Can These Over-The-Counter Drugs Really Provide Perimenopausal Symptom Relief?

If you’re in your 40s and have a social media account, the snoopy algorithm has probably clued into what you’re going through when it comes to the cascading symptoms that mark perimenopause.

Over the past few months, one perimenopausal health hack in particular has gone viral: women claiming that taking a daily combination of two over-the-counter medications—an antihistamine like Allegra and an antacid like Pepcid—has helped soothe some of the more miserable symptoms of perimenopause.

What’s happening with estrogen and histamine during perimenopause?

Cells in your body called mast cells contain histamine, a chemical that is released by your immune system, explains Dr. Michelle Jacobson, an ob-gyn and menopause specialist at Women’s College Hospital in Toronto. Those cells are responsive to estrogen. So, the more estrogen, the more histamine is released by the mast cells, she says. Paradoxically, that increase in histamine can also trigger the production of more estrogen in an unfortunate “feedback loop.”

During perimenopause, this loop can be exacerbated. That’s because estrogen levels can spike during perimenopause, and when it’s high, your histamine response is in overdrive, too. That can play out in various ways, symptomatically: women might experience worse allergic congestion, hives, itchy ears and overall body itchiness.

But histamine is more than just an allergic response chemical. It's involved in the regulation of a lot of bodily functions, too, and can affect your sleep-wake cycle, body temperature and mood. It can also affect gut health, increasing your risk of things like GERD and bloating.

How does this combination of antihistamines and antacids work for perimenopause symptoms?

Antihistamines and antacids work by blocking the histamine receptors that live in different areas of the body from your brain cells to your stomach cells, explains Jacobsen.

But both medications block different histamine receptors in the body. The kinds of antihistamine you would take for itching, sneezing and congestion, for example, works by blocking your H1 receptors, says Jacobson.

Antacids like Pepcid AC tackle H2 receptors, blocking the receptors in your stomach that trigger acid production. “They work in the stomach to block acid production, but still through an antihistamine response cycle,” she says.

When taken together, the two medications may target a broad histamine response in one sweep.

“There is real biology behind the treatment,” says Jacobson.

But does this combo really work for perimenopausal women?

There are caveats, says Dr. Alison Shea, a menopause specialist and associate professor of Obstetrics & Gynecology at McMaster University in Hamilton

“Theoretically, there is a link but there is limited scientific data to support this in terms of studies on humans,” she explains.

Jacobson says it’s important to note this is an off-label use of these drugstore medications—one that isn’t likely to be formally prescribed as a perimenopause treatment any time soon.  

That said, she’s encouraged that the viral combo has helped raise greater awareness among women and healthcare providers about some of the biological realities of perimenopause and the possibility for inexpensive, life-improving solutions.

“I’ve been doing this for 15 years,” she says, “and we’ve never really talked about the relationship between histamine and estrogen.”

Is it safe to try?

There’s no real concern about giving this combination a try if you’re suffering from symptoms that could be viewed as part of a broad estrogen-histamine response loop and want to see if it may mitigate symptoms, improve mood and strengthen your ability to get a better night’s sleep.

Shea views the health hack as a wellness trend for now until there’s more scientific research to confirm its overall effectiveness. But she says that taking the medications could be a “low-risk, reasonable” thing to try if you’re dealing with itchiness, hives, GERD and bloating.

Still, Shea adds that the fluctuations that mark perimenopause could throw a wrench into the combination’s effectiveness.

“What works one month in perimenopause may not work the next month as it is such a roller coaster,” she says.

Jacobson also cautions people not to assume perimenopause is the cause or driver of every physical symptom they experience in their 40s—even itchiness and hives. Mast cell activation syndrome is a real condition that needs to be properly evaluated by a health care provider, she says, and sometimes hives and itchiness are a sign of an undiagnosed allergy that ought to be vetted by a doctor or immunologist.

“You wouldn’t wouldn't want to ignore this if it could be something like an actual allergic reaction,” she says.