Irritable bowel syndrome (IBS) is heavily influenced by hormonal changes. Its symptoms can worsen and overlap with menstrual, menopausal, or pregnancy-related discomfort. Understanding this connection is key to effective management.

This article explores the link between IBS and hormones and offers practical tips for symptom relief.

Does Hormonal Imbalance Cause IBS?

Yes, hormonal imbalance can contribute to IBS, but it is not the sole cause. Hormonal shifts can affect gut pain sensitivity, digestive enzyme production, and how quickly food moves through the intestines.

While the exact cause remains unknown, IBS is believed to result from a combination of gut-brain interactions, altered gut motility, heightened intestinal sensitivity, and potential changes in gut microbiota.

Note: Read about the connection between gut health and hormones.

What Hormones Cause IBS?

Estrogen, progesterone, and cortisol are the primary hormones linked to IBS. Their fluctuations can affect gut motility, sensitivity, and digestion, often intensifying IBS symptoms and inflammation.

Some studies show that the two sex hormones may also interfere with the gut microbiome, leading to bloating, cramping, and irregular bowel movements. Moreover, cells in the gut contain receptors that allow these hormones to bind, indicating that the digestive system is designed to respond to hormonal changes.

Estrogen

Studies suggest that estrogen and its receptors influence the progression of gastrointestinal disorders, including IBS. Low estrogen levels can trigger IBS flare-ups in the following ways:

• Pain level - A decrease in estrogen lowers the pain threshold, partly due to its role in enhancing serotonin production, a neurotransmitter associated with wellbeing. Conversely, a rise in estrogen can reduce pain sensitivity, alleviating discomfort from cramps or stomachaches.
• Digestion – Estrogen promotes efficient digestion by stimulating intestinal muscles. Low estrogen levels can slow the process and reduce muscle tone in the gut, leading to constipation, bloating, and discomfort. A sluggish gut retains more water, further amplifying digestive issues.
• Inflammation - Estrogen's anti-inflammatory effects help regulate immune cells that protect against pathogens and maintain gut barrier integrity. When estrogen drops, inflammation increases, potentially worsening IBS symptoms.

Progesterone

Progesterone can impact digestive health and deteriorate IBS in the following manner:

• Gut microbiome – Increased progesterone levels may impact the activity of gut bacteria, and oral progesterone can alter GI microbiota, notably increasing Lactobacillus reuteri levels.
• Bowel movements – High progesterone levels during the luteal phase delay gastric emptying, leading to gas, firm stools, bloating, upset stomach, and indigestion. During menstruation, a sudden drop in progesterone and a rise in prostaglandins (hormone-like chemicals) may cause diarrhea.

Cortisol

Cortisol regulates the body's response to stress and worsens IBS symptoms if left unchecked. Chronic stress disrupts hormone and neurotransmitter balance, causing gas, bloating, and abdominal pain.

High cortisol levels can trigger colon spasms, leading to cramps and discomfort. Stress also disrupts gut bacteria, further worsening IBS symptoms and increasing the risk of gut dysbiosis.

Estrogen helps manage stress by regulating cortisol levels. When estrogen is low, cortisol increases, intensifying stress and IBS symptoms. Understanding this connection is key to managing stress-related IBS flare-ups.

Note: Read more about stress and hormones and discover seven ways to naturally lower cortisol levels.

Hormonal IBS Symptoms

Irritable bowel syndrome is a long-term condition, which means that the symptoms occur sporadically after specific triggers (e.g., food, medication, or hormonal changes). Constipation, abdominal pain, bloating, fatigue, anxiety, and depression are more common in women, whereas men are more likely to report diarrhea.

Hormonal shifts can trigger or worsen the following physical and mental IBS symptoms:

• Cramps
• Bloating
• Gas
• Belly aches
• Diarrhea
• Constipation
• Increased mucus in stool
• Increased bowel sensitivity
• Changes in gut motility
• Nausea
• Appetite changes
• Worsening of PMS symptoms
• Irregular or missed periods
• Heavier or more painful periods
• Fatigue
• Migraine
• Depression
• Anxiety
• Brain fog
• Irritability
• Food intolerance
• Headaches
• Urinary problems
• Pelvic organ prolapse
• Chronic pelvic pain
• Pain during intercourse

How Do Hormonal Changes Affect IBS?

Hormonal changes impact all bodily functions, including metabolism, mood, sleep patterns, and digestive health. Each hormonal shift can affect the intestines and worsen IBS symptoms.

Menstruation

During menstruation, progesterone and estrogen levels drop, and abdominal discomfort usually becomes more intense. Bleeding can be accompanied by constipation or diarrhea, stomach pain, and cramps. An IBS flare-up during menstruation is more challenging because IBS symptoms often overlap with menstrual discomfort.

These are the key factors that contribute to IBS symptoms during menstruation:

• Shedding of the uterine lining - The body releases prostaglandins that trigger uterine contractions to help shed its lining, which may also explain why many women report more severe IBS symptoms during menses. These hormonal fluctuations impact gut motility, increase sensitivity, and intensify cramps, pain, and bowel movements.
• Increased sensitivity - Women with IBS often experience heightened gut sensitivity (visceral hypersensitivity), which worsens with hormonal changes during the menstrual cycle, intensifying pain and discomfort.
• Fluid retention - Hormonal shifts during the menstrual cycle can cause fluid retention, increasing bloating and discomfort. In women with IBS, this may intensify abdominal distension and pain.

Pregnancy

High progesterone levels during pregnancy can slow motility, worsen constipation, and disrupt sphincter function, leading to heartburn and GERD (gastroesophageal reflux disease). Weight gain, abdominal pressure, and pelvic changes further impact bowel movements, especially during the third trimester.

However, for some women, IBS symptoms may improve due to high progesterone that relaxes the gut and reduces cramping. Elevated estrogen and progesterone levels may also reduce pain sensitivity and alleviate chronic pain syndromes like migraine.

Perimenopause and Menopause

Sex hormone production drastically decreases during perimenopause and menopause. The sudden drop in estrogen and progesterone levels can affect digestive health, triggering gastrointestinal issues like acid reflux, constipation, diarrhea, and IBS.

Scientists have discovered that women aged 40 and 65 often face gastrointestinal issues that stress, poor sleep, diet, and lack of physical activity exacerbate. However, more research is needed to clarify the exact relationship between menopause and IBS.

Birth Control Pill

Contraceptive pills have not been shown to cause irritable bowel syndrome or aggravate symptoms. However, they contain synthetic versions of progesterone, estrogen, or both, which can influence gut function.

The impact of hormonal contraception varies depending on the formulation and individual response. Some women may experience bloating, nausea, or changes in bowel habits due to hormonal shifts. Others may notice no digestive changes or even experience symptom relief.

Who Is Most Likely to Get Affected by Hormonal IBS?

Irritable bowel syndrome affects up to 15% of Americans, and women are twice as likely as men to develop this gastrointestinal condition.

This disparity may be due to female sex hormones (progesterone and estrogen) triggering IBS flare-ups. In contrast, the male sex hormone (testosterone) may protect against the condition, according to research.

Several factors increase the likelihood of developing hormonal IBS:

• Being female.
• Being under the age of 50.
• A family history of IBS.
• Early-life exposure to stressful events.
• Mental health conditions like anxiety or depression.
• Having a bacterial infection in the gut.

How Is Hormonal IBS Diagnosed?

Rome IV criteria, the standard diagnostic guideline for IBS, require symptoms to occur at least once a week in the last three months, with an onset at least six months earlier. Your healthcare provider will review your medical history and may ask you to track your IBS symptoms in a journal.

You may receive an IBS diagnosis if you experience:

• Stomach pain
• Bloating
• Cramping
• Pain and discomfort linked to bowel movements
• Changes in stool appearance or frequency

Since IBS can be mistaken for other digestive illnesses, your healthcare provider may perform additional testing for an accurate diagnosis. These tests include a stool analysis, CT scan, colonoscopy, upper endoscopy, lactose intolerance test, and test for bacterial overgrowth.

Hormonal IBS Treatment

There are many effective IBS remedies and treatments that can calm gastrointestinal irritation triggered by hormonal shifts. A combination of medication, home remedies, supplements, and lifestyle changes help manage IBS flare-ups and relieve most symptoms.

Bear in mind that IBS is a chronic condition that requires long-term solutions and a combination of strategies to address both gastrointestinal and hormonal symptoms. Treatment may also vary based on the type of IBS you have: IBS-C (constipation), IBS-D (diarrhea), or IBS-M (a combination of both).

Dietary Adjustments

You can keep IBS under control despite hormonal imbalance with the following dietary adjustments:

• Eat smaller meals more frequently to reduce bloating and discomfort.
• Eliminate trigger foods that increase inflammation and indigestion.
• Avoid eating high-FODMAP foods like wheat, garlic, onion, beets, cherries, honey, and almonds.
• Limit the intake of caffeinated and alcoholic beverages to reduce inflammation.
• Drink more water to reduce constipation and bloating and aid gut motility.
• Drink herbal teas like peppermint or chamomile to calm the digestive tract and soothe intestinal spasms.
• Avoid eating processed, salty, and sugary foods rich in additives, artificial sweeteners, and trans fats.
• Include anti-inflammatory foods rich in fiber, vitamins, minerals, and probiotics.
• Keep a food journal to track meals and determine potential triggers or food sensitivity.
• Eat mindfully and chew slowly to prevent overeating or bloating due to swallowed air.

Supplements

Dietary supplements support hormonal balance and digestive health by providing essential vitamins, minerals, and amino acids needed for overall wellbeing. A healthcare professional will help you find the right supplement for your specific IBS symptoms and hormonal issues.

Our health experts recommend the following:

• Gut-supporting supplements (Vibrant Gut Support and Vibrant Digest) - Enhance gut microbiome, improve motility, and aid digestion. They can improve IBS symptoms, boost nutrient absorption, and promote a healthy inflammatory response.
• Vitamins and minerals for stress reduction – Vitamin B complex (Vibrant B), magnesium (Vibrant MG), and vitamin D (Vibrant D) relax the intestinal muscles, reduce cramping and spasms, and improve metabolic health and GI regulation.
• Hormone-balancing supplementation – Includes essential vitamins and minerals that help optimize hormone levels and a healthy stress response, like Vibrant DHEA.
• Probiotics and digestive enzymes – Supplements like Vibrant Biome help balance gut bacteria, improve digestion, and reduce gastrointestinal inflammation.

Medication

Over-the-counter pain relievers like ibuprofen or naproxen can reduce menstrual cramps, while peppermint oil capsules can reduce bowel spasms and alleviate stomach pain.

Prescribed medication is used for severe or persistent IBS symptoms. The doctor customizes the treatment based on your hormonal levels and the type of IBS (diarrhea, constipation, or mixed).

The following medication can help relieve IBS during intense hormonal changes:

• Laxatives - Speed up bowel movements and help relieve constipation.
• Bulking agents or fiber supplements – They can ease the passage of stool.
• Antispasmodics - Reduce muscle contractions and decrease bloating and discomfort.
• Antidiarrheal agents - Reduce stool frequency, slow gut transit, and prevent cramping.
• Secretagogues and prosecretory agents - Increase digestive fluids, improve bowel movement regularity, and alleviate constipation.

Hormone Replacement Therapy (HRT)

Hormone therapy treats hormonal deficiencies that may contribute to IBS and other digestive disorders. Under a doctor’s guidance, a patient may undergo bioidentical hormone replacement therapy (BHRT) to optimize progesterone and estrogen production or testosterone therapy (TRT) to replace testosterone.   

By stabilizing hormone levels, HRT can reduce symptoms like bloating, abdominal pain, and irregular bowel movements. It can also alleviate emotional stress and mood swings, which are common triggers for IBS flare-ups.

Stress Management

Chronic stress can disrupt hormones, cause stomach issues, and activate inflammation. It is a key trigger for IBS, making stress management an essential part of hormonal IBS treatment.

Mindfulness, deep breathing, and yoga can reduce stress and improve overall wellbeing. Regular practice of these techniques, along with progressive muscle relaxation or guided visualizations, can help manage flare-ups and alleviate pain by promoting relaxation and calming the mind.

Exercise

Exercise positively impacts hormones and improves digestion, reduces stress, and provides IBS relief. Gentle exercises like brisk walking, stretching, jogging, swimming, and aerobics support gut motility, elevate heart rate, and increase blood flow to improve nutrient absorption and eliminate waste.

Aim for at least 150 minutes of moderate, low-impact exercise per week and avoid vigorous exercise as it may not be suitable during abdominal pain and digestive discomfort.

Heat Therapy

Applying a heating pad or hot water bottle to your stomach relaxes muscle spasms and reduces pain. Heat is especially soothing for menstrual cramps, IBS-related discomfort, and bloating. It increases blood flow to the area, providing relief from cramping and tension.

Using a heating pad before bed or during a flare-up can ease discomfort and promote relaxation.

Rest

Hormonal imbalances may provoke insomnia and disrupt sleep patterns. Disrupted sleep can exacerbate IBS symptoms and intensify hormonal discomforts like menopausal night sweats or menstrual cramps.

Establish a consistent sleep routine and create a calming environment to ensure you get deep, restorative sleep. Prioritizing sleep helps regulate your body’s stress response and supports overall digestive health.

What Happens If Hormonal IBS Goes Untreated?

Hormonal IBS is complex and multifaceted and may provoke severe health conditions if left untreated. You may experience increased abdominal pain, bloating, cramps, and nutrient deficiencies that may further disrupt your hormones.

Unmanaged IBS is especially risky during pregnancy as it may lead to preterm labor, miscarriage, a prolapsed uterus due to frequent constipation and a weakened pelvic floor, and dehydration due to prolonged diarrhea.

Closely monitor stool changes, such as excessive mucus, blood, or unusual consistency. Seek immediate medical attention if you experience severe abdominal pain, fever, vomiting, nausea, sudden weight loss, or rectal bleeding.

Conclusion

Understanding the relationship between IBS and hormonal changes is crucial for effective management. While women are more commonly affected, everyone can benefit from recognizing the connection between this chronic gastrointestinal condition and hormonal fluctuations.

Consult our medical staff for expert guidance on improving gut health and restoring hormonal balance.