Episode 16: How your menstrual cycle impacts your gut & IBS

This episode answers a question Erin gets asked almost weekly: why are my symptoms worse around my period?

The episode will dive into the different stages of the menstrual cycle and how each stage and change in hormones can impact the gut and IBS symptoms.

You can check out the podcast on iTunes here, Spotify here, and on YouTube here! Below is a full transcript of the episode if you prefer to read through it or want notes.

Don’t forget to connect to others in The GUT Community, a Facebook group for those with IBS and digestive disorders to support one another and dive deeper into each episode together.

Welcome back to The Gut Show! This episode is specifically for our females out there, because it is all about your menstrual cycle! So if you do not have a menstrual cycle, this episode may not be exactly for you, you will learn a lot if you still want to listen, if not, maybe go back to a previous episode, catch up on that, review some information that directly applies, and then come back next week as we dive into a new topic.

When we're looking at your menstrual cycle, it's so important that we break down what the menstrual cycle actually means, what it is, and how different phases of the cycle can impact IBS directly or indirectly. And we're also going to talk a little bit about changes in the menstrual cycle and what to know. Know that there's so much to this topic that we cannot cover in one single episode, so be sure to take information in, I'll give you some resources if you need them, and then consult with your trusted healthcare professional to create a plan that can help you evaluate where you're at, and then adjust what you need to to serve your body well.

So when we're looking at hormones and IBS, we've talked about this in different ways in different episodes before, but hormones are directly involved in how the gut functions. So hormones are the communicators and the messengers in the body, and they all work together. So they're like, you know, a line of women who meet up at the hair salon gossiping, it's a little bit like that. They're always talking with each other, whether they're involved with digestion, your digestive hormones, your hunger fullness hormones, your hormones that are involved in the menstrual cycle, your sex hormones, or even your hormones that are involved in stress management, they're all going to communicate. The reason why we have to think about that is when we're looking at supporting the hormonal systems as a whole, we have to make sure that we're taking into account the fact that they are communicating. So a lot of the things that we'll do to help hormones are going to overlap with what we would do for other hormonal systems, or even what we do generally for IBS. That's a benefit. It's also something to keep in mind as you're evaluating how your body might be responding or reacting, or even digging deeper into what could be driving your symptoms by understanding how these different pieces could potentially work together.

So menstrual cycle, let's dive into the four stages of the menstrual cycle and then we'll talk about what's really happening throughout those stages. So we have menstruation, the follicular phase, we have ovulation and then we have your luteal phase. So menstruation is also known as your period, and this is the beginning of the menstrual cycle when the uterine lining sheds. So that's where the blood flow is actually coming from. So we typically consider the first day of the menstrual cycle, the first full bleed day of menstruation. So that doesn't mean like spotting that means a full bleed day.

During menstruation estrogen, so one of our sex hormones, estrogen and progesterone, which is another sex hormone, they are lower, so estrogen and progesterone are lower. And then prostaglandin, which is hormone like, is elevated. So estrogen, progesterone, low. Prostaglandin high. The elevated prostaglandin can actually be the cause of increased nausea, bloating, abdominal distension, that form of bloating, and pain during menstruation, so like the cramping the pain that you may be feeling. Prostaglandins can also stimulate the motor activity of the gut, which could be one cause of more frequency and that looser consistency about movements during menstruation. So we call it like period poops, the reason for it is likely are prostaglandins. There could also be some cramping just from the uterine lining shedding which can feel like it's digestive cramping, but the real like pain, cramping and diarrhea is likely more related to the prostaglandin than the shedding itself.

So the follicular phase it actually overlaps. So menstruation is the bleeding, that's the start of our follicular phase. The follicular phase actually goes over towards ovulation, so it's going to cover menstruation and then the gap between menstruation and ovulation. It's going to be where estrogen levels start to rise. So our prostaglandins are high with menstruation so they come back down. Our progesterone is still kind of low, but our estrogen levels are rising up so they're slowly increasing as they move through the rest of the follicular phase and go into ovulation.

Ovulation is where the release of the egg from the ovary happens, and this is going to happen right in the middle of the menstrual cycle. So ovulation is one moment where the egg is released, and there's usually some cramping that might be involved with that release. Sometimes we consider the ovulation phase to be a few days, and the reason why is that you can only get pregnant during ovulation when the egg is released, but sperm can live for a few days. So they might consider ovulation being a few days, not really a full menstrual cycle length, but a few days because sperm can live and might still be present when that egg is fully released.

When this happens, estrogen levels are at their peak. So they're rising during our follicular phase, and then there's a peak at the top of ovulation. Then they're going to drop significantly after and that drop, so a significant shift can actually lead to an increase in constipation and bloating for many with IBS. So we typically see symptoms increase right after that drop in ovulation. And now if you're not familiar with the signs of ovulation, we have that egg white discharge that we can see. There's also a way to kind of feel where your cervix is located, you can measure your temperature, a lot of different ways to do that. Right after when estrogen levels drop, then you might see an increase in symptoms, which can explain why symptoms may happen. But there's no clear reason why ovulation is sometimes to blame for that.

After ovulation, so the moment of ovulation then we go into our luteal phase, so this is the time between ovulation or that moment of ovulation and the start of menstruation. So this is where the body is actually preparing for possible pregnancy because the egg is released, it might get fertilized and so now the body's preparing for a potential pregnancy. So this is where progesterone, so progesterone was kind of increasing, it drops, and that can go throughout that phase leading up to menstruation, that drop in progesterone, so the increase in progesterone that happens after your menstruation, kind of around ovulation when when progesterone was increasing, too, and that's where you typically feel good, I feel sexy, we love progesterone for that reason! But as it drops leading up to menstruation, that's going to lead to abdominal pain, bloating, diarrhea, and nausea for those with IBS. So that's another place in the menstrual cycle where we typically see symptoms occur, and that's right before menstruation. So that might occur during maybe the times of spotting if you spot a few days before a full bleed, because remember, menstruation is the full bleed day. If you're checking temperature, and you're kind of tracking or you have a very consistent cycle, you may actually know those few days before even if you don't see signs of it, then you may notice that symptoms worsen as you lead up to your menstrual cycle.

So everything that happens during the menstrual cycle, when it comes to symptoms is directly related to the hormones. So remember, in menstruation, we have prostaglandins, they're released, that can lead to those period poops, and symptoms, nausea as well. Then, after your period is over moving towards ovulation, at that drop of estrogen, we're going to see symptoms increase, right at the base of ovulation, particularly for those who are dealing with constipation. Then a few days before we start your period, or menstruation, the peak of progesterone and that drop is going to cause pain, bloating, diarrhea particularly, nausea, and all that for those with IBS, which can lead into a little bit more diarrhea during menstruation.

So that is for someone who has just a very clear cycle, right? You have all the hormones doing what they do naturally. There are reasons for that to be different. So those who are dealing with like PCOS or endometriosis, there may be a significant shift in the way that hormones are produced or released, and typically, we're going to see abnormal cycles. So an abnormal cycle, which is, I think, outside of the 28 to 35 day window, that's where your cycle should fall, so if it's way too short, or way too long, that could be considered abnormal. If you're skipping months, so let's say you only menstruate like once every few months, and it's kind of all over the place, there seems to be no clear cycle or routine that's happening within your body, that's a sign that those hormones are off, somethings going on. If you're on birth control, which is going to interfere and actually manipulate those hormones most of the time. There's only one form that doesn't, which I believe is the copper IUD, that's a conversation you want to have with your gynecologist, so the person that you are getting your birth control support from.

So if there’s a change, then that is usually a red flag to me as a provider that hormones can be playing a very significant role, and it's important to look deeper into what's happening. Is estrogen way too high? So do we have a really high amount of estrogen present? Is estrogen way too low? Our prostaglandins, are they being released like they need to? Is progesterone being released and like dropping at the rate that it's supposed to? What's happening? And then when it comes to birth control, what did the birth control manipulate? Because it can manipulate different pieces of the cycle, and so based on that manipulation, sometimes we can tell if birth control can be contributing to symptoms, or if birth control may actually be helping symptoms, and it can go in both directions. So the answer isn't do you take birth control or not? The answer is, it depends on your body and what's going on as well as your goals because there's a lot of different reasons why you may go that route. And so it's just important to know how that could be impacting your body and look for some of the signs of these hormone shifts in your body as you go through your cycle, track your cycle, and then see how your symptoms may overlap.

So some of the ways that we do this in our practice with our clients is one in your tracking, make sure you're actually tracking the different phases of your cycle. So we actually have that, I don't have it right in front of me, but we have our My Gut Journal and where we have assigned for ovulation or menstruation, that's a great way to basically do it. So what I do personally, if I'm tracking, in a period of tracking, what I'll do is I'll write whether I'm in my luteal phase. I’ll write if I'm a few days out from my period, just those notes that I kinda know about myself, to help me understand like why symptoms might be higher.

We also really recommend that you utilize some sort of menstrual cycle tracking platform. And so I really like doing the fertility awareness method where you're taking your temperature, so the basil temperature, I learned this through the Period Repair Manual, which has been really helpful. There's also one called Beyond The Pill, that's another great book. You can also do the gold standard, and talk to your provider. There's a lot of coaches out there as well that will help specifically with hormones and your cycle and getting your menstrual cycle kind of back on track. But really tracking when you're ovulating, when you're menstruating and trying to somehow get a handle on what those shifts in hormones look like for you, and so noticing like, are you ovulating? Do you have that discharge? Is your temperature changing? Are you noticing that you have a normal bleed, and those books that I mentioned, as well as your gynecologist should be able to help you measure that and understand that.

From a personal side, the cup, so using like the cup versus like a tampon or even a pad is really helpful because you can visually see how much blood is being produced. You can also utilize, like a tampon conversion rate, that a lot of the books as well as your provider might be able to help you with to understand like, are you bleeding enough, because that will be a sign of some of the hormones that are being released as well. If you're on birth control know that all of this is different. So it's important to understand how the birth control actually impacts you. Are you having a menstrual cycle? Or is it just a pill bleed, like what's going on? So we want to have those conversations.

As you start tracking your cycle, so you're tracking your ovulation, you're tracking your period, look out for symptoms that seem to coordinate with those significant changes. So are you having an increase in symptoms on your period that could be related to the period poops? Right? Are you having any symptoms that seem to go with your ovulation that might be from that drop in hormones? Are you seeing symptoms pop up right before your period that might be from a drop in hormones? Really look out for if there's some consistency there. And if there is, then that's a great sign that the food that you're eating, or maybe some changes that you're making, or other things that you're looking at, may not be to blame for those symptoms.

I see this a lot in practice, I see people going through like low fodmap diet or just kind of changing things and they have that increase in symptoms, and the first thing that gets blamed is the food like oh, well it must be this thing. And so that can lead to unnecessary restriction, or fear of foods that isn't needed, because it wasn't the food, maybe it was the hormones that were involved. Now that you know that and if you can recognize that then what you can do as you track your cycle and that if your cycle is, you know, consistent of course, you can pro actively prepare for the symptoms that might be present. So if you know that you have more constipation around ovulation, you might increase your fiber, you might bump up your movement a little bit, maybe you incorporate some kiwi or magnesium or something like that to help you go.

If you know that you have more diarrhea at the start of your period and on your period, then maybe you implement more self care, you bring down the intensity of your movement, you choose foods that are easy to digest that you know won't trigger you, you really bring stress down, all of those different kind of strategies that you can use. So you can actually proactively plan for that change in symptoms to support your body well, that's true self care, right, supporting your body in the moment, using your intuition and what you've learned about yourself to be able to make those changes so that you can have the least amount of symptoms possible.

If you're having abnormal cycles, or you're noticing that that trigger of your symptoms during those times is so significant, like it's the most severe trigger that you have, then that media sign that you need to plan in place to support your hormones. And unfortunately, or fortunately, depending on how you want to look at it, it does usually come down to stress management. And that's not just psychological stress of oh, you're anxious, you know, write it down, journal, meditate, go to therapy, those things are incredibly important. What also matters is cortisol, the stress hormones, so are really bringing down cortisol, which includes sleeping well, a lot of things we talked about all the time, bringing down your intensity of movement, and really activating the parasympathetic nervous system which can go back to vagus nerve activity. So when we talked about the vagus nerve, and one of our episodes like that would be really helpful to revisit, or working with a provider that understands those different layers and pieces that can give you a very specific plan for your body. That way, you are kind of looking at this in a holistic way, versus only treating it or you know, managing it through food, because it goes beyond food. If we've learned anything about IBS, through this podcast, through conversations that we may have had, through social media, through your own experiences with providers, we know that it's not just about food, it's not straight forward all the time, there are layers involved, and it's important to look at these layers, because that's gonna give you more insight into your body so that you can serve your body well.

So I hope that was helpful, just a deep dive into the menstrual cycle. We also have a full blog on this on our website, so if you feel like you got a little bit lost in this conversation, check that out! As always join us in The GUT Community on Facebook to have another conversation about this. If you have questions, or maybe aha moments or something that really stood out to you in this conversation, take it over to the Facebook community or on Instagram and tag me at @erinjudge.rd so we can chat a little bit more. Have you have an amazing rest of your day, whatever that looks like for you right now in this moment, and I will see you on the next episode!