Dr. Ahmed
IBS or Irritable bowel syndrome is primarily a gut disorder. However, it is strongly influenced by hormones. Women during their periods (menstrual cycles) have significant hormonal changes that can exacerbate the symptoms of IBS.
In addition, visceral pain and symptoms of PMS (premenstrual syndrome) are heightened in women with IBS.
IBS may be considered a condition in which the sensory nerves that carry pain sensations and stimuli from the gut are abnormally sensitive and irritable.
During menstrual cycles, pelvic cramps and hormonal disturbances lead to exacerbation of these symptoms.
Symptoms of IBS (Irritable bowel syndrome):
IBS is a disorder of the Gastrointestinal Tract (GIT) in which there is bloating, pain in the abdomen, constipation, mild to severe cramps, diarrhea, etc. These all can be treated with medications or just by changing lifestyle and diet.
Why do symptoms of IBS worsen in women during their Periods?
Periods or menstrual cycle is natural and every woman goes through it during their lifetime but the symptoms can be different for different individuals.
They can suffer from mild to severe pain, cramps, bloating, mood swings, etc but the symptoms are even more severe in the ones suffering from Irritable Bowel Syndrome (IBS).
The periodic cycle is accompanied by constant changes in hormones that affect your GIT and so IBS and period symptoms can correlate and depend on each other.
Hormonal fluctuations
The changes in the release of hormones are the major reason for worsening the symptoms of IBS. In periods, there are constant fluctuations in hormonal concentration and release due to the formation and regression of the corpus luteum.
This changes the release of hormones mainly estrogen and progesterone. According to researchers, the Gastrointestinal tract(GIT) has special receptors for hormones.
So due to this massive change of hormones during the menstrual cycle, the function of GIT bowel movements is thus highly affected, complicating the conditions for ones suffering from IBS [Ref].
Following are the hormones that fluctuate during the menstrual cycle:
- Progesterone
- Estrogen
- FSH (Follicle stimulating hormones)
- LH (Luteinizing Hormones)
In what way do periods affect IBS?
During periods, many women complain of getting worse symptoms of IBS. Many times an individual lives peacefully without even facing any symptoms of IBS but as soon as their menstrual cycle starts, the situation changes.
They may feel the following problems:
- Severe cramps
- Abdominal bloating
- Stomach ache
- Backache
- Gas
- Irritation
- Body pains
- Sleeplessness
- Frequent PMS in which mood and physical health change during periods.
Relation between IBS and Ovulation
During the menstrual cycle, hormonal changes take place. Such as the release of an egg i.e ovulation takes place after estrogen levels reach maximum.
So just after estrogen levels reach a peak, there is signaling to the release of eggs. Then the levels soon drop and progesterone levels increase.
Due to these abrupt hormonal changes just before and after ovulation, the receptors on the gut become very sensitive to these changes.
The symptoms of IBS may worsen. Women may feel severe cramps accompanied by rectal pain, difficult bowel movements, bloating, gas and palpitations, insomnia, diarrhea, or constipation.
IBS and Periods Spotting
IBS and period spotting is closely related as IBS symptoms increase during the initial days of periods and worsen even more during the first two days of bleeding.
So as spotting or bleeding starts, the IBS symptoms such as gas, abdominal bloating, cramps, diarrhea, constipation, etc increases more.
The initial spotting indicates the onset of uterine mucosal shedding. As the cells are sloughed off, the nerves are activated which may result in cross-signaling between the nerves innervating the gut.
Hence, during the initial spotting, the symptoms of IBS may worsen.
IBS One Week Before Periods
IBS is affected but not much one week before periods. Its symptoms mainly change during periods. Before the onset of periods, there is not much change in hormonal levels than that during periods, so IBS symptoms change but to a lesser extent one week before periods.
You might start getting slight problems with bowel movements, bloating, gas, cramps, constipation, etc.
However, women with PMS (Premenstrual syndrome) may experience pains a week prior to the onset of menses. These symptoms may simultaneously exist with the symptoms of IBS.
IBS One Week After Periods
IBS symptoms get worse from the 14th day i.e after ovulation to the first day of upcoming periods. This change is because on the day of evolution, the peak in estrogen level falls and progesterone levels start rising slightly.
This sudden drop in levels of estrogen increases the sensitivity of the Gastrointestinal (GI) system and thus worsens IBS with severe constipation or diarrhea.
IBS and Hormonal Changes
Same as during the menstrual cycle, pregnancy is also accompanied by sudden and many changes in hormonal concentrations.
During pregnancy, the estrogen and progesterone levels vary highly so the hormonal receptors on GIT detect this change and become more sensitive to it affecting the bowel movements.
It may cause severe constipation or diarrhea along with bloating, gas, irregular bowel movement, etc. So IBS is affected by both pregnancy and periods.
IBS Symptoms during the Luteal phase
During the 24th to 28th day of pregnancy, progesterone and estrogen levels fall quickly if pregnancy doesn’t take place as it is the job of progesterone to maintain the uterus for the conception of pregnancy.
So during this time of the female cycle, there is a sudden fall of hormones and thus IBS flares up with intense symptoms.
Thus during the late luteal phase, you may face severe constipation, abdominal pain, cramp, diarrhea, etc.
The worst part is that the ones having very painful periods, a condition called “dysmenorrhea”, have even worse periods when having IBS.
IBS and Menopause
There is no authentic and proven research about the direct relation between IBS and menopause but according to many individuals, IBS symptoms are less common in ones with menopause.
This can be due to the reason that hormonal changes stop due to menopause. As there is no sudden change or drop in levels of estrogen and progesterone, the main symptoms of IBS such as gas, bloating, diarrhea, constipation, etc don’t occur.
However, some women have also reported some of these symptoms after menopause. Proper research is yet to take place on the relationship between menopause and IBS.
How can you help IBS during Periods?
Since IBS symptoms are closely linked with hormonal changes, changes in gut flora, mood changes, and stress, treating these factors can greatly improve the symptoms of IBS.
There are some OTC medicines like Buscopan and mebeverine which improve visceral pain, antacids which may help acidity, and probiotics which can help restore the normal gut flora.
However, there isn’t one single drug that helps all people with IBS.
Keep yourself hydrated
Drink 8-12 glasses of water daily as water relieves cramps and increases the motility of GIT which not only relieves constipation but also fulfills the deficiency of water during dehydration caused by diarrhea.
Multivitamins
Take multivitamins as their intake reduces fatigue and muscle cramps. Vitamins such as magnesium relax the muscles reducing cramps.
Moreover, zinc, calcium, and iron also help in reducing fatigue and easing constipation, diarrhea, and bloating.
Avoid iron supplements that may worsen your symptoms of IBS.
Silicon gel
Start using silicon gel as it is very helpful in issues related to digestion. It contains silicic acid which attaches to the walls of the stomach and intestine that removes harmful pathogens safely from the body.
Fiber-rich foods
Eat foods rich in fiber such as fruits, vegetables, chia seeds, chickpeas, whole wheat grain, etc which not only relieves constipation and cramps but also safely removes toxins from the body.
Enough sleep
Try to sleep for 8 hours daily at least to relax your body muscles and increase your metabolism to reduce muscle cramps, abdominal bloating, gas, etc.
Exercise
Exercising daily will ease your muscles and speed up body functions as well as digestion. Thus relieving IBS symptoms in periods.
Healthy diet
Try to eat a healthy diet rich in nutrients such as fruits, vegetables, etc.
Follow a schedule
Be disciplined in eating and sleeping. Eat and sleep on time.
Foods to avoid
There are certain foods you should avoid that trigger IBS, periods, or both. Try to avoid spicy foods, and high protein foods as they may cause constipation.
Moreover, avoid eating too many fibers as they may not be suitable for diarrhea. A high FODMAP diet may worsen bloating and gas formation. They could also increase visceral pain.
Medications
Certain medications are proven to be very helpful in such conditions and are often prescribed by doctors such as:
- Antidepressants (Paroxetine)
- Antidiarrheal (Loperamide)
- Muscle relaxants (Buscopan)
- Laxatives (Miralax, stool softeners)
- Pain killer (Tramadol and Acetaminophen)
- Novel medicines (Linzess, Trulance, Lubiprostone, Tegaserod, Eluxadoline)
In Summary:
The symptoms of IBS worsen in women during their menstrual cycles. Women with PMS (premenstrual syndrome) are especially at risk of developing the symptoms of IBS as they have low pain thresholds.
The treatment of IBS during periods follows the same principles including pain medications, muscle relaxants, and the restoration of gut flora.
