How does the menstrual cycle affect IBS?
This post is for general information purposes only, is not meant to diagnose or treat, and is in no way a replacement for consulting a medical professional.
What are hormones?
Hormones are chemical messengers in our body. They are secreted into the bloodstream and are brought to the organs and tissues where they signal for a change to take place. Only a small amount is needed for a big impact, and even a small excess or deficiency can cause issues in the body.
There are different types of hormones, from ones that are part of the digestive process, to hormones responsible for regulating growth, to those involved in sexual function.
When we think about sex hormones involved in menstruation, we mostly think about estrogen and progesterone, and this is where the bulk of IBS research has focused on thus far. However, there are several other hormones also at play during the menstrual cycle.
The menstrual cycle basics
Different sources may group the phases of the menstrual cycle in different ways, but here we are going to look at 4 different phases of the cycle. Average cycle length can vary, while 28 days tends to be referred to as the standard, it can range from 26 to 36 days. (If you’re far outside of this range, definitely bring it up with your primary care physician.)
Phase 1: Menstruation
The first phase, starting on Day, 1 is your first day of menstruation (your period). Estrogen and progesterone levels drop which is what triggers your uterus to shed the lining, or the endometrium.
Phase 2: Follicular Phase
The drop in these hormone levels also triggers other hormone changes, like follicle stimulating hormone, to start to be released. This hormone, true to its name, stimulates the follicles in your ovaries to start getting an egg ready. Around Day 8 estrogen begins to rise again which stimulates the thickening of your uterine lining. Shortly after, testosterone also rises (elevating your libido).
Phase 3: Ovulation
Estrogen levels spike around Days 12-14 and trigger luteinizing hormone to be released. This is the start of ovulation, when the ovaries release the egg. The egg travels through the fallopian tube to the uterus where it is either fertilized by sperm and implants in the lining or will dissolve and pass out of the body during menstruation.
Phase 4: Luteal Phase
The follicle in the ovary, that once contained the egg, now releases progesterone and estrogen. This tells your body to prepare for pregnancy. While estrogen was dominant during the first half of the cycle until ovulation, now progesterone is the dominant hormone. Progesterone peaks around Day 21.
If the egg isn’t fertilized, then the levels of estrogen and progesterone drop, triggering menstruation, and the cycle starts again!
How does the menstrual cycle affect irritable bowel syndrome symptoms?
Estrogen and progesterone can impact our bodies beyond just our reproductive system, and so the rise and fall of these hormones throughout the month could be linked to a higher likelihood of experiencing IBS symptoms.
There are receptors for both of these hormones found in cells of the gastrointestinal tract, suggesting that the GI tract is meant to receive and react to them.
One study reported that around 40% of menstruating people with IBS found their symptoms were impacted by their menstrual cycle. However, the amount of these hormones is not different in menstruating people with IBS versus those who do not have IBS, even though the IBS symptoms appears to be more commonly triggered.
Some ways in which estrogen and progesterone have been seen to impact IBS symptoms during the menstrual cycle:
- Bloating and constipation tends to increase post ovulation as progesterone increases (until day before or day of menstruation)
- Abdominal pain and diarrhea potentially increase in the days before and first days of menstruation
- Visceral pain sensitivity may be higher during menstruation than other phases. A study using balloon distention in the colon showed that women with IBS are more aware and sensitive to discomfort during their menstruation phase
- In general, gut transit time is slower in people who menstruate than in those who don’t (regardless of whether they have IBS) and some studies have shown that transit time is longer in the luteal phase than in the follicular phase
- Changes in hormone levels can impact the muscle contractions of the GI tract, transit speed, and digestive hormone secretion which could affect gas production in the colon, the onset of bloating, abdominal pain, and changes in bowel movements
What about menopause and IBS?
Unfortunately, the data here is inconsistent. Some sources show a decrease in the frequency of IBS after menopause. Other data has reported that symptom severity may actually increase after menopause.
What about pregnancy and IBS?
Again, there is no consistent data for how pregnancy will impact IBS. For some, symptoms may improve, for others they may worsen.
In general, progesterone levels remain high during pregnancy, and can thus result in a higher chance of symptoms like constipation and reflux. This can be especially true during the later stages of pregnancy when there is the added pressure of the growing fetus onto the digestive organs.
What can you do to improve sex hormone related IBS symptoms?
The general consensus tends to be that symptoms increase in the second half of the cycle. It could be helpful to take extra care for your diet during these times, especially known trigger foods. The good news is that you may find that you can be less strict with trigger foods during the first half of your cycle!
During this time, make sure to get enough fibre and fluids to help reduce the chance of constipation. Bowel movements are an important part of our body’s natural detoxification process and we want to be sure we are getting rid of excess hormones.
Ensure you’re eating sufficient healthy fats, from foods like nuts, seeds, olives, avocados, etc. And put extra focus on those containing omega-3 essential fatty acids like in fatty fish, flax seeds, and walnuts. Our system needs healthy fats to produce sufficient hormones.
Make sure you’re eating enough; a severe calorie restriction can throw your hormonal balance off. If you’re struggling with this, especially due to food fears around IBS symptoms flaring, make sure to reach out to a nutrition professional!
Keep a food, gut, and cycle diary to track any patterns that may appear.
Don’t forget to work on stress management – excess stress and especially long-term chronic stress can lead to hormonal imbalances. Not to mention the well-known (at least if you’ve been around here for a while!) link between stress levels and IBS-symptoms.
Look for ways to reduce stressors in your life and make sure you’re incorporating stress management practices daily. This includes things like getting sufficient sleep, moving your body, meditation, journaling, social connection, eating nourishing foods, and spending time out in nature.
If you suspect you have a hormonal imbalance, make sure to bring this up to your health care team and nutrition professional.
Heitkemper, M. M., & Chang, L. (2009). Do Fluctuations in Ovarian Hormones Affect Gastrointestinal Symptoms in Women With Irritable Bowel Syndrome? Gend Med, 6(Suppl 2), pp. 152-167.
Hye-Kyung, J., Doe-Young, K., & Il-Hwan, M. (2003). Effects of Gender and Menstrual Cycle on Colonic Transit Time in Healthy Subjects. The Korean Journal of Internal Medicine(18), 181-186.
Mulak, A., Tache, Y., & Larauche, M. (2014, March 14). Sex hormones in the modulation of irritable bowel syndrome. World Journal of Gastroenterology, 20(10), 2433-2448.
Palssoon, O. S., & Whitehead, W. E. (2017, October). Hormones and IBS. Retrieved from UNC Center for Functional GI & Motility Disorders: https://www.med.unc.edu/ibs/patient-education/educational-gi-handouts/
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