Updated October 2026 ·Medically reviewed by Mr Naga Venkatesh Jayanthi, Consultant Upper GI Surgeon
What causes hiatus hernia in women is usually a mix of pressure and weakness. Pregnancy, extra weight around the middle, constipation and long-term coughing all push up on the diaphragm. Meanwhile, the opening the food pipe passes through loosens with age. Over time, part of the stomach slides up into the chest.
Mr Naga Venkatesh Jayanthi is a Consultant General and Upper GI Surgeon at Broomfield Hospital, Chelmsford, trained in keyhole and robotic reflux surgery. He sees many women whose reflux started in pregnancy or worsened in their fifties, and he explains below what drives a hiatus hernia and when it needs treatment.
Hiatus hernia in women at a glance
- How common: about 1 in 3 people over 50 have one (James Paget University Hospitals NHS leaflet).
- Main type: over 80% are sliding hernias, which are linked to reflux.
- Biggest triggers: pregnancy, being overweight, age over 50 and repeated straining.
- Often silent: many women only find out during a test for something else.
- Treatment: most need no surgery. Keyhole repair is for treatment of reflux symptoms that persist despite medicines.
What Is a Hiatus Hernia?
Your food pipe (oesophagus) passes into your abdomen through a small gap in the diaphragm called the hiatus. A hiatus hernia happens when part of the stomach pushes up through that gap into the chest. According to the NHS, it does not normally need treatment if it is not causing problems.
There are two main types. A sliding hernia, the most common, moves up and down through the gap and may cause reflux. A rolling (para-oesophageal) hernia, where part of the stomach bulges up beside the food pipe, accounts for 5-15% and is more likely to need a surgeon’s review, according to a James Paget University Hospitals NHS leaflet.
What Causes Hiatus Hernia in Women Most Often?
The exact cause is not fully understood, and there is rarely a single reason. Instead, two things usually combine: repeated pressure inside the abdomen, and a hiatus that has become looser over time. The factors below explain what causes hiatus hernia in women in most cases.
Pregnancy
The NHS lists pregnancy as one of the main situations in which hiatus hernia is more common. As the baby grows, especially in the last three months, pressure on the stomach and diaphragm rises. Pregnancy hormones also relax muscles, including the valve at the top of the stomach. As a result, many women first notice heartburn during pregnancy. For some, it settles after the birth. For others, it returns years later.
Extra weight around the middle
Being overweight is another factor the NHS links with hiatus hernia. Weight around the waist presses on the stomach and can gradually widen the hiatus. This is also the factor you can change most. Even modest weight loss often eases reflux. If you have significant obesity and severe reflux, weight loss surgery with a hernia repair may suit you better than a reflux operation alone. Mr Jayanthi’s weight loss surgery page explains that option.
Age and the menopause
The hiatus naturally loosens with age, which is why about one in three people over 50 have a hiatus hernia. Many women notice new or worse reflux around the menopause. Weight gain around the middle is common at this stage, adding pressure at the same time as the tissues weaken.
Everyday strain that adds up
Repeated pressure over many years plays a part too. Common examples are straining with constipation, a long-term cough from smoking or asthma, regular heavy lifting (including lifting children or caring for a relative) and frequent vomiting. The NHS also advises avoiding tight waistbands, which can make symptoms worse.
Takeaway: you cannot change your age or pregnancies, but you can change weight, constipation, smoking and how you lift.
Are Hiatus Hernia Symptoms Different in Women?
The symptoms are broadly the same in men and women. The NHS lists heartburn, acid reflux, bloating, nausea, bad breath and difficulty or pain when swallowing. Some people also notice a chronic cough, hoarseness, or reflux that wakes them at night.
Chest pain needs special care in women. Heart problems in women can feel like indigestion, so never assume chest pain is reflux. If you have sudden, crushing chest pain, pain spreading to the arm or jaw, or chest pain with breathlessness or sweating, call 999 or go to A&E straight away.
According to the NHS, get an urgent GP appointment or call NHS 111 if reflux comes with unexplained weight loss, difficulty swallowing, frequent vomiting, blood in your vomit or upper abdominal pain.
How Is a Hiatus Hernia Diagnosed?
A hiatus hernia is often found during a test for something else. If your symptoms point to one, the main test is a gastroscopy, where a thin camera checks your food pipe and stomach. It confirms the hernia, shows any inflammation and rules out other problems such as Barrett’s oesophagus. Mr Jayanthi’s endoscopy page explains what to expect.
A barium swallow, an X-ray taken as you drink a special liquid, used to be a common test, but endoscopy has now largely replaced it. If there is any question about the size of the hernia, a CT scan is the preferred test and gives much more detail than a barium swallow. If surgery is being considered, two more tests usually follow. Manometry measures how well your food pipe muscles work, and 24-hour pH monitoring confirms that your symptoms really come from reflux.
How Is a Hiatus Hernia Treated?
Treatment is only required if the hernia is causing symptoms of reflux. Mr Jayanthi’s reflux and heartburn page gives more detail. Most women with a small hiatus hernia need no treatment beyond simple changes. The NHS suggests eating smaller, more frequent meals, raising the head of your bed, losing weight if needed, and avoiding trigger foods, caffeinated drinks, smoking and too much alcohol. These steps will not close the hernia, but they often reduce reflux a great deal.
If that is not enough, a pharmacist can suggest antacids or alginates for short-term relief. After that, your GP can prescribe stronger acid-reducing medicines such as proton pump inhibitors. These control acid, but they do not fix the hernia itself.
Takeaway: if you have needed antacid medicines for months, or symptoms keep coming back when you stop, it is worth a specialist review.
When Is Surgery Needed?
The NHS says surgery is usually only considered when other treatments have failed and symptoms are still severe. A surgeon may also recommend it for a large rolling hernia, or if you do not want to take antacid medicines for life.
Surgery is usually keyhole, under general anaesthetic. The surgeon returns the stomach to the abdomen, narrows the gap in the diaphragm and often wraps the top of the stomach around the food pipe (fundoplication) to rebuild the valve. For some people, magnetic sphincter augmentation, a ring of magnetic beads placed around the bottom of the food pipe, is an alternative to the wrap. See Mr Jayanthi’s hiatus hernia repair and acid reflux surgery pages.
According to the NHS, it can take up to 6 weeks to return to a normal diet, and bloating or difficulty swallowing can take a few months to settle. Occasionally, further surgery is needed.
What Mistakes Do Women Make With Reflux?
The first is putting up with pregnancy heartburn that never went away. Reflux that continues months after the birth is worth checking.
The second is taking antacid medicines for years without a review. Long-term reflux can damage the lining of the food pipe, and a gastroscopy is the only way to see it.
The third is assuming chest pain is reflux. In women especially, heart problems can feel like indigestion, so get chest pain checked first.
Can a Hiatus Hernia Be Prevented?
Not always, especially when pregnancy or age is involved. However, you can lower the pressure that drives it. Keep to a healthy weight, treat constipation with fibre and fluids, get a long-term cough checked, stop smoking and lift with your knees bent rather than straining.
When Should You See a Specialist?
See a specialist if reflux lasts longer than a few weeks despite treatment, if you depend on antacid medicines, or if you have any warning sign such as difficulty swallowing, weight loss, vomiting or anaemia. Mr Jayanthi’s hiatus hernia page has more detail.
Frequently Asked Questions
What causes hiatus hernia in women most often?
Usually a mix of pressure and weakness: pregnancy, extra weight, age over 50 and repeated straining acting together over years.
Does a hiatus hernia caused by pregnancy go away?
Reflux often improves after the birth, but the hernia itself may stay. Heartburn that lasts months afterwards is worth checking.
Can the menopause make a hiatus hernia worse?
Many women notice worse reflux around the menopause, often alongside weight gain around the middle.
Is a hiatus hernia dangerous?
Most sliding hernias are not. Rolling hernias, which make up 5-15%, need a specialist review because of a small risk of complications.
Can losing weight help?
Yes. It will not close the hernia, but it often reduces reflux and the need for medicines.
How is a hiatus hernia confirmed?
Usually by a gastroscopy (endoscopy). If there is any question about the size of the hernia, a CT scan is the preferred test.
How long does recovery from hiatus hernia surgery take?
According to the NHS, up to 6 weeks to return to a normal diet, and a few months for bloating or swallowing to settle fully.
Finding the Cause Behind Your Reflux
What causes hiatus hernia in women is rarely one thing, but the factors you can change, such as weight, constipation and straining, often make a real difference. Mr Naga Venkatesh Jayanthi sees patients at Springfield Hospital in Chelmsford, The Oaks Hospital in Colchester, and on the NHS at Broomfield Hospital. Bring a list of your symptoms, the antacid medicines you have tried and any previous test results, and you will leave knowing whether you need a gastroscopy, a change in treatment or a surgical opinion. Book a consultation
