Advice on managing this complex gut condition
Irritable Bowel Syndrome (IBS) is a common problem that affects your gut. Symptoms can include abdominal pain or discomfort, bloating and a change in bowel habit – these are symptoms that people without IBS can experience from time to time, but with IBS they tend to be more frequent and more severe.
IBS can start at any age, often in early adulthood, and it’s usually a long¬-term condition. The exact cause is unknown, but it has been linked to genes, diet and gastroenteritis, and psychological stress can contribute to the development of IBS [1], as can early adverse life events, such as emotional abuse [2]. IBS is twice as common in women as it is in men [3].
RELATED: Irritable bowel bloating and digestive health with the gut experts
How is IBS linked to perimenopause and menopause?
There are receptors for your hormones progesterone, estradiol and testosterone on every cell in your gastrointestinal system. When hormone levels fluctuate or drop this can lead to many symptoms affecting your bowels. Similar symptoms - stomach pain, diarrhoea, nausea, bloating - can also occur before your periods, when hormone levels are at their lowest.
Studies have found that an increase in GI symptoms around the time of menstrual periods and early menopause occurs at times of declining or low hormones, suggesting that estradiol and progesterone withdrawal may contribute either directly or indirectly [4, 5].
If you already have IBS, your symptoms often worsen during perimenopause and menopause.
A study also found that menopausal women with IBS (those older than 45 who had not had a period for at least a year) have more severe IBS symptoms that premenopausal women (those younger than 45 with regular periods), while no comparable age-related changes were seen in men who had IBS [6].
How can I treat IBS?
While there is no one diet or medicine that works for everyone, lifestyle and diet changes can have an impact.
Your gut microbiome can affect your hormones, and what you eat can influence the delicate balance of this microbiome. For instance, probiotics are live bacteria and yeasts, often described as “good” or “friendly” bacteria, that can help maintain a healthy gut flora, which improves digestive function and reduces bloating. A healthy gut can also help to balance your hormones.
RELATED: Friendly bacteria: how probiotics can help your health – and hormones too
Some people with IBS usually find a low FODMAP diet very helpful. It means avoiding foods high in certain sugars (carbohydrates) that are hard to digest, including some fruits, vegetables, cereals and dairy foods.
Guts UK offers guidance on healthy eating and IBS dietary management [7]. It’s also important to keep hydrated, and limit or avoid alcohol, fizzy drinks, tea and coffee.
You can also find more advice on managing your symptoms in my article Bowel problems in menopause.
If diet changes don’t help your symptoms, consult your GP. Similarly, see 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.
What else can I do?
If you are experiencing perimenopause or menopause symptoms, HRT is the first-line treatment [8]. Some women find that when they are prescribed HRT and testosterone, their IBS symptoms improve.
Taking HRT and testosterone can positively impact your gut microbiome [9], which in turn may help improve symptoms.
A study found that HRT has beneficial metabolic effects and, alongside dietary changes and improvements in gut health, can counteract the detrimental metabolic changes that can occur during menopause [10].
As stress is an IBS trigger, it is useful to look at techniques for managing stress, such as breath work, yoga and mindfulness.
RELATED: Why am I so stressed?
