The reasons for this are not fully understood but it is believed that this is due to increasing hormonal fluctuations – especially during perimenopause and menopause.
According to the article by H. K. Neuhauser (2016); The epidemiology of Dizziness and Vertigo. Handbook of Clinical Neurology. The article gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. Stating in the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies.
Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. An imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level.
BPPV and Vestibular Migraine are largely underdiagnosed, while Menière’s disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
Another related article by Seong-Hae Jeong (2020) Benign Paroxysmal Positional Vertigo Risk Factors Unique to Perimenopausal Women in Frontiers in Neurology; noted Estrogen functions have been suggested to influence hearing and vestibular function. In addition, the expression of ERα and β decreases with increasing age. Estrogen may also play an important role in otoconial metabolism. Bilateral ovariectomized osteopenic/osteoporotic rats had larger otoconia with a reduced density compared to controls.
Recent reports have shown that reduced serum levels of vitamin D are associated with the occurrence of BPPV and supplementation of vitamin D with/without calcium reduces recurrent events in BPPV patients. An animal study conducted by Yang et al. demonstrated that bilateral ovariectomy in rats receiving female Hormone Replacement Therapy reversed the reduction in the level of otoconia 90, the main protein that preserves the normal morphology and growth of otoconia.
The article concluded that in menopause, the rapid decrease in Estrogen Receptors, especially ERα, due to the sudden decrease in estrogen can lead to the disturbance of otoconial metabolism, which can increase the prevalence of BPPV. Additionally, Hormone Replacement Therapy can reverse the low otoconia 90 levels and reduce the incidence of BPPV.
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