Menopause and Stomach Problems… What’s the deal?
Your stomach is playing up and you just can’t figure out what’s causing it. The stress of having to deal with unpredictable symptoms like acid reflux, stomach ache, and bloating (potentially along with a variety of others) is beginning to impact your day-to-day life and relationships.
When you’re already dealing with perimenopausal symptoms like hot flashes, night sweats and brain fog – I know this is no joke.
Did you know that 90% of women experience menopausal symptoms in their lifetime (1)?
Hot flashes, sleep problems, joint pain, brain fog… these are all “known” symptoms of the menopause, but what about digestive issues?
You’re not alone if you’re suffering with gastrointestinal (stomach and gut) problems during perimenopause and early post-menopause. In fact, a survey we ran with over 500 women showed us around 70% were suffering with excess gas/wind and bloating, around 40% acid reflux and constipation, and others with less common – but seemingly strangely connected symptoms – such as nausea (35%), indigestion (31%) and diarrhea (28%).
This easy-to-understand article will take you through why stomach problems can appear during perimenopause and early post-menopause, what you can do to better manage them, and when it’s time to get checked by a healthcare professional.
What is Menopause and Perimenopause?
Firstly, let’s make sure we’re all on the same page here.
Menopause refers to the loss of your period for 12 months. This may be natural, otherwise known as “spontaneous”, related to primary ovarian insufficiency (POI) or it can be induced i.e. surgical removal of ovaries or iatrogenic (e.g. chemotherapy, radiation).
In North America and the UK, the average age for menopause is 51, with 1 in 100 women experiencing menopause prior to 40 (UK Stat).
The term perimenopause refers to the “time around menopause”, usually associated with the most symptomatic period (although some may not experience symptoms at all!).
What symptoms do women get in perimenopause?
Perimenopause can come with an array of symptoms, so what else could you be experiencing alongside your new digestive problems?
Common menopause symptoms (non GI-related) include (3):
Hot flashes and night sweats
Vaginal dryness
Altered mood and sleep
Heart palpitations
Hair loss
Weight gain
Changing menstrual cycles
Foggy brain and forgetfulness
Irritation and mood swings
Common stomach (or gut) issues reported by women during perimenopause are:
Gas and wind
Constipation
Diarrhea
Acid reflux and heartburn
Nausea
Bloating (4)
…or what I like to call, the (not so) “Super Six”.
What’s the link between gut problems and perimenopause?
During perimenopause the level of hormones in the body fluctuates, particularly progesterone and estrogen. Progesterone levels decline; stopping completely (more or less) once you reach menopause. Estrogen levels become irregular and unpredictable but decline over time (5).
Simply put, oestrogen affects our gastrointestinal system and impacts our overall gut health. For example, it protects the stomach from acid, stimulates mucous secretion to aid digestion and works with progesterone to control gut movements.
Many studies have shown that changes to hormone levels affect our gut movement, especially if levels are low; this can slow down our gut significantly. This may lead to symptoms like bloating and, or, constipation.
Our pelvic floor can also be affected by decreasing estrogen levels (6). The layers of muscles making up the pelvic floor helps support the uterus, bladder, and bowel (7). A weak pelvic floor can make bowel movements harder to control.
Stress, perimenopause and gut symptoms
As you may already have experienced, stress can hugely impact many perimenopausal symptoms. Studies show that the hormone, cortisol, released particularly during times of stress, can also affect our digestive system. As the gut and brain are connected, they communicate with each other, this is known as the “gut-brain axis”. What is so interesting about this relationship is that the brain affects the gut and the gut affects the brain. So much more research needs to be done on this, but in a nutshell, it’s fascinating.
So, if your stomach problems become worse when you’re feeling stressed, this makes sense!
According to CarersUK 58% (3.34 million) of the 6.5 million unpaid carers in the UK are women. Women are also more likely than men to be providing around-the-clock care. Women who are aged 45-54 are also more than twice as likely to have reduced working hours because of their caring responsibilities.
I mention this because many women are providing care for both children and elderly parents during their 40s and 50s and this, in combination with perimenopause, can lead to increased levels of stress and impact mental health.
For some, stress can slow down the digestive system, leading to bloating and constipation. For others, it can speed it up causing diarrhea and an urgency to use the toilet.
Some forms of HRT (hormone replacement therapy), like oral estrogen, are associated with elevated cortisol levels. So, if you’re experiencing constipation or other gut symptoms, it’s worth checking the side effects and having a chat with your GP/doctor (8).
What about lifestyle changes to manage gut/digestive symptoms?
Certain tweaks to your diet and lifestyle may provide relief from menopause-related gut symptoms. Different gastrointestinal symptoms are treated differently and it’s so important to first figure out their root cause.
That said, there are some things you can do from a food and nutrition perspective that can improve your overall gut health and may help with both GI and non-GI symptoms.
Aim for regular mealtimes – try not to skip meals or eat too late at night. Irregular mealtimes can increase the risk of acid reflux (9).
Aim for a balanced plate – make sure to include carbohydrates, protein, and healthy fats in your diet. This will help ensure you’re getting a variety of nutrients to help promote a healthy gut!
Eat a fibre-rich diet– getting enough fibre in our diet can be key to regulating bowel movements and our gut needs lots of fibre to stay healthy. Guidance in the UK is 30 grams per day for women. We know that in the UK most people are only having 18 grams per day, which is concerning (10).
When to see a healthcare professional for advice?
It’s important to note - if your gut symptoms have been longstanding and are impacting your daily life, please seek advice from your GP/doctor or dietitian.
If you’re experiencing constipation, diarrhea, bloating, abdominal pain, and/or unexplained weight loss a GP can rule out any underlying causes. Your doctor may want to run some tests, for example a CA-125 blood test is used to rule out ovarian cancer. Other tests like an Anti-Iga TTG is used to rule out coeliac disease and a FIT (faecal immunochemical test) is used to detect any small traces of blood in your poo, to screen for inflammatory bowel disease and bowel cancer.
Summary
In summary, perimenopause stomach problems are commonly experienced in menopausal women, for a variety of reasons. Finding out the root cause of your new symptoms (whether its fluctuating hormones, stress, or something else) is key to knowing how to treat them.
Looking for more support? Grab my Digestive Issues in Perimenopause (and beyond) Workshop. Put yourself back in the driver’s seat of your gut and “get your life back”.