Hormone imbalances are most commonly associated with unexplained weight gain, mood swings and hot flushes. However, there are many symptoms that are often overlooked, for example acid reflux.
Studies have indicated a link between varying hormone levels and an increased incidence of gastrointestinal discomfort. Thankfully, these symptoms are often manageable and treatable with some lifestyle alterations, natural remedies and over-the-counter medication.
What is acid reflux?
Acid reflux, commonly known as heartburn and if it is more severe, gastroesophageal reflux disease (GORD), affects 20% of individuals in the USA1. While gastrointestinal symptoms are often mild and manageable, they are very uncomfortable for many. These symptoms occur when contents of the stomach leak into the oesophagus, causing a burning pain in the chest and regurgitation with a sour taste in the mouth2.
Waking in the night as well as coughing may be a tell-tale sign that you are experiencing acid reflux. Occasional acid reflux can occur following a large meal or when consuming foods you are intolerant to, but GORD is diagnosed when you experience severe and/or frequent burning sensations or gastrointestinal discomfort.
Hormones are powerful substances released by glands in the endocrine system and travel around in the bloodstream. Hormones are employed for a wide range of processes in the body; from regulating appetite and metabolism to sleep cycles, reproductive cycles and mood4. Thus, it should come to no surprise that minor imbalances – too much or too little of a hormone – can instigate major changes in your overall health and wellbeing.
Many causes of hormone imbalance are underpinned by reproductive hormones, such as estrogen and progesterone. Abnormally high or low levels are commonly experienced during menopause, pregnancy and polycystic ovary syndrome (PCOS) in people with ovaries of reproductive age3. Other than these age-specific underlying causes, there are also general causes induced by hormonal imbalances, including hormone therapy, medications, stress, cancer, and/or cancer treatments.
Menstruating people with hormone imbalances report various symptoms, such as bloating, weight gain, spikes in body temperature and delayed or skipped periods. These symptoms can significantly impact personal well-being, health, work and relationships with friends and family.
Fortunately, while these imbalances may cause discomfort, they are manageable and treatable through hormone control, or hormone replacement medications, amongst others. If you are experiencing any concerning symptoms, contact your doctor who may recommend a few diagnostic tests for hormonal imbalance.
Acid reflux and hormone imbalance
Many studies have suggested a relationship between acid reflux and hormone imbalances. While the underlying mechanisms of this link remain inconclusive, experts have indicated that aberrant hormone levels may cause various gastrointestinal symptoms.
For instance, the thyroid is where the hormones responsible for metabolism (also called the thyroid hormones) are produced. Low levels of thyroid hormones (hypothyroidism) may lead to a malfunction whereby the contents of the stomach leak into the esophagus – the tube connecting the throat with the stomach1. This is associated with numerous symptoms, such as acid reflux and heartburn.
Although some studies are contradictory, high levels of certain female sex hormones have been associated with GORD symptoms. Increased estrogen levels may relax the oesophageal sphincter – a tight band of muscle circling the top of the stomach – at the wrong time, causing semi-digested foods and stomach acids to backflow into the esophagus.
The acids and digestive enzymes irritate the lining of the esophagus, resulting in an uncomfortable and painful burning sensation2. Another hormone, progesterone, may worsen these symptoms when it is produced at high levels, as it may slow the digestive process and excessively relax the esophageal sphincter.
This is an occurrence particularly common with the use of oral contraceptives, during the perimenopausal phase and during pregnancy3. Abnormally low levels of estrogen may induce similar symptoms too. Particularly during menopause, estrogen levels fall which can impact the production of stomach acid, resulting in indigestion and gastric reflux4,6,7.
People suffering from PCOS have also reported acid reflux and gastrointestinal discomfort. This is underpinned by poor digestion and metabolic abnormalities, such as dyslipidemia, insulin resistance and glucose intolerance3.
For pregnant people, those undergoing menopause or dealing with general hormone imbalances, there are a few lifestyle and diet tips that help prevent the discomfort of acid reflux.
- Avoid spicy foods, fried foods, chocolate and dairy
These foods contribute to the relaxation of the oesophageal sphincter and can upset the digestive system.
- Eat smaller meals but more frequently
Instead of 3 large meals, eat multiple, small meals spread throughout the day. This will put less pressure on your digestive system and will help control your stress hormone levels.
- Watch your weight
Obesity, meaning a BMI of 25 or over, can put increased pressure on the sphincter muscles, causing acid reflux.
- Work with gravity
Sleep with your head raised on a wedge pillow or take a walk after a meal to help accelerate digestion. This will keep the food and stomach acids in their correct place.
If you develop new or worsening symptoms, contact your healthcare provider. They may recommend over-the-counter medications, such as antacids or proton pump inhibitors. However, these medicines are not a long-term solution. Instead, investigate the root cause of the problem and implement treatments accordingly.
Other causes of acid reflux
It is important to note that causes of acid reflux are multifactorial; while hormone imbalance (pregnancy, menopause, PCOS, etc.) can induce this discomfort, there are other issues that may worsen digestive symptoms.
Stress poses a variety of physical impacts. The stress hormone, cortisol, can compromise the digestive system by inhibiting the breakdown of food.
Weight gain, along with stress are common symptoms associated with menopause. Consuming large meals frequently may increase the pressure on the esophageal sphincter, causing it to remain partially open and allowing regurgitation8.
As we age, muscles in our bodies, such as the esophageal sphincter become weaker. It becomes more likely for stomach acids to leak into the esophagus.
- El-Serag, H.B., Sweet, S., Winchester, C.C., Dent, J. (2014). “Update on the epidemiology of gastroesophageal reflux disease: a systematic review”. Gut. 63(6): pp. 871–880.
- Clarrett, D. M., and Hachem, C. (2018). “Gastroesophageal Reflux Disease (GERD)”. Missouri medicine. 115(3): pp. 214–218.
- Ma, J., Lin, T.C., Liu, W. (2014). “Gastrointestinal hormones and polycystic ovary syndrome”. Endocrine. 47(3): pp. 668-78.
- A.Vogel. Is menopause causing your digestive problems? [Online]. A.Vogel: UK. Available from: el.co.uk/health/menopause/videos/is-menopause-causing-your-digestive-problemshttps://www.avog/
- Daher, R., Yazbeck, T., Jaoude, J. B., and Abboud, B. (2009). “Consequences of dysthyroidism on the digestive tract and viscera”. World journal of gastroenterology. 15(23): pp. 2834–2838.
- Jacobson, B. C., Moy, B., Colditz, G. A., and Fuchs, C. S. (2008). “Postmenopausal hormone use and symptoms of gastroesophageal reflux”. Archives of internal medicine. 168(16): pp. 1798–1804.
- Chen, C., Gong, X., Yang, X., et al. (2019). “The roles of estrogen and estrogen receptors in gastrointestinal disease (Review)”. Spandidos Publications. 18(6): pp. 5673 – 5680.
- Chang, P., and Friedenberg, F. (2014). “Obesity and GERD”. Gastroenterology clinics of North America. 43(1): pp. 161–173.