Could Your Hormones Be the Cause of Your IBS Symptoms?
Hormones are internal messengers that circulate through the body and regulate the activity and growth of cells and organs by stimulating or inhibiting specific functions. Simply put, they are the project managers that make sure things get done and processes run smoothly. While hormones are meant to be efficient and help the body out, if they are out of balance or not doing their job well, they can actually mess up different systems, causing the body to be out of whack. Hormones can also be doing their job very well, but have a negative effect on another system in the body. With irritable bowel syndrome (IBS), we see both the imbalance and the secondary effect of hormones being potential symptom triggers.
In my practice, working with women with IBS, a missing piece I typically find early on in my assessment of their symptoms is the role of hormones. I also see a lack of hormone support in many of my clients, which only adds fire to the flame. For this blog, you’ll learn why hormones may be triggering symptoms and a few ways to actually support your hormones while also supporting your gut!
There are many different hormonal systems in the body, but the three I want to focus on in relation to IBS are sex hormones, gut hormones, and stress hormones.
Sex Hormones
Sex hormones include estrogen and progesterone for women, and testosterone for men. While talking about sex hormones, we will also discuss the hormone-like substance prostaglandin (PG). These hormones, specifically estrogen, play a significant role in the physiology and pathology of the gastrointestinal (GI) tract, including the regulation of motor and sensory function. Sex hormones influence the peripheral and central regulatory mechanisms of the gut-brain axis (GBA) involved in the pathophysiology of IBS, contributing to to alterations in visceral sensitivity, motility, permeability, and immune activation of intestinal mucosa. Don’t fall asleep on me. The break down is that sex hormones can alter gut function and may be an underlying cause and symptom trigger for IBS. This is more of an issue for women than men, so we will focus mostly on women for this section.
To understand the role of sex hormones on IBS symptoms, it’s important to understand the menstrual cycle, which is broken down into 4 stages: menstruation, follicular phase, ovulation, and luteal phase.
Menstruation: also known as your period, which is the beginning of the menstrual cycle when the uterine lining sheds. Estrogen and progesterone are lower during this time, but PG is elevated. Elevated PG may be the cause of increased nausea, bloating, abdominal distention, and pain during menstruation. PGs also stimulate the motor activity of the gut, which may be the cause of more frequency and looser consistency of bowel movements during menstruation.
Follicular phase: includes the time between the first day of menstruation and ovulation, so this phase overlaps with menstruation and bridges the gap to ovulation. Midway through the follicular phase, estrogen levels rise.
Ovulation: the release of the egg from the ovary, happening in the middle of the menstrual cycle. Estrogen levels peak at the start of ovulation then drop significantly afterwards, which can lead to an increase in constipation and bloating.
Luteal phase: includes the time between ovulation and the start of menstruation, when the body prepares for a possible pregnancy. Progesterone is produced, peaks, then drops during this time. The drop in progesterone leading up to menstruation can cause abdominal pain, bloating, diarrhea, and nausea for those with IBS.
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In addition to the basics above, here’s what we know from research so far:
IBS affects more women than men with a ratio of 3:1, which highlights the potential role of female sex hormones in the development of IBS.
Women with IBS, compared to men with IBS, are more likely to report symptoms of constipation, bloating, severe pain, and the feeling of incomplete evacuation. Studies also support this by showing slower gut transit for women with IBS, compared to men with IBS.
Changes in ovarian hormones (estrogen and progesterone) during the menstrual cycle can modulate GI contractility (muscle function), transit (speed of digestion), secretion, visceral sensitivity (pain), and immune function at multiple target sites, including those located along the GI tract and the brain.
Estrogen interacts with serotonin (produced in the gut) and corticotropin-releasing factor (CRF) signaling systems, which may play a pivotal role in the change of symptoms with the change in estrogen. There is a distribution of estrogen receptors along all levels of the GBA, which may explain these interactions more. The receptors could also indicate that our GI system is meant to react and sense sex hormones.
Birth control may decrease IBS symptoms, but there are also studies that report increased symptoms with the use of birth control. This may depend on the type and the hormones affected with the use of the contraceptive. We need more research to understand this better.
Pregnancy is characterized by high ovarian hormone levels, as well as an increase in opioid-mediated antinociception. Pregnancy may improve symptoms for some, but may cause more constipation and reflux for others due to elevated progesterone.
IBS symptoms may be induced during the short-term decline of ovarian hormones, but menopause is typically marked by a significant decrease in symptoms.
Takeaway: IBS symptoms are highly influenced by sex hormones for women, which explains why IBS symptoms may be worse leading up to menstruation and following ovulation. This also explains why symptoms may change during pregnancy and menopause. This may also explain why IBS is typically onset between puberty and menopause, and why IBS affects more women than men.
What to do: track your menstrual cycle and learn your own body, so that you can support your body during these periods of time when your gut may be more vulnerable.
Gut Hormones
The role of our gut hormones in IBS is less complex and detailed than the role of our sex hormones. The gut hormones we are focusing on for this post are cholecystokinin (CCK), motilin, and vasoactive intestinal peptide (VIP).
What we know from research:
CCK and motilin may be involved in postprandial symptoms (post-meal) symptoms
VIP may be abnormally concentrated in IBS, which can cause cramping and watery diarrhea
We need more research. There’s a link there and a potential for a deeper understanding of IBS symptoms, but we don’t have the research to explain it.
Takeaway and what to do: your hormones are all connected and tend to work together, so focus on supporting your hormones as a whole to support your gut hormones.
Stress Hormones
The connection between stress and IBS is very complex. We know that stress, whether psychological or physical, plays a major role in the development of IBS and symptoms. Acute stress is known to be a symptom trigger, and chronic stress is known to be a cause of IBS due to an altered microbiome. The stress hormones we will focus on are cortisol, corticotropin-releasing hormone (CRH), and adrenocorticotropic hormone (ACTH).
What we know from research:
Compared to women without IBS, cortisol is shown to be elevated in women with IBS in the morning, with a decrease in the evening.
Cortisol is involved in producing many of the physical effects caused by emotional stress.
CRH is shown to cause stress-related intestinal muscle activity, which is shown to be stronger and longer-lasting in those with IBS.
Cortisol activates the HPA axis (bidirectional gut-brain communication pathway) and induces a Th2 response by the mucosal system that can increase mast cell numbers. Mast cells in the gut produce and release abundant histamine, serotonin, and proteases, and cause more excitation of the primary afferent neurons in IBS patients compared to healthy controls, which means more symptoms for those with IBS.
Activation of the HPA axis has been shown to alter the gut microbiota composition and increase gut permeability, which are both underlying factors in the development of IBS. Changes in the gut microbiota and gut permeability has been linked to the development of depression and anxiety, due to altered communication along the HPA axis, as well as chronic inflammation.
IBS patients were reported to secrete more CRH than healthy controls, and to have accelerated rates of ACTH and cortisol secretion in response to CRH.
During acute psychological stress, individuals with IBS were reported to show no difference in the cortisol response compared w/ those without IBS, but individuals with IBS displayed higher CRH and ACTH responses compared to those without IBS.
Takeaway: there is a complex relationship between IBS, the gut-brain communication pathway, and stress hormones. We know that stress is an underlying cause of IBS, as well as a trigger for symptoms. Stress hormones play an active role in this connection. Read here to dive deeper into the stress and IBS connection.
What to do: support your hormones by decreasing stressors and improving your ability to combat the stress response by activating the relaxation response.
Take Action
Take a deep breath. That was a lot of information that may leave you wondering what in the world you should do now. It can seem as though hormone changes are out of your control. That’s partly true, as some changes in hormones are simply part of nature. However, there are still actions you can take to support your hormones and your gut, without sending your brain into a stress cycle.
Sleep. This seems simple, but when we sleep, our hormones are synced up to our master clock, known as the circadian rhythm. Consistency with sleep times, quantity of sleep hours, and quality of sleep all matter. Aim to go to bed and wake up around the same time each day, sleep at least 7-9 hours each day, and improve your quality of sleep by establishing a bedtime routine.
Enjoy healthy fats. Healthy fats from fish and plant sources, including vegetable oils, avocado, nuts, and seeds support our hormone systems. Including healthy fats in your meals and snacks is a great way to make your hormones happier.
Eat enough food. Eating too little calories due to poor appetite, eating disorders, or severe restriction due to IBS symptoms can knock our hormones out of place and increase our susceptibility to whacky stress hormones. If you aren’t sure if you’re eating enough, or have no idea how to increase calories due to any of the reasons above, work with dietitian to get a little guidance!
Manage stress more effectively. There are many layers here, but I’ll simplify. First, remove stressors you can. Second, implement activities like consistent sleep, exercise, balanced meals, and mindfulness to help improve your tolerance to stress. Third, train your body to initiate a relaxation response during stressful moments with a breath work and meditation practice. You can incorporate this with yoga for an added benefit!
This 4 step plan is a great place to start right now. If you feel that your hormones may still be out of balance and working against you, meet with your doctor to check for any nutrient deficiencies (these can affect hormones and mask as hormone imbalance), as well as hormone levels. If it seems like you’re trying all of the above and you’re still noticing that your IBS symptoms are strongly affected by hormonal changes in your menstrual cycle, with meal times, and/or during moments of stress (or in the morning when levels may be elevated!), it may be time to meet with an IBS-specialist for a holistic approach to managing your symptoms. Schedule a consult call here to chat about what this could look like for you!
What was your biggest takeaway from this article? Comment below and let me know! If you found this helpful, take a moment to share it with a friend you think could benefit from it!
More articles you can check out to dive deeper:
Why IBS Symptoms May Be Worse During Your Period
PCOS and IBS: Diagnosis, Symptom, and Treatment Overlap
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