The image of a woman in the throes of menopause has been repeatedly painted for us: She is sweaty, she is sleepy, she is on the verge of tears of rage or both. She is also, as it turns out, gassy. That’s because, among other indignities, the perimenopausal and menopausal period brings with it a notable surge in digestive and GI issues. “Acid reflux, constipation, diarrhea, bloating, and gassiness can all be very common,” says Renita White, MD, an ob-gyn and advisor to The Honey Pot Co.
While the knee-jerk reaction is to blame hormones for everything happening to our bodies and psyches during these menopausal years, here, the connection isn’t quite so clear-cut. It’s confirmed in the scientific data that constipation is simply more prevalent with age regardless of gender, but in terms of the effects of female hormones specifically, the results are mixed. Some studies show decreasing estrogen being correlated with increased constipation, says Daniela Turley, a New York-based medical herbalist, but then when women are given estrogen they also can become more constipated. “One thought is that declining ovarian hormones (estrogen and progesterone) can contribute to increased visceral hypersensitivity, so pain perception in different parts of the GI tract can have a lower threshold as a result of these hormonal shifts,” says Mythili Pathipati, MD, a gastroenterology fellow at Mass General Hospital and a clinical advisor for Ayble, a personalized app that provides relief for GI symptoms.
“Hormones can also alter the motility of the GI tract and can contribute to altered bowel habits.” Turley points to a 2018 study of perimenopausal women for additional clarity which found that gastric disturbances were linked to a different hormone: cortisol. “Constipation may be due to the changes in stress perception and stress hormones, rather than a direct influence of changes in sex hormones,” says Turley, adding that several studies point to stress and the resulting wave of cortisol to be causative in the development of diarrhea and constipation. Taniqua Miller, MD, an ob-gyn and medical advisor for menopause telehealth startup Evernow, agrees. “Cortisol not only encourages fat storage but also slows digestion, thereby causing increased bloating and gassiness because of slower transit time in the gut,” she says.
There is also the possibility that other aging, not hormone, related issues can be the root cause of GI disruptions during this time. Pathipati points to pelvic floor dysfunction (a weakening of muscles in the pelvic floor), something that tends to happen with more frequency in the menopausal years and beyond, as a cause of both fecal incontinence and constipation. And Miller says that prescribed medications for health conditions like thyroid disease and high blood pressure can tip off GI disturbances. “Some classes of blood pressure medications, antidepressants, or iron supplements can all cause changes to the GI tract, such as constipation,” adds Miller.