Histamine Intolerance

As a menopause specialist, I see many women struggling with symptoms that seem to intensify during perimenopause—headaches, anxiety, digestive issues, and skin reactions. While these symptoms are often attributed to hormonal changes, there's another factor at play that many women (and even some healthcare professionals) may overlook: histamine intolerance. 

 In this post, we'll explore what histamine intolerance is, how it relates to the hormonal shifts of perimenopause, and what lifestyle changes and treatment options, including hormone replacement therapy (HRT), can help you manage these symptoms effectively. 

What is Histamine Intolerance? 

Histamine is a naturally occurring compound that plays a crucial role in your body’s immune response, digestion, and communication within the brain. However, when your body is unable to break down histamine effectively, it can accumulate and cause a range of symptoms that mimic allergic reactions. This condition is known as histamine intolerance. 

Common symptoms of histamine intolerance include: 

• Migraines or headaches 

• Nasal congestion or sinus issues 

• Fatigue and brain fog 

• Digestive problems like bloating and diarrhoea 

• Skin issues such as hives or itching 

• Heart palpitations or rapid heartbeat 

• Anxiety and mood swings 

  
  

How Perimenopause Affects Histamine Levels 

Perimenopause is the transitional period leading up to menopause, marked by fluctuating hormone levels, particularly oestrogen and progesterone. These hormonal shifts can significantly impact histamine levels in your body. 

The Role of Oestrogen 

Oestrogen is known to stimulate the release of histamine from mast cells, which are immune cells responsible for allergic responses. It also inhibits the enzyme diamine oxidase (DAO), which is crucial for breaking down histamine in your gut. When oestrogen levels rise, as they often do in perimenopause due to irregular ovulation, histamine levels can increase, leading to more pronounced symptoms. 

The Role of Progesterone 

Progesterone, on the other hand, helps to stabilise mast cells, reducing the release of histamine. It also supports the activity of DAO, helping your body to break down and clear histamine more effectively. During perimenopause, as progesterone levels decline, the protective effect against histamine diminishes, exacerbating histamine intolerance. 

Lifestyle Guidance to Manage Histamine Intolerance 

Managing histamine intolerance, especially during perimenopause, requires a holistic approach that includes dietary changes, stress management, and lifestyle modifications. 

1. Dietary Changes 

Certain foods are high in histamine or trigger the release of histamine in the body. Avoiding or limiting these foods can help manage your symptoms: 

• High-Histamine Foods: Aged cheeses, smoked meats, fermented foods (e.g., sauerkraut, kimchi), alcohol, and certain fish (e.g., tuna, mackerel). 

• Histamine-Releasing Foods: Tomatoes, spinach, aurbergine, avocados, strawberries, and citrus fruits. 

  
  

Additionally, fresh foods tend to have lower histamine levels, so focusing on a diet rich in fresh fruits, vegetables, and unprocessed foods can be beneficial. 

2. Stress Management 

Stress can increase histamine release and worsen symptoms. Incorporate stress-reducing activities into your daily routine, such as: 

• Mindfulness and Meditation: Practicing mindfulness or meditation can help reduce stress levels and improve overall well-being. 

• Regular Exercise: Moderate physical activity, such as walking, yoga, or swimming, can help lower stress and improve mood. 

• Adequate Sleep: Prioritize getting 7-8 hours of quality sleep each night, as poor sleep can exacerbate both stress and histamine-related symptoms. 

  
  

3. Gut Health 

Supporting gut health is crucial in managing histamine intolerance. Consider the following: 

• Probiotics: Certain strains of probiotics, such as Lactobacillus rhamnoses, may help break down histamine in the gut. However, some probiotics can produce histamine, so it's important to choose the right strains. 

• Anti-Inflammatory Diet: An anti-inflammatory diet can help heal the gut and reduce symptoms. This includes foods rich in omega-3 fatty acids, like fatty fish, flaxseeds, and walnuts, as well as plenty of fruits and vegetables. 

  
  

Treatment Options: Hormone Replacement Therapy (HRT) 

For women experiencing significant symptoms of histamine intolerance during perimenopause, hormone replacement therapy (HRT) can be an effective treatment option. HRT helps to balance the fluctuating levels of oestrogen and progesterone, which can in turn help to manage histamine levels. 

How HRT Can Help 

• Balancing Oestrogen: HRT provides a controlled amount of oestrogen, which can prevent the spikes in histamine release associated with fluctuating natural oestrogen levels. 

• Supporting Progesterone: Including progesterone in your HRT regimen can counterbalance the effects of oestrogen, helping to stabilise mast cells and reduce histamine release. 

  
  

Types of HRT 

• Oestrogen-Only HRT: Typically prescribed for women who have had a hysterectomy, this type of HRT provides oestrogen without progesterone. In women with histamine intolerance, it’s crucial to monitor symptoms closely, as unopposed oestrogen can increase histamine levels. 

• Combined HRT: This type of HRT includes both oestrogen and progesterone, which is ideal for women with histamine intolerance as it helps to maintain a balance between these two hormones. 

  
  

Personalised Approach 

It’s important to work with a healthcare professional who understands the complexities of histamine intolerance and hormonal balance. A personalised approach to HRT, tailored to your specific symptoms and hormone levels, can provide relief while minimising potential side effects.