Vertigo

The NHS describes vertigo as feeling that you, or everything around you, is spinning, enough to affect your balance. It says vertigo is more than just feeling dizzy. An attack can last from a few seconds to hours, and severe vertigo can go on for days or months.

Dizziness is the wider word. The NHS dizziness page counts feeling light-headed, faint or off-balance as dizziness too. Vertigo is the one where something moves that is not moving.

This is a recognition page. The NHS menopause pages mention feeling dizzy as part of a hot flush, but no guideline we checked names vertigo as a symptom of the menopause. What links the two is research, set out below.

• the room spinning when you lie down, turn over in bed or sit up
• a lurch when you look up at a high shelf or tip your head back
• the floor seeming to tilt as you bend down
• feeling sick while it lasts, and shaky afterwards
• a wariness about moving your head at all

The NHS says one kind, benign paroxysmal positional vertigo or BPPV, is brought on by particular head movements. Lying down, turning over and sitting up all count.

In Urdu, Roshara uses the word a Pakistani doctor writes, vertigo, and keeps chakkar aana for dizziness. What women say is plainer: sab kuch ghoomta hua lagta hai, everything seems to be spinning, or sar ghoomna, the head spinning. The formal medical word is dawaar.

The NHS says inner ear problems, which affect balance, are the most common cause of vertigo. It lists BPPV; labyrinthitis, an inner ear infection that follows a cold or flu virus; vestibular neuritis, inflammation of the balance nerve; and Ménière's disease, a rare inner ear condition that can come with ringing in the ear or hearing loss. Migraine and some medicines can cause it too, and sometimes the cause is never found.

The menopause link sits with BPPV, and it comes from research, not guidance.

A 2014 study in the journal Menopause, by Ogun and colleagues, looked at 1,377 people treated for BPPV at one US balance clinic over ten years. It explains BPPV the accepted way: tiny crystals of calcium in the inner ear come loose and fall into the part that senses the head turning. Women outnumbered men two to one overall, and more than three to one in their forties. Of the 168 women who answered a follow-up survey, nearly half said their first attack came after the menopause. The authors suggest that hormone changes, especially around the menopause, may make BPPV more likely. They also note the limits: one hospital, and fewer than one woman in five answered the survey.

A 2020 review by Jeong, in Frontiers in Neurology, calls BPPV the most common cause of vertigo that keeps coming back. It proposes that the sharp fall in estrogen at the menopause may disturb how the body makes and keeps those crystals, mostly on the evidence of animal studies, and says it is not fully understood why women after the menopause have BPPV more often.

A 2020 analysis of 19 studies, by Chen and colleagues, also in Frontiers in Neurology, found BPPV linked with being female, osteoporosis, low vitamin D, migraine, head injury and high cholesterol. It did not look at the menopause itself. If your bones or your migraines are already on your doctor's radar, that list is worth bringing.

These are researchers' findings. None of them tells you what to do about your own vertigo.

The NHS vertigo page lists these to ease an attack and make them less frequent:

• lie still in a quiet, dark room until the spinning eases, and sit down straight away when you feel dizzy
• move your head carefully and slowly through the day
• turn the lights on if you get up in the night, and use a walking stick if you are at risk of falling
• sleep with your head slightly raised on two or more pillows
• get out of bed slowly, and sit on the edge for a while before you stand
• squat to pick things up rather than bending over, and do not stretch your neck to reach a high shelf
• try to relax, because anxiety can make vertigo worse

The NHS says most people with vertigo get better without treatment, and that treatment depends on the cause. A GP may prescribe antibiotics for an infection, give you exercises to help correct your balance, or suggest antihistamines, which it says can sometimes help.

The NHS says to see a GP if your vertigo will not go away or keeps coming back. A GP will ask about your symptoms and may do a simple balance test that moves you quickly from sitting to lying down. The NHS warns it could bring on the spinning, so it helps to know that before it starts. You may also be referred to a specialist.

Ask for an urgent GP appointment, or call NHS 111, if you have vertigo with a severe headache, if you are being sick or feel very sick, or if you have a very high temperature or feel hot, cold or shivery.

Call 999 or go to A&E if you have vertigo with double vision or loss of vision, hearing loss, trouble speaking, or weakness, numbness or tingling in an arm or leg. The NHS says not to drive yourself: ask someone to drive you, or call an ambulance, and take your medicines with you.

Salah asks the head to go down to the ground and come up again, many times a day. For a woman with BPPV, sajda and rising from it can be exactly the movements that set off the spinning. Women ask whether they may pray sitting, or slow the movements, when it comes. Those are questions for a qualified scholar, and plenty of women ask them.

The NHS advice to get up slowly, sit on the edge of the bed and turn the lights on fits the hour before Fajr, when the house is dark and you are the first one up. If someone at home says you are only tired, a note of when the spinning happens, lying down, turning over, looking up, gives your doctor more to go on than tiredness does.