Bloating and bowel problems in the menopause Factsheet

It’s common to have abdominal discomfort and changes to your bowel habits during the perimenopause and menopause. This can cause symptoms which are similar to Irritable Bowel Syndrome (IBS). The symptoms can be hard to live with, but many women find changes to their diet and lifestyle, and taking HRT can help.

What is IBS?

Irritable Bowel Syndrome (IBS) is a common problem that affects the gut. Many people experience stomach pain or discomfort or bowel problems 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 infection, and is often associated with times of stress or life changes.

During the perimenopause and menopause, many women have IBS­-like symptoms. They tend to come and go in waves and can last for days, weeks or months at time. How long they last for varies from woman to woman. If you already have IBS, your symptoms may become exacerbated by the hormonal changes during the perimenopause or menopause.

What symptoms might you have?

Symptoms 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.

Heartburn
Some people have heartburn (acid reflux) around the time of the menopause. This is a burning feeling in the chest that happens when the acid normally in your stomach comes up into your oesophagus (food pipe). It is not the same as IBS, but diet and eating habits that help with IBS will often help heartburn too.

What causes IBS-­like symptoms around the time of the menopause?

Changes in hormones
Your body produces less of the hormone estrogen which can affect the way your gut works. There are cells that respond to estrogen in the gut and digestive system. The drop in estrogen also impacts other hormones such as cortisol and adrenalin which have roles in digestion too.

Changes in diet and lifestyle
Sometimes symptoms can simply 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.

Changes in mood and other menopausal problems increasing stress
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 issues related to the menopause can also impact on stress levels such as problems at work due to memory difficulties or mood issues affecting your relationship – any of these can cause a greater feeling of stress and your body will respond to this.

Treatments

Symptoms vary from person to person and treatments do too.

Lifestyle changes
It can help to experiment with changes to your diet and lifestyle to see what works for you. See our advice below on how to manage your symptoms.

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

Medicines
If lifestyle changes and HRT don’t bring you satisfactory relief for your gut symptoms, you could see your doctor who might offer medicines such as:

– anti­-diarrhoea medications
– laxatives or bulking agents for constipation
– antispasmodic tablets to relax the gut.

Talking therapies
Feeling stressed or overwhelmed does have an effect on your gut and bowel movements. Talking therapies to deal with difficult emotions and events, and ways to manage stress and anxiety, might help improve your symptoms and your wellbeing.

Things you can do to manage your symptoms

Try these changes to see what works for you:

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, make sure you eat regularly and don’t skip meals, to keep the bowel moving.

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

Have drinks 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 your teas and coffees to around three cups a day, and keep alcohol and fizzy drinks to a minimum. These can all cause gas, bloating and stomach cramps, and can make you dehydrated which will make constipation worse. Peppermint tea is a great substitution for fizzy drinks as it is calming for the stomach (although for some it can trigger heartburn).

Learn your trigger foods
Certain foods might trigger your symptoms. 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. Try avoiding these foods in times of stress and adding them back in when things are more settled.

Find out if you have any food intolerances
You may want to see if you have any food intolerances. The most common ones are wheat, gluten, and lactose.

Keep a food diary
Try keeping a food diary to see what triggers 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.

Try a low FODMAP diet
It might be worth looking into a low FODMAP diet, people with IBS usually find this very helpful. It means avoiding foods high in certain sugars (carbohydrates) which are hard to digest, including some fruits, vegetables, cereals and dairy foods.

Eat enough fibre
If you have constipation, high-­fibre 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 high­-fibre foods slowly, in small amounts, to see how you go.

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

Move more
Exercising can help with digestion and improve problems such as constipation and wind. It can also reduce stress and improve your mood and overall health. Make sure you get some exercise every day.

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. Going out with friends and enjoying yourself can also help your body to relax.

When to see your doctor
Visit your GP if you’re having ongoing and troubling IBS­-like symptoms that don’t improve with a healthy diet and HRT. You should also see your GP if you have lost a significant amount of weight without trying to, or you have bloody diarrhoea or bleeding from your anus. They can prescribe medications if you need them, consider what might be causing your symptoms and rule out other conditions if necessary.