Dietitian UK: Periods and gut health

Periods and Gut Issues

Most of us know that the average length of a menstrual cycle is 28 days. Day 1 is the start of the cycle when bleeding starts, day 14 is when we ovulate. The main hormones at play are oestrogen and progesterone. Oestrogen builds up the lining of the womb and increases from day 1-14. Progesterone starts to increase aftter day 14 and is the calming hormone. The balance between oestrogen and progesterone is therefore very key.

Before your period, chemicals called prostaglandins are produced in the cells lining your uterus. These acts upon the smooth muscle in the uterus lining to make it contract and shed and may cause pain and cramps. If too many prostaglandins are produced, they can travel in your blood stream and then also act on the smooth muscle cells of your gut, causing pain in your tummy. More prostaglandins are produced when we don’t have as much progesterone. This can happen when you are stressed as more cortisol is made instead. So if you are more stressed then you may find you have more IBS style symptoms and pain. Women who already have IBS may find their symptoms, especially gas, are worse around their period. (Whitehead, 1990).  

Sometimes it’s hard to tell whether your cramps are from your period or from your gut. Also, because prostaglandins reduce how much your gut can absorb, while increasing the amount of electrolytes being secreted, this causes diarrhoea. The prostaglandins can also be the cause behind nausea and headaches coming up to your period. Progesterone can alos impact your gut as it affects the rate of your gut transit. (Wald 1981).

Now lets think about oestrogen, too much of this can lead to painful periods, tender breasts and affect your sleep too. You may feel moody and grumpy. Guess what happens to extra hormones? They are got rid of via the liver and bowel. So your bowel function can be affected and you want to make sure your liver is well looked after.

Look after your liver and bowels by:

  • not too much alcohol and caffeine.
  • Eat more leafy green veggies and make sure you have adequate fibre.
  • Stay hydrated and use gentle movement around your period and higher intensity on other days.

Periods: how do they effect my gut. Including bloating, pain, constipation and diarrhoea

Anti-inflammatory drugs, such as aspirin and ibuprofen, work by blocking the action of the certain enzymes and so reduce prostaglandin levels, and therefore their side effects of pain, nausea and diarrhoea.  However too much of these is not beneficial for the body, so only use these if needed.

Studies show 3 in 4 women have abdominal cramps, nausea, diarrhoea, constipation or bloating in the 5 days before their period and during their period.  You are not alone! Stick to a balanced diet, add in some dark chocolate if you fancy it, movement can definitely help (yoga and pilates or walking) and be kind to yourself.

A hormone that may be coming in to play for some women is serotonin, which can drop along with 0estrogen before a period. This can contribute to low mood.  

Women that also felt depressed or anxious before or during a period are more likely to have gut troubles: with depression it’s diarrhoea, and with anxiety it was found to be nausea. Feelings of depression were found to be worse just before the period than during.  

Another common symptom around periods is fatigue, and those that feel fatigued are also more likely to experience a variety of issues with their gut, (Bernstein, 2014).  

Other studies show that at a certain point during our cycles, women are more sensitive to pain. (Stening, 2017), so not only are the prostaglandins making the uterus and gut cramp up, but your tolerance for dealing with that pain could be reduced too!  

Depending what symptoms you get, here’s some advice you could try: 

Advice for diarrhoea 

  • Top up fluids so you don’t become dehydrated 
  • Limit caffeine intake from tea, coffee and soft drinks to three drinks per day. 
  • Try reducing intake of high-fibre food (such as whole-wheat breakfast cereals and breads). 
  • Avoid sugar-free sweets, mints, gum and drinks containing sorbitol, mannitol and xylitol. 

Advice for nausea 

  • Ginger tea or chamomile tea or peppermint tea 
  • Small meals 
  • Dry foods 
  • Plain foods like toast or crackers 
  • Avoid smelly foods 

Advice for bloating  

  • Limit intake of gas producing foods e.g. beans and pulses, Brussels sprouts, cauliflower, and also sugar-free mints/chewing gum. 
  • You may find it helpful to eat oats (such as oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day). 

Advice for low mood  

  • Eat regular meals based on starchy carbohydrate (potatoes, rice, pasta, bread) to keep your blood sugar levels stable.  
  • Eat a variety of fruits, vegetables and nuts to make sure you get enough vitamins and minerals, especially iron, selenium and B vitamins like folic acid. 

Sources 

BDA Fact Sheet on IBS and for Food and Mood 

Bernstein, M.T., Graff, L.A., Avery, L. et al. Gastrointestinal symptoms before and during menses in healthy women. BMC Women’s Health 14, 14 (2014). https://doi.org/10.1186/1472-6874-14-14 

Stening K, Pain sensations to the cold pressor test in normally menstruating women: comparison with men and relation to menstrual phase and serum sex steroid levels. Am J Physiol Regul Integr comp Physiol 2007, 293 (4) R1711-R1716 

Whitehead WE et al, Evidence for exacerbation of IBS during menses. Gastroenterology. 1990, 98:1485-2488 

Wald 1981 Gastrointestinal transit: the effect of the menstrual cycle. Gastroenterology.  Jun;80(6):1497-500. 

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