The image of a woman in the throes of menopause has been repeatedly painted for us: She is sweaty, she is sleepy, she is on the verge of tears of rage or both. She is also, as it turns out, gassy. That’s because, among other indignities, the perimenopausal and menopausal period brings with it a notable surge in digestive and GI issues. “Acid reflux, constipation, diarrhea, bloating, and gassiness can all be very common,” says Renita White, MD, an ob-gyn and advisor to The Honey Pot Co.
While the knee-jerk reaction is to blame hormones for everything happening to our bodies and psyches during these menopausal years, here, the connection isn’t quite so clear-cut. It’s confirmed in the scientific data that constipation is simply more prevalent with age regardless of gender, but in terms of the effects of female hormones specifically, the results are mixed. Some studies show decreasing estrogen being correlated with increased constipation, says Daniela Turley, a New York-based medical herbalist, but then when women are given estrogen they also can become more constipated. “One thought is that declining ovarian hormones (estrogen and progesterone) can contribute to increased visceral hypersensitivity, so pain perception in different parts of the GI tract can have a lower threshold as a result of these hormonal shifts,” says Mythili Pathipati, MD, a gastroenterology fellow at Mass General Hospital and a clinical advisor for Ayble, a personalized app that provides relief for GI symptoms.
“Hormones can also alter the motility of the GI tract and can contribute to altered bowel habits.” Turley points to a 2018 study of perimenopausal women for additional clarity which found that gastric disturbances were linked to a different hormone: cortisol. “Constipation may be due to the changes in stress perception and stress hormones, rather than a direct influence of changes in sex hormones,” says Turley, adding that several studies point to stress and the resulting wave of cortisol to be causative in the development of diarrhea and constipation. Taniqua Miller, MD, an ob-gyn and medical advisor for menopause telehealth startup Evernow, agrees. “Cortisol not only encourages fat storage but also slows digestion, thereby causing increased bloating and gassiness because of slower transit time in the gut,” she says.
There is also the possibility that other aging, not hormone, related issues can be the root cause of GI disruptions during this time. Pathipati points to pelvic floor dysfunction (a weakening of muscles in the pelvic floor), something that tends to happen with more frequency in the menopausal years and beyond, as a cause of both fecal incontinence and constipation. And Miller says that prescribed medications for health conditions like thyroid disease and high blood pressure can tip off GI disturbances. “Some classes of blood pressure medications, antidepressants, or iron supplements can all cause changes to the GI tract, such as constipation,” adds Miller.
Our diets, and how our bodies react to them, will play a role. “Foods you could tolerate in your 20s and 30s may not be as well tolerated in your 40s and 50s,” says Miller, adding that as we age we may simply become more sensitive to certain food classes. She recommends finding a specialist who can help you identify those sensitivities. There is no one size fits all diet for overall gut health, says Pathipati; the best MO is to find and limit the unique foods that trigger symptoms for you. The most common food intolerances and allergies Turley sees are to wheat, dairy, soy, eggs, nuts, fish and shellfish. Many (around 78%) of IBS sufferers will also test positive for SIBO (small intestinal bacterial overgrowth), says Turley, and in those cases following a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet that restricts the foods that feed the bacteria can be helpful. And there are some regular culprits of GI turbulence, says Turley: alcohol is an irritant to the gut lining; dehydration can worsen constipation; fatty foods slow gastric emptying; and not enough fiber can make constipation more likely, while too much will increase bloating.
Ideally doctors and specialists prefer that we get our recommended fiber intake through food—a reasonable fiber goal, says Miller, is between 25-30 grams; to put that in perspective, a cup of raspberries has 8, an apple has 4, and a cup of black beans has 15. If you can’t meet that goal with your diet, a once a day fiber supplement (like psyllium, a non-fermentable version) can be helpful. Pathipati recommends peppermint oil for abdominal pain and bloating and herbal combinations like STW 5 or Iberogast for IBS or functional dyspepsia (aka, indigestion). Though the guidelines from the American Gastroenterological Association (AGA) suggest against probiotics for the treatment of global IBS symptoms, many find that they are helpful for their patients. “Probiotics can increase bowel transit time,” explains Turley, who suggests Ideal Support by Jarrow which has a specific strain of lactobacillus plantarium that has been shown to be effective for IBS. Turley also points her menopausal clients with GI issues to magnesium: “It can act as a mild laxative and also help with anxiety levels and stress perception.”
Because just as stress can impact so many other corners of our lives, the same is true here. “Increasing sleep and minimizing stress can also improve GI issues,” says White. To that end, Turley suggests a regular meditation practice and engaging in 4-7-8 breathing (breathe in for 4, hold for 7, exhale slowly for 8) before each meal to reduce cortisol and adrenaline and stimulate the vagus nerve and, in turn, digestive function. Sleep disruptions, which can become more frequent during the menopause transition, also increase the body’s release of the stress hormone cortisol, so honing better sleep practices will make a difference. So will regular exercise—“Not only is movement great for cardiovascular health, but it helps with the motility of the digestive tract to keep things moving,” says Miller. Pathipati specifically likes yoga which has been shown to significantly decrease bowel symptoms, IBS severity, and anxiety. While some GI changes are to be expected during the menopause transitions, there are red flag symptoms that warrant a visit to the doctor for additional testing like blood or any other noticeable changes in your stool and unexplained vomiting or weight loss. The key as with everything during this time: listen to your body.
This article was originally published on Vogue.com.