Causes of Vertigo in Women: 3 Hidden & Frustrating Reasons

Vertigo is more common than most people realize. According to the Vestibular Disorders Association (VEDA), over 35% of people over 40 will develop vertigo at some point, impacting about 69 million people. Vestibular disorders disproportionately affect women as compared to men largely due to hormonal differences.

A general lack of understanding of vestibular disorders remains in healthcare, with patients often needing to consult 4-5 different providers before receiving an accurate diagnosis. This, in combination with current gender disparities in healthcare, make vestibular disorders especially challenging for women. Before we dive into the overlooked causes of vertigo in women, we first have to understand how the vestibular system works

What is the Vestibular System?

The vestibular system describes the relationship between your inner ear balance organs and your brain. Working together, they produce your sense of balance. The inner ear balance organs can be thought of as two little gyroscopes on either side of the head. The Inner ear includes fluid and calcium carbonate crystals that shift with head movement. These shifts are how your ears detect head position and movement relative to gravity.

The brain then has to interpret this information correctly and combine it with signals from your eyes and body to keep you balanced. When any part of this system is disrupted, dizziness and vertigo can occur.

1. Hormonal Causes of Vertigo in Women

Hormonal fluctuations can directly influence how the inner ear processes motion and gravity.

Estrogen and progesterone play a role in:

Fluid balance in the inner ear
Calcium metabolism
Otolith (ear crystal) stability – structures in the inner ear that help you detect linear movement.

Changes in these systems can make the inner ear more sensitive to movement, which is why we often see vertigo during times of hormonal change such as perimenopause, pregnancy, postpartum, or puberty. These major fluctuations also make women more susceptible to other inner ear pathologies.

Hormonal disruptions can vary widely, leading to symptoms that can come and go. We also don’t have any reliable way, such as imaging, that can detect these changes that occur on a microscopic scale. In addition, not all healthcare providers are well-versed in women’s health, so the connection to hormones is easy to overlook.

2. Vitamin D and Inner Ear Health

Vitamin D is best known for bone health, but it also plays a critical role in how the inner ear works. This is because both your inner ear and bones include calcium, whose levels are mediated by vitamin D.

As mentioned earlier, your inner ear relies on tiny calcium-based crystals to detect linear movements. Low vitamin D levels are heavily associated with dizziness and vertigo, especially the recurrence of benign proxysmal positional vertigo (BPPV), where these calcium carbonate crystals are dislodged into another part of the ear called the semi-circular canals. When these crystals end up in the semicircular canals, short but intense episodes of vertigo can occur with head movements, such as rolling in bed.

The influence of vitamin D on the inner ear is not always so apparent though, leading to subtle signs that can be hard to interpret.

3. Vestibular Migraine (Even Without Headache)

Women are significantly more likely to suffer from migraine as compared to men. Vestibular migraine is a variant where migraine attacks are accompanied by vertiginous episodes. Interestingly enough, you do not need to have a headache to qualify for a vestibular migraine diagnosis.

There are no specific, universally accepted biomarkers for vestibular migraine. It also can’t be seen on imaging. Diagnosis therefore primarily relies on patient symptoms and history, making vestibular migraine especially difficult to identify. On average, it takes 8.4 years after the first onset of migraine for women to get properly diagnosed. Symptoms may include:

Spinning or rocking sensations
Ear fullness or facial pressure
Light, sound, and motion sensitivity
Decreased tolerance for busy environments
Visual discomfort or eye strain

Hormonal changes also have an impact on migraine pathology. Given how many systems are influenced by hormonal changes, diagnostic guidelines can start to blur, making the problem hard to pinpoint.

The Solution

The causes of vertigo in women can be complex, often involving multiple factors. But with proper care coordination between your healthcare providers, vertigo is very treatable. Health care providers you may wish to consult include:

Primary care physician
OB/GYN or women’s health practitioner for hormonal changes
Neurologists for migraine or other neurological causes of vertigo
A vestibular physical therapist

Your physicians are responsible for stabilizing your body’s physiological systems while a vestibular physical therapist’s job is to recalibrate the inner ear & brain to address any vestibular disruptions. This recalibrating process is known as vestibular rehabilitation and involves exercises that coordinate head movements, eye movements, and overall balance. With the right team and a proper plan, recovery is possible.

If you’re having difficulty getting a handle on your vertigo, you’re not alone.

When hormones, migraine, or metabolic factors are involved, dizziness often requires a more individualized approach. A personalized plan can help clarify what’s contributing to your symptoms and outline next steps. Get your FREE treatment plan here.

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