Why Is Benign Paroxysmal Positional Vertigo (BPPV) More Common in Women

Benign paroxysmal positional vertigo (BPPV), a common cause of dizziness, is characterized by the detachment of debris from the otoconial membrane, which results in otoconia fragments floating in the semicircular canals. Women, in particular postmenopausal women, are at higher risk for BPPV occurrence than men. Risk factors, such as estrogen, osteoporosis, and vitamin D deficiency, contribute significantly to BPPV occurrence in women. Otoconia, which consist of core proteins and calcium carbonate crystals, are influenced by the ion balance in the endolymph and calcium metabolism. Estrogen deficiency, in particular in postmenopausal women, is significantly associated with an increased occurrence and recurrence of BPPV. Hormone fluctuations during puberty and pregnancy increase the risk for BPPV occurrence in women. The high prevalence of osteoporosis in postmenopausal women increases their susceptibility to BPPV. Vitamin D deficiency increases the risk for BPPV occurrence by affecting the absorption of calcium from the intestine. Estrogen can regulate intestinal calcium absorption and modulate the action of vitamin D. Several studies have demonstrated the increased risk for BPPV occurrence in patients with low vitamin D levels. Pathophysiological factors specific to women should be considered in the prevention and management of BPPV.