Menopause: Constipation and stress may worsen symptoms

• Experiencing menopause can come with a wide range of symptoms and challenges.
• One area of interest is how factors like gut health influence menopause symptoms.
• Data from a recent study found that increased perceived stress and certain gastrointestinal symptoms were associated with worse menopause symptoms.
• Future research in this area may help discover ways to improve menopause symptoms.

Menopause is common, but that doesn’t make it easy to experience specific symptoms associated with it and the time of transition into menopause. Some may experience worse symptoms than others. Research is ongoing about factors that may influence the severity of menopause symptoms.

A study published in Menopause: The Journal of the Menopause Society found that reporting higher stress levels, having anxiety or depression, and experiencing constipation were associated with more severe menopausal symptoms. Future research can further examine the relationship between these factors.

Common challenges of menopause

The National Institute on Aging describes menopause as “a point in time 12 months after a woman’s last period.” The time before menopause is sometimes called menopause transition or perimenopause.

Menopause and perimenopause are associated with several symptoms that can be unpleasant and affect quality of life. A few symptoms include mood swings, joint pain, hot flashes, and trouble sleeping.

Sometimes, people will refer to the symptoms in the menopause and the perimenopause time frame as menopause symptoms.

Non-study author Dr. Sherry Ross, an OB/GYN and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica, CA, offered further insight into menopause symptoms to Medical News Today:

“The most common symptoms of menopause include irregular periods, hot flashes, sweating, insomnia, depression, anxiety, feeling apprehensive, weight gain or loss, fatigue, poor concentration, memory loss, low sex drive, vaginal dryness, and heart palpitations. All of these disruptive symptoms affect a person’s quality of life and have become a major challenge for the majority of people going through this normal hormonal cycle. Lack of professional guidance and treatment from healthcare professionals is one of the major roadblocks for millions of people suffering from these common debilitating symptoms.”

The severity and number of symptoms can vary greatly. So, researchers are interested in discovering more about what may impact menopause symptoms.

How stress, bowel movements affect menopausal symptoms

Researchers of the current study sought to “evaluate whether there is a relationship between menopausal symptoms, subjectively perceived stress, and reported gastrointestinal symptoms in midlife women.”

The study was a cross-sectional study that included 693 participants. All participants were around fifty years old. Researchers included premenopausal and postmenopausal women in their survey. However, they excluded some individuals, including women who had hysterectomies and those currently taking hormonal contraceptives.

To look at menopause symptoms, researchers had participants fill out the Menopause-Specific Quality of Life Questionnaire (MENQOL). This questionnaire examines several areas of menopause-related symptoms and the degree to which the symptoms bothered participants. A higher score indicates a worse quality of life because of menopausal symptoms.

Participants filled out a questionnaire to measure perceived stress. They also answered several questions about their health, obstetric and gynecological history, and certain gastrointestinal symptoms. When looking at gastrointestinal symptoms, participants had to answer questions about their frequency of bowel movements and stool consistency. Participants also had to answer specific demographic questions like their age and level of education.

Results of the study found that diagnoses of anxiety and depression and higher levels of perceived stress were associated with a more severe impact of menopausal symptoms. Regarding gastrointestinal health, researchers found that women with constipation experienced more severe menopause symptoms. Researchers noted that stool consistency and frequency of bowel movements may relate to a person’s gut microbiota.

Non-study author Dr. Kecia Gaither, MPH, MS, MBA,FACOG, a double board certified in OB/GYN and Maternal Fetal Medicine, and Director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx commented with her thoughts on the study to Medical News Today:

“Scientists are coming to recognize that microbiomes play important roles in health; vaginal microbiomes are important to neonatal health, and likewise gut microbiomes impact adult health. The gut is impacted by a multitude of factors– food consumed, medications taken, and the hormonal milieu– among other intrinsic and extrinsic influences. Gut microbiomes and its effect on health is a novel and burgeoning arena for research– which needs further information. The study proposed a great foundation on which to explore the relationship between hormonal fluctuations impacting the gut microbiome–and the physiologic and metabolic bodily changes that result from such.”

Study limitations and continued research

This study does have some limitations to its findings. First, it does rely on participant self-reporting, which doesn’t always result in accurate measurement. It also cannot establish a causal relationship between the factors that the researchers examined. Participants also completed the survey online, which means all participants had online access.

Researchers acknowledge the possibility of sample bias due to factors like conducting their survey in an urban area and most participants having higher education. This makes it hard to generalize the study’s results. Researchers also note that culture and attitude toward menopause can impact menopausal symptoms. So, future studies can include more participants from more diverse backgrounds.

This current study only included ethnically Lithuanian women, limiting the generalization of the results. Researchers note that further research can examine the relationship between the studied factors and include long-term follow-up.

Overall, the study points to the complexity of factors related to menopause symptoms. Dr. Gaither was optimistic that future research into the gut microbiome could uncover a way to improve menopause symptoms.

Dr. Gaither explained that it might be helpful “to narrow the field to see if there was a similarity of a specific protein or gene sequence that despite exogenous factors like environment, diet, ethnicity, co-morbidities was impacted by menopausal hormonal decline — and as such produced a host of clinical symptomatology.”

“To find such within analyzing the gut microbiome, perhaps treatment of menopausal symptoms might reflect the need for supplementation of that particular deficient protein– ultimately working to reverse symptoms associated with menopause,” Dr. Gaither added. “Further research along this line is needed– a breakthrough of sorts would change the lives and well-being of women –globally– who are impacted by symptoms of menopause.”

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