Read More at Well+Good
[[{“value”:”
Perimenopause isn’t just marked by days on the calendar until full-blown menopause arrives. It comes with its own host of symptoms, which you’ll likely notice alongside irregular menstrual cycles. Some major ones include hot flashes, poor sleep, and mood swings. But this midlife shift can also majorly affect your gut, as I’ve learned firsthand.
As someone who travels often, I’m no stranger to the occasional travel constipation. The change to my routine, food choices, and time zones can cause me to feel particularly backed up. As I progress through the stages of perimenopause, though, I’ve noticed this constipation has intensified and become more of a constant in my life.
Turns out, constipation is an especially common symptom for people in perimenopause. There aren’t current stats, but one 1998 study in Women & Health found that 14 percent of people report changes in bowel function during perimenopause. (That number rose to 38 percent in people who’d already reached menopause.)
Thankfully, there are ways to relieve it. Here, learn more about the link between perimenopause and constipation, how to get your gut “going” again, and when to see your doctor.
Why does perimenopause cause constipation?
There are a few reasons why perimenopause causes constipation, including:
Hormone fluctuations
The most common reason for gut changes, and constipation in particular? Hormones. As your estrogen levels begin to drop in perimenopause, another hormone called cortisol (i.e., a stress hormone) can spike. Alternatively, being under a lot of stress can increase your cortisol and affect the amount of reproductive hormones your body makes, per the Cleveland Clinic.
“Cortisol surges can affect digestion,” explains Taniqua Miller, MD, OB/GYN, a clinician at Evernow and founder of TaniquaMD. “It’s a stress hormone, and any time we’re stressed we’re going to see an exacerbation of motility issues in the gut.” (In other words, stress can slow digestion way down.)
Between that and common life stressors (like aging parents, teenage kids, and/or challenging careers), it can add up to the perfect stress storm, grinding your gut to a near-halt.
On top of rising cortisol, drops in the hormone progesterone (commonly seen during perimenopause) can also cause your colon to slow down, according to an April 2022 review in Physiological Research.
Dietary changes
Any dietary shifts you make during this time can worsen constipation, too. Dr. Miller says you’re more likely to crave carbohydrates or comfort food during this time, to help cope with any physical and emotional discomforts of perimenopause. But these foods (like fried food or ultra-processed foods) tend to sit in your digestive tract longer, causing constipation, she says.
On the other end of the spectrum, you may start to eat less in an effort to lose weight gained during perimenopause. Not only is this unhealthy and unsafe, but it can make your gut feel even worse, too.
“Sometimes, when women gain weight during this transition, they’ll start doing fad diets,” says Dr. Miller. “Or they start doing intermittent fasting, but not in a way that actually promotes increased metabolism. That can actually slow down gut transit.”
Pelvic floor dysfunction
Last but not least, there’s the pelvic floor to consider. Perimenopause can cause complications for the often-overlooked group of muscles within your pelvis—which help support body functions like pooping, peeing, sex, and pregnancy, per the Cleveland Clinic.
Any irritation, muscle spasms, scar tissue, or tightness of the pelvic floor can negatively affect your colon function, leading to potential constipation, per the Cleveland Clinic.
“Problems with the pelvic floor that women have over time—like issues with past hysterectomies or other kinds of pelvic surgeries—may also create risk factors for constipation,” says Asma P. Khapra, MD, a gastroenterologist with Gastro Health in Fairfax, Virginia.
How to treat perimenopause-related constipation
Thankfully, no matter the cause, there are safe and effective options to manage perimenopause-related constipation. These include:
Get more fiber
One of the best ways to regulate your gut is by eating enough fiber, whether you’re in perimenopause or not. Aim to get at least 25 to 30 grams of fiber per day, from food sources that help increase healthy bacteria in your gut, per UCSF Health.
“Prebiotic high-fiber foods include things like oats, sweet potato, onions, leeks, garlic, chicory root, Jerusalem artichoke, asparagus, and apples,” says Susie Garden, BN, a clinical nutritionist based in Australia.
Move your body
It’s never a bad idea to get moving, especially if you want your bowels to “get moving,” too.
“Exercise is huge,” says Dr. Khapra. “Your gut motility just slows down over time. But if you think of your gut as a muscle, you have to exercise it just like you would any other muscle, to keep it active and moving.”
That’s why it’s extremely important for perimenopausal people to exercise if dealing with constipation, she adds.
Stay hydrated
Staying hydrated helps keep stool soft and reduces your risk of constipation. For overall health, aim to drink about eight 8-ounce glasses of water per day. Or you can choose other hydrating beverages like prune juice or tea, according to Penn State College of Medicine.
Try over-the-counter (OTC) or prescription laxatives
If diet, movement, and hydration changes don’t make much difference, turning to certain medications can help, too. Ask your doctor about the safest OTC laxatives or stool softeners, which can help provide temporary relief, per Penn State College of Medicine.
If your constipation is chronic or severe (i.e., you regularly have fewer than three bowel movements per week, per the Mayo Clinic), your doctor may be able to offer a prescription-strength laxative or stool softener.
Consider supplemental estrogen
Looking at your perimenopause symptoms in a more holistic way may also lead you to trying a low, supplemental dose of estrogen. This may not only offer constipation relief, but could address other symptoms like hot flashes and vaginal dryness.
“I see the constipation as a byproduct of everything else that’s happening,” Dr. Khapra says. “If I have someone who’s telling me her sleep is poor, she feels irritable, her mood is worsening, I’m going to know that is probably an estrogen deficiency issue, and we’ll talk about what it looks like to give back a bit of estrogen. In my mind, if I give you back a little, now you’re sleeping well. Now the cascade of events reverses, you’re feeling better, and eating better.”
You might just be pooping better, too.
A note: Estrogen and other forms of hormone replacement therapy (HRT) may not be best for everyone. Talk to your doctor about whether or not HRT is right for you, and ask about alternative treatment options if not.
How long does perimenopause-related constipation last?
The literal and figurative strain of perimenopause and constipation can make life miserable, so it’s natural to wonder when things will start “moving” again. Unfortunately, every body is different, so there’s no clear answer.
“It’s all over the map,” says Dr. Khapra. “Sometimes, any acute changes even out, but a patient’s new ‘baseline’ may become different. It’s not like one big blip and then everything normalizes—it’s more like you have a change and then a ‘new normal.’”
What’s more, patients with pre-existing gut issues might find their conditions worsen as perimenopause progresses. Dr. Miller says some of her patients with IBS-C (irritable bowel syndrome-constipation) or IBS-D (irritable bowel syndrome-diarrhea) often have flares due to stress in the digestive tract during this transition.
Personally, I’ve found my own symptoms have worsened and last considerably longer, particularly when I’m on the road. I’m usually indulging diet-wise and working out far less. Add to that a disrupted sleep schedule, all the stresses of travel, and having to “hold it” if I’m on-the-go…and well, you get the picture.
Symptom management for me looks like taking extra precautions when I travel, or when I’m particularly stressed at home, to prevent constipation in the first place. This means always having a water bottle on hand, exercising as often as I can, choosing probiotic-rich food for breakfast, and making time for meditation each day, to relieve stress.
And if you don’t think lifestyle changes could possibly work, Garden says they go a long way when it comes to relieving stress-induced constipation.
“It’s very easy to get overwhelmed in perimenopause, so women need to be kind to themselves,” she says. “Seeing a therapist to help during this time is ideal, but otherwise, eating well, breathing deeply, drinking your water, and practicing self-care will help.”
When to see a doctor
Constipation is very normal during the transition to menopause. If you’ve tried making the above changes and are still backed up, reach out to your doctor for support.
Additionally, if your constipation is prolonged and comes with alarming symptoms like rectal bleeding, severe pain, and rapid weight loss, get to your doctor as soon as possible. They’ll likely run some tests to help rule out any serious underlying conditions like inflammatory bowel disease (IBD) or colon cancer.
And lastly, if other perimenopause symptoms are getting you down, there’s no shame in reaching out for help, says Dr. Khapra.
“I do still think women come in a little embarrassed to talk about it, likely because the stigma still remains (though it’s getting better),” adds Dr. Khapra. She says patients will preface the conversation by saying “I know this is embarrassing…,” but she always replies, “This is what I do all day, you never have to apologize!”
“}]]