Bowel problems in the menopause

If your gut is feeling unsettled, learn how to manage your symptoms

• Women often experience a variety of bowel symptoms during the menopause
• Hormones, diet and lifestyle can all have an impact
• Symptoms can be improved by making changes

It’s common to experience abdominal discomfort and changes to your bowel habits during the perimenopause and menopause. Symptoms can come and go in waves and can last for days, weeks or months at time.

Although symptoms can be hard to live with, many women find changes to their diet and lifestyle, and taking HRT, can help.

What bowel symptoms are common in menopause?

The symptoms can be similar to that of Irritable Bowel Syndrome (IBS). They vary for each person and can include:

• stomach pains or cramps
• bloating
• wind, trapped wind and rumbling noises
• diarrhoea
• constipation
• needing to rush to the toilet
• a feeling of incomplete emptying when you go to the toilet.

RELATED: IBS and the menopause: what’s the link?

What causes symptoms during the menopause?

Changes in hormones

Cells in the gut and digestive system respond to the hormone oestrogen, so when your body produces less of it during the menopause, this can affect the way your gut works. The drop in oestrogen also impacts other hormones such as cortisol and adrenaline, which have roles in digestion too. Although there’s still lots to discover about how the menopause affects the gut microbiome, we do know that it’s associated with lower gut microbiome diversity [1].

Changes in diet and lifestyle

Sometimes symptoms can be caused by a change in diet, activity levels and routines. If you’re tired and lacking in motivation, you may be less active and turn to comfort eating junk food or overly processed foods, which can trigger constipation and bloating.

RELATED: Healthy lifestyle, happy gut

Changes in mood

Your mood and your gut health and function are interconnected. Stress and other difficult emotions such as anxiety and low mood can cause problems in your gut, and this can in turn make you feel stressed or low. Other menopause-related issues, such as memory difficulties, can impact on stress levels and your body will respond to this stress.

How can I manage my symptoms?

Eat smaller meals, more often

Eat less in one sitting, sit up straight to give your tummy room, and chew, chew, chew. Your stomach won’t have to work so hard and you may feel less gassy after a meal. If you have a tendency towards constipation, eat regularly and don’t skip meals, to keep your bowel moving.

Take your time

Eating should be an enjoyable experience. Eat your meals in a relaxing environment – not at your desk or on the go as feeling rushed won’t help your digestion.

Drink outside of meal times

It’s important to stay hydrated, but avoid drinking lots of fluid when you’re eating, as it may cause gas and discomfort.

Watch what you drink

Keep tea and coffee to around three cups a day, and alcohol and fizzy drinks to a minimum. These can cause gas, bloating and stomach cramps, and can make you dehydrated, which will make constipation worse. Peppermint tea is good for calming for the stomach (although for some it can trigger heartburn).

RELATED: Gut matters – Emma Ellice-Flint

Learn your trigger foods

Keep a food diary to see if certain foods trigger your symptoms. Write down the time of day, what you eat, any symptoms, and your mood. You should be able to spot patterns over time.

For some women, spicy, fatty or very processed foods can cause problems, for others it might be dairy foods, or wheat. Some vegetables are harder to digest than others and produce more gas, such as beans, onions, broccoli, cabbage, sprouts, and cauliflower. Honey and certain fruits can sometimes cause diarrhoea, including stone fruits such as plums and prunes.

Your gut may be more sensitive at certain times, for example when you are feeling stressed or overwhelmed. Avoid these foods in times of stress and add them back in when things are more settled.

Consider prebiotics and probiotics

Probiotics in supplement or yoghurt form, like kefir, increase the amount of good bacteria in the gut, which will aid digestion. Prebiotic foods – garlic, onion, leek, asparagus, beetroot, fennel bulb, snow peas, sweetcorn, cabbage, artichokes, apples, and dark berries such as blueberries – feed the good bacteria in the gut. However, you may not be able to tolerate all these prebiotic foods, so choose ones that suit your gut.

RELATED: fermented foods and gut health

Eat enough fibre

If you have constipation, high­fibre foods such as oats, fruit and veg will help to keep your bowels moving. But if you also have other symptoms you may need to add in high­fibre foods slowly, in small amounts, to see how you go.

Take time to relax

Find ways to reduce your stress levels. You could try breathing exercises or meditation, stretching or yoga, listening to relaxing music, or going for a walk in green spaces. Talking therapies can help you deal with difficult emotions and events, and might help improve your symptoms.

Can I take anything to help?

Along with changes to your nutrition and activity levels, HRT often improves bowel symptoms if the symptoms are caused by hormone changes, as it works to replace your missing hormones.

If lifestyle changes and HRT don’t relieve your gut symptoms, you could see your doctor who might offer medicines such as: anti­diarrhoea medications; laxatives or bulking agents for constipation; or antispasmodic tablets to relax the gut.

What else do I need to consider?

Visit your GP if you have:

• Lost a significant amount of weight without trying to
• Bloody diarrhoea or bleeding from your anus
• New symptoms of indigestion that persist despite changes in your diet and lifestyle
• A persistent change in your bowel habit with no explanation, such as loose bowel motions for several weeks
• A feeling you need to open your bowels but nothing comes out.

Your GP can consider what might be causing your symptoms, prescribe any necessary medications and refer you to see a dietician. You may need further tests to rule out other conditions.

Resources

1. Brandilyn A Peters, Nanette Santoro, Robert C Kaplan, Qibin Qi. (2022), ‘Spotlight on the Gut Microbiome in Menopause: Current Insights, International Journal of Women’s Health’, 14: 1059-1072, DOI: 10.2147/IJWH.S340491