Can perimenopause cause nausea? Why you might feel sick, and what helps

It comes out of nowhere. A queasy, churning feeling in your stomach, maybe first thing in the morning, maybe when you're rushing about, maybe when you're lying awake worrying. You haven't eaten anything odd. You don't seem to have a bug. And yet you feel sick.

So can perimenopause cause nausea? For some women, yes. The Menopause Charity includes nausea in its list of perimenopause and menopause symptoms. But it isn't one of the main symptoms the NHS lists, and there's very little research on it. So it's worth ruling out other causes first, rather than putting it down to "just the menopause".

If there's any chance you could be pregnant, take a pregnancy test first. You can still get pregnant in perimenopause.

Could it be pregnancy?

It's easy to rule out, so start here. The NHS says it's possible to get pregnant during perimenopause. Your periods may be all over the place, but you can still release an egg in some months. And feeling sick is very common in early pregnancy.

When your periods are irregular, it's hard to know when one is "late". NHS advice on pregnancy tests says:

• If you don't know when your next period is due, do the test at least 21 days after you last had unprotected sex.
• A positive result is almost certainly right. A negative result is less reliable.
• If the test is negative but you still think you might be pregnant, wait a few days and test again.

It's also worth knowing when you can stop contraception. Women's Health Concern, the patient arm of the British Menopause Society, says:

• If you're under 50, keep using contraception until you've had no periods for 2 years.
• If you're 50 or over, you can stop after 1 year with no periods.
• If your contraception stops or hides your periods, ask the person who prescribes it when it's safe to stop.

HRT is not a contraceptive, the NHS points out, so if you're taking it you may still need contraception too.

Can perimenopause cause nausea?

Yes, some women do feel sick in perimenopause and menopause. The Menopause Charity describes it as a feeling of queasiness, or an urge to be sick. It lists it alongside other gut symptoms, such as bloating, heartburn and changes in bowel habits.

What's much less clear is how common it is, and exactly why it happens. Gut symptoms in menopause haven't been studied much. A 2024 research plan from the University of Plymouth notes that the studies so far have conflicting results, there are few reviews, and gut symptoms are largely missing from menopause guidelines.

So if you feel sick, you're not imagining it. But be wary of any website that gives a neat figure for how many women get it. Nobody really knows yet.

Why might you feel sick in perimenopause?

There isn't one clear answer. These are the most likely links.

• Anxiety. Anxiety is a common symptom of perimenopause, the NHS says. And feeling sick is a common sign of anxiety (more on this below).
• Headaches and migraines. These can get worse around menopause. Feeling or being sick is one of the main symptoms of a migraine attack.
• HRT. If you've recently started HRT, feeling sick is a possible side effect of both oestrogen and progestogen. The NHS says these side effects often go away after a few weeks. Don't stop your HRT on your own. Talk to your GP, who may suggest a different dose or type, such as patches instead of tablets.
• Changing hormones. Some researchers think falling oestrogen and progesterone may affect the gut, partly through the links between the gut and the brain (Lenhart and others, 2020). This is still an idea being tested, not a proven fact.

Anxiety and nausea: how one feeds the other

Anxiety isn't only in your head. It shows up in your body too. The Royal College of Psychiatrists lists stomach problems, including indigestion, cramps and feeling sick, among the physical signs of anxiety. These feelings come from the body's "fight or flight" response, which gets you ready to deal with danger.

The trouble is, the physical feelings can then become something new to worry about. The Royal College notes that worrying about these sensations can make anxiety worse. So a loop can start:

1. You feel anxious, and your stomach churns.
2. You start to worry about feeling sick: will it happen in the meeting, in the car, at dinner?
3. The worry makes the churning worse.

If this sounds familiar, our article on menopause anxiety explains more about why anxiety can arrive out of nowhere in perimenopause.

What else could be making you feel sick?

Lots of things can cause nausea, so don't assume it's your hormones. The NHS lists common causes including:

• pregnancy
• anxiety
• medicines (check the leaflet for any you've started recently)
• alcohol
• motion sickness
• a stomach bug or food poisoning, especially if you also have diarrhoea or are being sick
• an infection such as flu, especially if you also have a headache and a high temperature

Nausea can also be one of the symptoms of irritable bowel syndrome (IBS), along with tummy cramps, bloating, diarrhoea or constipation.

What can help with nausea?

Things to try now

The NHS suggests:

Try	Avoid
Getting some fresh air	Strong-smelling food, and cooking smells
Distracting yourself, with music or a film	Hot, fried or greasy food
Sipping a cold drink regularly	Eating too quickly
Ginger or peppermint tea, or a ginger biscuit	Big drinks with your meals
Smaller meals, more often	Lying down straight after eating
	Clothes that are tight around your waist

If anxiety is part of it

• Slow your breathing. NHS Every Mind Matters suggests breathing exercises and relaxation to help calm anxiety.
• Keep a diary. Note when you feel sick, what you'd eaten, how anxious you felt, and where you are in your cycle. Patterns are easier to spot on paper, and it's useful to take to your GP.
• Set a "worry time". Every Mind Matters suggests a set time each day to go through your worries, so they take up less of the rest of the day.

What your GP can do

• Look for the cause. A GP can check what's behind the nausea and may prescribe anti-sickness medicine if you need it.
• Talk about menopause treatments. Women's Health Concern calls HRT the most effective treatment for menopause symptoms. Cognitive behavioural therapy (CBT) can help with low mood and anxiety, the NHS says.
• Talking therapies. In England, you can also refer yourself to an NHS talking therapies service without seeing a GP first (NHS).

When to see a GP about nausea

See your GP if:

• you still feel sick after a few days
• you often feel sick, and it keeps coming back
• you've started HRT and the sickness is severe, or lasts longer than 3 months
• anxiety is making it hard to get on with your day
• you're worried, for any reason

If you can't get a GP appointment, call 111 for advice.

Where relaxation fits in

Feeling sick and feeling anxious often travel together. If worry is part of the picture for you, some women like to have a calm, steady voice to listen to when their mind starts racing. Hypnosis for menopause anxiety is a recording to help you relax and feel calmer. It's a relaxation recording, not a treatment, and it doesn't replace advice from your GP.

You might also find these useful: menopause dizziness, menopause bloating and perimenopause headaches. Or see the full list of perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms