Periods are annoying enough as they are without adding gut issues such as bloating and gas to the mix. Who hasn’t noticed that at certain times of the month, the two seem to go hand in hand? Rest assured it’s normal, explains dietitian Sophie Medlin of City Dietitians .
“We know that the hormonal changes associated with the menstrual cycle impact gut function on many levels, includes how the bowel contracts, how fast food moves through the bowel, the amount of digestive enzymes that are secreted as well as how sensitive we are to stretches in the bowel wall,’ she says.
However, if you also suffer from Irritable Bowel Syndrome (IBS), your monthly hormone fluctuations can make your already difficult gastrointestinal symptoms (abdominal pain, bloating, flatulence, diarrhoea and/or constipation) worse.
Why would your body be so cruel and what can you do to soften the blow of this double whammy? We asked consultant gastroenterologist Simon Smale to explain.
Men don’t seem to get IBS as much as women, why is this?
“Irritable Bowel Syndrome (IBS) affects men and women of any age, but there is now an overwhelming wealth of medical and anecdotal evidence pointing to the fact that hormones are likely to play a role in exacerbating IBS symptoms meaning women are more likely to suffer. In fact twice as many women have it as men.
What have periods and hormones got to do with IBS?
This may explain why you have more flare-ups at different points of your menstrual cycle. The time of the month at which this happens is hugely variable but there is a tendency for many people to get more abdominal pain and bloating approaching and around the time of menses (your period).
Will hormone-related IBS become easier when I reach menopause?
“While a few people find the menopause leads to changes that exacerbate their symptoms post-menopausal women often find their symptoms improve.”
What are sex hormones doing in my digestive system?
“Oestrogen and progesterone can affect IBS symptoms in different ways, from how our intestines move waste and food along (known as gut motility) to how much pain you feel. Cells in the gut have ‘receptors’ that let these hormones latch on to them. This suggests that your digestive system is designed to sense them. Normally this is a good thing. We rely on all sorts of hormones such as glucagon, insulin and neurotransmitters such as like serotonin to co-ordinate our digestion. However this amazing and complex system can become over or under-senstive to the effects of hormones. This then puts the gut into disarray. In people with IBS, sex hormones influence the bowel function abnormally. It’s like a complex machine, if one thing goes wrong it can have all sorts of effects on other parts.”
What time of the month is worst for IBS?
“Studies show that IBS symptoms can increase in the luteal phase, which is just after ovulation around day 14 to the start of your period. This is when oestrogen and progesterone levels rise to a peak, before falling. The changes in both these can exacerbate symptoms leading up to or during your period. What you experience depends on which symptoms are more predominant for you – such as cramping, loose stools, bloating or constipation.”
Why do I feel not just cramps but everything is more painful around my period?
“Female hormones have an effect on how much pain you experience. Oestrogen enhances the levels of serotonin, a key neurotransmitter in both the gut and the brain, which improves mood and your experience of pain. It works by stopping serotonin re-uptake by the neurons – meaning there is more of it in your system (ie better mood). It works in a similar way to anti-depressants known as SSRIs, which are also sometimes used to treat IBS. Rising levels of oestrogen just after ovulation may lessen pain, but falling levels as your period approaches can lead to increased abdominal discomfort and pain."
“Another factor which may make things feel more painful is that during your period, the uterus also produces messengers known as prostaglandins, which control inflammation and pain, either increasing or decreasing it, depending on which are more prevalent for you. Around the time of your period, some of these prostaglandins may make the feeling of pain in the uterus and the nearby bowel worse, resulting in more painful menstrual cramps and more painful IBS symptoms."
What can I do to lessen the symptoms of IBS?
“Some patients find that HRT or the contraceptive pill can help, but it’s also very important to consider lifestyle factors such as diet, and making sure you are managing stress, with relaxation and exercise."
“A good start is establishing good dietary and lifestyle habits and recognising the role that both stress and diet lapses may play. If you need further help seek the support of an appropriately trained healthcare professional such as a dietitian. Psychological interventions such as cognitive behavioural therapy (CBT) can help manage stress as can exercise and apps such as Zemedy (a 10-week CBT programme for IBS) and Chill Panda - a relaxation app currently being tested by the NHS."
Help is also available from the IBS Network , the national charity supporting patients with IBS. Probiotics too can help reset the system.
How can probiotics help with IBS?
“A good quality probiotic can also help to support your gut before your period. Probiotics that are currently available don’t affect hormone levels directly but some such as Alforex can reduce the sensitivity that is associated with menstrual changes whereas others may help manage stress by improving resilience and the changes in the brain associated with anxiety."
“They usually take about ten days to establish themselves in the system and should be taken for a month or so to assess whether they are of benefit."
Simon Smale is a consultant gastroenterologist working at, among others, York Hospitals NHS Foundation Trust and who works for Alflorex probiotics, £24.95 for 30.