IBS and THAT time of the month
by Lyndal McNamara (Research Dietitian), Monash University
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:
- 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.
- 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.
- 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.
- 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.