Dizziness & vertigo

Light-headedness on standing, the briefly tilting room when you roll over in bed, the muffled, off-balance, can't-quite-track-this-conversation feeling — dizziness is a quietly common midlife hormone symptom and almost always treatable. It's also one that deserves a proper sort, because not all dizziness is the same.

Four common patterns, often in combination. Worth naming yours before you treat it.

Benign paroxysmal positional vertigo (BPPV). The classic 'roll over in bed, room spins for 30 seconds' picture. Tiny calcium crystals in the inner ear dislodge and float into a balance canal. Twice as common in midlife people. Fixed by the Epley manoeuvre in one visit — your GP, vestibular physio or ENT can do it.

Vestibular migraine. Dizziness as a migraine variant, often without much headache. Tied to hormonal swings, sleep loss and stress. One of the commonest causes of midlife dizziness and routinely missed. Responds to migraine prevention.

Orthostatic light-headedness. Stand up too fast, vision tunnels for a few seconds. Blood pressure regulation gets less tight with estrogen drop and with deconditioning. Hydration, salt, slow standing and (sometimes) compression stockings fix most.

Anxiety and breath-driven dizziness. Subtle over-breathing all day produces a near-constant foggy, untethered feeling that gets misread as inner-ear trouble. A capnometry-confirmed pattern; CBT and breathing retraining fix it.

Iron, B12 and thyroid all sit in the background. Low ferritin, low B12 and under-treated thyroid all produce a wobbly, light-headed picture. All worth checking before you settle on a label.

Match the move to the pattern. Treating BPPV like anxiety doesn't work, and vice versa.

If it's BPPV — ask for an Epley. Hallpike test to confirm, Epley manoeuvre to fix. Most people are well after one or two sessions. A vestibular physio is the gold standard if your GP isn't comfortable doing it.

If it's vestibular migraine — treat the migraine. Trigger reduction, magnesium, B2, sleep regularity, and prescription preventives (propranolol, amitriptyline, candesartan, sometimes CGRP antagonists). A neurologist or migraine-trained GP is the right route.

If it's orthostatic — water, salt, slow. Two glasses of water on waking, generous salt unless contraindicated, stand up over two breaths, calf-pumps before standing if it's been a long sit. Compression stockings for stubborn cases.

Vestibular rehab physiotherapy. A specialist physio retrains the balance system. Effective for almost every kind of chronic dizziness, including the post-BPPV wobbliness that lingers for weeks.

MHT helps in some pictures. Vestibular migraine, in particular, often quietens when estrogen is stabilized. Worth raising with a menopause-trained doctor if cycle-tied dizziness or migraine is part of the picture.