Histamine intolerance is increasingly recognized in perimenopausal and menopausal women. This condition can worsen during menopause due to hormonal fluctuations, particularly imbalances in estrogen and progesterone. Estrogen influences histamine levels, and as hormone levels shift, histamine intolerance symptoms may become more pronounced.(1)
What is histamine?
Histamine is a chemical involved in immune responses, digestion, and neurological functions. It plays a role in allergic reactions, regulates stomach acid, and influences sleep, mood, and body temperature. The body produces histamine through mast cells, which store and release histamine when triggered by stimuli like allergens and stress.(2)(3)(4)
What is histamine intolerance?
Histamine intolerance occurs when the body cannot break down histamine efficiently, leading to an accumulation that triggers various symptoms. This imbalance can result from reduced activity of the enzymes diamine oxidase (DAO) and histamine-N-methyltransferase (HNMT), which are responsible for metabolizing histamine.(2)(3)
Mast cells, a type of immune cell, release histamine as a response to stress, allergens, infections, or hormonal changes. Histamine clings to receptors throughout the body, influencing functions such as blood vessel dilation, digestion, and immune responses. When too much histamine builds up, intolerance symptoms emerge.(2)(3)
Histamine Intolerance Symptoms
Histamine intolerance can cause a range of symptoms, including the following:(2)(3)(4)(5)
Headaches or migraines
Bloating and digestive discomfort
Hives, itching, or skin flushing
Fatigue or brain fog
Nasal congestion or sinus and respiratory issues
The following symptoms may indicate histamine intolerance during menopause:(2)(3)(4)(5)
Hot Flashes: Hormonal changes can increase histamine levels, triggering or intensifying symptoms like hot flashes.
Night Sweats: Since histamine helps regulate body temperature, excess levels may contribute to night sweats.
Fatigue: Unbalanced estrogen can impair histamine metabolism, contributing to chronic fatigue.
Heart Palpitations: Histamine can influence cardiovascular function, leading to rapid or irregular heartbeats.
Anxiety and Irritability: Histamine interacts with neurotransmitters, potentially contributing to mood disturbances and restlessness.
Histamine Intolerance and Menopause
Hormonal fluctuations during perimenopause and menopause impact how sensitive the body is to histamine. Many women experience increased histamine intolerance symptoms during this stage of life, likely due to shifts in estrogen and progesterone levels.(4)
The Estrogen-Histamine Connection
Higher estrogen levels relative to progesterone can increase histamine release. Estrogen influences mast cells, promoting histamine release and reducing DAO enzyme activity, which slows histamine breakdown. Estrogen imbalance also contributes to inflammation, which can worsen histamine intolerance symptoms.(1)(4)
How Menopause Can Worsen Histamine Intolerance
Estrogen and progesterone help regulate histamine levels. When progesterone declines in menopause, estrogen’s effect on histamine becomes more pronounced.(1)(4)
A drop in progesterone can cause an imbalance with estrogen, which can increase histamine sensitivity.(1)(4)
Histamine accumulation can create a cycle where increased histamine worsens estrogen imbalances.(1)(4)
How to Test for Histamine Intolerance
Testing for histamine intolerance can be tricky because there isn’t a single definitive test. Instead, it’s usually diagnosed based on symptoms, dietary response, and sometimes lab tests.(3)
Here are the main ways to assess histamine intolerance:(3)
Symptom-Based Assessment
Histamine intolerance often presents with reocurring symptoms after eating high-histamine foods (e.g., aged cheese, wine, fermented foods). Keeping a food and symptom diary can help identify patterns.
Low-Histamine Diet Trial
A common diagnostic method is to eliminate high-histamine foods for 2–4 weeks and then gradually reintroduce them. If symptoms improve during the elimination phase and return with reintroduction, histamine intolerance is likely.
Histamine Blood Test
A blood test can measure DAO activity, and low levels may suggest histamine intolerance. Diamine oxidase is the primary enzyme responsible for breaking down histamine in the gut. If histamine levels remain persistently high while DAO levels are low, this could indicate an intolerance. However, this test isn’t always definitive because other factors can also affect histamine breakdown.
Skin Prick Test or Mast Cell Testing
A Skin Prick Test (SPT) can help rule out allergies as a cause of histamine-related symptoms. However, it does not diagnose histamine intolerance. Mast cell testing measures specific blood or urine markers to assess excessive histamine release. These tests help differentiate between allergies, mast cell disorders, and histamine intolerance.
Managing Histamine Intolerance During Menopause
Dietary and Lifestyle Changes: Reducing histamine-rich foods (e.g., aged cheeses, fermented foods, alcohol) and prioritizing fresh, low-histamine options can help manage symptoms. Anti-inflammatory diets may also support histamine balance.(3)(5)
Hormone Replacement Therapy (HRT): Balancing sex hormones through HRT may help stabilize histamine levels. Certain hormone adjustments in therapy can reduce histamine release from mast cells, while keeping estrogen in check may further limit its effects.(1)
Antihistamines: These medications may help manage symptoms but could also influence estrogen levels, making it essential to discuss options with a healthcare provider.(3)
Natural Remedies and Supplements: Probiotics, vitamin C, and DAO enzyme supplements may support histamine metabolism and improve tolerance, but they should only be taken for this purpose under the guidance of a medical professional.(3)(5)
Understanding Histamine Intolerance and Menopause
Histamine intolerance is a real and increasing concern for menopausal women, particularly due to hormonal fluctuations that affect histamine metabolism. Managing symptoms through diet, lifestyle changes, and potential HRT options can help improve overall well-being.
For women who suspect histamine intolerance, a doctor or dietitian can provide guidance on testing and dietary adjustments. A healthcare provider can help develop a personalized approach that considers both hormonal imbalances and histamine intolerance, ensuring a more effective management plan.
