IBS Symptoms in Menopausal Women

Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder that presents more often in women than in men and occurs in up to 15% of the U.S. population. This condition is usually diagnosed in people under 40 and typically is accompanied by abdominal discomfort, coinciding with changes in bowel movements.¹

While menopause is not classified as a direct cause of this disorder, the hormonal fluctuations commonly associated with menstruation, perimenopause, and the menopausal transition may worsen IBS symptoms in some women. In this article we’ll talk about the connection between fluctuating hormones, menopause, IBS and its symptoms, along with how this disorder is diagnosed, treated and other conditions which might cause IBS-like symptoms to occur in menopausal women. 

What is Irritable Bowel Syndrome?

IBS is a gastrointestinal disorder that affects the large intestine. There are three common types of this condition and the type you have is determined by your most commonly occurring symptoms²:

• IBS-C (IBS with constipation)
• IBS-D (IBS with diarrhea)
• IBS-M (IBS with mixed bowel habits of diarrhea and constipation)

The root cause of IBS is unknown, however, possible causes may include³:

• Stressful childhood events or trauma
• Emotional distress caused by somatic symptom disorder
• Depression
• Anxiety
• Bacterial infections in the digestive tract
• Bacterial overgrowth in the small intestine
• Food sensitivities or intolerances
• Genetics

Menopause and IBS: How Common is this Condition?

You might be wondering; can you develop IBS later in life? As mentioned earlier, menopause doesn’t directly cause IBS, however, the drop in estrogen and progesterone that begins during perimenopause, may potentially exacerbate IBS symptoms.

Data regarding the incidence of IBS in perimenopausal and menopausal women is mixed. Some studies indicate that IBS is less common in postmenopausal women than in those who have not yet gone through menopause. One specific study demonstrated that the frequency of IBS actually declined after the age of 45 in women, while it remained unchanged in male participants.⁴ In a separate study, however, women aged 45-60 were shown to frequently seek out treatment for increasingly more severe IBS and IBS-like symptoms.⁵

There may be many reasons why gastrointestinal distress and IBS symptoms worsen during a woman’s menopausal years. Common causes include hormonal fluctuations, and the impact of other menopausal symptoms, such as hot flashes, bloating and cramping. Increased stress can also play a role in increased stomach upset or bowel movement changes.

Can Menopause Cause IBS or Its Symptoms?

Fluctuating hormones don’t cause IBS, but they can certainly impact the severity of the symptoms. Certain cells in the gastrointestinal tract respond to fluctuations in estrogen and progesterone levels, which affect the gut microbiome. Women with or without IBS may experience stomach upset, diarrhea, constipation, and bloating during their periods, when estrogen and progesterone are at their lowest levels.⁶

Estrogen and progesterone levels also fluctuate and decline during perimenopause and the menopause transition. Some women report an increase in gastrointestinal distress and symptoms, such as stomach pain, during this timeframe.⁷ As mentioned earlier, once women have gone through menopause and their hormonal levels have stabilized, the occurrence of IBS and its symptoms, may start to decline, demonstrating the end of these hormonal shifts may be beneficial for those struggling with IBS and symptoms during perimenopause or menopause.⁸

Additionally, stress is no stranger to women in this age group. The physical challenges of perimenopause and menopause, such as hot flashes and insomnia, coupled with increased personal and professional responsibilities can both cause and exacerbate physical and emotional distress, including stomach issues. Increased levels of cortisol, a stress hormone, can certainly worsen existing IBS, increasing the incidence of symptoms such as diarrhea, constipation, and stomach pain in women transitioning through menopause.⁹

Getting a Diagnosis for IBS

To determine an IBS diagnosis, your healthcare provider will conduct a physical exam and ask you about your medical history and current symptoms. A set of guidelines, called the Rome Criteria, may be used to make a diagnosis of IBS and IBS type. These criteria include information about the frequency and duration of, menopause stomach issues, such as constipation and diarrhea, as well as the amount of time the symptoms have persisted.¹⁰

The most common symptoms of IBS are bloating, abdominal pain, and chronic diarrhea.¹¹ These can be caused later in life by other health conditions that your healthcare provider will seek to rule out first. Other conditions with similar symptoms include¹²:

• Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
• Colon cancer
• Celiac disease
• Lactose intolerance
• Diverticulitis
• Ovarian cancer

You may also have symptoms that make a diagnosis of IBS less likely; these symptoms include rectal bleeding and/or abnormal vaginal bleeding.^13,14 Make sure to talk with your healthcare provider about all your symptoms, and when they occur, so you can determine a diagnosis and treatment plan that works best for you.

There is unfortunately no specific diagnostic test for IBS, but your healthcare provider may recommend certain tests designed to rule out other issues. These include¹⁵:

• Colonoscopy
• CT scan
• X-ray
• Pelvic ultrasound
• Lactose intolerance test
• Celiac panel
• Upper endoscopy
• Stool test for occult blood or abnormal DNA
• Breath test for bacterial overgrowth

Treatments for IBS

The treatments for IBS center upon symptom relief. You may wish to work with your healthcare provider or a nutritionist on treatments and lifestyle changes that can reduce symptoms and help you feel your best.

Identifying and avoiding foods that trigger your IBS and symptoms is an important first step. These food triggers differ from person to person, but may include¹⁶: 

• Refined grain products, such as white bread
• Gluten
• Dairy products that contain lactose, such as cheese
• Soy
• Carbonated beverages
• Alcohol
• Coffee

Dietary changes can have a significant impact upon IBS symptom relief. In addition to eliminating trigger foods, your healthcare provider or nutritionist may recommend the FODMAP diet (which is low in sugars and may help reduce gastrointestinal distress), eliminating gluten, eating more fiber, and avoiding gas-producing foods. Recommendations are based on each individual’s sensitivities.

Exercising regularly, reducing stress, and getting enough sleep may also help alleviate symptoms. While dietary supplements have not been shown to treat IBS or its symptoms, incorporating a quality gut probiotic can help to support and maintain the delicate balance present in the gut’s microbiome.  

Learn more about Bonafide’s Essential Gut Probiotic formulated to support a balanced gut while keeping digestion regular and smooth.*

Certain medications may also help address the symptoms of IBS, but it’s important to speak with your healthcare provider first to see what’s best for you. These include¹⁷:

• Over-the-counter laxatives
• Over-the-counter anti-diarrheal medication
• Anticholinergic medications to relieve painful bowel spasms
• Antidepressants
• Alosetron (Lotronex) - a prescription medication that relaxes the colon
• Eluxadoline (Viberzi) - a prescription medication that reduces muscle contractions and diarrhea
• Linaclotide (Linzess) – prescription medication that increases fluid secretion to ease stool passage

No matter what your age, if you are experiencing what you think are IBS symptoms, be sure to talk with your healthcare provider. If they’re dismissive, you can consider changing providers or ask for a recommendation for a gastrointestinal specialist. It’s important to rule out the serious conditions that mimic IBS to help support your overall health and well-being. It’s also important to get the support you need to live a full, comfortable, and pain-free life through menopause and beyond.

Resources

1. https://www.hopkinsmedicine.org/health/conditions-and-diseases/irritable-bowel-syndrome-ibs
2. https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs
3. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/symptoms-causes
4. https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-and-Hormones.pdf
5. https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-021-00064-5
6. https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-and-Hormones.pdf
7. https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-and-Hormones.pdf
8. https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-and-Hormones.pdf
9. https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-and-Hormones.pdf
10. https://www.verywellhealth.com/the-rome-criteria-for-ibs-1941670
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495893/
12. https://www.healthgrades.com/right-care/irritable-bowel-syndrome/6-conditions-with-symptoms-similar-to-ibs
13. https://www.umwomenshealth.org/conditions-treatments/uterine-fibroids-abnormal-bleeding#:~:text=Fibroids%20can%20grow%20on%20the,periods%20or%20bleeding%20between%20periods
14. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064#:~:text=There's%20no%20test%20to%20definitively,conditions%2C%20such%20as%20celiac%20disease.
15. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064
16. https://www.webmd.com/ibs/ibs-triggers-prevention-strategies
17. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064