Most women with IBS suspect that hormone fluctuations affect their IBS symptoms, and research has shown this to be true - quite dramatically true. Women have a higher prevalence of IBS than men in the first place. This may 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 even estrogen receptors in the stomach and small intestine, which react to changing levels of hormones.
Periods? Bad News... Most women with IBS quickly learn through experience that menstruation leads to worse IBS pain and bloating, and increased bouts of diarrhea as well. The high progesterone levels that trigger menstrual cramps can also cause bowel spasms. This makes sense, as both the uterus and the bowel are smooth muscle tissue - but it's a really unfair experience for many women, who have to endure painful IBS cramps on top of painful menstrual cramps.
Not surprisingly, studies show that three-quarters of women with IBS say their symptoms are worse during their periods.
For many women, taking steps to prevent or relieve menstrual cramps can help prevent period-related IBS symptoms as well.
Birth control pills and hormone-releasing IUDs can lessen cramps and associated IBS flares for some women. Ask both your GI doc and your ob/gyn about options.
Pregnancy? Could Go Either Way...
Research shows that pregnancy can have a significant impact on IBS, but 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 have 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 coin toss.
It's not uncommon for pregnant women to feel that their IBS has completely gone into remission, but the flip side of that 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 be constipated, or vice versa. Gas and bloating may worsen one month while abdominal cramps disappear, but the next month the opposite happens.
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.
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.
Menopause? Good News!
The research on IBS and menopause is fortunately clearer and more optimistic (yay!). 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 IBS abdominal pain and 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, many of which overlap with benefits for both IBS and menstrual cramps. 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.
Hormonal fluctuations that affect IBS for the worse are typically temporary, with no serious or permanent health consequences. 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 - IBS does not have to control you.
Tip Takeaway: Pregnancy, periods, hormones, and menopause can all play a significant role in IBS. But, their effects for the worse are typically temporary, and there are active steps you can take to counteract them!