If you are someone who has periods, then you have probably experienced the changes your body goes through. Maybe you’ve had a hormonal driven acne breakout, mood swings that cause you to cry at the most unexpected thing, a craving for chocolate that seems endless or more than likely, all of the above! You might also have noticed changes in your bathroom habits in the time building up to your period and even a few days after. 

Even if you don’t have IBS, it is very normal to experience bowel changes during the course of your period⁽¹⁾. This is caused by the release of hormones, such as prostaglandins. They have a variety of roles but do cause your uterus to cramp and can cause your bowel to contract⁽²⁾. This can increase the frequency you need to use the bathroom, change in stool consistency, flatulence and bloating. 

What does this mean for those of us with IBS? 

It is likely that if you have a period, your IBS symptoms will be worse during your period⁽³⁾. One study demonstrated that women with IBS have a more sensitive gut during menses than the healthy controls⁽⁴⁾. IBS is also more prevalent during the menstruation years of a persons life and prevalence decreases post menopause. 

If you have IBS, you may experience more painful and potentially more frequent symptoms. 

Additional symptoms such as: 

1. Fatigue 

2. Back ache 

3. Increased sensitivity to certain foods 

4. Water retention 

5. Insomnia 

6. Chronic pelvic pain 

These symptoms and changes in bowel habits also fluctuate over the course of your period, due to the changing levels of hormones. One study found that in the luteal stage (this is the stage where your uterus lining is thickening, before you bleed), that a significant number of the participants experienced constipation. They attributed this to an increase in progesterone which can actually slow down gut transit time and inhibit smooth muscle contraction. Then, during the menstrual stage, many participants experienced diarrhoea, likely due to the prostaglandins released which increase gastrointestinal motility⁽³⁾.

Not only can IBS symptoms increase during your period, but if you have IBS you are also more likely to suffer from gynaecological disorders such as more intense period pains or experiencing PMS⁽⁵⁾.  It is also been shown that women with IBS are more likely to be diagnosed with endometriosis⁽⁶⁾. This is a condition where tissue that is similar to the tissue that lines your womb is found in places outside of the womb, such as your ovaries. 

So in summary; IBS, gut health and hormones are quite closely linked and because of this, your IBS is probably worse during your period due to the large change in hormones you experience!

How can you treat it? 

Unfortunately, there is no magic pill to relieve symptoms you might experience around your period.  This can be pretty disappointing and honestly a bit frustrating! Most advise around managing these symptoms is the same guidance given to manage IBS. However some slightly more specific things you can try include:

1. Being aware of foods that normally cause bad IBS flare ups – you may be more sensitive to these during your period 
2. Invest in a hot water bottle – if you have IBS you probably already have one but if not go out and grab one now. 
3. Eating well – try not to eat greasy, fast foods and focus on overall good nutrition such as eating protein and complex carbohydrates (brown rice) and foods with fibre. 
4. Yoga has been shown to help relieve period pains and may also help soothe your gut.
5. Keep a food, symptom and period diary – there are loads of apps now to help you do this (e.g clue) but you can also keep a simple paper diary to track when you have experienced symptoms and if this was affected by your period. 
6. Making sure to get enough calcium – some studies have shown that a diet high in calcium may reduce period symptoms. Some studies do recommend a calcium supplement but it is worth also focusing on your diet and ensuring you are getting a decent amount of calcium throughout the day in your food. If you are vegan or even lactose free make sure to get foods fortified with calcium to ensure you are meeting your target of 3-4 servings of dairy a day⁽⁷⁾.

If you find your period pains are unmanageable, are affecting your daily life or cause significantly worse IBS symptoms it may be worth speaking to your GP. If appropriate your doctor may recommend going on the pill to relieve period pains. 

References

1. Simmons, L., Heitkemper, M. and Shaver, J., 1988. Gastrointestinal function during the menstrual cycle. Health care for women international, 9(3), pp.201-209.
2. Lahat, A., Falach-Malik, A., Haj, O., Shatz, Z. and Ben-Horin, S., 2020. Change in bowel habits during menstruation: are IBD patients different?. Therapeutic advances in gastroenterology, 13, p.1756284820929806.
3. Pati, G.K., Kar, C., Narayan, J., Uthansingh, K., Behera, M., Sahu, M.K., Mishra, D. and Singh, A., 2021. Irritable Bowel Syndrome and the Menstrual Cycle. Cureus, 13(1)
4. 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.
5. https://aboutibs.org/signs-and-symptoms/gynecological-aspects-of-irritable-bowel-syndrome/
6. The UNC Center for Functional GI & Motility Disorders – https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-in-Women.pdf
7. Shobeiri F, Araste FE, Ebrahimi R, Jenabi E, Nazari M. Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial. Obstetrics & Gynecology Science. 2017;60(1):100-5.

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