Monday, 13 March 2017

IBS and THAT Time of the Month...

By Lyndal McNamara (Research Dietitian)




That’s right ladies, you have not been imagining things. IBS symptoms really can and often do worsen around the time of your period. Over our next few blogs we will explore why this is the case and also discuss some practical strategies to help you better manage symptoms around your period.
So why do my symptoms get worse in the lead up to and during my period?
The short answer… Hormones.

Levels of female sex hormones (oestrogen and progesterone) fluctuate significantly throughout the month (see diagram below). Oestrogen reaches its peak just before ovulation, followed by a rapid drop in levels after ovulation. Progesterone on the other hand reaches its peak during the ‘luteal phase’, then levels drop rapidly just prior to the start of menses (your period). Both hormones are at their lowest level around the start of your period. Studies have noted that IBS symptoms tend to worsen as hormone levels fall. You see, just like your uterus, your gut also has receptors for these hormones, which can affect how your gut contracts, gut sensitivity and levels of inflammation.1



In fact, a landmark study using rectal balloons (yes, a balloon inflated in the bottom!) demonstrated that women with IBS have a more sensitive gut around the time of menses than healthy controls.2 Prospective studies have also shown that GI symptoms are more severe in women with IBS compared to those without IBS around menses.1 This suggests that women with IBS respond differently to fluctuations in female hormones, however more studies are needed to identify the exact mechanisms behind this.1,2  
If your periods are particularly painful or heavy, it is important to consider having your symptoms reviewed by a gynaecologist. Endometriosis is a common condition affecting 1 in 10 women, and like IBS, can increase gut sensitivity.3,4  Endometriosis symptoms often overlap with features of IBS, including worsening of GI symptoms around menstruation.3,4

In next week’s blog we will discuss specific strategies to implement during THAT time of the month to assist with alleviating symptoms.

References:

  1. Bharadwaj S, Barber MD, Graff LA, Shen B. Symptomatology of irritable bowel syndrome and inflammatory bowel disease during the menstrual cycle. Gastroenterology Report. 2015;3(3):185-93.
  2. Houghton LA, Lea R, Jackson N, Whorwell PJ. The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers. Gut. 2002;50(4):471-4.
  3. Issa B, Onon TS, Agrawal A, Shekhar C, Morris J, Hamdy S, et al. Visceral hypersensitivity in endometriosis: a new target for treatment? Gut. 2012;61(3):367-72.
  4. Hansen KE, Kesmodel US, Baldursson EB, Kold M, Forman A. Visceral syndrome in endometriosis patients. European journal of obstetrics, gynecology, and reproductive biology. 2014;179:198-203.


5 comments:

  1. This is sooooooo on-point with my body. Hormones are really getting in my way of feeling normal! I am desperately considering getting on birth control just to stabilize this and see if it helps my IBS (even though I really hate drugs) Please keep the articles coming. I am EAGER to hear more!!!

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  2. Thank you for this precious information. However I am 60 years of age and of course menopaused. I am certain I have had IBS all my life with worsening as I age. I am using hormones to alleviate hot flashes and other rather tiring symptoms. While trying to cut down on the medication I have notices an increase in disconfort and pain in my gut. Could even a small decrease in hormones cause such trouble ? Thanks for your precious response. Suzanne

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    Replies
    1. Hi there,

      Thank you for your comments. There is still a lot of research to be done in this area. If you are experiencing further discomfort and pain we recommend visiting your doctor and/or dietitian to understand more what may be the cause. If diet can help your dietitian will be able to support and guide you appropriately.

      Kind regards, Marina

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  3. I get constipated before my period then everything works better when I get my period.I try to predict the dates so I can eat more roughage but they are changing I think? I am 50.

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