Period & bowel: what’s the relationship?

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It’s been a while since I came here to share knowledge and good information with you. Behold, the day has come! Today dedicated to menstrual education, as the World Menstrual Hygiene Day, celebrated on 28 May, is approaching. If you menstruate, you have possibly observed some changes that occur in your body before and/or during that time of the month. Changes such as fatigue, irritability, headaches, emotional changes and anxiety may be experienced more intensely during this period due to hormonal activity. However, gastrointestinal symptoms can also occur, such as nausea, vomiting, changes in bowel movements (e.g. diarrhoea), abdominal pain and distension. In fact, most people who menstruate report bowel disturbances, usually not severe and for a few days (including a few days before the menstrual cycle). However, when a gastrointestinal disorder or disease is already present, these symptoms can be exacerbated and experienced more intensely.

But what exactly occurs at this time of the month?
Well, in each phase of the menstrual cycle (follicular phase, ovulation and luteal phase) a series of hormonal changes occur in the female body, which we will not talk about in detail in this article. Just before menstruation appears, the cells lining the uterus increase their production of prostaglandins which cause the muscles of that organ to contract, triggering menstrual cramps and pain. Once the levels of prostaglandins remain high in the uterus, they can enter the bloodstream and travel to other parts of the body… like the bowel, for example. Like the womb, the walls of the intestine are lined with smooth muscle, which promotes their contraction and distension, resulting in diarrhoea. This is why gastrointestinal symptoms can occur during the menstrual phase, even in healthy people. Note that despite discomfort and pain, excessive levels of prostaglandins do not appear to cause any health risks.

Do you usually experience gastrointestinal changes during the period?

Do people who menstruate with gastrointestinal disorders experience symptoms more acutely than healthy people?
Yes! Although gastrointestinal symptoms during the menstrual cycle are also reported in healthy people (as we have seen before), studies indicate that if you have a gastrointestinal disorder, you may experience them more acutely.
In menstruating people with irritable bowel syndrome (IBS), symptoms such as abdominal pain, bloating and diarrhoea may be aggravated (an important finding, particularly for those with diarrhoea-predominant IBS). In menstruating people with inflammatory bowel disease (IBD), symptoms may also be exacerbated. However, the underlying mechanism associated with this pathophysiology is not yet fully understood. The influence of female sex hormones on the gut-brain axis is a hypothesis to be investigated.
IBD diagnosis also seems to be associated with several factors influencing the menstrual cycle, namely irregularities either during the cycle or in the duration of the menstrual flow or dysmenorrhoea (uterine pain). The role of oral contraceptives and medicines, such as non-steroidal anti-inflammatory, immunosuppressants or biologicals, in the menstrual cycle is still unclear in these users.
Knowing the influence of gastrointestinal disease activity during menstruation (and vice versa) will allow to have a better understanding and improve management of symptoms in this phase, so more studies should be done in this direction.

Would you like to know some dietary strategies for this phase of the month? Then comment on this article so we can know what you think!

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Bharadwaj, S., Barber, M. D., Graff, L. A., & Shen, B. (2015). Symptomatology of irritable bowel syndrome and inflammatory bowel disease during the menstrual cycle. Gastroenterol Rep (Oxf), 3(3), 185-193.                   

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. (2018). The Influence of Hormonal Fluctuation on Inflammatory Bowel Disease Symptom Severity-A Cross-Sectional Cohort Study. Inflamm Bowel Dis, 24(2), 387-393.         

Saha, S., Zhao, Y. Q., Shah, S. A., Esposti, S. D., Lidofsky, S., Salih, S., Bright, R., Law, M., Moniz, H., Flowers, N., Merrick, M., & Sands, B. E. (2014). Menstrual cycle changes in women with inflammatory bowel disease: a study from the ocean state Crohn’s and colitis area registry. Inflamm Bowel Dis, 20(3), 534-540.        

Shirwaikar Thomas, A., Duran, A., & Abraham, B. P. (2020). Correlation of menstrual distress to severity of gastrointestinal symptoms in inflammatory bowel disease patients. Indian J Gastroenterol, 39(5), 514-520.  

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Sara Barreirinhas

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