IBS Symptoms in Women
Women and IBS, Pregnancy, Female Hormones, & Menopause
What role do hormones play in IBS, and IBS symptoms?
While most women with IBS have long suspected that female hormones (chemical substances created by the body that control numerous bodily functions) have an impact on their IBS symptoms, research has recently shown just how dramatic and wide-ranging this link is.
Women have a higher prevalence of IBS than men in the first place, which may actually be due to sex-related differences in brain responses to visceral (body) and psychological (mind) stressors, as well as hormonal influences.
Women with IBS have more severe symptoms and need more medications than men. Small-bowel transit, gastric emptying, and colonic transit times are all significantly different for women (even women without IBS) than for men. and hormones are believed to play a large role here. There are also estrogen receptors in the stomach and small intestine, which react to changing levels of hormones.
Most women with IBS quickly learn through experience that menstruation leads to a worsening of their abdominal pain and bloating, and increased bouts of diarrhea as well.
This is often due to the high progesterone levels that trigger the uterine cramping of menstruation, which can also cause gastrointestinal muscle spasms.
Studies actually show that three-quarters of women with IBS say their symptoms are worse during menses.
There is some helpful news - a 2013 study just proclaimed that
fennel is an effective herbal drug for menstrual pain. This is terrific, because fennel is already known for its carminative (gas and bloating relief) benefits for IBS. This makes
fennel a double whammy for
cramps and IBS in the best way. And as many women know from experience, taking steps to prevent or relieve menstrual cramps can also help prevent period-related IBS symptoms.
Regular exercise,
abdominal hot packs, and herbal teas with smooth muscle relaxant properties (particularly
medicinal strength peppermint or
high volatle oil fennel, but chamomile and raspberry leaf as well) are all healthy approaches to take for reducing or preventing menstrual cramps and resultant IBS symptoms.
Personally, I've had spectacular results reducing menstrual cramps
(and completely eliminating cramp-related IBS flares!) from
practicing yoga. For some women, birth control pills can lessen menstrual symptoms and associated IBS flares - this is an issue to address with both your GI doc and your ob/gyn.
What's known about pregnancy & IBS?
While research has acknowledged that pregnancy can have a significant impact on IBS, there is no consensus as to what that impact will be. The extreme hormonal fluctuations of pregnancy often trigger GI distress in women who do not even IBS; for those who have a dysfunctional gut to begin with, predicting whether IBS will worsen or improve during pregnancy is a bit of a crapshoot.
It's not uncommon for pregnant women to feel that their IBS has completely gone into remission, but the flip side of the coin is that other women may feel that pregnancy makes their IBS worse than it has ever been before. Or, the severity of IBS symptoms may stay the same while the symptoms themselves change - someone who is normally diarrhea-predominant will suddenly find themselves dealing with constipation, or vice versa. Gas and bloating may worsen one month while abdominal cramps disappear, but the next month will see just the opposite happen.
This inconsistency can happen not just within the term of a single pregnancy, but women can also have dramatically different experiences with their IBS from one pregnancy to another. Unfortunately, I don't know of any way for a woman to predict what exactly will happen with each pregnancy of her own, nor have I seen any research that specifically addresses this issue.
In general, medical studies of IBS during pregnancy recommend conservative treatment, including
IBS dietary changes,
prebiotic soluble fiber supplements, exercise, and biofeedback.
I would also add
gut-directed hypnosis to the list of safe and highly effective (not to mention enjoyable) means of treating IBS during pregnancy as well.
For a note of reassurance here, remember that pregnancy seems just as likely to affect IBS for the better and not automatically for the worse. Also keep in mind that, to my knowledge, there is no evidence at all that IBS has any effect whatsoever on a woman's ability to conceive and carry a full-term, healthy pregnancy with normal delivery. I don't know of any reason why IBS should compromise your wish to have children - and your own ob/gyn should be able to address all of your concerns here.
IBS Pregnancy Glossary
General notes
Please run ALL medications and supplements you are taking past your OBGYN and/or midwife, BEFORE you actually take them. This glossary is not meant to replace personal advice from your own medical practitioners.
Many herbs and dietary supplements have not been studied under scientific conditions much, so advice will vary. It is sensible to take the precaution of using anything that you or your doctor are not totally sure about only when necessary.
Also, make sure you check the other ingredients on any supplements you are taking and run them by your OBGYN - cat's claw, for instance, is found in some digestive enzyme pills, and is not recommended during pregnancy.
What To Expect
Trying to conceive: Prenatal vitamins contain a lot of iron, which can make constipation worse. If you are prone to C, talk to your OBGYN or pharmacist and they can give you one either without iron, one with ferrous gluconate instead of ferrous sulfate, or one with a mild stool softener in it to offset constipation.
1st Trimester: It can take some weeks for the effects of the hormones to be felt on your IBS, but most people then find their IBS symptoms either ease or disappear. This is likely to be the worst time for morning (or all day!) sickness. You may need to simply eat whatever makes you feel best, whether it's the
What To Eat When You Can't Eat Anything guidelines from
Eating for IBS, sweet foods or salty foods. The usual advice of never letting your stomach get empty, snacking on fat-free soda crackers, and drinking ginger tea can also help.
2nd Trimester: IBS symptoms may increase during the hormonal changes between trimesters.
3rd Trimester: Again, IBS symptoms may increase during the hormonal changes between trimesters. Constipation is likely to become an increasing problem, particularly as you get to the 8th month, but if it is a major issue for you, your doctor is likely to be able to help. Also, try increasing your insoluble fiber intake more than usual, increase your soluble fiber supplement dosage, drink lots and lots of water, and get as much exercise as you can.
Post-natal: IBS sometimes starts after the birth. However, IBS is known to sometimes disappear for a while after the birth and then come back, or even to ease long-term.
Supplements, Medications and Alternative Therapies (in alphabetical order)
Please ask your doctor about any and all medication/supplement use in pregnancy!
Acetaminophen - see Tylenol.
Anti-depressants have not really been studied enough, but the general consensus seems to be that Prozac and Zoloft have been most studied and are probably the safest to take whilst pregnant (this does NOT mean that they are known to be risk-free). Use of SSRIs (selective serotonin reuptake inhibitors) and serotonin norepinephrine reuptake inhibitors in the 3rd trimester has been shown to increase the risk of new babies suffering from neonatal behavioral syndrome, or withdrawal syndrome (symptoms of which include jitteriness, irritability and respiratory problems). Please ask your doctor about using these medications while pregnant.
Bentyl (Dicyclomine) is considered safe throughout pregnancy. However, it is excreted into breast milk and there have been reports of apnea (cessation of breathing) when dicyclomine has been given to children, so it should probably not be used by nursing mothers.
Codeine is generally avoided in pregnant and nursing women.
Colace (docusate) should be used during pregnancy only when your doctor thinks it is clearly needed, but can be used when the benefits outweigh the potential risks. It has not been studied in nursing mothers.
Dicyclomine - see Bentyl.
Diclectin - a prescription medication for morning sickness. It consists of a combination of Vitamin B12 and an antihistamine.
Digestive enzymes - talk to your doctors about these as some will want you to stay off enzymes to be on the safe side.
Donnatal: effects on fetuses and nursing babies are unknown so it should only be prescribed when the expected benefits outweigh the potential risks, and then used with caution.
Fennel is considered safe in small amounts during pregnancy, as long as only the seeds or fruit are used (the tea is made from the seeds).
Fennel tea may actually help milk production in nursing mothers, and is a traditional remedy for infant colic.
Ginger is considered safe and can be great for morning sickness. For ginger tea: slice a few slices of ginger the size of a quarter and steep in a mug of boiling water. Drink several cups a day.
Hyoscyamine should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. This drug may be excreted into breast milk. Consult your doctor before breast-feeding.
Hypnosis is safe during pregnancy: you can even use
hypnosis to help with the birth!
Immodium (loperamide) has not been adequately studied in pregnant women (although studies in animals receiving very high doses of loperamide suggest no important, detrimental effects on the fetus). Physicians may use loperamide during pregnancy if its benefits are deemed to outweigh the potential but unknown risks. It is not known if loperamide is secreted in breast milk.
Immodium Advanced (simethicone & loperamide) - see Immodium and Simethicone.
Lansoprazole - see Prevacid.
Levsin - see Hyoscyamine.
diphenoxylate/atropine (diphenoxylate and atropine) has not been adequately studied in pregnant women, so it should be used during pregnancy only when clearly needed. Diphenoxylic acid, a metabolite of diphenoxylate (that is, diphenoxylate that has been changed chemically by the body) is excreted into breast milk, as is atropine. Although there have not been problems reported in the infants of women who breast-feed, the benefits to the mother should be weighed against the potential risks to the nursing infant.
Loperamide - see Immodium.
Miralax should be used only when needed, but is considered safe enough to be used if your doctor thinks it is necessary and under full doctor supervision. It is not known whether it passes into breast milk, so consult your doctors before using it whilst breast feeding.
Paracetamol - see Tylenol.
Peppermint is helpful and usually considered safe, but don't use too much as it relaxes uterine muscles as well as the GI ones so in high doses it can increase the risk of miscarriage. It can also increase the occurrence of heartburn, which is a common problem in pregnancy anyway. Talk to your OBGYN or midwife about taking it during pregnancy for complete peace of mind. It may also decrease milk production in nursing mothers - the tea has traditionally been used for that purpose.
Prevacid (lansoprazole) has not been adequately studied in either pregnant or nursing women.
Soluble fiber supplements are safe for use for both constipation and diarrhea during pregnancy and nursing.
Tummy Fiber Acacia is particularly useful as it is tasteless and can be combined into many foods and drinks - helpful when a lot of things are making you gag anyway!
Simethicone is safe during pregnancy and for use by nursing mothers.
Slippery Elm is usually considered safe, but should ideally only be taken as taken and not regularly as adequate studies have not been done. Talk to your doctors before taking this during pregnancy.
Tegaserod - see Zelnorm.
Tylenol (acetaminophen/Paracetamol) is safe throughout pregnancy. It is excreted in breast milk in small quantities. However, acetaminophen use by the nursing mother appears to be safe (source www.medicinenet.org).
Yoga is safe although some poses are to be avoided. There are prenatal yoga classes, CDs and DVDs available.
Zelnorm (tegaserod): there are no adequate studies of Zelnorm in pregnant women (although studies found it caused no ill effects in pregnant rats and rabbits). Therefore, physicians must weight the potential benefit of giving Zelnorm during pregnancy against the unknown risk and some physicians will not prescribe it to pregnant women. Zelnorm is secreted into the breast milk of nursing rats. Very high doses of Zelnorm in mice cause tumors. Due to the demonstration of these tumors and the lack of safety data in children, physicians must weigh the potential benefit of giving Zelnorm to nursing women against the unknown risk to the infant.
How does menopause affect Irritable Bowel Syndrome?
The research on IBS and menopause is fortunately both more clear and more clearly optimistic. Studies have shown that the drop in hormones after menopause results in reduced severity of IBS symptoms; after age 50, the severity of IBS symptoms in women and men is identical. Women in postmenopausal age groups have significantly less severity overall for IBS abdominal pain, bloating, and have higher quality of life scores compared to younger women with IBS. The theory that the drop in hormones from menopause directly correlates with improved IBS symptoms is further supported by studies finding that hormone replacement therapy in menopause is associated with an
increased risk of IBS flares.
So, while hormones and gender do play a significant role in IBS (possibly the development of the disorder as well as the severity and frequency of symptoms), it's not all bad news. IBS flares from menstruation can be well-managed with healthy lifestyle adjustments. Pregnancy seems to be at least as likely to improve symptoms instead of worsen them, and if pregnancy does trigger more IBS attacks there is nothing to show that this won't completely subside after childbirth. Menopause is clearly linked to significant improvements in IBS across the board. Unfortunately, recent research shows that
hormone replacement therapy for postmenopausal women
increases the risk of IBS.
All hormonal fluctuations that affect IBS for the worse are typically temporary, with no serious or permanent health consequences to be concerned about. As is the case with so many other elements that affect IBS, arming yourself with as much knowledge as possible is one of the very best ways to manage your symptoms from the outset. You can successfully control your IBS - it does not have to control you. To read through a wealth of research findings on hormones, pregnancy, and menopause in IBS, including all of the studies referred to in this column,
go to the gender section of the IBS Research Library.
