Gut Health

Constipation and menopause: easy ways to get things moving

Nutritionist Stephanie Moore explains why constipation can become such a problem during menopause, and shares her top tips for getting things moving again.

Constipation is just one of the more than 48 known symptoms of perimenopause and menopause. It might seem like an odd connection – bowels and females sex hormones – but oestrogen and progesterone have many roles around the entire body.

Constipation is officially classified as having fewer than three bowel movements a week along with straining; stools being hard and pellet-like; feeling like bowel movements are incomplete, along with a really unpleasant smell. This is almost always accompanied with persistent bloating, wind, feeling heavy and stuck, along with a general blah feeling. All in all, pretty unpleasant and frustrating.

So what’s going on and why does it matter?

The link between menopause and constipation

During early perimenopause, it is progesterone that declines most rapidly. Lower progesterone affects the muscular tone of the intestine, which slows transit time. The longer food is in the digestive system, the more moisture gets absorbed into the bloodstream. This creates hard stools that don’t pass easily.

Low progesterone also tends to reduce bile secretion. Bile is concentrated in the gall bladder and gets added into the intestine to help with digestion. Less bile means slower bowels.

Another hormonal impact on constipation in perimenopause is the rise in the master stress hormone, cortisol. The menopausal process can be stressful for many reasons: it often occurs at a time of life where we’re juggling teenage children, elderly parents, a busy job and so much more. Couple this with declining sex hormones that naturally lead to an elevation in cortisol and this shift can cause the bowels to become more sluggish.

This is true at any stage of life – higher stress hormones means slower digestive processing because we’re in stress-mode, aka fight or flight. This activates the sympathetic side of the nervous system, suppressing the rest and digest (parasympathetic) response, which governs good digestion and regular bowels.

Why healthy digestion matters

Managing constipation is essential, and not simply because of the unpleasant feeling of being bunged-up.

Without regular bowel movements, toxins, including excess hormones, heavy metals and other substances the body is trying to eliminate, can be reabsorbed through the wall of the colon. This can trigger the body to make yet more cortisol, causing more constipation.

Meanwhile the liver, in charge of breaking down these toxins, can become over-burdened. A sluggish liver can make perimenopausal symptoms worse.

The gut microbiome is also vulnerable to being overwhelmed with nasty gut bugs if the colon is not clearing daily. If the delicate ecosystem of the gut microbiome is thrown off and the liver is over-worked, the resulting increase in circulating nasties can lead to headaches, aches and pains and general malaise. As the gut microbiome is managing so much of our physical and mental health, it’s no wonder that constipation can have far-reaching negative knock-on effects.

A word on iron

Another possible cause of constipation during menopause can be iron supplements. Thse are well known to be constipating, but may be necessary at this time of life. In early menopause, oestrogen levels can still be normal, or higher than normal, but progesterone is crashing. This can lead to heavy periods.

With an increase in loss of blood, women can become low in iron. Couple this with higher cortisol levels that reduce stomach acid and enzymes, and our absorption of iron from food can be impaired. This can be a double-whammy for iron levels.

Optimising our iron levels is essential for physical and mental resilience, not least because iron is essential for activating thyroid hormones. Low thyroid hormones means low everything. We might feel tired, overwhelmed and have sluggish digestion. Standard iron supplements can quickly cause or add to constipation.

So, if you’re feeling exhausted all the time, seek professional help to get your iron levels checked and a non-constipating supplement recommendation, if needed.

Natural ways to get things moving

Prioritise hydration

The first, easy must-do is to hydrate better. Being constipated allows too much moisture in the bowel to get reabsorbed into the bloodstream, causing further constipation.

We can’t resolve constipation if we’re dehydrated. However, drinking copious amounts of plain water is often not the answer. Plain water will rapidly pass through the kidneys into the bladder. This is important for keeping your kidneys healthy, but for constipation, you need to make sure plenty of fluid gets to the bowels.

Throughout the day, top up your hydration with herbal teas, or water with a tiny pinch of rock or sea salt. If you’re having a particularly sweaty day due to exercise and/or hot flushes, some sugar-free electrolytes can help make your water more hydrating.

Focus on ‘swollen’ foods

To hydrate the bowels to ease the flow, focus on ‘swollen foods’. These have absorbed water through being soaked or cooked. These foods take up lots of water into their fibre structure. This allows it to pass, undigested, through the intestine, carrying the water to ease constipation while also providing prebiotic fibre to feed beneficial microbes. These bacteria then further support more complete, regular bowel movements.

One of the most effective of these swollen foods is soaked chai. These tiny seeds take on 25 times their weight in water. As they swell, the fibre in the seeds expands and the resulting gloopy, ‘swollen fibre’ really helps hydrate and ease bowel movements. It also provides excellent prebiotic fibre to feed the good gut microbes.

Flax seeds are also good at doing this, with the added benefit of hormone and gut-friendly polyphenols and phytoestrogens. To get the best results, freshly grind 2-3 tablespoons of a 50/50 mix of flax and chia seeds to a rough meal. Add in half a teaspoon of psyllium husk powder – this is another water-loving, gloopy superstar for constipation. Generously cover the mix with water and leave to soak overnight. In the morning you’ll have a nutritious, high fibre, mucilaginous gloop to add to a smoothie or mix into yogurt and berries. Alternatively, if you’re feeling brave, drink down with more water.

Other great swollen foods include beans and lentils, overnight soaked whole oats and noodles made from glucomannan. This is another natural, water-loving fibre that takes fluid-filled soluble fibre to the bowels. Fresh fruit and vegetables are natural fully of hydrating ‘structured’ water along with fibre. Drinks like water kefir and kombucha are great hydraters, as long as they are not too sweet.

Get moving

Exercise is a great bowel mover. Walking is safe and effective and will often initiate a bowel movement. Gentle stretches that involve twists through the spine are really good at stimulating bowel function, too.

Keep things regular

Finally, get into the habit of going to the toilet at roughly the same time each day. Do this even if you don’t feel that you need to go. Sit on the toilet, don’t strain, and take some deep breaths. Sometimes this can be enough to get things moving. Raising your knees can really help too. Putting something under your feet, like a pile of old magazines, to bring your knees higher than your hips can help. This works to put your pelvis in a better position to open up your bowels.

Words: Stephanie Moore