If you’re somebody who menstruates (or previously) and you notice a change in your digestion at different stages of your cycle, you are not alone! Among those with irritable bowel syndrome (IBS), women are more likely to have severe digestive symptoms and these symptoms are more severe during menses (1).
Despite this being so common, it’s not something we openly talk about. There is certainly still a strong #pootaboo and while we are becoming more open about talking about periods and female health as a whole, this can still be a very private topic.
The good news is I’ll do the talking so you can learn a bit about how to support yourself!
But why do women have it worse than men? (2)
Due to the fluctuating hormonal cycle which takes place each month, we can experience a range of digestive issues at different stages of the month as well as in different life stages such as pregnancy, perimenopause and menopause.
Starting with the menstrual cycle, let’s discuss the stages of the cycle, common digestive issues experienced in each stage and how to manage those symptoms.*
*The effect of our hormones on our digestive system is complex and there is still quite a lot that we do not know. This is a very simplified breakdown of what we do know and may help you if you experience digestive issues which worsen at different stages of your cycle.
Let’s firstly talk about the menstrual cycle, which has 4 key phases:
1.The Menstrual phase (day 1-5, sometimes longer for some individuals)
As you’ll see in the graph, during menstruation (shown as our period) we see a sharp drop in hormonal levels, including the two main hormones involved with the menstrual cycle, oestrogen and progesterone.
These two hormones slow gut motility, so their sharp decline can come with altering bowel habits such as bloating, more frequent or loose bowel movements.
How to manage:
Around this time it can be helpful to be mindful of stimulants such as caffeine or alcohol. If you experience urgency, altered bowel movements or other digestive discomfort these may make this worse.
Including regular meals supports normal gut motility and energy intake. Drinking plenty of fluids can aid hydration, particularly if you experience loose bowel movements in which case you would lose fluids, increasing the risk of dehydration.
In terms of food, regular meals with a focus on fibre foods such as wholegrains, fruit and veg, nuts, seeds, oats, potatoes and legumes can aid stool bulk and motility. If you are sensitive to fermentable carbohydrates, be mindful of your intake.
2. The Follicular phase (the first half of our cycle lasting about 13-15 days)
In my experience, this doesn’t tend to be a time when I’ve heard someone I work with complaining about digestive issues, which is great news!
That being said, we are all different and getting to know your body can help you notice which stages bring the worst digestive symptoms.
3. The Ovulatory phase (the middle of the individuals cycle)
During this phase oestrogen levels peak ahead of ovulation. Oestrogen is a hormone which can slow gut motility, which can increase instances of bloating and constipation. Some people also experience cramps or pains in the side around ovulation.
How to manage:
If you notice a change to digestion including symptoms such as bloating or constipation around this time, movement can aid gut motility and gas release to relieve bloating along with supporting the movement of food and waste through the system.
In terms of food, regular meals support normal gut motility which can slow down around this time due to high oestrogen levels.
Eating every 3-4 hours creates routine and structure to support the contraction and relaxation of gut muscles, which propel food and waste along the digestive system.
4. The Luteal phase (the second half of our cycle up to the onset of menstruation)
In the luteal phase, as you can see in the graph, we see rising levels of progesterone post ovulation and a second peak in oestrogen.
Progesterone has a lovely calming effect on the body, including our digestive system and the muscles associated, which can cause slower gut motility and the addition of oestrogen in its second peak adds to this.
This can result in increased water retention, bloating, and constipation for many individuals.
In the late stage of this phase in the few days leading up to menstruation, we experience an increase in pro-inflammatory prostaglandins which are involved with triggering the shedding of the lining of the uterus which we experience as our period.
The cramps we often experience around this time are a result of these pro-inflammatory prostaglandins!
How to manage:
During this phase, to support bloating and stool bulk, a focus on regular meals, fibre and fluid intake can be very helpful. Eating regular meals every 3-4 hours helps to stimulate gut motility, keeping things moving along nicely.
Fibre rich foods such as oats, potatoes, whole grains, fruit, veg, nuts, seeds and legumes can help with bulking out the stool while including 1.5-2 litres of water can aid fibre’s journey along the digestive tract and support hydration levels. A bonus side effect of these fibre foods is that they can help with reducing pain, due to their anti-inflammatory effect.
Gentle movement such as walking, yoga or swimming can also support gut motility. Lower impact exercise may be more approachable if you feel more tired in this phase so stick with what works for you!
These recommendations are for the general population and work in most cases however it is important to point out that each one of us are different.
Those with co-occuring conditions such as polycystic ovarian syndrome or endometriosis may need more specific recommendations and support.
For some people, things like stress, medication and food sensitivities can play a role so don’t be afraid to reach out for support if you need it.
The best way to get to know your body is to track your cycle, mood and symptoms to identify any trends. From here you can implement the above strategies and monitor your progress.
Pregnancy
Pregnancy involves a number of physiological changes in order to prepare the body for the growing foetus. For many individuals, this can be a time where digestive issues occur, mainly constipation, heartburn and acid reflux.
Constipation
Due to the close proximity of the reproductive organs and our digestive system, the growing foetus can exert pressure on rectum which can contribute to constipation in the early stages of pregnancy.
Hormonal changes can also play a role as progesterone and relaxin slow gut motility, further contributing to constipation. (3)
How to manage (3):
Including gentle forms of movement, regular meals, fluids and fibre foods such as whole grains, legumes, seeds, oats, potatoes, fruit and veg are great ways to ease constipation. For severe constipation, please speak to your gp.
Heat burn and acid reflux
In later stages of pregnancy, the pressure of the growing foetus on the abdomen can contribute to heartburn and acid reflux and hormonal changes such as progesterone which delays gastric emptying and gastrin, which stimulates acid production can contribute to acid reflux. (4)
How to manage (4):
Try not to eat too close to bedtime and be mindful of spicy foods. Rising the head of your bed at bedtime can tilt acid back into the stomach. If it continues to be a big problem, speak with your GP about further support.
What if I no longer have a period?
All over our body and organs, we have oestrogen receptors, including inside our gut. During perimenopause, oestrogen levels begin to decline. This can come with many symptoms, including digestive issues. For some, digestive issues may improve while for others, they may experience digestive issues for the first time.
For more information on how to manage digestive issues at this stage of life, you can listen to a recent podcast I recorded with Marian Hearne who specialised in this area: ‘5 ways to beat the perimenopausal bloat’ here.
If you’re reading this and aren’t quite sure where to start with getting on top of your digestive issues, I have good news!
The how to beat the bloat without cutting out more food group programme is returning on Monday 23rd October. This programme will teach you how to identify what triggers your digestive issues and most importantly how to manage your symptoms.
In addition to weekly live sessions and group support, you’ll also get access to weekly gut directed yoga flows to support your gut.
Our supportive community will be there to support you on the hard days and to celebrate your wins on the good days, you will never be alone on this journey!
Click here for all information and to book your place. We can’t wait to have you join us!
References:
- https://doi.org/10.1016%2Fj.mayocp.2020.10.004
- https://doi.org/10.1159/000504701
- https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/common-health-problems/
- https://www2.hse.ie/conditions/heartburn-indigestion-pregnancy/
