Perimenopause and IBS: Causes and Treatment

Experiencing perimenopause with irritable bowel syndrome (IBS) is uncomfortable and embarrassing.

Perimenopause does not cause IBS but can make the symptoms worse, making life feel more challenging.

There is good news; IBS is manageable through diet and lifestyle. In this article, we will discuss causes, symptoms, and treatment options related to IBS and perimenopause.

What is IBS?

Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Symptoms include diarrhea, constipation, cramping, abdominal pain, bloating, and gas. IBS is a chronic condition that is managed over the long term.

Evidence suggests that IBS is related to changes in the nervous system and gut-brain axis. As a result, there are changes to the digestive system (1).

Female hormones also play a role in IBS. Estrogen and progesterone hormones responsible for the menstrual cycle frequently impact IBS, often making symptoms worse (2).

Symptoms of IBS

Women with IBS experience the following symptoms:

• Constipation
• Diarrhea
• Abdominal bloating
• Abdominal pain
• Cramping
• Gas

Natural remedies and medications can help relieve these symptoms (1).

Who gets Perimenopause and IBS?

Perimenopause happens when your body begins transitioning into menopause. In women, this occurs as early as the mid-30s to as late as the ’50s. Along with typical perimenopause symptoms, women may also develop IBS symptoms.

Women in perimenopause experience changes in ovarian hormones estrogen and progesterone. Throughout perimenopause, estrogen and progesterone rise and fall. These changes in ovarian hormones affect and worsen IBS symptoms (2).

If you are perimenopausal, certain risk factors set you up for getting IBS. These factors include (1):

• Female
• Younger than age 50
• Having a family member with IBS
• A history of stressful or difficult life events
• Having a severe infection in your digestive tract

Causes of Perimenopause and IBS

Changes in estrogen and progesterone hormones worsen IBS symptoms.

Changes to Digestive Motility

Declining levels of estrogen and progesterone slow digestive motility. As a result, food takes longer to get through your GI tract. The longer food remains in your digestive tract, the more water is reabsorbed back into your body. This results in hard stools and constipation.

Changes in hormone levels can also lead to intestinal permeability. This causes diarrhea by irritating the lining of your digestive tract, weakening stomach muscles, or reducing the absorption of food into the body (3).

Increase in Pain Sensations

Estrogen hormone is associated with the production of serotonin, the feel-good hormone. During perimenopause, estrogen may drop, leading to a decrease in pain tolerance. As a result, abdominal pain associated with IBS may feel more painful (4).

Increase in Cortisol Hormone

As women approach menopause, estrogen may increase. An increase in estrogen can increase cortisol levels. As a result, having high cortisol in our system can negatively impact the digestive system, worsening gastrointestinal symptoms (5).

Decrease in Bile Production

Low estrogen will affect the production and flow of bile. Bile is key for digesting fats. When we aren’t producing enough bile, our gut has trouble breaking down fats (6), often causing diarrhea (7).

Thus, women in perimenopause may be more sensitive to fat from food.

At the same time, in those with IBS, too much fat can activate pancreatic hormones, resulting in constipation. Thus, too much fat may make symptoms like constipation worse (8, 9).

All in all, women who have perimenopause and IBS will likely experience problems digesting fat. This leads to worsening IBS symptoms.

Increase in Sleep Disturbances

Sleep disturbances are a common occurrence during perimenopause.

During perimenopause, estrogen and progesterone levels fluctuate, leading to changes in cortisol and serotonin metabolism in the body. As a result, cortisol and serotonin both impact the body’s sleep cycle. 

Additionally, it is likely that a woman in perimenopause will experience hot flashes. This is due to fluctuating hormones. You are likely to wake up right before experiencing a hot flash (10).

Poor sleep is correlated to worsening IBS symptoms. 

Diagnosing Perimenopause and IBS

Perimenopause is a natural part of life. For this reason, perimenopause is usually not diagnosed. Women receive a diagnosis only if they are experiencing significant discomfort.

A gastroenterologist provides an IBS diagnosis using the ROME IV criteria (11). Symptom severity varies, but usually, IBS patients have had symptoms for at least three months.

Symptoms include:

• Abdominal pain, cramping, or bloating that is related to passing a bowel movement
• Changes in the appearance of bowel movement
• Changes in how often you are having a bowel movement
• Increased bloating or gas

If you think you have IBS, it’s essential to go to the doctor and receive a diagnosis. Do not self-diagnose, because symptoms could be related to a more serious illness.

Remedies for Perimenopause and IBS

There are a variety of ways to improve symptoms of perimenopause and IBS:

Change Fiber Intake

The right fiber intake can help manage your IBS symptoms.

Constipation: women will want to meet or exceed their fiber goals. Women will also benefit from adding more insoluble fiber to their diet.

For example, insoluble fiber includes oranges, kiwi, raspberries, or brown rice.

Diarrhea: women will want to meet, not exceed, their fiber goals. In addition, they will benefit from switching to more soluble fiber.

Examples of foods high in soluble fiber include oats, flax seeds, potatoes, and strawberries (12).

Eat Smaller Meals

Eating smaller meals can help the digestive tract do its job. Eating large meals can result in too much pressure on the digestive tract. As a result, this pressure creates digestive issues.

For instance, be aware of tendencies to snack unnecessarily, eat from large buffets, or eat emotionally. In addition, work on eating intuitively and acknowledging hunger and fullness cues (13).

Manage Fat Intake

In IBS, too much fat can cause diarrhea or constipation.

Women can reduce their fat intake in a few ways. For example:

• Cook food at home
• Reduce take-out food
• Decrease consumption of packaged foods
• Avoid fast food 

Adopt a Low-FODMAP Diet

The low-FODMAP diet, or the IBS diet, is 75% effective at reducing IBS symptoms (14).

What are FODMAPs? FODMAPs are a group of short-chain carbohydrates that aren’t absorbed properly in the gut, which can trigger symptoms in people with IBS. FODMAPs are found naturally in many foods.

Many foods are high in FODMAPs: For example, garlic, onion, lactose, wheat, shallots, leeks, asparagus, mango, apples, beans, high-fructose corn syrup, honey, cashews, and pistachios.

The FODMAP diet is a 3-step diet that includes an elimination, reintroduction, and personalization phase. So, women can help pinpoint specific FODMAPs which worsen IBS symptoms.

Decrease Stress

Stress and increased cortisol worsen IBS symptoms. Additionally, increased cortisol can increase estrogen, further worsening IBS symptoms (5).

There are many ways to remedy stress and boost mental health. For example:

• Going on walks
• Spending time in nature
• Journaling
• Spending time with friends and family
• Playing with a pet
• Working on a hobby
• Yoga
• Pilates
• Mindfulness 
• Hobbies
• Talk therapy
• Massage therapy 

Increase Exercise

Exercise is an excellent way to decrease stress related to IBS symptoms. Exercise affects gastrointestinal symptoms. This results in a decrease in constipation and bloating.

Furthermore, exercise can improve gut motility.

It’s important to find a type of exercise you enjoy. For example, take a 20-minute walk, do yoga, do pilates, do running, or do sports. The most important part of an exercise routine is consistently showing up (13).

Improve Sleep Quality

Poor sleep quality leads to worsening IBS symptoms (14). The good news is that you can improve sleep quality by making diet and lifestyle changes.

Some ways to improve sleep quality:

• Keep your bedroom at a cool temperature
• Wear sweat-wicking pajamas and sheets
• Go to bed and wake up at the same time every day
• Keep your bedroom dark
• Avoid large meals before bedtime
• Avoid drinking alcohol
• Exercise during the day. 
• Stress less

Limit Alcohol

Limiting alcohol during perimenopause is a good idea for a variety of reasons.

First, drinking alcohol can increase estrogen levels, making IBS symptoms worse. Next, alcohol disrupts rapid eye movement (REM) sleep. This part of sleep is the most restorative. Disruptive sleep leads to feeling tired the next day and being more likely to make poor health choices (15).

For instance, try replacing your nighttime wine or cocktail with a delicious mocktail, non-alcoholic beer, or a cup of warm tea.

Try Hypnotherapy

Hypnosis is safe and effective in managing IBS symptoms. Various IBS-focused hypnotherapy apps exist. Additionally, hypnotherapy can improve hot flashes associated with perimenopause (16).

Medications for Perimenopause and IBS

Diet and lifestyle may not be enough to manage IBS symptoms. Therefore, other treatments such as over-the-counter and prescription medications are available for IBS.

Over the Counter

• Laxatives: increase transit time, relieving constipation or bloating 
• Bulking agents: psyllium husk or bran can improve constipation, diarrhea, or bloating

Prescription

Sometimes prescription medications are necessary for more severe IBS symptoms (17).

For example:

• Secretagogues/Prosecretory drugs: increase fluid and movement in the GI tract
• Anticholinergics/Antispasmodics – relieve abdominal pain or discomfort after eating
• Anti-diarrheal drugs – slow gut transit and decrease diarrhea
• Anti-anxiety medications – relieve pain and improve the changes in bowel habit
• Antidepressants – can reduce the intensity of pain signals going from gut to brain

When to See a Doctor About Perimenopause and IBS

Routine checks with your gastroenterologist are part of IBS management. However, there might be times when a visit to your physician might be necessary in between these visits.

If IBS symptoms do not improve, or you experience the below symptoms, it’s important to see a doctor right away.

Symptoms include:

• Weight loss
• Diarrhea at night
• Rectal bleeding
• Iron deficiency anemia
• Unexplained vomiting
• Difficulty swallowing
• Persistent pain that isn’t relieved by passing gas or a bowel movement

These symptoms indicate a more serious issue, such as irritable bowel disease (IBD) or colon cancer (1). 

Summary

While perimenopause is an expected part of a woman’s life cycle, the addition of IBS symptoms may come as a shock. Changes in estrogen and progesterone may worsen IBS symptoms, such as constipation, diarrhea, bloating, and pain.

IBS can be managed at home through various natural remedies, such as diet changes, exercise, sleep, and stress reduction.

Additionally, you can speak to your doctor and health care team about taking prescription medication if necessary.

In conclusion, always be sure to receive a formal diagnosis of IBS from your doctor. 

Please share with those in your life that can benefit from reading this post.

“Perimenopause and IBS” was written by Registered Dietitian Becky Rashidifard. Reviewed/edited by Su-Nui Escobar, DCN, RDN, FAND.