Constipation, Stress Linked to More Severe Menopause Symptoms

Gut health is linked to the severity of menopause symptoms, a new study finds.

Menopause can cause a number of uncomfortable symptoms as people approach middle age. New research has uncovered an association between some of these symptoms and gastrointestinal issues. 

The new study, published earlier this month in Menopause, found that certain menopause symptoms may be linked to a person’s stool consistency and frequency.

Researchers found that women who had bowel movements twice a week or less were more likely to report their menopause symptoms as bothersome or severe.

The study also found a connection between stool consistency and hot flashes.

Researchers used the Bristol Stool Form Scale to understand how participants’ stool consistency linked to certain menopause symptoms. They found that women with constipation or diarrhea were more likely to report worse menopause symptoms.

The research team also found that physical activity, body mass index (BMI), and a depression or anxiety diagnosis were related to menopause symptoms’ severity.

That said, more research is needed to “confirm the relationship between stress, gastrointestinal, and menopausal symptoms.”

“This isn’t an article about cause and effect,” Lauren Streicher, MD, clinical professor of OBGYN at the Feinberg School of Medicine and host of the Dr. Streicher’s Inside Information podcast, told Health. Streicher wasn’t involved in the research and is a member of the Menopause journal’s editorial board.

“It’s an article about correlation—simply that these gastrointestinal symptoms do appear to correlate with women who are having more menopause symptoms,” she said.

Association Between Pooping Patterns and Menopause

To understand how gut health and menopause may be linked, researchers distributed surveys anonymously to 693 women between the ages of 40 and 60.

Researchers also conducted a bowel assessment that included self-reported information on what each person’s typical stool consistency was, and how often they defecated. 

Lastly, participants filled out a stress assessment and were asked general questions about their health, including their physical activity and sleeping habits.

“This was really the first time that someone specifically looked at gastrointestinal symptoms,” Streicher said.

“What they found is that there were some very specific symptoms that did seem to correlate with women who are the most symptomatic, and the women who appear to be having the most stress," she added.

In other words, the data showed that women who were more stressed and those who had constipation were more likely to have worse menopause symptoms.

Vasomotor symptoms—hot flashes or night sweats—were related to stool consistency.

However, it’s not yet possible to draw further conclusions from these survey results—stress, menopause, and gastrointestinal issues are simply associated.

“We have to be very careful about interpreting it,” said Streicher. “They’re not saying that the gastrointestinal symptoms cause hot flashes. They’re not saying that the gastrointestinal symptoms cause anxiety or stress. What they’re saying is there’s an association.”

How Menopause May Affect the Gut

The root cause of the relationship between bowel movements, stress, and menopause is not yet clear.

It’s almost a “chicken or the egg” situation, Streicher explained. Menopause symptoms could be causing constipation or other gut issues, or those symptoms could be making menopause worse.

At the very least, “we’ve always found that there’s a relationship between hormones and the gut,” Streicher said. “Many women who, when they have their period, they’ll have diarrhea or they’ll get constipated at certain times in their cycles.” 

Stress is another factor to consider, since certain menopause symptoms, like hot flashes, anxiety and depression, or sleep issues, are linked to the central nervous system.

And, both stress during menopause and the gut microbiome—which changes as a woman gets older—can affect the central nervous system’s function.

“We have this microbiome and the gastrointestinal tract, and we know that that might affect the brain,” said Streicher. “And we know that hot flashes originate from the brain.”

Or, the relationship could be flipped.

It’s possible that worsening menopause symptoms make women uncomfortable and stressed, which by extension, has a negative effect on their gut function.

“The stress that women have, who have the most hot flashes, manifests in many different ways,” said Streicher. “So it would not surprise me if one of the ways that it manifests is with a change in gastrointestinal function.”

Considering that stress can cause constipation, diarrhea, abdominal pain, nausea, and other gastrointestinal issues, this connection isn’t a stretch.

But, without more research, all of these possible connection points are simply hypotheses, said Stephanie Faubion, MBA, MD, medical director of The Menopause Society and director of the Mayo Clinic Center for Women’s Health, who was not involved in the study.

For now, "stool consistency is associated with some menopause symptoms. That’s pretty much all you can say," Faubion told Health.

More Research Is Still Needed

Because the study was done via questionnaire, it’s hard to draw firm conclusions, Faubion said.

“It would be better to look at it, say in a longitudinal study,” she said.

That way, researchers could follow a population over time and see if women’s transition into menopause also brought along changes in their stool or other gastrointestinal markers, she said.

“This is just not the right data set to look at that,” Faubion said.

Another one of the study’s limitations is the fact that there are so many factors at play here, noted Streicher.

Stress, BMI, physical activity, sleep habits, gastrointestinal factors, and more were included in the analysis, but not every health change should be attributed to menopause.

Beyond strictly menopause-related changes, other factors—such as poor diet or lack of physical activity—might simply be driving worse gastrointestinal issues in middle age, for example.

Faubion stressed that more research is needed—previous studies aren’t strong enough to make any certain claims.

One 2018 study found that, in the menopause transition, diarrhea and constipation can be linked to cortisol, stress, and anxiety, but not to “key reproductive hormones.”

Another found, however, that race and ethnicity, as well as menopause status, both influenced the severity of gastrointestinal symptoms in middle-aged women.

While more research is necessary for clinical claims, finding evidence of symptom association can still be helpful, even if it’s not completely fleshed out, Streicher said.

For example, researchers have found that people who experience menopause-related hot flashes or depression may be at a higher risk of high blood pressure and cardiovascular risk factors.

But, the findings aren’t necessarily applicable just yet, Faubion and Streicher agreed.

“GI symptoms [aren’t] what should get [people] to a menopause expert. It should be the hot flashes and that they’re not sleeping,” Streicher said. “These people should be talking to a menopause expert anyway, with or without their GI symptoms.”