Gut Health, Bloating and IBS in Perimenopause and Menopause

A participant from my group program asked our private group this question:

I'm noticing some significant changes in digestion during my cycle - either around ovulation or PMS. Has anyone else experienced this? I'm in early perimenopause and wondering if the estrogen/progesterone dance is affecting my GI symptoms.

And many women chimed in that they too were noticing changes like this. I answered that yes, estrogen and progesterone do have an effect on gut motility, and the balance of the two can affect bloating, especially around ovulation and the start of a cycle. But I thought I’d share a bit more about the gut-hormone connection. And more importantly, what can we do about it?

But first, an important disclaimer: This article discusses common causes and possible treatments for bloating caused by digestive changes in perimenopause and menopause. It is not intended to diagnose or be a substitute for medical care. As bloating can be a symptom of many other gynecological concerns including fibroids and ovarian cancer, please discuss any new symptoms with your primary care provider.

What GI symptoms are women more likely to experience in perimenopause?

A number of studies have found that women with, and without IBS, report an increase in symptoms during perimenopause. These can include:

Bloating
Increased gas
Changes in bowel regularity
Changes in stool consistency

It shouldn’t come as a surprise that hormones can influence digestion and it’s well known that women are more than twice as likely to be affected by IBS than men. And even women without IBS report bowel changes associated with their menstrual cycle, commonly experiencing mild constipation in the days leading up to a period, followed by 1-2 days of looser stool.

So you could say that women are already predisposed to the influence of our hormones on gut health. But why does it seem to get worse in perimenopause? And will it get better after menopause?

Estrogen, Progesterone, and Bloating

Quick hormone recap: In perimenopause, estrogen levels decline erratically as our ovaries sputter towards the finish line. Progesterone is also in decline as the quality and number of our follicles start showing signs of aging. ;) Once women reach menopause, estrogen and progesterone remain consistently low, with small amounts being produced by adipose tissue and the adrenal glands. You can read more about perimenopause in general here.

We have estrogen and progesterone receptors throughout our GI tract. And, we know that estrogen and progesterone influence the regular muscular movement in our intestines (aka peristalsis), which dictates how quickly (and smoothly) food travels from one end to the other. When estrogen levels are high (mid-cycle and unpredictably in perimenopause), gut motility decreases. There’s also some evidence that women who take HRT may be at increased risk for developing IBS, although this needs to be further studied. But adds to the theory that estrogen levels are correlated with symptoms of IBS, including bloating and bowel changes.

In pre-menopausal women, estrogen’s mid-cycle peak lasts a few days, before falling as progesterone rises. But women in perimenopause can experience a second higher estrogen peak in the luteal phase (second half) of their cycle. This is called a luteal out-of-phase (LOOP) event and is thought to be caused by elevated levels of FSH, stimulating the ovary to start another cycle before one has finished. And the normal drop in progesterone that happens just before a period is thought to cause the well-known IBS-like symptoms that many women are already familiar with.

In other words, good times ahead.

The Gut-Brain Axis

Hormone changes aside, midlife can be challenging for many women. Life and work stressors, combined with managing the symptoms of perimenopause and menopause (hello insomnia) can lead to an increase in stress, a well-established disruptor of healthy digestion.

Stress and the sympathetic nervous system response (“fight, flight or freeze”) is at odds with the “rest and digest” response of the parasympathetic nervous system. In other words, our body doesn’t prioritize digestion when we experience stress. Instead, it’s diverting blood flow and resources to helping us run away from the proverbial tiger.

Engaging the relaxation response around mealtimes can be very helpful if you regularly experience bloating, or notice it at certain times during your cycle. What’s the best way to do that? Breathing exercises are backed by science and are always my go-to as they can be done anywhere! But I also have an entire module devoted to managing mood in The Midlife Feast Community

The Estrobolome and Gut Health

You’ve probably heard of the gut microbiome, which describes the population of microorganisms that live in our gut. But recent research points to specific populations of bacteria that influence the metabolism of various forms of estrogen, specifically relating to an enzyme called beta-glucuronidase which is produced by certain bacteria. What does this special enzyme do? It’s involved in the recycling of estrogen in the gut.

When estrogens are broken down in the liver, they become “conjugated” and are sent to the intestines to be eliminated. But, they can become “unconjugated” by the enzyme beta-glucuronidase in the lower intestine and reabsorbed in a hormonally-active form. This recycling mechanism helps to conserve estrogen, which may be problematic when we’re swimming in the high estrogen soup of perimenopause. Research is ongoing into the possible effect of these bacteria on hormone-sensitive conditions including some cancers, but I think it’s worth acknowledging the gut-hormone connection especially if you’re experiencing symptoms such as bloating in perimenopause and menopause.

Now before I talk about ways we can influence our estrobolome, please keep in mind that this is a very new area of research, and caution needs to be used when interpreting the data. There aren’t any large clinical trials to hang our hat on, so most of what we’re talking about are known ways to support healthy populations of gut bacteria. But in the studies that have looked at how to influence the activity of beta-glucuronidase, two trends have emerged:

Diets that are high in plant-based fiber are associated with fewer beta-glucuronidase producing bacteria
Some research suggests benefits from diets that are high in magnesium, calcium and iron as well as certain families of plants including cruciferous vegetables.
Maintaining a diverse microbiome can help support a healthy estrobolome.

Take home message? Try to enjoy more plants on your plate and support a healthy diverse microbiome.

Enjoy foods that are high in fiber! And good news, beans, and lentils (which are also rich in symptom-reducing phytoestrogens) are great sources of resistant starch, known to support gut bacteria. Grab my FREE workbook and recipe guide here.
Discuss trying lower-FODMAP foods with your health care provider.
Treat and manage dysbiosis. If you already have IBS, or experience symptoms like bloating, gas, diarrhea, or constipation on a regular basis, it’s probably a good idea to discuss with your care provider.
Enjoy a variety of fermented foods from a variety of sources to maintain microbial diversity!
Talk to your provider about using probiotics, and other supplements that can support a healthy estrobolome.

How to Manage Bloating in Perimenopause and Menopause

Getting back to our original question - how can we reduce and manage hormonal bloating?

Support hormone balance. Supporting estrogen/progesterone balance will help reduce the wild swings of estrogen in perimenopause, helping to maintain more consistent gut motility. But keep in mind that some slowing down is normal at certain times in your cycle.
Support the “rest and digest” parasympathetic nervous system. Try taking 3 deep breaths before you eat, limit distractions while eating, and take your time! And probably best not to eat right after a moment of “meno-rage”. ;)
Support a diverse population of gut bacteria, primarily by enjoying plants and foods that are high in fiber as often as you can and include fermented foods when you can!

Need a plan to help you manage all of the above? Or looking for women’s health and nutrition info you can trust?