The room greys out when you get up from a chair, or you have to pause on the stairs. It is common, it is usually explainable, and one of the explanations is a medication you are already taking — which makes it one of the more fixable things in this decade.

Where we stand: Menova is an independent publication. We sell no tests, we are not your doctor, and this is general education, not a diagnosis. Do not change blood pressure medication on your own.

What is happening

When you stand, gravity pulls blood toward your legs. Your body should respond within seconds — tightening blood vessels and raising heart rate — to keep blood reaching your brain.

Orthostatic hypotension is when that response is too slow or too weak, and blood pressure drops on standing. The result is lightheadedness, greying vision, weakness, and sometimes fainting.

It is defined by a measurable fall in blood pressure within three minutes of standing, which is why the test below matters more than any description of symptoms.

The test worth asking for

Lying and standing blood pressure. Blood pressure measured after lying down for five minutes, then again at one and three minutes after standing.

This takes about ten minutes, it is free, and it is the single test that answers the question. It is also frequently not done, because a standard seated reading looks normal.

Ask for it by name — see blood pressure and menopause.

The causes, roughly in order of how often they explain it

Medication. The most common cause, and the most correctable:

  • Blood pressure medications, particularly if the dose has crept up or you have lost weight
  • Diuretics
  • Antidepressants, especially tricyclics
  • Medication for an overactive bladder — relevant if you are taking one for urinary symptoms; see bladder leaks and pelvic floor changes
  • Some pain and Parkinson's medications

See medications that mimic menopause. A medication review resolves more of these than anything else.

Dehydration, which is more consequential than people expect — and more likely with night sweats, hot weather, or fasting; see getting through summer.

Anaemia and iron deficiency. Lightheadedness on standing, breathlessness on stairs, exhaustion. Very common with heavy perimenopausal bleeding — see low ferritin in perimenopause.

Blood loss, including from heavy periods — see heavy periods in perimenopause.

Alcohol, which dilates blood vessels and dehydrates — see alcohol in midlife.

Prolonged bed rest or illness.

Diabetes, through effects on the nerves that control blood vessels — see menopause with diabetes.

Thyroid and adrenal conditions.

Heart rhythm or valve problems, which is why an ECG is often part of the assessment.

Where menopause fits

Estrogen influences blood vessel tone, and some women notice orthostatic symptoms becoming more prominent during the transition. It is a plausible contribution rather than an established cause, and it should not be the first explanation.

What is clearly relevant: hot flashes and night sweats cause fluid loss, and vasomotor episodes themselves involve vasodilation — which is why lightheadedness sometimes travels with a flash. See dizziness and vertigo in menopause and heart palpitations in perimenopause.

The mistake to avoid is attributing it to hormones and skipping the medication review and the blood tests.

PTS and POTS, briefly

If your heart rate rises sharply on standing — commonly cited as an increase of 30 beats per minute or more sustained over ten minutes — without a fall in blood pressure, alongside lightheadedness, palpitations, fatigue and brain fog, that pattern is called postural orthostatic tachycardia syndrome.

It is more common in women, it can follow a viral illness, and it is frequently misdiagnosed as anxiety. It needs proper assessment rather than self-diagnosis — but if your symptoms fit and standard checks are normal, it is worth raising by name. See long COVID and menopause and fibromyalgia and chronic fatigue.

Get urgent help for

  • Fainting, particularly without warning, or while sitting or lying
  • Chest pain, or palpitations with dizziness
  • Fainting during exercise — this always needs assessment
  • Dizziness with weakness, facial droop, difficulty speaking, or visual loss — emergency
  • Black stools, vomiting blood, or heavy ongoing bleeding
  • Dizziness after a head injury

Fainting is not the same as feeling faint, and it is investigated differently. Report it.

What helps

Once causes are identified and treated, these are the standard measures:

  • Stand up in stages. Sit on the edge of the bed for a minute before rising
  • Pump your calves before standing — ankle circles, or clenching the calf muscles. This physically pushes blood back up and works within seconds
  • Cross your legs and tense your thighs if you feel it coming on, or squat briefly
  • Drink more. Steady fluid through the day matters more than large amounts occasionally
  • Salt, if advised — this is a genuine treatment in some cases and not appropriate if you have high blood pressure or heart failure, so ask rather than assume
  • Smaller meals. Large meals divert blood to the gut and worsen symptoms afterwards
  • Compression stockings, which reduce pooling in the legs — see aching legs and varicose veins
  • Raise the head of the bed slightly
  • Avoid very hot baths, saunas and prolonged standing — see sauna in menopause
  • Strength training, which improves the calf pump and general vascular function — see strength training in menopause

The falls point

Worth being direct: lightheadedness on standing is a risk factor for falls, and falls in a body with declining bone density are what produce fractures.

Treating this is therefore not just about comfort. It sits alongside balance training and bone protection — see bone health in menopause and what to do about a DEXA result.

What to say

"I get lightheaded and my vision greys out when I stand up, several times a week. Could I have lying and standing blood pressure measured, a medication review, and full blood count, ferritin, thyroid and HbA1c checked?"

That names the test, the most likely cause, and the bloods — which is most of the assessment in one sentence.

Our free 30-day symptom tracker lets you record when it happens and what preceded it, and the free printable visit prep sheet has space for your full medication list — the thing this assessment turns on.

The free 2-minute Menova self-check organizes your wider symptom picture — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice or a diagnosis. Do not change prescribed medication or start salt supplementation without medical advice. Fainting, chest pain, or dizziness with neurological symptoms requires prompt assessment.

Sources: NHLBI — Low Blood Pressure, NINDS — Orthostatic Hypotension, The Menopause Society, and NHS — Dizziness.