Female Hormone Related

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Table of Contents
Gender Bias And IBS
Can Menstrual Cycles Worsen IBS?
Hormonal Birth Control
Pregnancy And IBS
Perimenopause And IBS
Can Menopause Cause IBS?
Hormone Replacement Therapy
How To Manage Symptoms
Further Reading And References

Gender Bias And IBS

Women are twice more likely to have IBS than men. Hormones such as oestrogen and progesterone may play a part in this. (1)

Intestinal walls have receptors which hormones attach to. Digestion senses and reacts to these hormones. (1) Oestrogen and progesterone have functions in the regulation of the digestive system. Progesterone inhibits gastrointestinal contractions, slowing motility (2). Conversely, oestrogen speeds up digestion (3).

Interestingly, new IBS diagnoses in females are more prevalent in teens through to those aged around 45 years. After this age, new onset IBS decreases becoming in line with males from age 70 onwards. (11)

Can Menstrual Cycles Worsen IBS?

Yes. The menstrual cycle, which is roughly 28 days, has 4 stages:

Menses (days 1-5): during your period, oestrogen and progesterone levels are at their lowest
Follicular (days 6-14): the uterine wall thickens from rising levels of oestrogen, which may reduce gastrointestinal symptoms
Ovulation (day 14): the egg is released
Luteal (days 15-28): the uterus prepares for pregnancy with a rise in progesterone, which can lead to bloating, constipation or diarrhoea. Both oestrogen and progesterone drop quickly around days 24 to 28 if pregnancy does not happen. At this point stomach pain, discomfort, and constipation or diarrhoea can become more common and intense

(1) (4)

About 40% of women with IBS report that their menstrual cycle affects their IBS (5).

Hormonal Birth Control

There is mixed evidence about whether birth control pills alleviate or worsen existing IBS (4). Some research suggests no difference between IBS symptoms for those on the pill and those who are not. Some experts believe that continuous birth control, where hormone levels do not change and periods do not occur, may ease IBS symptoms, but more research is needed. (1)

Pregnancy And IBS

Hormone levels rise during pregnancy, which means that some women find that their IBS symptoms improve. According to research pregnancy may also increase pain thresholds, meaning there may be a reduction in cramps and discomfort. (1)

However, hormone changes may impact the lower gastrointestinal tract, causing constipation. (4) The function of the stomach or intestines may be affected as the baby grows and takes up space, potentially causing heartburn, constipation, diarrhoea, nausea and vomiting. (4)

Perimenopause And IBS

There may be significant fluctuations in oestrogen and progesterone in the time leading up the menopause called perimenopause, which can be 8 to 10 years prior to the menopause. These fluctuations can worsen IBS symptoms such as constipation and diarrhoea. (4)

Can Menopause Cause IBS?

No. However, menopause can worsen IBS symptoms. Since oestrogen and progesterone play a part in regulating the digestive system, a drop in both hormones means that food travels more slowly through the gastrointestinal tract. This can increase symptoms such as constipation and bloating. (6)

Oestrogen and progesterone also contribute to the production of stomach acid and bile, which are used to break down food. A reduction in both hormones can lead to gastrointestinal symptoms such as constipation, bloating, acid reflux, or diarrhoea. (6)

There is mixed evidence as to whether IBS symptoms decrease or worsen during the post menopausal period. (5) However, one study suggests that postmenopausal women with IBS experience more severe IBS symptoms than premenopausal women with IBS. (10)

Hormone Replacement Therapy

Studies suggest that hormone replacement therapy (HRT) can worsen IBS, cause newly diagnosed IBS and prolong IBS symptoms due to changes induced in the gastrointestinal tract. (7) (8) (9)

How To Manage Symptoms

Management strategies for IBS, which is worsened by hormonal changes, depend on what symptoms are being experienced. Refer to the Symptoms menu option for information on this.