Aside from the loss of periods, menopause can bring with it a host of other changes, including menopause symptoms such as hot flushes, mood changes and vaginal dryness. The onset of menopause can also bring to light other underlying health issues that may have previously gone unnoticed or have been exacerbated by the hormonal changes that occur.
Histamine intolerance (HIT) is one such condition that some women in menopause experience. It is more common in women and midlife and is thought to affect 1 -3% of the global population(1). However, it is often mistaken for a food allergy or a gastrointestinal issue, making it difficult to manage and some of its symptoms can overlap with those that occur during menopause.
Understanding the root cause of physical and emotional symptoms is pivotal to determining the right line of treatment. In this guide, we explore histamine intolerance and look at how to manage it during menopause.
What is histamine?
Histamine is a chemical produced by your mast cells that your immune system releases. It acts as a chemical messenger(2) and as such, has important functions in the body. Although it is predominantly known for its role in allergic and anaphylactic symptoms, it also:
- Has a vital role in the immune system
- Helps transmit messages in the brain and nerves
- Triggers the release of stomach acid
- Is important in the contraction of some muscles
- Regulates your sleep-wake cycle
- Affects blood pressure
- Impacts sex drive
- Contributes to cognitive function (2, 3, 4)
Histamine is also present in some foods, especially those that involve an ageing or fermentation process. There are also foods that can cause your mast cells to release histamine (these are called histamine liberators). These types of foods can increase the amount of histamine in the body and include:
- Alcohol (beer, wine and champagne)
- Processed meats
- Pork
- Fish (mackerel, tuna, sardines and herring) and shellfish
- Tropical fruit (pineapple, bananas, papaya and citrus)
- Vegetables (tomatoes, aubergine and spinach)
- Strawberries
- Egg white
- Sauerkraut
- Cheeses
- Nuts and legumes
- Chocolate and cocoa
- Liquorice
- Vinegar
- Wheatgerm
- Additives (such as preservatives and colourings) (3, 5)
What affects levels of histamine in our bodies?
Histamine can be thought of like water in a bucket. Certain things add more water (histamine) into our buckets such as certain foods, stress, chronic inflammation, hormonal changes (such as those which occur during menopause) and some medications.
Some people are also genetically prone to either producing more water (histamine) or having smaller buckets because they have lower levels of the enzyme diamine oxidase (DAO) which removes histamines from the body. There are many things which can affect our histamine levels and our ability to get rid of histamine from the body including:
- Medications – some medications can block or prevent the production of DAO.
- Gastrointestinal disorders – such as inflammatory bowel disease can result in DAO deficiency.
- Bacterial overgrowth - if the body is unable to digest food properly, bacteria grow, and this causes you to produce too much histamine (6).
What is histamine intolerance?
Histamine intolerance (HIT) occurs when people develop symptoms as a result of higher levels of histamine in their bodies. This can occur at any time but may happen during menopause directly because of fluctuating and reducing levels of hormones contributing to higher levels of histamine, and indirectly because of the effect menopause has on things like the gut microbiome, stress levels, sleep and so on.
Histamine intolerance symptoms
Histamine is a whole-body condition, meaning its symptoms can affect various parts of the body. Not everyone will have the same symptoms or severity of symptoms. One study found that on average, individuals experience 11 symptoms, with 97% of people with HIT afflicted by more than three symptoms (7).
Symptoms of histamine intolerance include:
- A general feeling of unwell
- Fatigue
- Gastrointestinal
- Indigestion
- Diarrhoea
- Constipation
- Acid reflux
- Food sensitivities
- Abdominal pain
- Bloating
- Nausea and/or vomiting
- Flatulence
- Central nervous system and cognition
- Headache or migraine
- Dizziness
- Lightheadedness
- Brain fog
- Aches and pains
- Mental health
- Anxiety
- Depression
- Panic attacks
- Insomnia
- Respiratory
- Wheezing
- Shortness of breath
- Nasal and sinus congestion
- Runny nose
- Skin
- Flushing
- Rash
- Hives
- Eczema
- Cardiovascular
- Tachycardia
- Irregular heartbeat
- Low blood pressure
- Palpitations
- Intolerances
- To medicines
- To strong smells
- To temperature changes
- Food sensitivities
- Urinary symptoms (2, 6)
How is histamine intolerance diagnosed?
There is no test for HIT. It is possible to test the levels of DAO, and for things which may contribute to its function such as vitamins C and B6 and zinc, but a normal level of DAO does not rule out HIT.
Remember, your bucket may be a normal size (Normal levels of DAO) but you may still have too much water in it (for example, by producing too much histamine and/or consuming food high in histamine.)
Histamine intolerance and menopause
Menopause can contribute to histamine intolerance due to the close relationship between oestrogen and histamine. Oestrogen stimulates histamine release and histamine stimulates the ovaries to produce more oestrogen, creating a cycle (8).
During perimenopause and menopause, oestrogen levels fluctuate, which directly affects histamine levels. When oestrogen levels are lower, this gives rise to menopause symptoms. When oestrogen levels are higher and histamine levels are balanced, menopause symptoms will reduce. However, if you are histamine intolerant, the oestrogen stimulates even more histamine to be produced, and symptoms of histamine intolerance may occur (8).
In addition, high oestrogen levels can inhibit the activity of DAO, meaning that histamine cannot be broken down as efficiently, leading to a build-up in the body (8).
How to manage a histamine intolerance
If you feel that you may have histamine intolerance, it is always best to consult with a doctor to rule out other possibilities and get management advice. However, there are some straightforward steps you can take to improve symptoms when you have HIT:
Stress-reducing activities
It’s common to experience stress during menopause due to the changes that happen to your body and life responsibilities that occur in midlife. However, stress triggers histamine release (9) so finding ways to manage stress can be beneficial not only for helping navigate menopause but for managing HIT too.
Yoga is a great option but practicing mindfulness or meditation and getting regular exercise can also help reduce stress.
DAO supplements
DAO supplements are over-the-counter products that can be used to try and avoid the amount of histamine that is ingested and absorbed when eating.
Some research indicates that DAO supplements can reduce migraine attacks, improve HIT digestive symptoms and relieve hives (10).
However, they are expensive and there aren’t any standards for making these kinds of supplements. Some are also produced with animal kidney extracts which make them unsuitable if you have certain religious beliefs or animal product dietary restrictions.
Further, as HIT can be hard to diagnose, you could take them unnecessarily which provokes safety concerns (10).
Antihistamines
Antihistamines are a common over-the-counter medication used by allergy sufferers, but they can also be used for the management of HIT symptoms. They do not lower histamine levels but can help get rid of excess histamine in the body (8)
H2 Blockers
There are 4 types of histamine receptors, H2 being one of them that is present in the stomach. H2 blockers, such as Cimetidine, are prescription-only medications that reduce the amount of stomach acid made in response to excess histamine (8).
Vitamin C and L-glutamine
These are natural antihistamines which can help reduce histamine levels in the body, suppress inflammation and relieve symptoms(8)
Quercetin
Quercetin belongs to a group of plant pigments called flavonoids. Evidence is limited, but it is thought that it can prevent immune cells from releasing histamines and may reduce HIT symptoms including a runny nose, hives, and swelling (11).
Does HRT help with histamine?
Hormone replacement therapy (HRT) is a first-line treatment for menopause symptoms, with the majority of women experiencing a reduction in the amount or severity of symptoms within 3-6 months of beginning treatment.
However, women with histamine intolerance may find their HIT symptoms worsen as the oestrogen replacement fuels histamine production.
This is why it is important to take a holistic approach to managing menopause and consider the possibility of histamine intolerance in cases where new symptoms arise, or existing symptoms worsen after starting HRT (8).
How can a dietician help with histamine intolerance?
Implementing a dietary restriction of histamine is a crucial step in both diagnosing and managing this condition. The low histamine diet involves a short-term elimination phase, followed by a systematic reintroduction of foods to identify individual tolerance levels to histamines.
Seeking dietetic support is pivotal to effectively identifying triggers while maintaining optimal nutrition. Here are a few ways in which a dietician can assist:
- Identification of trigger foods
- Customised nutrition plans to improve gut health and reduce high histamine foods
- Symptom tracking
- Supplement recommendation
- Behavioural and lifestyle counselling
The objective is to keep the diet as diverse as possible, minimising food restrictions while managing symptoms. Given that each individual’s tolerance to histamine is unique, the approach to reducing dietary sources of histamine needs to be personalised.
Find out more about nutrition during menopause.
At Menopause Care, our doctors are experienced in supporting women going through menopause on its own or when managing other conditions. Dr Rebecca Smithson is a histamine sensitivity specialist and is available for new or follow-up consultations.
In addition, our menopause dietician, Marcela Fiuza, can help you by providing evidence-based nutritional guidance based on your individual concerns, lifestyle, health goals and medical history. By adopting a tailored diet, you can reduce high-histamine foods, alleviate symptoms and improve your overall well-being. To get started, book a consultation with a menopause doctor.
¹Histamine intolerance: Causes, symptoms, and test (February 2023)
²³What Is Histamine? (March 2023)
⁴⁶Histamine Intolerance: Causes, Symptoms, and Diagnosis (November 2024)
⁸Histamine Intolerance (HIT) (September 2021)
