesophagus. However, when it weakens or relaxes inappropriately, stomach acid can escape and irritate the delicate lining of the oesophagus, leading to the burning sensation known as heartburn.


Several factors can contribute to the development of acid reflux, including:

Hiatus hernia: A condition where part of the stomach protrudes through the diaphragm, weakening the sphincter and increasing the risk of reflux.

Obesity: Excess abdominal fat can put pressure on the stomach, forcing acid back into the oesophagus.

Pregnancy: Hormonal changes and increased abdominal pressure during pregnancy can relax the sphincter and promote reflux.

Certain medications: Some drugs, such as certain blood pressure medications, can relax the sphincter and increase reflux risk.


The Menopause Connection

Hormonal changes can significantly contribute to an increased risk of heartburn in  menopause. Oestrogen and progesterone play a crucial role in maintaining the tone and function of the sphincter. As oestrogen levels decline during menopause, the lower oesophageal sphincter may become weaker, allowing stomach acid to reflux more easily.


Additionally, progesterone fluctuations can also impact the sphincter and gastric emptying, further exacerbating reflux symptoms. Progesterone helps regulate the sphincter and promote gastric emptying, but during menopause, these hormonal changes can disrupt this process, leading to increased acid reflux.


Moreover, weight gain during menopause, often due to hormonal shifts and lifestyle factors, can increase intra-abdominal pressure, putting additional strain on the sphincter and promoting reflux. This increased pressure can force stomach contents back into the oesophagus, causing discomfort and potential damage.


Managing Acid Reflux During Menopause

While heartburn can be a frustrating and uncomfortable condition, there are several strategies to help manage it during menopause:


  1. Lifestyle Modifications:

– Maintain a healthy weight through a balanced diet and regular exercise. Excess weight can exacerbate reflux symptoms.

– Avoid trigger foods like spicy, fried, or acidic foods that may exacerbate reflux.

– Quit smoking and limit alcohol consumption, as both can relax the lower oesophageal sphincter and increase reflux risk.

– Eat smaller, more frequent meals and avoid lying down immediately after eating to prevent acid from refluxing.

– Elevate the head of your bed by 6-8 inches to prevent acid from refluxing while sleeping.


  1. Medications:

– Over-the-counter antacids like rennies or gaviscon can provide temporary relief by neutralising stomach acid.

– Proton pump inhibitors (PPIs) like omeprazole or esomeprazole (Nexium) can reduce acid production and are often prescribed for more severe or chronic cases.

– H2 blockers like famotidine can also reduce acid production and provide relief.


  1. Hormone Replacement Therapy (HRT):

– The role of HRT in managing heartburn during menopause is controversial. Some studies suggest that HRT may increase the risk of reflux symptoms by relaxing the sphincter, while others indicate no significant impact. Discuss the potential benefits and risks with your healthcare provider.


  1. Surgical Interventions:

– In severe cases where medications are ineffective, surgical procedures like fundoplication may be considered. This procedure involves wrapping the upper part of the stomach around the sphincter to strengthen it and prevent acid reflux.


By understanding the connection between menopause and acid reflux, and implementing appropriate lifestyle changes and treatments, women can effectively manage this condition and improve their overall quality of life.


Potential Complications and Long-Term Effects

If left untreated, chronic acid reflux can lead to several complications, including:

– Oesophagitis: Inflammation of the oesophageal lining due to prolonged exposure to stomach acid, which can cause pain, difficulty swallowing, and bleeding.

– Oesophageal strictures: Scar tissue formation in the oesophagus, which can narrow the oesophagus and make swallowing difficult.

– Barrett’s oesophagus: A precancerous condition where the oesophageal lining changes due to long-term acid exposure, increasing the risk of oesophageal cancer.

– Respiratory problems: Acid reflux can cause aspiration of stomach contents into the lungs, leading to coughing, wheezing, and even pneumonia.


It is essential to seek medical attention if you experience persistent or severe acid reflux symptoms, as early diagnosis and treatment can help prevent these potential complications and long-term effects.

By understanding the intricate mechanisms behind acid reflux, the hormonal changes associated with menopause, and the various management strategies available, women can take proactive steps to alleviate their symptoms and maintain a better quality of life.

Nadira Awal

Stay in the loop

Subscribe to our free newsletter.