Vertigo and Dizziness in Women: What We Still Need to Understand

Abstract

Vertigo and Dizziness in Women: What We Still Need to Understand

In the current context of medical practice—marked by a pursuit of diagnostic and therapeutic precision—there remains an area requiring greater attention: the differences in the incidence and presentation of vestibular disorders according to the patient's sex. Various population-based studies have shown that women experience vertigo and dizziness more frequently than men, with significant implications for the diagnosis, management, and prognosis of these conditions.

Epidemiological data indicate that up to 29.5% of the population has experienced episodes of vertigo, with a higher prevalence in women.

This difference has been linked to physiological factors, including hormonal fluctuations associated with the menstrual cycle, pregnancy, contraceptive use, and menopause. The presence of estrogen and progesterone receptors in the inner ear suggests a direct role of these hormones in vestibular function, potentially explaining both the higher incidence and the variability in clinical presentation of vestibular disorders among women.

For example, benign paroxysmal positional vertigo (BPPV) accounts for approximately 8% of moderate to severe dizziness cases, with a lifetime prevalence of 2.4% and a marked female predominance (65% of cases), especially among women aged 50 to 70 years.

The decline in estrogen during menopause has been associated with increased frequency of BPPV, possibly due to alterations in calcium metabolism affecting the stability of otoliths. Some studies suggest that hormone therapy could reduce the incidence of BPPV in postmenopausal women, although further research is needed to establish clear clinical recommendations.

Similarly, Ménière’s disease—characterized by episodes of vertigo, hearing loss, and tinnitus—has an incidence of 13 per 100,000 people, with women accounting for approximately 65% of cases. In women of reproductive age, attacks have been observed to coincide with phases of the menstrual cycle when estradiol levels drop, while hormonal contraceptive use may reduce the frequency and intensity of episodes. One proposed hypothesis is that hormonal changes affect microcirculation in the inner ear, potentially disrupting endolymphatic balance and contributing to symptom onset.

Traditionally, when neurological or cardiovascular causes were ruled out, dizziness in women was often attributed to psychosocial factors.

However, recent findings on hormonal influence offer plausible physiological explanations that must be considered in the comprehensive evaluation of patients with dizziness or vertigo.

In this regard, the work of Dr. Carolin Lerchenmüller in the field of cardiology has been key in paving the way toward a gender-based approach to medicine—one that seeks to recognize and understand the biological and hormonal differences between men and women as a fundamental element for more accurate diagnosis and treatment. This approach is becoming increasingly relevant in other specialties, and in otolaryngology there is a clear need to delve deeper into these differences, not only in the context of vertigo and dizziness but also in other areas that impact women’s auditory and vestibular health.

Incorporating this knowledge into clinical practice can enable more accurate diagnoses and personalized management—particularly for populations such as women undergoing significant hormonal changes. Moreover, there is a clear need for prospective research to confirm these findings and to define therapeutic strategies based on the underlying pathophysiology.

In conclusion, recognizing and studying sex-based differences in the presentation of vestibular disorders is essential to optimizing medical care, improving quality of life, and advancing toward more precise, evidence-based medicine. Further research is needed to fully understand how the hormonal and physiological characteristics specific to each sex influence the incidence, manifestation, and progression of vestibular disorders, with the aim of developing diagnostic and therapeutic strategies that improve patient outcomes across the board.

Sincerely,

Melissa Castillo Bustamante
Director, Acta de Otorrinolaringología & Cirugía de Cabeza y Cuello