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Histamine Intolerance and Menopause: How to Tackle This Heightened Sensitivity

Updated: Jun 1

Understanding the relationship between histamine intolerance and menopause could be the key to effectively managing your symptoms and optimizing your well-being during this important stage of your  life.

Women undergo a lot of hormonal transitions throughout their lives – be it puberty, pregnancy, perimenopause or menopause.

Menopause is also a biological transition every woman undergoes that typically starts from their late 30s or 40s. The experience of every woman can be quite varied.  One of these changes is histamine intolerance or sensitivity.

If you are in the early stages of perimenopause and facing histamine sensitivity, you must be wondering how you can manage this heightened sensitivity to histamine.

In this article we will dive into:

Our hope is that you will feel confident about how to better manage your condition.

perimenopausal woman sneezing at work as she has histamin intolerance

What is Histamine Intolerance?


Whenever the word "histamine" comes to mind, we immediately think of a runny nose, sneezing and itchy eyes. We usually take antihistamines to tackle these allergies.

But what is histamine actually?

Immune cells called mast cells release histamine, a chemical called a biogenic amine that helps to performs many functions in the body including:

  • regulating gut motility,

  • acting as a neurotransmitter and

  • supporting immune function by triggering an inflammatory response to fight off pathogens and foreign substances.

However, some individuals may have a histamine intolerance which means their mast cells overproduce histamine leading to excess histamine or is slow to break it down and so histamine can accumulate in the blood or tissues of the body, causing uncomfortable symptoms.

Two enzyme called Diamine oxidase (DAO) and  Histamine N-methyltransferase (HNMT) are responsible for histamine breakdown. With histamine intolerance they may not work so efficiently.

As a result, extra histamine builds up in the body, causing uncomfortable symptoms.

Histamine intolerance is thought to impact about 1 in 100 people.


What are the Histamine Intolerance Symptoms?

In some people histamine intolerance can look like allergic reactions.

Here are some common symptoms of histamine intolerance:

  • Respiratory symptoms such as sneezing and runny nose, nasal congestion, swollen eyelids,  or red eyes

  • Skin symptoms: rashes or urticaria and itchy skin

  • Brain symptoms: Headache or migraine, anxiety, insomnia, brain fog

  • Autonomic symptoms such as: dizziness, palpitations, tingling

  • Gut symptoms: these can overlap with typical irritable bowel syndrome such as; abdominal pain, bloating, constipation or diarrhoea, also acid reflux

  • Pelvic symptoms: menstrual cramps, irritable bladder/interstitial cystitis.

Perimenopausal and menopausal women may also experience exaccerbation of underlying allergy at certain times of their cycle due to fluctuating estrogen. It can make it hard to figure out what's causing them, especially during the estrogen dominant phase of perimenopause. Since the symptoms of histamine intolerance can be similar to those of menopause, diagnosis can be even trickier.


Estrogen and Histamine — How Are These Two Connected?


Histamine regulation is closely connected with female sex hormones, especially estrogen. In a woman's body, estrogen levels change at different times in their life: during puberty, during the menstrual cycle - peaking at ovulation, and during perimenopause and menopause.

When estrogen goes up, so does histamine, making your ovaries release even more estrogen, creating a cycle. Also, estrogen makes the histamine-breaking enzyme (diamine oxidase) less effective.

In women with histamine sensitivity, histamine can cause symptoms during your menstrual cycle associated with high estrogen levels such as rashes or can trigger asthma flares.

During perimenopause, hormonal fluctuations often occur. When estrogen is low, typical menopausal symptoms like hot flashes, mood swings, and joint pain can be troublesome. But when estrogen is high, these symptoms might lessen unless you're histamine intolerant, in which case high estrogen can worsen histamine-related symptoms.


The Link Between Histamine Intolerance And Menopause


So, how does histamine intolerance connect to menopause?

The hormonal shifts that occur perimenopause are the key. As you enter perimenopause, the phase leading up to menopause, levels of estrogen and progesterone begin to fluctuate. These hormonal changes can impact histamine production and the way your body processes histamine, leading to an excess of the histamine and histamine-induced symptoms.

According to Dr. Anna Garrett, a leading expert on women's health and menopause, says the theory behind this increased susceptibility is that high estrogen enhances histamine release. As estrogen and progesterone levels rise and fall much more erratically during perimenopause, it can become harder for the body to effectively break down, what becomes an excess histamine load.

More histamine stays in the system, leads to symptoms of histamine intolerance in susceptible women.


Is there Any Overlap Between Histamine Intolerance And Menopause Symptoms?


Histamine intolerance can look a lot like menopause, which can make it tricky to tell them apart. For instance, symptoms like hot flashes and night sweats, usually linked to low estrogen levels of peri/ menopause, can also happen because of too much histamine in the body.

Similarly, feeling moody and tired, often linked to hormonal changes during menopause, can get worse if you have histamine intolerance.

Experiencing low estrogen triggering perimenopausal symptoms and high estrogen- triggering histamine release and histamine intolerance symptoms can cause a lot of discomfort, making life at home and work tougher for women going through perimenopause.


Who's More Likely to Have Histamine Intolerance During Menopause?


Not all women have histamine intolerance during menopause.

Let's see who is more likely to develop histamine intolerance symptoms during menopause:


  • Women with food sensitivities

  • Who consumes alcohol more frequently or with a pre-existing sensitivity to alcohol

  • Women with chronic inflammatory diseases (e.g., arthritis, colitis)

  • Women with imbalances in gut bacteria

  • Those who eat high-histamine foods

  • Women with a deficiency of histamine-breaking enzymes

Is there a histamine intolerance test?

Currently, there is no specific blood test for histamine intolerance.

There are blood tests to look at DAO activity, histamine levels and tryptase levels. These are largely used in the research setting and are impractical in the clinic setting due to variability in levels from hour to hour and day to day.

Diagnosis is usually made based on a person's medical history and symptoms, and guided by their response to treatment.  

Managing Histamine Intolerance During Menopause


Menopause is a natural part of a woman's life, but it doesn't mean you have to suffer from severe symptoms. By addressing issues like histamine sensitivity, you can ease those uncomfortable symptoms.

So, what can be done to address histamine intolerance during menopause? The main strategy is to limit the intake of foods that trigger histamine release and make some lifestyle modifications.

Here are a number of options to manage histamine intolerance.


Dietary Factors: High and Low Histamine Foods


There's no such thing as a "histamine-free diet"!

However you can reduce your histamine load by eating foods that are low in histamine and avoid high-histamine foods.

a variety of citrus foods cut in half and displayed on a table which represent citrus foods to avoid as they are high histamine foods


High Histamine Foods


Some foods contain high levels of histamine, while others cause excessive release of histamines.


Foods that have been reported to contain higher levels of histamine:

  • Rice vinegar

  • Matured cheeses

  • Chocolates and other cocoa-based products

  • Long-stored nuts – e.g., peanuts, cashew nuts, almonds, pistachio

  • Fermented foods. pickled or canned foods – sauerkrauts, kimchi

  • Smoked meat products – salami, ham, sausage

  • Seitan

  • Alcohol - this can have immediate histamine reaction with facial flushing, wheeing and gut symptoms.

  • Shellfish

  • Beans and pulses – chickpeas, soy flour

  • Eggplant/Aubergine

  • Ready meals

  • Salty snacks, sweets with preservatives, and artificial colorings

  • Black tea

  • Energy drinks

  • Mate tea


Foods Causing Release of Histamine (Histamine Releasers):


  • Most citrus fruits – lemon, lime, oranges

  • Papaya, pineapples, plums, kiwi and bananas

  • Tomatoes

  • Legumes

  • Wheat germ

  • Most vinegars

  • Cocoa and chocolate

  • Walnuts, peanuts

  • Additives – benzoate, sulfites, nitrites, glutamate, food dyes - common in many processed foods.


Low Histamine Foods


  • Fresh/frozen meat

  • Fresh/frozen fish

  • Most Fresh fruits – except strawberries, blueberries, plums, citrus fruits, papaya, banana.

  • Most Fresh vegetables—with the exception of avocado, aubergines, tomatoes, spinach, rocket, mushrooms, and pickled and canned vegetables.

  • Gluten-free grains and flours, e.g., rice, oats, corn, quinoa. Einkorn ancient wheat flour is okay, as are grain products such as rice noodles, white bread, rye bread, rice crisp bread, oats, puffed rice crackers, millet flour, and pasta.

  • Fresh pasteurized milk and milk products

  • Milk substitutes – goat milk, sheep milk

  • Cream cheese, mozzarella, butter (without the histamine generating rancidity)

  • Most cooking oils

  • Most leafy herbs

  • Herbal teas – except those listed below

  • Eggs

This food list helps you manage your symptoms better. If this seems overwhelming, trial just switching to a whole food diet initially. Doing this will remove all additives and chemicals that can exaccerbate histamine intolerance.

Eat more fruits, vegetables, healthy fats and organic meat. Try a low-histamine diet and enjoy healthy recipes.

Remember, these lists are just guides, not strict rules. Food research is always changing, so we will keep you updated.


Note: It is always recommended that you speak with your health professional before starting an elimination diet, and special care should be taken with any restrictive diet if you ahve a history of disordered eating.

Lifestyle Modifications for Histamine Intolerance

Besides dietary changes, there are some other lifestyle modifications that can improve your symptoms:

1. Avoid Harmful Chemicals:

Xenoestrogens are chemicals found in plastic, pesticides, and cosmetic products. These chemicals mimic the body's natural estrogen and disrupt histamine levels.

Staying away from xenoestrogens is important for people with histamine intolerance. Try using natural alternatives for cleaning and personal care. You can check your skincare products at Environmental Working Group's Skin Deep Cosmetic Database.

2. Menopause Hormone Therapy:

For most women, hormone replacement therapy (HRT) helps reduce menopausal symptoms quickly. It may even improve your symptoms of histamine intolerance as it can stabilize estrogen levels.  However it is crucial to consider histamine intolerance if HRT causes new or worsened symptoms.

3. Manage Stress and Get Enough Sleep:

Did you know that too much stress can cause histamine release?

During moments of stress, your fight-or-flight response is turned ON, which in turn activates your immune system. When the immune system is activated, it can cause more release of histamine.

Regular exercise can help reduce stress, improve mood, and support overall health. Try different activities like walking, yoga, or swimming to keep your body moving.

4. Take Care of Your Gut:

A 2021 opinion suggests that histamine intolerance originates in the gut. There is ongoing

research that confirms the intimate connection between gut health, our gut bacteria and our immune system.

Overgrowth of bacteria such as E. coli or S. typhi in the gut can result in excessive histamine release. 

Eat foods that support a healthy gut: including plenty of low histamine fruit and vegetables to provide your healthy gut bacteria with plenty of prebiotics.

Supplements for histamine Intolerance

Vitamin C: 

Vitamin C is a natural antihistamine that can help lower the release of histamine. Folate, vitamin B6, and B12 also play a role in regulating histamine levels. As citrus fruit is best avoided with histamine intolerance, you can get vitamin C from kiwifruit, capsicum and mango.


Quercetin is found in  onions, apples and red wine is a natural antihistamine. It helps reduce the release of histamine from mast cells.


These healthy bacteria can help regulate histamine levels in your gut and can improve symptoms of histamine intolerance.


Diamine oxidase (DAO) is an enzyme that helps break down histamine in the gut. Some people with histamine intolerance may have a reduced amount of DAO, leading to increased levels of histamine. Taking DAO as a supplement  may help with managing symptoms.


This amino acid can help strengthen the gut lining and reduce inflammation, it also acts as a natural antihistamine.

Medications for Histamine Intolerance

Anti-histamines (H1-blocker): 

These work by blocking the histamine H1 receptor in cells and is typically most effective with allergic type symptoms and needs to be used twice daily.

Histamine H2-blockers:

H2-blockers  work by blocking the histamine H2 receptor mostly in gut cells and are typically most effective with reflux/gut type symptoms.

Mast cell stabilizers:

Mast cell stabilizers include sodium cromoglycate. They work by preventing mast cells from releasing histamine and other inflammatory substances.

The Takeaways: Histamine Intolerance and Menopause


Dealing with histamine intolerance during menopause can be tricky.

Understanding how histamine and menopause symptoms are linked, you can take steps to manage your histamine levels, and breeze through menopause, while feeling healthy and comfortable.

Join our Menothrive Program, to feel great and love your life during peri and menopause.

Book an appointment with Dr Deborah Brunt at Otepoti Integrative Health.


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  2. She/Her, P. W. (2024, January 30). Could histamine intolerance be worsening perimenopause symptoms for your team members?. LinkedIn.

  3. Bonds, R. S., & Midoro-Horiuti, T. (2013). Estrogen effects in allergy and asthma. Current opinion in allergy and clinical immunology, 13(1), 92 99.

  4. Dr. Anna Garrett, A. (2023, August 17). Histamine intolerance and the connection to perimenopause. LinkedIn.

  5. Słomczyńska M. (2008). Xenoestrogens: mechanisms of action and some detection studies. Polish journal of veterinary sciences, 11(3), 263–269.

  6. Tristan Asensi, M., Napoletano, A., Sofi, F., & Dinu, M. (2023). Low-Grade Inflammation and Ultra-Processed Foods Consumption: A Review. Nutrients, 15(6), 1546.

  7. Ito C. (2000). The role of brain histamine in acute and chronic stresses. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 54(5), 263–267.

  8. Schnedl, W. J., & Enko, D. (2021). Histamine Intolerance Originates in the Gut. Nutrients, 13(4), 1262.



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