From the Guidelines
Estrogen can cause nausea as a side effect, particularly when taken in medications like hormonal contraceptives or hormone replacement therapy, as evidenced by the most recent study in 2024 1. This nausea typically occurs when first starting estrogen-containing medications and often improves within 1-3 months as the body adjusts. To minimize nausea, take estrogen medications with food, especially at bedtime, and consider starting with lower doses when possible. Some key points to consider include:
- Patients taking combined estrogen and progestin ECPs are more likely to experience nausea and vomiting than those who take levonorgestrel or UPA ECPs, as shown in studies 1.
- Anti-nausea medications like ginger supplements (250mg four times daily) or over-the-counter options such as dimenhydrinate (Dramamine) may help manage symptoms, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 1.
- If nausea persists or becomes severe, alternative formulations like transdermal patches or vaginal rings might be better tolerated as they bypass the digestive system and provide more consistent hormone levels. The nausea occurs because estrogen can stimulate the chemoreceptor trigger zone in the brain that controls vomiting and can also slow gastric emptying, which contributes to feelings of nausea, as discussed in the context of nausea and vomiting of pregnancy (NVP) 1. If symptoms don't improve after three months or significantly impact quality of life, consult your healthcare provider to discuss adjusting your treatment plan.
From the Research
Estrogen and Nausea
- Estrogen has been found to be positively associated with nausea with or without vomiting risk in pregnant women, although the association was only evident after adjustment for other measured compounds 2.
- The study found that higher levels of estradiol, a type of estrogen, may contribute to or correlate with the occurrence of nausea with or without vomiting at any time during pregnancy until the 27th gestational week 2.
- However, other studies have not found a direct link between estrogen and nausea, and the cause of nausea and vomiting in pregnancy is still unknown, with possible factors including the rise in human chorionic gonadotrophin concentration 3, 4.
- Estrogen is a complex hormone with both positive and negative effects on the body, and its relationship to nausea is not fully understood 5.
- Psychological factors, such as depressive symptoms, have also been found to be independently related to nausea and vomiting during early pregnancy, suggesting a multifactorial etiology 6.
Hormonal Factors
- Human chorionic gonadotropin (hCG) has been found to be independently related to nausea and vomiting during early pregnancy, with high hCG levels increasing the risk of NVP 6.
- Thyroid hormones, such as thyroid-stimulating hormone and thyroxin, have not been found to be related to nausea and vomiting during pregnancy 6.
- The relationship between estrogen and other hormones, such as hCG and thyroid hormones, may play a role in the development of nausea and vomiting during pregnancy, but further research is needed to fully understand these relationships 2, 6.