Constipation can be an uncomfortable, debilitating and sometimes painful symptom of perimenopause and menopause. And there’s evidence to suggest that fluctuating levels of the hormones oestrogen and progesterone are partly responsible.

Thankfully, there are several natural remedies and lifestyle changes that can help, including eating the right foods, various forms of exercise and certain supplements.

We’ll also look at whether hormone replacement therapy can improve constipation, as well as the over-the-counter laxatives that can bring short-term relief from your symptoms.

If you’re experiencing digestive issues like constipation – or any of a range of other menopause symptoms – targeted probiotic supplements can help.

To find out more, visit The Better Gut. And for 10% off your first order, use the discount code WELCOME10.

Menopause, hormone changes and constipation

As you near menopause, reproductive hormones like oestrogen and progesterone drop permanently low. But during perimenopause – the years leading up to menopause – these hormones fluctuate unpredictably, going up as well as down.

One way that changing oestrogen levels may contribute to constipation is through its effects on the stress hormone cortisol. Oestrogen has a complex relationship with cortisol and can cause it to both rise and fall in different situations.

Higher cortisol levels have been linked to less severe constipation, so when cortisol levels drop, constipation may get worse.

Meanwhile, increased levels of progesterone can slow the movement of your gut muscles so that it takes longer for food to pass through your digestive system. This can also cause constipation.

How do you know if you’re constipated?

Everyone’s bowel habits vary from time to time, but if you think you might be constipated look out for these symptoms:

• Having pooed less than three times in the last week, or less than usual
• Straining to go or finding it painful
• Unusually small or large poos that are dry, hard or lumpy
• Feeling like you haven’t fully emptied your bowels after going to the toilet
• Bloating or excess gas
• Abdominal pain or discomfort

Natural remedies for menopause constipation

If you make them part of your routine, these natural remedies and lifestyle changes could all help to prevent or improve constipation.

Eat a wide variety of plants

Getting more plants into your diet is one of the best things you can do for your overall health. But plants also contain a range of nutrients that could have particular benefits during menopause, including when it comes to constipation:

• Soluble fibre: This type of fibre absorbs water in your gut, forming a gel that helps your food pass more smoothly through your digestive system. You can get soluble fibre from oats, barley, legumes like beans and pulses, apples, berries, stone fruits, nuts and seeds – particularly flaxseeds – as well as a wide range of vegetables.
• Insoluble fibre: This form of fibre adds bulk to your poo – another way of helping it to move more quickly through your gut. Foods rich in insoluble fibre include whole grains, some fruits and, again, plenty of different vegetables.

• Sorbitol: A type of carbohydrate known as a sugar alcohol, sorbitol adds sweetness to fruits like apples, apricots, grapes, raspberries and strawberries. It has a natural laxative effect that could help reduce constipation.

• Phytoestrogens: These natural plant compounds mimic some of the functions of oestrogen, which may help with menopause symptoms. You can find phytoestrogens in certain fruits, leafy green vegetables, whole grains and legumes – especially soyabeans.

Try these exercises

Regular exercise is a good idea for all women going through perimenopause or menopause. But there are specific types of physical activity that can help with constipation.

• Aerobic exercise: One small study found that 20 minutes of aerobic exercise three times a week significantly reduced constipation for premenstrual women with hormonal symptoms. Aerobic exercise is anything that gets your heart rate up – like brisk walking, running, cycling, swimming or dancing – but the exercises in the study were relatively moderate and included movements like stretching and rotating arms and legs and rotating the upper body.
• Pelvic floor exercises: Your pelvic floor is the collective name for the muscles around your rectum, bladder and uterus that you use when you go to the toilet. If you’re not engaging your pelvic floor properly when you go, strengthening these muscles can help with constipation. Follow the NHS advice on training your pelvic floor.
• Abdominal massage: Massaging your belly can help to relieve constipation by speeding up your digestion. It can also ease other digestive issues, like trapped wind and bloating, as well as menstrual cramps. There are several different abdominal massage techniques you can try.

Stay hydrated

Being dehydrated increases your risk of constipation, because your stools become drier and harder to pass.

As you get older, you become less sensitive to thirst, so it’s important to remember to drink liquids regularly.

The NHS recommends 6 to 8 cups of water a day, but if you’ve been sweating due to hot weather, exercise – or hot flashes – you may need more.

Try probiotic supplements

Probiotics are friendly bacteria that have benefits for your gut health and overall health.

The Better Gut probiotic supplements contain specific strains of bacteria that have been shown in studies to improve constipation and other digestive issues during perimenopause and menopause.

They can also help to manage a range of other menopause symptoms, from hot flashes to anxiety, brain fog to maintaining a healthy weight.

Visit The Better Gut to find out more.

Laxatives for faster relief from constipation

The remedies we’ve looked at so far could all reduce your chances of getting constipation. But if you currently have constipation and need faster relief, your pharmacist may recommend an over-the-counter laxative.

There are four main types of laxative, that each work in different ways:

• Bulk-forming laxatives: These increase the size and weight of your poo, helping it to move faster through your gut. They take 2–3 days to work. Types include psyllium/ispaghula husk (brand names Fybogel and Ispagel).
• Osmotic laxatives: These draw water into your poo, softening it and making it easier to pass. They take 2–3 days to work. Types include Duphalac, Lactugal, macrogol (Movicol, Laxido, CosmoCol, Molative) and polyethylene glycol.
• Stimulant laxatives: These stimulate the muscles of your gut to help them move things along. They take 6–12 hours to work. Types include bisacodyl (Dulcolax), senna (Senokot) and sodium picosulfate.
• Stool softeners: Like osmotic laxatives, these soften your poo by pulling in water, making it easier to pass. They can be taken as capsules or as a liquid enema. They take 1 or 2 days to work. Types include docusate.

Laxatives are only meant for short-term use. Stop taking them when your constipation improves and don’t take them for more than a week at a time. If you’re still constipated at this point, talk to your doctor.

Can HRT help with constipation?

Hormone replacement therapy (HRT) refers to a range of medications that replace reproductive hormones lost during perimenopause and menopause.

HRT is taken either by mouth or via skin patches or gels and can help with a range of menopausal symptoms.

There’s not a huge amount of research looking at HRT’s effects on constipation but one small study involving postmenopausal women reported some interesting results.

It found that while oestrogen had no impact on the time it took for food to move through participants’ digestive systems, progesterone sped things up significantly.

When to see a doctor about constipation

Although constipation doesn’t usually indicate a serious health condition, it can be a sign of illnesses ranging from irritable bowel syndrome (IBS) to diverticular disease and even bowel cancer.

Talk to your doctor if:

• Your constipation lasts more than 3 weeks
• It keeps coming back
• It stops you from doing everyday activities
• Improving your diet doesn’t help
• You have a lump or swelling in your belly
• You have several different digestive issues
• You have constipation and have also lost weight
• You have blood in your poo

Summary

Fluctuations in oestrogen and progesterone during perimenopause and menopause may affect levels of other hormones, and slow down your digestion, leading to constipation.

Eating a wide variety of plants high in different types of fibre and other nutrients could improve symptoms by helping food to pass through your gut more easily. Staying hydrated can also help with this.

Although research is limited, some studies suggest that hormone replacement therapy using progesterone could help to speed up digestion too.

When it comes to physical activity, regular aerobic exercise, strengthening your pelvic floor and abdominal massage could all reduce constipation.

For short-term faster relief, your pharmacist may recommend an over-the-counter laxative.

The Better Gut probiotic supplements can help with a whole range of perimenopause and menopause symptoms, from constipation and bloating to hot flashes, anxiety and brain fog.

Visit The Better Gut and use the discount code WELCOME10 to get 10% off.