IBS and periods: what you need to know

It’s no secret that having your period can come with uncomfortable and annoying symptoms like bloating, frequent bathroom trips, constant stomach aches, and painful cramps. But for people with irritable bowel syndrome (IBS), symptoms can be even worse, from the start of your period and throughout your cycle. The reason could be the connection between the gut and the functioning of the reproductive system during a menstrual cycle. Read on to find out how your IBS symptoms may affect your period. The Gut and the Reproductive System The gut and the reproductive system influence each other According to Olubunmi Oladunjoye, MD, MPH, a general internist and assistant professor at Baylor College of Medicine in Houston, the gut contains receptor cells for the female sex hormones estrogen and progesterone. So changes in these hormone levels can impact how the gut functions. An article published in Gut Microbes in 2021 noted that the gut microbiota – all the microorganisms present in the intestine – coordinates the activities of the reproductive system by interacting with sex hormones such as insulin, estrogens and androgens. Research also shows that excess harmful gut bacteria (dysbiosis) can increase estrogen levels by preventing the liver from breaking down excess estrogen. According to the Cleveland Clinic, high estrogen causes an overgrowth of tumor-like cells along the uterine lining, leading to pain and conditions such as endometriosis. And that’s not all. Disruption of the balance of the gut microbiome may also play a role in cancers, pregnancy complications, and disorders like polycystic ovarian syndrome, among other reproductive-related conditions. But, as the authors of the Gut Microbes article state, research into exactly how the gut and reproductive system interact in this way is lacking. The connection between the gut and reproductive health is “basically a control or balance of estrogen and progesterone,” says Rudolph Bedford, MD, director of gastroenterology at Providence Saint John’s Health Center in Santa Monica, California. He adds that estrogens, in particular, can “control and cause various situations within the gastrointestinal tract.” Using estrogen as an example, Dr. Bedford explains how female sex hormones interact with the gut microbiome: the liver turns off active estrogen carried by the ovaries. This deactivated estrogen then leaves the liver through the bile and travels to the small intestine, which is home to the microbiome. Gut bacteria produce an enzyme that interacts with estrogen before it is excreted. But if the microbiome is disrupted, estrogen may not be metabolized properly. Instead, it can return to the bloodstream, possibly causing digestive problems such as constipation and bloating. Bedford believes that excess circulating estrogen and progesterone caused by dysbiosis can also lead to heavy periods, uterine fibroids, breast cancer, and painful periods (dysmenorrhea), as well as altered bowel habits. Menstrual Cycles and Gut Health How do menstrual cycles impact gut health? It all depends on hormones. During your period, hormones don’t just affect your mood and energy levels—they can also control your digestive system. Sex hormones fluctuate during different phases of the menstrual cycle, explains Dr. Oladunjoye. “Estrogen typically peaks just before ovulation, while progesterone is at its peak during the luteal phase – the phase between ovulation and the start of menstruation. But these hormones drop to the lowest levels just before menstruation begins.” Estrogen and progesterone control contractions of smooth muscle in the intestines, affecting how quickly food moves through the gastrointestinal (GI) tract. “During menstruation, some women tend to have abdominal pain and others have diarrhea,” she says. Many of these gastrointestinal disorders are linked to the actions of female sex hormones. Oladunjoye also notes that when progesterone peaks during the luteal phase, it usually causes constipation. Additionally, each month before your period, your body releases natural chemicals called prostaglandins, which play a vital role during your cycle. They trigger the muscles in your uterus to contract, making it easier to shed the uterine lining. The bad news is that these prostaglandins can have the same effect on your intestines. The result? More frequent poops and even diarrhea. In a nutshell, the hormones associated with your period interact with your gut to cause various symptoms. With IBS, symptoms can be much worse, according to the International Foundation for Gastrointestinal Disorders. IBS and your period What is the link between IBS and your period? Again, hormones appear to play a role in worsening IBS symptoms. “Estrogen and progesterone inhibit smooth muscle contractions in the intestines, which negatively affects intestinal motility and may cause an increase in IBS symptoms during menstruation,” explains Oladunjoye. In a study published in Cureus in 2021, more than half of participants with IBS experienced bloating during all phases of their menstrual cycle. The study also found that premenopausal IBS patients experienced more symptoms during their periods that affected their daily activities and reduced their quality of life than during other stages of the cycle. In a study published in Neurogastroenterology Motility in 2021, postmenopausal IBS patients had more severe symptoms than premenopausal patients. The study also compared men (who don’t menstruate) of similar ages and found no age-related changes in symptom severity. The findings suggest that lower levels of female sex hormones – particularly estrogen and progesterone – may affect brain-gut interaction and increase IBS symptoms. There is also evidence that low levels of sex hormones could also be the cause of the increased severity of pain and gastrointestinal symptoms in IBS patients during their monthly cycle. Estrogen affects how the body uses the feel-good hormone serotonin, which increases your pain threshold to help you manage pain such as menstrual cramps. If you’re experiencing terrible cramping early in your cycle, a drop in estrogen levels may be the cause. As female sex hormone levels decrease, cramping and gastrointestinal symptoms such as constipation, bloating, and bowel movements increase. People with IBS already suffer from the gastrointestinal symptoms associated with periods, so when that time of the month arrives, the severity of these symptoms skyrockets. How to Relieve IBS Symptoms How to Relieve IBS Symptoms During Your Period During this time of the month, Oladunjoye recommends treating your IBS symptoms the same way you would treat them at any other time. She suggests: Avoiding trigger foods, like fried foods, that could set off your symptoms, especially during your period. Eat more foods with soluble fiber. Avoid foods that cause gas like beans, broccoli, Brussels sprouts, and cabbage because they increase bloating, especially during your period. Drink plenty of water. Exercise regularly. Enjoy quality sleep. Follow your IBS medications as prescribed by your doctor. See a doctor to ensure proper diagnosis and treatment if your symptoms prevent you from performing your daily activities. Taking Care of Your Gut and Reproductive Health Taking Care of Your Gut and Reproductive Health Maintaining the interplay between sex hormones and the gut microbiome will support gut and reproductive health, says Bedford, and improve the period experience. He notes that a healthy microbiome is important for a healthy reproductive system; it promotes the proper metabolism of sex hormones, which prevents the appearance of digestive disorders. To keep your gut and reproductive health in tip-top shape, follow these tips: Stay physically active – from walking to lifting weights, the key is to keep moving. If you’re too busy and can’t make it to the gym, Oladunjoye says at-home workouts can be just as effective. Here’s how you can get started. A healthy and balanced diet is essential. Oladunjoye argues that what we feed our guts can affect our reproductive health (and our health in general). Include plenty of fruits and vegetables in your diet as they promote quality bowel movements. But keep in mind that some fruits and vegetables may be difficult for some people to digest. If this happens, it’s a good idea to consult your doctor or a nutritionist to develop an eating plan. And if it’s difficult to get enough fiber from food alone, Oladunjoye says taking a supplement could help. Consider taking probiotics, suggests Bedford. (Note: According to the American Gastroenterological Association guidelines, there is insufficient evidence to support the use of probiotics to treat IBS.) Reduce your alcohol intake, and don’t overdo it with caffeine, either. Try to manage and reduce stress.