For many menstruating women struggling with IBS, symptoms get worse at certain times of their cycle. Some women may not even recognise these patterns unless they have spent time tracking their symptoms alongside their cycle.
As if we didn’t have enough to deal with, GI symptoms on top of the ups and downs that come with fluctuating hormones throughout the month can be incredibly frustrating for any menstruating woman.
This blog will cover the reasons hormones can increase IBS symptoms, and provide some tips for identifying these patterns and what you can do to reduce symptoms if you struggle with this.
How Menstrual Cycles Impact Gut Health
Bloating, abdominal discomfort and changes to bowel motions just before your period is due, and during your period is common and to some extent, normal.
For those with IBS, these symptoms can be greatly exacerbated for longer periods of time than for those who don’t struggle with IBS. Typically, symptoms will be worse from mid cycle/when ovulation occurs, to the end of your period, and sex hormone fluctuations play a big role in this.
Estrogen is usually at its peak just before ovulation, while progesterone is at its peak during the luteal phase — the phase between ovulation and the onset of menstruation. But these hormones drop to the lowest levels just before the period begins.
Both estrogen and progesterone control smooth muscle contractions in the intestines, affecting how quickly food travels in the gastrointestinal (GI) tract. During menstruation, some women tend to have abdominal pain, and some have diarrhea. Many of these GI-related disturbances are linked to the actions of female sex hormones.
Beyond pain and loose bowel motions, Increased constipation during the luteal phase is a common annoyance, especially for those who already deal with IBS or other gut issues.
Progesterone is the main driver for this. After ovulation progesterone is at its highest, and it causes muscles in your digestive tract to relax which reduces bowel motility, leading to constipation. Constipation will then increase bloating, which is not ideal as bloating and water retention during the week leading up to your period is already very common.
Additionally, every month before your period, your body releases natural chemicals known as prostaglandins, which play an essential role during your cycle. They trigger the muscles in your uterus to contract, making it easier to shed the uterine lining. The bad news is that these prostaglandins can have the same effect on your bowels and can increase abdominal pain. The result? More frequent poops and cramping.
Finally, hormonal shifts can also affect the diversity of bacteria in your gut and the health and function of your intestinal barrier—both associated with IBS.
In a nutshell, the hormones associated with your period interact with your gut to cause a variety of symptoms. With IBS, the symptoms can be significantly worse.
How to Track These Patterns
Tracking symptoms alongside your menstrual cycle can be helpful, especially because IBS symptoms can often appear to be so random, and most people tend to focus on food being the main trigger for a flare-up. Being unaware of these patterns can leave you feeling confused, especially when you may have weeks of minimal symptoms and then all of a sudden you find yourself in a flare up, wondering what you did to cause it.
Spotting these patterns is simple but it does take a bit of time to collect the data over a couple of months. But the end result can mean a greater understanding around what is driving your symptoms and help you to identify when it is more important to follow practices that can help to reduce them.
The best approach to tracking cyclical IBS symptoms is to use a period tracking app or simply record symptoms in a journal alongside your menstrual cycle. It is important to track beyond your period, and consider the other phases of your cycle as hormones continue to fluctuate throughout the month.
The four phases of the menstrual cycle are:
Menstruation - commonly known as your period. Increased diarrhea and abdominal pain is most common during your period.
The follicular phase - starts on the first day of your period and lasts for 13 to 14 days, ending in ovulation.
Ovulation - about two weeks before your next period, and can last from 16 to 32 hours.
The luteal phase - Starts after ovulation and ends when your period begins.
The luteal phase is the most common time to experience increased IBS symptoms, particularly constipation, discomfort and bloating.
Tips for reducing cyclical related IBS symptoms
Consider using osmotic supplements for increased constipation, like magnesium citrate and vitamin C, which help to soften stools and make it easier to pass.
Keep on top of fiber intake, aiming for 25-30g per day. Focus on fibers that are less likely to drive bloating: berries, flax seeds, hemp seeds, quinoa, brown rice, edamame beans and leafy greens.
Increasing daily movement, aiming for at least 30 minutes of walking everyday.
Ensure you’re getting 7-8 hours of sleep every night.
Keep water intake high, aiming for a minimum of 2L daily.
Consider reducing high FODMAP foods during the luteal phase.
Reduce processed sugars in diet as they can increase pain and discomfort.
Consider getting hormone testing to identify any abnormal fluctuations between estrogen and progesterone that can make symptoms worse.
Look into root causes that may be driving your IBS like SIBO, nervous system dysfunction and dysbiosis.
Questions? Leave a comment below. I love hearing from you!