Swallowing Difficulties in Menopause and Aging

As women approach midlife, we’re often prepared for hot flushes, hormonal shifts, and emotional ups and downs. But what rarely gets talked about are the unexpected physical changes—like difficulties with swallowing. Struggling to swallow, experiencing a dry mouth, or choking on pills can be part of the menopause and ageing journey.

So, what’s the link between hormones, ageing muscles, and the act of swallowing? And most importantly, what can be done about it?

Let’s take a closer look at this often-overlooked issue that affects many women but is rarely discussed openly.

Hormones, Muscles, and the Menopause Connection

One of the key players in muscle maintenance is estrogen. During menopause, estrogen levels plummet. While most women associate this hormone with menstrual cycles and fertility, it also plays a major role in muscle tone and repair—including the oropharyngeal muscles responsible for swallowing.

Estrogen receptors have been found in the very muscles we use to chew and swallow. So when hormone levels drop, the strength and coordination of these muscles can decline. What may start as a subtle dryness in the mouth or slight difficulty swallowing certain foods can gradually become more noticeable.

Reduced saliva production (a condition known as xerostomia) is another common symptom linked to menopause. Without adequate saliva, food doesn't form into a neat "bolus" for swallowing. It can feel like food sticks in the throat or takes longer to go down. Some women even find that swallowing tablets becomes unexpectedly difficult—and this can lead to anxiety at mealtimes.

The Role of Ageing and “Presbyphagia”

Even outside of menopause, age-related changes can affect swallowing. A natural decline in muscle mass, called sarcopenia, can impact the muscles used for swallowing, especially in women aged 65 and older. This age-related change is often referred to as presbyphagia.

As muscles weaken, the swallowing reflex can become slower or less efficient. Nerve function may also decline, and oral health issues like missing teeth or ill-fitting dentures can further disrupt normal eating patterns. It’s a perfect storm of factors that can make eating more challenging, and more anxiety-inducing, than it once was.

Can Singing Help with Swallowing Muscles?

Surprisingly, yes. Singing—especially choir singing—has been shown to support respiratory muscle strength and improve coordination. When you sing, you engage the diaphragm and intercostal muscles, which are vital for breathing and swallowing.

Singing also provides emotional and social benefits. It reduces stress, boosts mood, and can motivate people to stay active. For older adults, particularly those feeling isolated or inactive, singing could offer a fun and therapeutic way to maintain throat and chest muscle strength.

While it won’t replace targeted therapies, it can be a valuable addition to a holistic approach to swallowing health.

Nutritional Support for Muscle and Nerve Function

Nutrition is another key pillar of support when it comes to swallowing problems in older women. While supplements can’t replace hormonal changes or reverse ageing, they can help strengthen muscle and nerve function.

Here are a few nutrients worth paying attention to:

• Calcium and Vitamin D help maintain bone density and muscle function. Postmenopausal women should aim for 1,200 mg of calcium daily, along with adequate vitamin D.

• Vitamin B12 is essential for nerve function. As absorption decreases with age, supplementation or fortified foods may be required.

• Magnesium plays a role in muscle and nerve communication. While not specifically studied for swallowing muscles, it helps overall muscle performance.

• Potassium supports muscle contraction and is usually sufficient through a balanced diet.

Swallowing difficulties can make large pills feel intimidating. Consider switching to chewables, liquids, powder or gels if swallowing tablets is uncomfortable or unsafe.

Hormone Replacement Therapy (HRT): Worth Considering?

There is growing evidence that Hormone Replacement Therapy (HRT) may help support muscle tone and slow the progression of age-related changes in the oral and throat muscles. While not prescribed solely for swallowing problems, it could be a helpful secondary benefit for those already considering HRT for other menopausal symptoms.

Of course, HRT isn’t suitable for everyone. Anyone who has had cancer or endometriosis won't usually be prescribed HRT. Always discuss the risks and benefits with your GP or specialist before starting any new treatment.

Therapies That Can Help

If swallowing problems are persistent or worsening, speech and language therapy can be incredibly effective. These therapists can guide you through exercises that target the muscles involved in chewing and swallowing, as well as help adjust your diet and mealtime habits.

Therapists can also help you explore the emotional side of swallowing issues. Stress, anxiety, and past choking experiences can cause throat tension and hyper-awareness—making swallowing feel harder than it physically is.

Hydration, Pill Safety, and Meal Adjustments

Staying well hydrated helps keep tissues moist and supports saliva production, both of which aid the swallowing process. When taking tablets, try swallowing one at a time with plenty of water. Don’t hesitate to ask your doctor or pharmacist for smaller pills, divided doses, or non-pill formats if you’re struggling.

Small changes at mealtimes, like sitting upright, taking smaller bites, or choosing moist, soft foods, can also improve comfort and confidence.

Final Thoughts: It’s Not “Just You”

If you’ve noticed swallowing becoming more difficult during or after menopause, you’re not imagining things—and you’re not alone. Hormonal shifts, ageing, and emotional stress all play a part in making swallowing feel different, sometimes even distressing.

If you're currently having problems swallowing and you're reaching your late 30s, consider that this may be part of the perimenopausal changes. Make an appointment to see your women's health nurse, and they can make a proper assessment.

Once they can give you any treatment, anything that is psychological can be helped by either Human Givens or Hypnotherapy.