Navigating menopause is hardly a one-size-fits-all process. Every person who goes through this life change juggles their own set of side effects, and while most of us are familiar with usual symptoms like hot flashes, mood swings, weight fluctuations, and vaginal dryness, others are a little more unknown and surprising. One of them is a feeling of dizziness, lightheadedness, or unsteadiness from time to time. Who knew?!

Unfortunately, I did. I’ve had my share of clumsy moments recently, and with my increasingly irregular cycles in perimenopause, I can also feel pretty spaced out and off balance. While it’s frustrating and sometimes a little scary, it’s thankfully far from abnormal. Research estimates that 1 in 4 people experience dizziness at some point during menopause. In other words, it shouldn’t come as a surprise if you get a case of the wobbles here and there as your hormones shift.

Want to know exactly why menopause can cause dizziness? Read on to learn more about the connection, plus how to restore your balance so you feel a little more even-keeled.

How dizziness and menopause are connected

This connection all starts with the powerhouse that is your endocrine system—the body system that helps produce and distribute your hormones. During menopause, reproductive hormones like estrogen, testosterone, and progesterone will fluctuate wildly with dips and spikes. This hormonal imbalance can throw a whole host of body systems out of whack—which can lead to dizziness. Here is a breakdown of some of the reasons why:

1. Blood vessel changes

Your hormones help control the way that your blood vessels narrow and widen. More specifically, when your estrogen levels dip, your vasomotor system (a network of nerves that control blood flow) responds, which can trigger feelings of vertigo or dizziness. This same system is also partly responsible for hot flashes, which can occur as blood rushes through dilated vessels.

“There are over 100 different symptoms associated with menopause or estrogen loss, and both palpitations and dizziness are nearing the top of the list,” explains Bruce Dorr, MD, FACOG, an OB/GYN and certified practitioner with the Menopause Society. “Both are potentially a sign of vascular or blood vessel dysfunction which can lead to unsteady feelings.”

2. Poor sleep

There are a few different reasons why you tend to have poorer sleep quality throughout menopause. This can include anxiety and stress keeping you awake at night or restless legs syndrome—a condition that’s common during menopause and causes pain and heaviness in the legs. No matter the cause, this lack of shut-eye can lead to a feeling of imbalance or unsteadiness the next day.

“Sleep disruption whether due to night sweats, urge to urinate, or just the busy mind and racing thoughts often experienced during perimenopause, can contribute to mental fogginess, dizziness, and clumsiness,” says Alyssa Dweck, MD, FACOG, a board-certified OB/GYN based in New York and chief medical officer of Bonafide Health.

3. Fluctuating glucose levels

Hormones can also help regulate your body’s insulin response, i.e., how it processes sugar. But when they are in flux during menopause, your glucose levels can also quickly go up or down, leading to hyper- or hypoglycemia (aka high or low blood sugar). And some of the main side effects of hypoglycemia? Shakiness, weakness, and feeling lightheaded.

4. Low iron

While some of us might experience fewer periods during perimenopause, others find their periods arrive closer together, last longer, or come with a heavier flow of blood. If you’re losing more blood, your iron levels could drop and lead to iron deficiency anemia, which could send you straight into the dizzy zone. Other symptoms of iron deficiency anemia can include fatigue, weakness, and pale skin.

5. Swelling and stiff joints

Lastly, bloating (from your body holding onto water) is a commonly reported menopause symptom. That, coupled with joint pain, can bring on a lack of coordination and make you feel off-balance. “Water retention is a common complaint during perimenopause,” says Dr. Dweck. “Swelling in the hands from water retention and general joint stiffness, another common symptom of perimenopause can lead to clumsiness.”

Are there any long-term complications of dizziness during menopause?

While annoying, the good news is that menopausal dizziness usually clears once a person stops menstruating (aka stops getting a period) and those hormone swings slow down. “In general, symptoms of menopause subside over time, so it’s a matter of reassurance and time,” says Dr. Dorr. Eventually, things will start to level out.

One thing to note, however: Menopausal clumsiness can make you more prone to misstepping or bumping into things. And because declining estrogen causes thinner skin during menopause, you might end up bruising more easily. (I’ve picked up more than my fair share of bruises, and I often can’t even remember how I got them in the first place.)

How to reduce menopause-related dizziness

With all this in mind, is it possible to regain balance and feel steadier during menopause? Turns out, some simple steps can go a long way toward keeping menopause-related dizzy spells to a minimum. Here’s what you can do:

Don’t skip meals or snacks

Try to reach for plenty of high-quality nutritious meals and snacks throughout your day, which will help keep dizzy spells at bay. What you put into your “tank” will ensure you’re not running on fumes or feeling weak. Aim to incorporate more whole grains, lean protein, healthy fats, and produce into your daily meals.

Stay hydrated

If you’re dealing with hot flashes and night sweats, chances are you’re losing a bit of water each day, which can lead to dehydration. This loss of fluid can wreak havoc on your steadiness. “Dehydration results in lower blood pressure which can cause dizziness, especially upon standing,” says Dr. Dweck. Make sure you’re replenishing by getting 11.5 to 15.5 cups per day, through drinking and eating water-rich foods.

Get plenty of sleep

When it comes to reducing dizzy spells (and other menopause symptoms), getting enough sleep is crucial. This means you might have to up your sleep hygiene, or daily habits that help facilitate a good night’s rest. This might look like setting the thermostat in your bedroom a few degrees cooler, less scrolling on your phone and exposure to screens at night, and skipping that post-dinner glass of wine or cocktail to help you stay asleep longer. All this can lead to feeling less lopsided the next morning.

Calm anxiety and stress responses

Research has shown that lightheadedness can be associated with anxiety and stress, so calming your nerves may help you feel more steady. You can do this with mindfulness activities like guided meditations, gentle yoga, or breathwork. Or, you can try clinically studied supplements to help you relax—like ashwagandha and Relizen (made from Swedish flower pollen and thought to relieve things like hot flashes).

Of course, always talk to your healthcare provider before trying out any new supplements.

Consider hormone therapy

Taking supplemental estrogen—often called hormone therapy—can be a helpful way to reduce menopause symptoms like hot flashes and joint pain, thereby possibly reducing dizziness. Case in point: A 2017 study found people who took estrogen for menopause symptoms reported a significantly lower incidence of dizziness when compared to those who had not.

“Safe and effective hormone therapy can be helpful and in the long term, not only improve quality of life symptoms, but overall health and wellness,” Dr. Dorr says.

When to see a healthcare provider

While it’s comforting to know many people in menopause experience dizziness, it can still be a scary experience when it strikes. If it’s starting to hit you on a daily, you’ll want to consult with your care team.

“It’s always important to seek medical advice when your life is affected and normal routines are limited due to the symptoms,” Dr. Dorr says. “Dizziness can be attributed to a wide variety of diagnoses,” so it’s important to see your healthcare provider to get to the root cause.

From there, your provider can determine which treatments would be right for you. This could include lifestyle changes that make a big difference in both your balance and your overall well-being as you work through menopause.