Irritable Bowel Syndrome

Menopause is always a surprise. Together with all the symptoms already recognised (see here the 34 symptoms of menopause) many women suffer from bowel problems, commonly Irritable Bowel Syndrome (IBS).

To go a little bit more in detail, when you have IBS, your nervous system releases neurotransmitters that can change the function of your colon (which is the large part of the intestine), leading to diarrhoea, constipation, diarrhoea alternating with constipation, and bloating. IBS is more common in women than men. The female hormones responsible for menstrual periods frequently change IBS symptoms, often making them worst. There the hormones go again!

Menopause

During menopause, your hormone levels change forever. They fluctuate for quite a long time before settling. Some studies have shown that Irritable Bowel Syndrome symptoms improve with menopause, while others have reported that IBS symptoms worsen with menopause. So which is it??

There is an urgent need to understand the role of menopause in IBS. Some studies have also reported that the onset of perimenopause can trigger IBS. Oestrogen replacement therapy does not appear to have any effect on IBS symptoms, so it is probably better to use remedies that worked for you previously.

Some studies have shown that IBS symptoms improve with menopause, while others have reported that IBS symptoms worsen with menopause. So which is it??

Recent studies (Lenhart 2019) demonstrated that IBS is already more common in women than men. Women in fact, have a higher prevalence in symptoms of constipation, bloating, and extra-intestinal manifestations. This study aims to understand what the role of hormones in IBS is. Unfortunately, the study didn’t identify a precise explanation for the role of hormones in menopause.

It is known though, that oestrogen and progesterone affect IBS symptoms in a few ways, from how your intestines work to how much pain you feel. Cells in your gut have receptors (part of the cells on which hormones or other molecules can attach) that let these hormones latch on to them. This suggests that your digestive system is designed to sense and react to them. Here are the main ways in which hormones are able to affect IBS:

Digestion

  • They control the smooth muscle layer in your intestines, which dictates how quickly food travels through your system. This muscle layer is involuntary therefore we are not able to control it. Low dose of one hormone can change the equilibrium in your intestine. This may explain why low levels of sex hormones can lead to constipation.

Pain Level

  • These hormones affect how much your cramps bother you. A dip lowers your pain threshold, in part because oestrogen boosts the production of serotonin, a feel-good chemical release in your brain. A jump in oestrogen instead can reduce some of the ouch factor, so your cramps don’t hurt as much.

Inflammation

  • Sex hormones can raise levels of inflammation throughout your body. That could make your Irritable Bowel Syndrome symptoms worse.

Hormones

Most research has linked oestrogen and progesterone with IBS. But scientists have also found that male sex hormones, like testosterone, may also protect against the condition. This may be partly the reason why men are less likely to get the disorder.

Your sex hormone levels then drop with “the change”.  But it’s unclear how this affects IBS. In some women Irritable Bowel Syndrome improves after menopause, when these hormonal changes stop. Because sometimes it is more the hormone fluctuation causing the problems.  On the other hand, more than a third of menopausal women in one recent study reported IBS-type symptoms, like gas and heartburn. We need more research about this.

As mentioned earlier, female sex hormones levels influence the composition of the microbiota in many sites of the body, especially the gut. The gut microbiota influences many diseases outside the gut. This is because of the larger gut immune system. Imbalance of the gut microbiota, called dysbiosis, has been extensively related to metabolic and immunological diseases. Interestingly, the presence or absence of oestrogen may be able to alter the gut microbiota equilibrium and corresponding disease pathways. The interaction between the gut microbiota and oestrogen changes due to lack of oestrogen. This relationship is restructured according to the new circumstances, and this can cause the problem.

Obesity

Obesity affects 65% of postmenopausal women. It is usually associated with metabolic dysfunction. Multiple studies have suggested that postmenopausal women exhibit increased total fat mass and abdominal fat and decreased lean body mass compared with those of premenopausal women, this regardless of ageing. The accumulation of abdominal fat in postmenopausal women seems to be a critical factor in the development of insulin resistance and type 2 diabetes, and the relationship between the gut microbiota and a lack of oestrogen it can be responsible for weight gain and lipid deposition during menopause. Few studies have investigated whether prebiotics and probiotics can improve insulin sensitivity in postmenopausal women or body fat in mice.

Gut Microbiota

Flaxseed mucilage is a prebiotic. The intake of flaxseed mucilage improves insulin sensitivity and alters the gut microbiota in obese postmenopausal women. Thus far, the implications of the gut microbiota with low levels or the absence of oestrogen hormone in the metabolism of women have not been sufficiently studied and require further clarification.

Bone Health

Another link between the gut microbiome and menopausal health is related to bone. Interesting, the gut microbiota has also been found to influence bone homeostasis. And this is very important when it comes to menopause. Approximately one in two women over age 50 or above will break a bone because of osteoporosis. A study that involved twenty postmenopausal women with a mean age of 65 years showed that the group that consumed Lactobacillus helveticus-fermented milk had increased serum calcium levels and reduced bone reabsorption compared with those of the control milk consumption group. It is probably wise to take some supplements once you enter menopause, in order to take care to the gut microbiota.

To conclude, we can say that gut microbiota is influenced by oestrogen levels and this is one of the reason why women in menopause (but even during fertile age as our hormones level change during the month) are more susceptible to IBS or in general digestive problems. Of course, it does not exist (up to now) something that works for everyone, but for sure it is pivotal to follow a healthy diet with plenty of fibres in order to prevent the health of our gut. Supplements as well are something recommended to improve the overall health.

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