Updated: 2019, Jun 12

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How Female Hormones Aggravate Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a collection of symptoms such as cramping, abdominal pain, bloating, diarrhea, and constipation.
Irritable Bowel Syndrome
The most common symptoms of irritable bowel syndrome (IBS) are the pain in your abdomen. Shutterstock Images

Do hormones play a role in the development of Irritable Bowel Syndrome (IBS) symptoms in women? In this article, we will discuss how hormones play a role in the development of IBS in females, as well as the importance of hormonal balance in the prevention and treatment of IBS.
Irritable Bowel Syndrome, also known as IBS or spastic colitis, can affect around 10 to 20 percent of the population worldwide[1]. It is a gastrointestinal condition with distressing symptoms like abdominal pain and irregular bowel movements, such as alternating constipation and diarrhea.
IBS is a totally different condition than inflammatory bowel disease or IBD. IBD, which is composed of Crohn’s disease and Ulcerative Colitis, is also an inflammatory disease just like IBS, but with more severe symptoms that IBS. The management of these two conditions is also different from each other.
The symptoms of IBS often start in adolescence or early adulthood and is marked by remissions and exacerbations, which has something to do with diet. Exacerbations can cause more psychological stress to the sufferer; however, there are no serious symptoms, unlike inflammatory bowel disease wherein there is weight loss, insomnia, fever or bloody stools.
Instead, IBS usually causes gastrointestinal symptoms such as diarrhea, constipation and abdominal pain.
However, IBS symptoms can be more severe in females. Evidence shows that this may be due to hormonal fluctuations all throughout the menstrual cycle. In women with IBS, pregnancy is a challenge because constipation can worsen during pregnancy.
The factors that contribute to constipation include the intake of iron-containing supplements, decreased hydration due to increased fluid demands and increased progesterone levels.
Pregnancy also has effects on gut function. During pregnancy, there is an increase in blood volume by 50%, so that fluid volume is diverted from the intestines to the other parts of the body. As a result, there is decreased water content in stools, leading to constipation.

What are the Symptoms of IBS?

Irritable Bowel
Irritable bowel syndrome – An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. Shutterstock Images

The manifestations of IBS range from changes in bowel movements such as constipation, hard and narrow stools, pain during bowel movements and infrequent bowel movements. Constipation that results may not respond with laxatives.
There may be additional symptoms of irritable bowel syndrome in women such as mucus that comes from the vagina, mucus during bowel movements, nausea, indigestion, muscle aches, pain during sex, low sex drive, urinary symptoms such as urinary frequency and premenstrual symptoms.

The Impact of Female Reproductive Hormones On the Gut

Menarche or the first menstrual period is dependent on hormones such as estrogen and progesterone. These hormones are needed in producing and releasing an egg per month. If the egg or ovum is not fertilized, menstruation results because there will be a sudden drop of hormones at this phase.
Scientific evidence has shown that these two hormones influence bowel movements, particularly progesterone, which can slow down gut transit time[2]. Progesterone levels are highest during ovulation, and this will also be the time when constipation may be more present.
However, both progesterone and estrogen levels drop before the beginning of menses, bringing about cramps and even diarrhea. Menstrual cramps may occur simultaneously with bowel cramps.
Estrogen and progesterone levels spike up during pregnancy. Thus, in the later stages of pregnancy, progesterone may continue to rise up until the third trimester.
This is why constipation most likely occurs during the third trimester, adding to the decreased fluid intake, the increased abdominal pressure brought about by the expanding uterus, and iron supplement intake, which all trigger constipation.

Menstrual Cramps
The majority of women with IBS who seek health care are of reproductive age. Shutterstock Images

There is more evidence that shows how female reproductive hormones affect the gut. According to studies, the gallbladder and the gastrointestinal tract are more sensitive to female reproductive hormones than to any other substance in the body. Thus, during pregnancy, women are more inclined to have IBS, and also while they are in their reproductive years.
During pregnancy, the gallbladder increases in size and becomes more slow in its movements after a meal. The small bowel also moves slower, while the esophagus experiences reflux. All these changes may get reversed once the baby is born.

IBS Is Diagnosed Based On Symptoms

IBS is diagnosed clinically, from a medical history and a physical exam. The doctor usually asks the patient with regards to the frequency of bowel movements and the consistency and appearance of stools.
There are no blood tests nor other exams that can accurately diagnose IBS. The stools may appear as hard lumps or may be dry, cracked, watery, soft, mushy or smooth. The characteristics of stools are better defined by the Bristol Stool Scale[3].
The Rome IV criteria are normally used to classify IBS. The main criterion is abdominal pain that occurs at least once a week for three months that must be accompanied by changes in stool appearance, frequency, or increased pain.
Here are the classes of IBS

  • IBS-C, where constipation is the primary symptom
  • IBS-D, where diarrhea is predominant
  • IBS-M, where there is both constipation and diarrhea
  • IBS-U for those not belonging to the above categories[4]

IBS may also present with mucus production and abdominal distention. Women who are affected by IBS may change from one category to another over time, depending on their predominant symptoms. Usually, when there is diarrhea, there may be rebound constipation and so on, creating a cycle.

Patient
Your doctor will ask about your symptoms and look for a certain pattern in your symptoms to diagnose IBS. Shutterstock Images

The diagnosis of IBS can be done easily by the doctor, unless there are symptoms such as the following, which may warrant more testing:

The quality of life of women with IBS is usually based on the following parameters:

  • Food avoidance – 32%
  • Emotional distress – 45%
  • Sexual issues – 60%
  • Relationship problems – 63%
  • Body image – 57%
  • Activity interference – 49%
  • Anxiety over health – 54%

Outlook

The management of IBS in women varies differently from that in men due to the influence of the female reproductive hormones. Good hydration and proper nutrition should be ensured all throughout the menstrual cycle and during pregnancy.
Hormonal imbalances should be treated with oral contraceptive pills, injectable medicines and other treatments for better control of IBS symptoms. Physical activity and relaxation also help.
Read Next: 7 Foods Rich In Probiotics That Are Beneficial To Your Gut
Also, as IBS is also dependent on other factors such as the gut microbiome, patients with IBS should also explore ways on how to maintain beneficial flora in the gut. These ways include making proper food choices, avoiding stress and lessening antibiotics use.
If the gut microbiome is healthy, symptoms of IBS will also subside[6]. Consuming fiber, prebiotics and probiotics are also beneficial ways that can keep the gut microbiome healthy, and there is a lot of evidence proving that.

[1] Bercik P, Verdu EF, Collins SM. “Is irritable bowel syndrome a low-grade inflammatory bowel disease? Gastroenterol Clin North Am. 2005 Jun. 34 (2):235-45, vi-vii.
[2] Everson GT, “Gastrointestinal Motility in Pregnancy”,Gastroenterol Clin North Am. 1992 Dec;21(4):751-76.
[3] Heaton, K W & Lewis, S J 1997, 'Stool form scale as a useful guide to intestinal transit time'. Scandinavian Journal of Gastroenterology, vol.32, no.9, pp.920 - 924.
[4] Schmulson MJ, Drossman DA. What is new in Rome IV. J Neurogastroenterol Motil. 2017 Apr 30. 23 (2):151-63.
[5] Brandt LJ, Chey WD, Foxx-Orenstein AE, et al, for the American College of Gastroenterology Task Force on Irritable Bowel Syndrome. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009 Jan. 104 suppl 1:S1-35.
[6] Mayer EA, Savidge T, Shulman RJ.” Brain-gut microbiome interactions and functional bowel disorders”, Gastroenterology 2014 May;146(6): 1500-12.
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