IBS Symptoms During Your Period: What To Do

Irritable bowel syndrome (IBS) impacts between 25 and 45 million Americans. Of those affected, two-thirds are women. The impact and severity of IBS symptoms can vary from a mild inconvenience to more severe and debilitating symptoms. IBS can often be unpredictable and can cause severe stress for many patients which can impact a variety of factors including their emotional, social and professional life.

 Although IBS may sound like a definitive diagnosis (“You have IBS”), it is simply a collection of symptoms and often provides us limited insight on the cause of your symptoms. Since it is a collection of symptoms, one-size-fits-all treatment approaches rarely resolve symptoms. We also know that women are impacted differently by their IBS than men and often notice worsening of their symptoms throughout the month. IBS is an important women’s health issue as data suggest that women with IBS are at an increased risk of unnecessary extra-abdominal and abdominal surgeries, like hysterectomies and ovarian surgeries. 

Symptoms of IBS 

In order to be officially diagnosed with IBS, you must meet what is known as the Rome IV criteria. According to the Rome IV criteria, IBS is defined as recurrent abdominal pain (happening at least one day per week in the last three months) as well as is associated with two or more of the following: 

1. Abdominal pain associated with bowel movements (defecation) 

2. Changes in stool frequency (diarrhea most commonly, but constipation as well

3. Changes in stool form/appearance. 

Since symptoms can slightly varied person to person, there are a few important subtypes to note: 

1. IBS with predominant constipation

2. IBS with predominant diarrhea 

3. IBS with mixed bowel habits (may experience alternating constipation and diarrhea) 

Although the specific cause of IBS is often multifactorial, many studies suggest that hormones play a pivot role. Many women with IBS will experience bowel changes during their menstrual period. This is thought to be most associated with fluctuations in both estrogen and progesterone. Researchers believe that female sex hormones, like estrogen and progesterone may modulate responses to stress, gut motility and visceral pain perception via the gut-brain axis. Estrogen and progesterone are known to inhibit smooth muscle contract and therefore can impact your gut motility which in turn can impact the frequency of bowel movements you experience. For some, this may mean experiencing more constipation prior to their period, while for others, this may mean experiencing more diarrhea during their period when estrogen and progesterone levels have dropped. 

Understanding your hormones is a vital part of addressing your IBS. This is why at NMD Wellness of Scottsdale, we believe in the importance of comprehensive hormone testing,when addressing patients suffering from IBS. 

Adding a probiotic isn't the solution for most women and instead it is important that we address any hormonal disorders or imbalances patients are experiencing. This is also the reason why when evaluating patients for hormonal conditions like endometriosis, we often see a high risk of developing IBS. By addressing hormone disorders, like endometriosis, many of our patients experience significant relief, and in some cases, reversal of their IBS symptoms. 

No crazy diet or a variety of supplements. 

Although every case can vary, over the years, we have noticed that patients with abnormally elevated estrogen levels or those with estrogen sensitive conditions, like endometriosis tend to experience constipation more often than diarrhea, where as women with abnormal progesterone, like luteal phase defect, most often experience episodes of diarrhea. 

So how do you know if your hormones are impacting your IBS and what can you do about it? 

I’m so glad you asked! 

The first, most important factor to address is how to properly evaluate your hormones. Although we could “assume” your hormones are impacting your IBS symptoms, it’s important that we test and don’t guess. Not only will this help us determine the best solutions for your particular case but it will help us resolve your symptoms faster. Asking your doctor to test your hormones is an important first step. Generally speaking the most accurate way to assess your hormones is via a simple blood test. You will want to be off of all hormonal contraceptives (the pill, IUD, etc) before testing can be complete. Testing is often most accurate if collected during the follicular phase of your cycle. We generally suggest getting your blood drawn between cycle day 2-5. Remember cycle day 1 is the first day of your period (not the last). If there are concerns that you are experiencing imbalances in your progesterone production, a second blood draw may be ordered around cycle day 18-21. 

If you are currently on some form of hormonal birth control and wondering if your symptoms of IBS are related to your hormones, you have two options. Option 1 is to discontinue hormonal birth control and get your labs drawn after experiencing 1-2 regular cycles. Option 2 is to consider other forms of hormone testing like urine testing. Urinary hormone testing can be helpful in evaluating how you make and metabolize your hormones, however it does not give us an accurate evaluation of your exact hormones. Think of it more as a guesstimate and more importantly a way to evaluate how you metabolize hormones, which blood testing will often not tell us. 

Once you have completed hormone testing, we want to make sure we are addressing your unique hormonal imbalance both internally as well as externally. Although we would like to think our environment isn’t impacting our health, more and more research points to the direct correlation between hormonal disorders and exposure to hormone disrupting chemicals, known as endocrine disrupting chemicals. Endocrine disrupting chemicals are chemicals that can be found in a variety of ways including in the cosmetics we use, the house cleaning products we own and the foods we eat. Focusing on eliminating your exposure to these harsh endocrine disrupting chemicals is an important step in addressing your IBS as well as your hormones. 

Exercise is another important but often forgotten treatment for IBS. Improvement in both our blood and lymphatic system is an important way to stimulate proper gut motility and transit time but is also an important way to support our blood sugar, inflammation markers and hormones, that all appear to impact the severity of symptoms associated with IBS. Aiming for 20-30mins of moderate activity each and everyday is an important step to prevent or reduce the symptoms of IBS. 

So before you start Lotronex, Amitiza or Xifaxan for your IBS symptoms it’s important we remember that food is truly medicine. What we eat, how we eat all have an impact on IBS symptoms. Making sure you are focusing on a whole-foods diet with 0.5-1lb of organic vegetables per day is a great way to nourish your body and support your gut health. Reducing your consumption of caffeine, processed foods and sugars can also help stabilize your blood sugar control, reduce inflammation and support your hormones naturally. Many of our patients with severe IBS, will often begin the autoimmune paleo diet for at least 1-3 months before reintroducing new foods. Many patients will have immediate results simply from changing their diet. So for those of you out there who have pondered the idea of changing your diet but have not committed to it, I want to ask you what life would be like without your IBS symptoms? What things could you accomplish in your life? So although eliminating gluten or eating more vegetables may seem hard at first, a life without symptoms is well worth it. If you are interested in making dietary changes but struggling to stay accountable or looking for additional support, I highly recommend working with a naturopathic doctor, dietician or health coach to help support you during this transition. 

Botanicals used for IBS 

Once you have made changing your diet and lifestyle a priority, it’s time we add in some additional support. As a naturopathic doctor, I love the use of herbs for our patients but it is extremely important to remember that although herbs are “natural”, they can absolutely come with their own side effects and it is extremely important to work with a qualified professional before implementing any additional herbs. Herbs can also interact with certain medications so make sure to always consult your doctor before making any changes to your health. 

One commonly used botanical that has been used especially with those with IBS- constipation was Aloe Vera. A double blind randomized controlled study found that the use of aloe vera was effective in reducing constipation in patients with IBS. Aloe vera did not however impact abdominal pain. Another important and often forgotten botanical well tolerated in IBS patients is Mentha piperita, aka, peppermint oil. Researchers in a double blind placebo randomized study found that not only was peppermint oil well tolerated by those with IBS, but they experienced significant improvement in bowel habits as well as abdominal symptoms. 

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About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...