ICU – “I See You” Podcast
Menopause & Dizziness
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In this episode we’re exploring an important and often overlooked topic: how menopause can impact people living with a vestibular disorder. Hormonal changes during menopause can affect the inner ear and brain function, often intensifying symptoms like dizziness, imbalance, brain fog, and migraines. For those already managing a vestibular condition, this transition can bring new challenges — but also new opportunities for understanding and support. In this episode, we’ll dive into the connections between hormonal shifts and vestibular health, and offer insights on how to navigate this complex time with greater resilience and hope.
Guests
Lara Bishop is a mother of twins who was diagnosed with vestibular migraines in 2012, vestibular neuritis in 2013 and PPPD in 2018 — all of which have been profoundly life-changing. Coping with invisible illnesses has been a challenging journey, often difficult for her family and friends to fully understand. In addition to her vestibular disorders, Lara also lives with Anxiety, panic Disorder, depression as well as some other chronic conditions. Over the years, she has made significant lifestyle changes to help manage her conditions, including participating in Cognitive Behavioral Therapy (CBT) and Vestibular Rehabilitation Therapy (VRT), adopting a regular routine of daily exercise such as biking and weight training, and making important changes to her diet. Lara is passionate about raising awareness of debilitating vestibular conditions, supporting fellow sufferers, and educating both the general public and medical professionals. Despite the many challenges she faces, she maintains a positive outlook on life and is determined to share her optimism and motivation with others.
Dr. Heather Bartos is an OB/GYN, menopause specialist, author, and speaker, recognized as one of the nation’s top five experts in menopause by Oprah Winfrey and Maria Shriver. Her mission is to dismantle the taboos surrounding menopause and sexuality, empowering women through transformative midlife transitions. Her latest book, Quickies: 100 Little Lessons to Living Sexily Ever After in Midlife, is out to rave reviews. Her diverse background from PR to medicine to Reiki Practitioner and service in the Navy, underscores her holistic and personalized approach to healthcare. Featured in Shape, Glamour, Refinery29, ABC News, and more, her insights are pivotal in changing the narrative around midlife and menopause. Cosmo magazine celebrates her as a ‘supremely badass gyno,’ highlighting her significant impact on women’s health advocacy.
Summary
Lara’s Journey: Vestibular Disorders Across Life Stages
Lara’s vestibular story begins when her twin daughters are born in 2009. After two months without periods postpartum, her cycle returns—and so do strange sensations of disequilibrium. Initially labeled as labyrinthitis that “might clear in two months,” her symptoms instead persist and evolve over years.
Eventually, Lara accumulates several diagnoses:
- Vestibular migraine (around 2011)
- Vestibular neuritis (2013), likely from nerve damage after repeated viral infections and antibiotics
- PPPD (Persistent Postural-Perceptual Dizziness) (2018), emerging after years trapped in a “dizzy loop”
At one point, vestibular migraine and neuritis are both active, making vestibular rehab (VRT) extremely difficult; her brain is receiving mixed signals, and exercises that should help instead feel destabilizing.
Over time, Lara manages to significantly improve the neuritis—enough that hospital staff calls her a “medical miracle”—but vestibular migraine and PPPD remain long-term companions.
Alongside her vestibular conditions, Lara also lives with anxiety, panic disorder, depression, and endometriosis. She responds by reshaping her life:
- CBT and VRT to retrain thoughts and balance systems
- Daily exercise, especially walking, weight training, and indoor cycling
- Nature-based coping, like walking barefoot on the ground and even “hugging trees”
- Dietary changes and elimination experiments, plus detailed diaries to track food, symptoms, and triggers
Over years, she shifts from searching for a cure to learning to live alongside her conditions, aiming for the best life possible despite chronic symptoms.
Dr. Bartos: Why Hormones and the Vestibular System Are So Intertwined
Parallel to Lara’s story, Dr. Heather Bartos lays out the biological framework that makes her experience make sense.
She explains that across a woman’s lifespan—puberty, menstrual cycles, pregnancy, postpartum, perimenopause, menopause—hormone levels constantly rise and fall. Crucially:
- The vestibular system is rich in estrogen receptors, just like joints and urinary tissues.
- These receptors react when estrogen is too low, too high, or changing rapidly.
- Women therefore live in a state of near-constant hormonal flux, while men’s hormones remain relatively stable.
Historically, this reality has been misread. Women reporting dizziness, migraines, or strange sensory shifts have often been:
- Dismissed with “It’s just hormones” or “it’s stress”
- Or siloed into either “real medical problems” or “female issues,” instead of seeing how the two are connected
Dr. Bartos argues that medicine is only now starting to appreciate how broadly hormones affect women’s bodies, including the vestibular system. She frames the main sex hormones with a memorable analogy:
- Testosterone = Greg Brady
- Estrogen = Marcia Brady
- Progesterone = Jan Brady
They need to function as a harmonious family. When one is out of sync—or when levels spike or crash too fast—the “family” becomes chaotic, and symptoms like dizziness, brain fog, migraines, and joint pain can flare.
She also notes that testosterone therapy, while often helpful in menopause (for strength, energy, sleep, and brain health), can in some women convert into estrogen, raising estrogen levels in ways that may be problematic for hormonally sensitive patients. An over-the-counter supplement (DIM) can reduce this conversion, but the deeper point is that dose and balance matter more than simple “high” or “low” labels.
Perimenopause, Spikes, and Lara’s Relapse
Lara is now in her late 40s, having been in perimenopause since about 44, and is “sharply” moving toward menopause. The last four years, she says, have “rocked her boat”, stirring up symptoms that echo her worst periods from 2013–2015, though less extreme.
Recently, a menopause specialist found that:
- Her total testosterone was low-normal.
- Her free androgen index—the testosterone actually available to her body—was low.
She was started on testosterone, which she’d heard could be “migraine‑friendly” and sometimes beneficial for people with migraines. But the dose was too high for her uniquely sensitive system. Her body converted the excess testosterone into estrogen, sending her estrogen level from a modest baseline (around 107 pmol) to roughly 835 pmol—a huge jump.
The result: a new vestibular migraine relapse, lasting weeks by the time of the recording.
For Lara, the key isn’t just absolute hormone levels; it’s the rate of change:
“It’s not so much the estrogen itself. It’s the actual sudden spike or sudden drop that kills me.”
Dr. Bartos affirms this: bodies crave stability, even if women rarely get it hormonally. She notes that many symptoms—including those in the vestibular system—worsen with rapid rises and falls, not simply with being “high” or “low.”
Lara’s long‑time GP has learned to be very cautious with estrogen adjustments because of her vestibular sensitivity. Her new menopause specialist, with only one appointment of context, didn’t yet know that history. Lara plans to advocate for slower, smaller dosing changes and possibly support therapies (like DIM) to prevent another massive estrogen spike.
Thyroid, Adrenals, and the “Brady Bunch” of Hormones
Dr. Bartos broadens the lens beyond sex hormones. She explains that thyroid function often shifts in midlife as well:
- The thyroid may still test “normal” on lab ranges, but functionally be at a “D‑minus” level—technically passing, but not working well.
- Thyroid hormones also have receptors in systems related to balance and energy, and thyroid disorders (like Hashimoto’s or Graves’) can interact with vestibular symptoms.
In the “Brady Bunch” analogy, she casts thyroid hormones and even adrenal hormones (like cortisol) as other family members—Mike, Carol, Alice, the kids—who must all coordinate. If one hormone system is off (thyroid, adrenals, sex hormones, or even gut-related hormones like insulin), the whole internal “family” can become unstable.
Kimberly shares her own experience with Graves’ disease (hyperthyroidism that later flipped to hypothyroidism) and how adjusting thyroid medication affects her sleep, nighttime cortisol surges, and vestibular symptoms. Both she and Lara emphasize that cortisol spikes, especially at night, can predict symptom flares.
Gut Health, Food Triggers, and the Second Brain
The conversation also turns to the gut. Dr. Bartos calls the gut our “second brain” and insists on addressing gut health with all her midlife patients. She describes:
- Using probiotics, digestive enzymes, and elimination diets to reduce inflammation and uncover food sensitivities.
- Noting that improving gut health can help with weight, mood, and even medication needs, and likely intersects with vestibular symptoms as well.
Lara strongly agrees. She has undergone microbiome testing, experimented with one‑ingredient, colorful, minimally processed foods, and seen gut‑related patterns in both her vestibular symptoms and endometriosis. For her, high‑sugar foods or certain categories (beans, pulses, some cruciferous vegetables) can be clear triggers.
Because fermented foods—often recommended for gut health—are common migraine triggers, the group notes that vestibular migraine patients may especially need personalized gut strategies rather than one-size-fits-all advice.
Emotional Resilience, Mindset, and Advocacy
Both Lara and Dr. Bartos highlight the emotional dimension of this journey.
Dr. Bartos describes menopause as “reverse puberty”: the same kind of hormonal turbulence, but on the way out. Just as teenage girls struggle to “roll with the punches” because their internal landscape is unstable, midlife women facing hormone shifts plus chronic illness can find everyday stressors overwhelming. She suggests that what we often label as “crankiness” or “Karen behavior” can, in many cases, be unmanaged hormonal distress layered on top of real-life challenges.
Lara emphasizes the importance of mindset and acceptance. With anxiety and panic disorder, she’s learned that pushing symptoms away often makes them worse. Instead, she practices:
- CBT techniques
- EFT tapping
- Time in nature and regular movement
She encourages others to recognize that living with a vestibular disorder is inherently stressful and anxiety‑provoking, even if they don’t feel stressed in a traditional sense.
On the advocacy front, Lara’s meticulous diaries and willingness to share her findings eventually led to her being invited to lecture to vestibular consultants about the hormonal connections she’d observed. It took years—and delays like COVID—but her data and story are now directly informing specialist education.
Bringing It All Together
By the end of the episode, the listener has walked through:
- Lara’s lived reality of vestibular disorders across pregnancy, perimenopause, and now near‑menopause.
- Dr. Bartos’ clinical framework connecting estrogen, progesterone, testosterone, thyroid, gut, and adrenals to the vestibular system and midlife health.
Together, they send a clear message:
If your dizziness, migraines, or imbalance shift with your cycle, pregnancy, perimenopause, or menopause, you are not imagining it. Hormones and vestibular function are deeply linked. With careful tracking, informed clinicians, and patient advocacy, it is possible to move from confusion and dismissal toward understanding, validation, and more tailored care.
