Menopause is a life event that occurs when a woman has stopped menstruating for one year. In the U.S., 52 is the average age women reach menopause.(1) The years prior to menopause in which women begin experiencing irregular periods is called perimenopause. Throughout perimenopause and menopause, many women experience a wide range of symptoms. This can include more common menopausal symptoms like hot flashes, night sweats, and mood changes to lesser-known symptoms like changes in body odor or fingernail texture and increased gastrointestinal discomfort.
One study showed that out of nearly 500 women, 42% of perimenopausal women and 47% of menopausal women said they had experienced gastrointestinal symptoms.(2) For some, this can include an increase in abnormal bowel movements, such as diarrhea. Understanding when diarrhea may or may not be related to the menopause transition can help women seek appropriate treatment options.
Symptoms of Menopause-Related Diarrhea
Healthy stools are soft and smooth. In comparison, abnormal bowel movements are hard, lumpy, fluffy, or watery. Diarrhea occurs when a disruption in intestinal functioning causes stool to contain excess water. Individuals with diarrhea produce three or more watery bowel movements daily.(3)(4)(5)
Women who experience diarrhea during menopause may notice the following physical symptoms or changes in bathroom habits:(6)
Increased passing of loose stool
Fecal urgency
Fecal incontinence
Abdominal pain
Cramps
Nausea
Gas
What causes diarrhea during menopause?
Diarrhea can have a number of causes depending on the type. Acute diarrhea — or bouts of sudden, short-term diarrhea — may be caused by a viral infection, food poisoning, or medication use. Consuming contaminated food or water while traveling may also cause acute diarrhea. Alternatively, certain digestive diseases, food allergies, or food intolerances are potential causes of chronic or persistent diarrhea.(6)
Research findings vary, but the link between menopause and diarrhea is believed to be related to changes in hormone levels. It may also be influenced by increased stress during menopause.
Hormonal Imbalances
Hormonal fluctuations that occur during menopause may impact gut health. Estrogen is the primary sex steroid hormone in women and is suggested to play a role in the strength and functioning of intestinal tissue. Research has shown links between increased estrogen levels and decreased severity of diarrhea. Meanwhile, low estrogen levels have been associated with changes in gut permeability and inflammation-related proteins, which may increase the risk of diarrhea.(2)
Changing levels of sex steroid hormones may also affect nerves that regulate the body’s sensitivity to pain.(7) As hormone levels begin to drop during perimenopause and throughout menopause, women may experience changes in bowel movements and other uncomfortable gastrointestinal symptoms.
Increased Stress and Anxiety
Stress and anxiety can also influence gut health. Stress has been associated with increased gastrointestinal permeability, or the passing of material through the intestinal lining.(2) It can also cause imbalances in the diversity of gut bacteria. These changes in the gut microbiome occur through a communicative pathway in the body called the gut-brain axis.(8) All of these are important aspects of gastrointestinal functioning that can be impacted by stress.
Many women experience increased stress during menopause due to hormone fluctuations that can affect psychological health. Other menopausal symptoms like hot flashes, mood shifts, brain fog, or sleep disruptions can cause additional stress during this phase of life. A study found that tension, anxiety, and perceived stress are factors that increase the severity of diarrhea in women going through the menopause transition.(2)
Menopause and Digestive Issues: The Link with IBS
Menopausal women may experience gastrointestinal issues even if they’ve never been diagnosed with a digestive disorder. For those who have, symptoms may worsen during menopause, such as those associated with irritable bowel syndrome (IBS).(9)(10)
IBS is a gastrointestinal disorder in which disruptions in the gut-brain axis cause bowel dysfunction. Symptoms include abdominal pain and stool changes. People with IBS may experience constipation, diarrhea, or mixed bowel movements. The condition is estimated to affect approximately 12% to 15% of people in the U.S.(9)
Women are affected by IBS more than men. Symptoms of bloating, abdominal distension, and constipation are also more common among women. Some research indicates that perimenopausal, menopausal, and postmenopausal women diagnosed with IBS may experience worse symptoms than premenopausal women with the condition.(7)(10)
In some cases, women find that symptoms lessen as they enter postmenopause. More research is required to better understand the link between IBS and menopause, but changes in estrogen and progesterone levels may be contributing factors.(7)(10)
Menopausal Diarrhea Treatment and Prevention
Depending on the duration and severity of symptoms, diarrhea does not always require professional treatment. For acute cases of diarrhea, the following at-home treatment options are recommended:(11)
Staying Hydrated: Water, broth, and sports drinks are all fluids that can rehydrate the body and restore low electrolyte levels.
Eating Light Foods: Gastrointestinal issues can cause appetite to wane. Eating foods that are gentle on the stomach, like applesauce or toast, can reduce digestive discomfort as the body recovers. It’s also recommended to avoid things that may exacerbate gastrointestinal distress, such as spicy foods, fatty foods, or caffeine.
Using OTC Medications or Supplements: Over-the-counter (OTC) antidiarrheal medications can help relieve symptoms by slowing gut motility. Probiotic supplements may also be beneficial, although research is inconclusive regarding the efficacy of probiotics for diarrhea. Individuals should speak with their doctor before taking any medications or supplements.
Certain preventative strategies may help reduce the risk of diarrhea during menopause, including the following:(9)
Drinking Enough Water Daily: Water is critical for gut health. Hydration is also essential during menopause when many women experience hot flashes and night sweats. These common menopausal symptoms can heighten stress, potentially contributing to digestive issues.
Making Dietary Adjustments: Modifying portion sizes or the timing of meals throughout the day may help relieve gastrointestinal symptoms. Additionally, incorporating more fiber into one’s diet can add bulk to stool. If diarrhea is due to a food sensitivity or food intolerance, it’s recommended to avoid known triggers.
Managing Stress: Because the brain and the gut are so intricately connected, mindfulness practices and stress-reduction techniques, such as meditation, journaling, or breathing exercises, may help reduce digestive distress. Seeking community support from others may also help with symptom management.
Implementing Lifestyle Changes: Healthy sleep habits and regular exercise can help support gastrointestinal function and maintain healthy bowel movements.
How can HRT help with menopause-related diarrhea?
Hormone replacement therapy (HRT) can help reduce menopausal symptoms by supplementing important hormones like estrogen and progesterone. With HRT, many women find relief from frustrating symptoms, such as changes in libido, vaginal dryness, and vasomotor symptoms. Estrogen is believed to influence digestive health, so increasing hormone levels with systemic HRT treatments may minimize gastrointestinal symptoms.
However, because HRT is not a treatment drug for diarrhea, patients should first consult with a healthcare provider. Diarrhea during menopause may also be related to an alternate health condition, requiring proper diagnosis and treatment.
When to Seek Professional Help
Individuals should seek professional help from their healthcare provider if acute diarrhea becomes more severe or does not improve within two days of OTC medication use.(11) In serious cases, diarrhea caused by infection can lead to dehydration or malabsorption. Extreme pain, bloody stool, vomiting, dark urine, reduced urination, and lightheadedness are all signs that a person should seek medical attention.(6)
Consultation with a doctor is also recommended if diarrhea is persistent or chronic. Such cases could indicate a food allergy, underlying health condition, or alternate digestive disorder, such as celiac disease, ulcerative colitis, or Crohn’s disease.(6)
A doctor may use a combination of diagnostic tools to determine the cause of diarrhea. This may include a physical exam, blood test, stool test, or endoscopy. A doctor may also test for food intolerances or bacterial overgrowth. Asking for the patient’s overall health history, medication use, and dietary habits, as well as a detailed family medical history, may also be necessary. Depending on the cause, prescription medication or other treatments may be suggested.(12)
