Women: How do our hormones affect bloating & other IBS symptoms?

We’re probably all familiar with the feeling: when you put on a nice outfit for an event and love how it fits and looks, but halfway through the party you’re struggling to sit down comfortably and everything you’re wearing feels tight.

Have you noticed that you’re more regular when you’re close to your period? Or that your IBS is always worse at a certain time of your cycle?

Today we’re exploring all things IBS, bloating and female sex hormones to try and answer some of these questions.

Why are women more affected by IBS?

Unfortunately for women in Western countries, we are more likely to be affected by IBS. The reason for this is not certain, although there are a few studies that have looked into it. Firstly, it was thought that women are more proactive about their healthcare issues, more likely to seek assistance and therefore, a diagnosis. There’s emerging evidence that also suggests a few other things may play a role here. Women often have slower gut motility (i.e. our food takes longer to pass through us) than men, which may have something to do with why we are more prone to gut issues, especially with constipation. Female and male sex hormones might also have something to do with how people are affected by IBS. That means we actually might experience IBS in different ways, both in terms of symptoms and pain perception.

Why do we bloat? And why do women experience it more?

Bloating is the feeling of your tummy expanding and increased pressure in your gut. It is often accompanied by distension, which is the visible expansion of the abdomen either after a meal or just as the day goes on. It’s when you feel the need to loosen your belt or undo your jeans that fit perfectly well earlier in the day.

Looking at the physiological differences mentioned earlier, women have longer intestines, which ultimately gives the food more time to ferment (i.e. produce gas build up) and for water to be absorbed from the food. Female sex hormones are also important as they can impact on how quickly – or slowly – food passes through. These can all contribute to bloating.

Have a look at our previous post ‘A bad case of the bloat – What is chronic bloating and what can I do about it?’ for some tips on how to reduce or manage bloating.

How much do female sex hormones make an impact?

There is still a lot of investigating left to do when it comes to how much the female sex hormones, mainly estrogen and progesterone, impact IBS. The current research suggests that female sex hormones affect IBS symptoms in a few ways. They can slow digestion and gut transit time, as already mentioned, which can lead to an increased chance of constipation and bloating. When these hormone levels are low, it can actually lower your pain threshold, making you more sensitive to painful IBS symptoms. When the sex hormones are elevated at various stages throughout your cycle, they can raise your body’s level of inflammation. This includes inflammation in the gut and therefore can worsen IBS symptoms.

What about the menstrual cycle, pregnancy and menopause?  

The menstrual cycle
The female sex hormones change throughout the menstrual cycle. As we approach menstruation, progesterone levels have dropped and estrogen levels are low, while prostaglandin levels are high. Low progesterone causes the body to retain fluid in preparation for pregnancy. This can lead to feeling bloated. Prostaglandins are the hormones that help shed the uterine lining by contracting the muscles of the uterus. You might notice that you are more regular around the time of your period – these are the elevated levels prostaglandins in your blood. They are responsible for menstrual cramps but can also contribute to symptoms such as diarrhoea and bloating. For people with IBS – it has been reported that menstruation is associated with an increase in symptoms, especially diarrhoea and bloating.

Pregnancy
Pregnancy can be unpredictable for people with IBS. As the female sex hormones are elevated during pregnancy, it can mean that symptoms don’t bother you as often and your pain threshold is higher. For others, IBS can get worse during pregnancy especially for those prone to constipation. It is important to note that restrictive diets such as the low FODMAP diet are not recommended during pregnancy. Rather try focusing on eating foods that are good for digestion: vegetables that are cooked well, a variety of grains and starches (not just wheat) for fibre, and plenty of water.

Menopause
Menopause can also be unpredictable, as the research is very mixed. This is the time that female sex hormones drop. For some women, this time can be the worst for symptoms of bloating. In fact, bloating was recorded to be worse for all menopausal women, not just those with IBS. Alternatively, some women who are post-menopause experience an alleviation of IBS symptoms. The link between IBS, bloating and menopause is definitely an area that needs more investigation.

In Summary

Bloating is an uncomfortable symptom of IBS that is inevitable for some. Having smaller, more frequent meals and chewing your food well can be a good start to reducing bloating. Watch out for meals with lots of high FODMAP foods and be aware of how this may increase the risk of bloating. There’s also no denying that sex hormones impact IBS symptoms. In regard to female sex hormones, they can worsen symptoms and increase sensitivity to them. Sometimes, just being aware of where you are in your cycle and what this means for your hormones can help you understand what’s happening with your body and prepare for symptoms. Working with a Dietitian can help you understand your symptoms even better, as well as help you manage them.

Written by: Jess Cheshire (Dietitian)
Reviewed by: Kiarra Martindale (Accredited Practising Dietitian)