Constipation, Bloating, and Perimenopause

Woman in white shirt uncomfortably grasping stomach with both hands.

The Latin word “peri” translates to around, about, beyond. So, quite literally, perimenopause is the phase of life around menopause.

Perimenopause is marked by changes in reproductive hormones as your body prepares to stop…well, reproducing. These hormonal changes can cause a wide range of symptoms that don’t logically have any connection to the reproductive system. Symptoms can include hot flashes, trouble sleeping, fatigue, joint pain, and headaches.

Symptoms also often begin long before we expect, with the average woman entering perimenopause in their 40s and some starting as early as their late-30s. 

So, we don’t know when it’s coming or what exactly to look for, and often our healthcare providers don’t recognize the symptoms.  Clear as mud, right?  I’m here to help!

In this article, we’ll be talking about two common symptoms of perimenopause you might not know could be linked to perimenopause – constipation and bloating.  Read on for information about what causes GI discomfort in perimenopause and what you can do about it.

What is Constipation?

Constipation is generally defined as having infrequent bowel movements. While uncomfortable, it’s completely normal for a person to have constipation occasionally throughout life.

Chronic constipation, however, is more than just a short-term discomfort. Depending on severity, it can even interfere with your normal day-to-day life at times.

Chronic constipation involves having three or fewer bowel movements each week or trouble having bowel movements consistently over the course of several weeks. Trouble having bowel movements may involve straining to pass stool, passing hard lumpy stools, pressure or pain in the rectum that feels like things are backed up and can’t pass, or feeling as if bowel movements are incomplete.   

What is Bloating?

Bloating is generally a feeling of fullness and distention, or swelling, of the abdomen.  Like constipation, it’s normal to feel bloated from time-to-time, particularly before menstruation or after overeating.  Bloating on a regular and consistent basis isn’t just uncomfortable, though, it isn’t normal.

What Causes Constipation and Bloating for Women Over 40?

While the causes of bloating and constipation are distinct and having one of these symptoms doesn’t necessarily mean you have both, they are frequently linked.  Unfortunately, women are more likely than men to report chronic constipation and bloating, and prevalence increases with age. (1) Let’s talk about why that may be.

Causes of constipation

Hormones

While it’s not 100% certain how hormones influence constipation, research suggests that estrogen and cortisol levels are correlated with constipation. (1)

In general, estrogen slows movement through the GI tract. So, then, shouldn’t decreased estrogen levels during perimenopause and after menopause decrease constipation? This is where it gets tricky.

First, perimenopause is a time of unpredictable hormone levels, so the rise and fall of estrogen is not on a regular cycle and may be more extreme at both the high and low end.

Second, estrogen has a bidirectional relationship with stress and the stress hormone, cortisol, which is not completely understood currently. We do know that cortisol also slows gastric motility (1) and that women over 40 tend to deal with increased stress and anxiety. More on this in the section on stress.    

There are other less understood interactions between estrogen and the digestive system that are at play as well. For example, we know there is a bidirectional relationship between estrogen and the gut microbiome.  We also know that the bacteria that make up our gut microbiome have wide-reaching influence on all aspects of our health, however this area of research is still in its infancy.

Diet

Simply put, not eating enough fiber and/or dehydration are very common causes of constipation. It is recommended that adults consume 25-30 grams of dietary fiber daily. Most Americans fall short due to a lack of fruits, vegetables, whole grains, beans, and nuts/seeds. 

Additionally, the standard American diet these days tends to be high in sugar and processed foods, both of which have a negative impact on gut health. 

Chronic Stress

It is known that stress slows digestion in order to conserve energy to react to a threat. In the situation where stress is ongoing, it is considered chronic and can lead to chronic constipation, among other health issues like high blood pressure and insulin resistance.

Lack of Exercise

With the demands of life ever-increasing as we get older, many women over 40 struggle to find time for fitness.  Exercise does more for your health than just keep your heart strong and help with weight management.   Exercise literally gets things moving.

Additionally, exercise induces stress in the body and, with regular exercise over time, the body experiences beneficial adaptations to stress. (2)

Medications

Some common medications have the unfortunate side effect of constipation.  Examples include iron supplements, pain meds, and some anti-depressants.  Talk with your medical provider if you think one of your medications may be causing constipation for you.

Other Causes

In some instances, constipation can be caused by disfunction of the pelvic floor muscles, obstruction in the intestines or rectum, or other anatomical or mechanical disfunction. (3)  If you do not find relief through lifestyle modifications discussed in the next section, talk with your medical provider.

Causes of bloating

Bloating is generally caused by gas in the intestines. Most of the food you eat is digested and absorbed in the small intestines. When undigested food makes it to your large intestine, bacteria in your gut break down, or ferment, those food particles. As with any chemical reaction, you have an input (food particles) and an output. One of the common outputs of bacterial fermentation is gas.  

Some people produce more gas than others for various reasons.  One reason may be that they don’t absorb certain foods very well, so more of that food makes its way to the large intestine for bacterial fermentation.

Another reason may be that the types and variety of bacteria in their gut are out of balance. Many factors play a role in the composition of your gut bacteria.  One of the biggest factors is what you eat. We will discuss how diet impacts bloating in the next section.

It should be noted that sensitivity of the neurons along the GI tract sometimes plays a role in the perception of high levels of bloating. In other words, some people experience more discomfort from being gassy than others even if they produce the same amount of gas.


Manage Constipation and Bloating with Lifestyle

Diet

The first step in managing constipation and bloating is changing your diet to include plenty of fiber and limit sugar and highly processed foods.

It’s no secret that fiber helps keep you regular. The unfortunate truth, though, is that sometimes fiber can cause uncomfortable gas and bloating.  This can then lead to a vicious cycle of limiting fiber intake because it makes you uncomfortable, which then leads to constipation and more discomfort.

How do you break the cycle?  It takes time.  If you significantly increase your fiber intake suddenly, you might end up making matters worse because your body isn’t used to processing so much fiber.  Rather, the more accurate statement would be that your gut bacteria aren’t ready for all the fiber.

When your diet is low in fiber, the bacteria that consume the fiber can’t thrive, so their numbers are low.  These are generally the good bacteria that you want in your gut, so it’s important to slowly increase fiber intake and allow those good bacteria to multiply.  As you increase fiber intake, it’s also important to drink plenty of water and before long things will be moving like clockwork!

But what about the gas? As noted, when the bacteria ferment fiber, one of the byproducts is gas. Good news! There are also bacteria in your gut that consume and/or help absorb and eliminate gas from your body. (4)  So, as the fiber-consuming bacteria multiply, the gas-consuming bacteria should follow.

You’ll likely have some gassiness when you initially start eating fibrous foods, but that should decrease over time as your gut adapts to consistent fiber intake. (4) If, after a few weeks of slowly increasing fiber, you don’t notice improvement, talk to your medical provider to rule out any underlying issue.   

Exercise

Regular exercise helps promote regular bowel movements.  While it’s not completely understood exactly how exercise improves GI health, it’s believed to be due to a combination of adaptations over time. 

Regular exercise stimulates improved blood flow to the digestive tract, which maintains health of the intestinal lining. Your digestive organs also move and shift as a result of bending and twisting of the abdomen during exercise, which may promote bowel movement. 

Additionally, there are adaptations that occur as a result of regular exercise that improve digestive health over time, which involve changes to the amounts and types of enzymes and hormones released.

Sleep

It may feel like it’s time that just cuts into your productive hours, but for your health, sleep may be the most productive time of day. Sleep is when your body repairs damaged cells, builds muscle and memory, recovers from the stress of the day, and regulates many of our body’s hormones.

Not getting enough sleep can lead to multiple health conditions. Increased stress, hormonal imbalances, and disturbances to the gut microbiome that can all lead to constipation and bloating in women who are chronically sleep deprived.  Try to get 7-9 hours of sleep every night.

Stress Management

I’ve mentioned stress a few times in this article, so it’s probably no surprise that stress management is considered a treatment for constipation and bloating. It’s important to find stress management techniques that work for you and your lifestyle. Some common techniques include meditation, deep breathing, activities that take your mind off of your worries such as coloring or knitting, and regular exercise as previously mentioned. Experiment and find what works for you.

Note, stress is one of the biggest issues I see with women experiencing constipation and bloating. Even if you’re doing everything else perfectly, chronic stress can sabotage your digestive health.

Summary

Constipation and bloating are common symptoms experienced by women over 40.  While hormonal changes during perimenopause often play a role in causing constipation and bloating, there are lifestyle modifications that can ease symptoms.  Lifestyle changes that may decrease constipation and bloating include eating plenty of fiber, exercising regularly, and practicing stress management. 

If you continue to experience uncomfortable gas and bloating after making the recommended lifestyle changes and sticking with them for at least a few weeks, talk with your medical provider. Uncomfortable constipation and bloating shouldn’t interfere with your life.

For more guidance with diet, download Essential Foods for Women Over 40 for free.  This guidebook provides a list of foods that support your changing hormones, a one-week meal plan, and a guide for creating your own meal plan.

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