IBS and the menstrual cycle. Is there a connection?

Do you feel that your IBS symptoms increase during your period? You’re not alone.

Irritable bowel syndrome (IBS) and the menstrual cycle are connected because the symptoms of IBS can be exacerbated during the menstrual cycle. Some women may experience more abdominal pain, bloating, diarrhea, or constipation. Additionally, stress and changes in the diet can exacerbate symptoms. 

There are several articles floating around suggesting that the fluctuation of hormonal levels during the menstrual cycle may influence GI symptoms. So, I thought, let’s dig into this and see if there is any truth to it. 

First, let’s take a look at some of the research that has been done by various authors. 

A study done by Kane et al looked to see if there was a relationship between the menstrual cycle and bowel function. They used a questionnaire to interview people with both, IBS and IBD, to determine GI symptoms and patterns in their menstrual cycle. 

Their results: those people with IBS and IBD were more likely to experience premenstrual and menstrual bowel habit changes (recurrence of diarrhea being the most significant), with worsening of disease symptoms during both phases. 

Another study done by Bernstein et al concluded very similar results to Kane et al. Their main focus was to look at the relationship between GI symptoms and emotional symptoms during menses. Their study was interesting as they excluded women with a known history of IBS or IBD. 156 women participated in their study and of those 156, 73% reported at least one GI symptom premenstrually, and about two-thirds (67%) reported at least one GI symptom during menses. 

The most common complaints were abdominal pain and diarrhea and the secondary GI symptom was bloating. Those with anxiety reported significantly more issues with nausea and GI symptoms (abdominal pain, diarrhea, vomiting), premenstrually, and during menses. 

The why.

Well, several theories are circulating out there as to why some women may experience GI symptoms around menses. Here are a few of them. 

1. Prostaglandins: In the gut, prostaglandins can cause smooth muscle contractions, as well as reduced absorption and induced secretion of electrolytes in the small bowel, all of which may intensify GI pain and diarrhea. 
2. Progesterone: Increasing or changing levels of progesterone may be a cause of diarrhea. 
3. Estrogen: Estrogen surges during the menstrual cycle appear to cause decreases in gut motility, increased gut permeability, and heightened pain perception. Theories suggest that times of hormonal surges may contribute to worsening GI symptoms. 
4. Non-steroidal anti-inflammatory (NSAID) use: NSAIDs are known to cause intestinal and colonic inflammation and the use of these medications to relieve menstrual symptoms may lead to an increase in diarrhea.

I don’t know about you, but for me, these findings were very interesting. I, myself, suffer from IBS and have never really put my GI symptoms and menstrual cycle together. Going forward, I think I’ll be paying more attention to my cycle and bowel habits to see how I compare to some of the studies that have been reported.  

1. _{SB;, K. S. V. S. K. H. (n.d.). The menstrual cycle and its effect on inflammatory bowel disease and irritable bowel syndrome: A prevalence study. The American journal of gastroenterology. Retrieved December 30, 2022.}
2. _{Bernstein, M. T., Graff, L. A., Avery, L., Palatnick, C., Parnerowski, K., & Targownik, L. E. (n.d.). Gastrointestinal symptoms before and during menses in Healthy Women. BMC women's health. Retrieved December 30, 2022.}
3. _{Rolston, V. S., Boroujerdi, L., Long, M. D., McGovern, D. P. B., Chen, W., Martin, C. F., Sandler, R. S., Carmichael, J. D., Dubinsky, M., & Melmed, G. Y. (n.d.). The influence of hormonal fluctuation on inflammatory bowel disease symptom severity-a cross-sectional cohort study. Inflammatory bowel diseases. Retrieved December 30, 2022.}