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Menopause and GI Symptoms

Medically reviewed by Asma Khapra, MD, Susan Kerrigan, MD and Marianne Madsen on March 29, 2023

Menopause is a natural change every woman undergoes as her body begins to stop producing hormones such as estrogen. That change, though, is accompanied by several symptoms that can be uncomfortable to experience. One of the many changes occurs in the gastrointestinal tract, which can lead to constipation and diarrhea. Many women are familiar with these symptoms which often occur in the days ahead of and during a menstrual cycle. While these symptoms aren’t particularly pleasant, there are ways to counteract them.


Why does menopause impact my GI tract?


Menopause can have several gastrointestinal symptoms, ranging from constipation and diarrhea to bloating, indigestion, weight loss or gain to heartburn and vomiting.


Most people think about changes to the ovaries and the uterus when considering menopause. While hormones such as estrogen are produced in the ovaries, those hormones have impacts throughout the entire body, including the GI system. Interestingly, estrogen receptors are actually located in the small intestines and stomach. 


Scientists and doctors often refer to the brain-gut axis because the two are so closely connected through hormones, particularly estrogen and stress hormones such as cortisol. Some studies have shown that cortisol can have an even bigger effect on gut function than estrogen. Cortisol production can increase during certain stages of menopause, which can lead to gastrointestinal issues. The increase in cortisol production triggers a boost in adrenaline production, and that can lead to several gastrointestinal issues as well.


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Constipation during menopause


Several factors can play into why constipation is a symptom of menopause. One is that the estrogen receptors located in the small intestine and stomach can impact muscle contractions in places such as the colon, which can lead to constipation. Adrenaline stops digestion, which can lead to several issues, including constipation. An increase in adrenaline leading to the shutdown of the gastrointestinal tract makes sense — adrenaline is often released in a fight-or-flight situation, and blood needs to move away from the intestines and into the muscles of the arms and legs. Additionally, menopause typically causes the muscles of the pelvic floor to weaken, which can cause more issues in creating bowel movements. 


In addition to those changes, menopause and older age can cause pain in the joints and the back, which could lead to less movement overall. That reduction in physical activity also can slow down the intestines and cause constipation. IBS, or irritable bowel syndrome, is also common among women and can be affected by hormonal shifts during menopause. This can result in constipation but also diarrhea.  


Diarrhea during menopause


On the flip side of the gastrointestinal coin is the symptom of diarrhea. This is the symptom where cortisol plays the biggest role. Increased cortisol levels can lead to elevated blood sugar and blood pressure, and it also can interfere with the levels of stomach acid. Diarrhea can also be an unfortunate consequence of these higher cortisol levels, in conjunction often with other hormonal changes.  Unfortunately, like constipation, diarrhea is a common symptom during perimenopause and menopause.


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Differences in menopause symptoms based on ethnicity


A study by the North American Menopause Society of 1,000 women across different several different ethnicities found that while all women undergo menopause, women from different ethnic backgrounds have widely varying experiences based on that background. The study found:


  • Asian women had the least severe gastrointestinal symptoms.
  • White women had the most severe gastrointestinal symptoms, particularly nausea/vomiting, diarrhea, constipation, and loss of appetite.
  • Hispanic women had more severe constipation, weight gain, and bloating.
  • Black women had the most severe weight loss.


While women may experience different symptoms or severity of symptoms, there are several ways to improve overall digestive health.


Improving digestive health during menopause


One major way to improve digestive health is to ensure you are consuming the correct foods and beverages. Foods including vegetables, fruits, whole grains, lean proteins such as lentils and beans, and low-fat dairy products should be the bulk of your diet. Additionally, limiting alcohol consumption to one drink per day or less and increasing water consumption can help with many gastrointestinal symptoms. Also, if you’re struggling with hot flashes, reduce your consumption of caffeine and spicy foods, as those both can trigger some hot flashes.


Continuing to exercise also can help improve digestive function, particularly constipation. Engaging in regular movement is important not only for a woman’s gastrointestinal health but also to keep bones strong and to prevent weight gain.


Written by John Bankston

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