Hemorrhoids are a common condition, with peak prevalence occurring between the ages of 45 and 65 — a time when most women transition through menopause.(1) While hemorrhoids can develop at any stage of life, the hormonal and physical changes that occur during menopause can increase their risk.
Menopause is often associated with hot flashes, mood swings, and bone loss, but its impact on digestive and rectal health is frequently overlooked. Slower digestion, increased bloating, and a higher tendency for constipation can strain the rectal veins, leading to swelling, discomfort, and bleeding. Weight changes and pelvic floor weakening, both common during menopause, can further contribute to the development or worsening of hemorrhoids.
It’s important to know that hemorrhoids are manageable. A combination of lifestyle changes, medical treatments, and hormone therapy can help alleviate symptoms and prevent their recurrence.
What are hemorrhoids?
Hemorrhoids form when the normal anal cushions, which are small, soft structures filled with blood vessels, become swollen and shift from their usual position. These cushions help control stool passage, but when their supporting tissues weaken, they can enlarge and may protrude as hemorrhoids.(1)
Inside the anal canal, three main anal cushions are positioned at the right anterior, right posterior, and left lateral areas, with smaller ones scattered in between. In individuals with hemorrhoids, these cushions undergo significant structural changes — the veins enlarge, collagen fibers break down, and the muscle supporting the tissue weakens. Over time, these changes contribute to persistent swelling and discomfort.(1)
Prolonged pressure on these veins can also cause them to expand and lose their elasticity. Researchers believe that poor vascular tone and excessive growth of blood vessels may play a role in this process. In many cases, inflammation sets in, affecting the blood vessels and the surrounding tissue. This can lead to irritation, swelling, and, in some cases, small clots forming within the vessels.(1)
Symptoms of Hemorrhoids
One of the earliest and most common signs of hemorrhoids is rectal bleeding during bowel movements. This happens because the stretched blood vessels in the cushions become fragile and prone to rupture.
Hemorrhoids can present with a range of symptoms, varying in severity depending on their size, location, and complications:(1)
Anal itching or perineal irritation
Mucus discharge or fecal soiling
A sensation of incomplete evacuation or rectal fullness
Probable Causes of Hemorrhoids During Menopause
While menopause may not directly cause hemorrhoids, several changes occurring during this stage of life can increase the risk. Shifts in hormone levels, digestive health, pelvic floor strength, and body weight can increase the likelihood of developing hemorrhoids.
Hormonal Fluctuations
Estrogen helps maintain blood vessel integrity, connective tissue strength, and gut motility. As estrogen levels drop during menopause, blood vessels may weaken, and tissue support in the anal area can decrease. Research shows that estrogen receptors are present in the gastrointestinal tract and internal anal sphincter, playing a role in gut movement and pelvic stability.(2)(3)(4)(5)
Constipation and Slower Gut Motility
Straining due to constipation puts extra pressure on the anal cushions, increasing the risk of hemorrhoids. Lower estrogen levels have been associated with a higher prevalence of constipation-predominant irritable bowel syndrome (IBS-C). A 2020 study found that premenopausal women with constipation were more likely to experience hemorrhoids, anal pain, and discomfort.(6)
Weakened Pelvic Floor Muscles
Research suggests that people with hemorrhoidal disease often have weakened levator ani muscles, a key part of the pelvic floor that supports the rectum and anal canal. Estrogen helps maintain the strength of these muscles and connective tissues, but as its levels decline during menopause, connective tissue integrity and muscle tone can weaken, making pelvic floor dysfunction more common.(5) When the pelvic floor loses strength, it provides less support for the anal cushions, making them more likely to shift and swell, increasing the risk of hemorrhoids.
Weight Gain
Weight gain can increase the risk of hemorrhoids by putting added pressure on the pelvic region and rectal veins, contributing to poor circulation and venous congestion. Hormonal changes occurring during menopause can increase the probability of weight gain, with around 70% of women gaining an average of 1.5 pounds per year.(7)
Declining estrogen levels also affect how the body distributes fat, often leading to increased abdominal weight. This shift raises intra-abdominal pressure, which can weaken support for the anal cushions and make hemorrhoids more likely to develop or worsen.
Hemorrhoid Relief and Treatment During Menopause
Managing hemorrhoids involves a combination of lifestyle changes, medical treatments, hormone replacement therapy (HRT), and procedural interventions. Treatment is typically tailored to the severity of symptoms and underlying causes.(1)(8)
Lifestyle Modifications
Lifestyle changes are the first line of treatment for hemorrhoids and play a key role in both symptom management and prevention.
Dietary Changes: A high-fiber diet (25g/day for women) can help soften stools and reduce straining. Drinking at least 64 ounces of water daily also helps maintain stool consistency and prevent constipation.
Bowel Habits: It’s recommended to avoid straining, prolonged sitting on the toilet (limit to 3–5 minutes), and excessive wiping. Sitz baths (at ~40°C) can help relieve itching, pain, and burning. However, it’s best to avoid adding salts, oils, or lotions to sitz baths, as they may cause further anal irritation.
Exercise and Weight Management: Regular physical activity supports healthy digestion and circulation, reducing the likelihood of hemorrhoidal symptoms.
Hormone Replacement Therapy (HRT)
Since estrogen supports vascular function, connective tissue maintenance, and gut motility, its decline during menopause may increase the prevalence of hemorrhoids. Evidence suggests that HRT may help maintain vascular integrity, reduce constipation-related straining, and lower the risk of hemorrhoids by replenishing hormones.
Oral Medications
Flavonoids (Venotonics): These compounds improve vascular tone and reduce inflammation. A meta-analysis of 14 randomized trials found that flavonoids reduced the risk of hemorrhoidal bleeding by 67%, pain by 65%, and itching by 35%.
Calcium Dobesilate: This compound reduces blood vessel permeability, improves blood viscosity, and decreases tissue edema. When combined with fiber supplements, it provides effective symptom relief, particularly for acute bleeding and inflammation.
Topical Treatments
Topical medications are often used for symptom relief rather than as a curative treatment. They are available in various forms, including creams, ointments, and suppositories, and commonly consist of the following options:(1)(8)
Local anesthetics to reduce pain and discomfort
Corticosteroids to minimize inflammation
Vasoconstrictors to shrink swollen blood vessels
Vasodilators or calcium channel blockers to relax the internal anal sphincter and relieve symptoms of thrombosed external hemorrhoids
When should an individual see a doctor?
All cases of rectal bleeding should be evaluated by a healthcare provider to ensure an accurate diagnosis and appropriate treatment. While hemorrhoids are a common cause of rectal bleeding, it can sometimes be a sign of other conditions, such as colorectal cancer, inflammatory bowel disease, or anal fissures. Seeking medical attention is especially important for anyone experiencing the following symptoms:(1)(8)
Severe or persistent pain in the anal or rectal area
Heavy rectal bleeding or blood clots
Dark, tarry stools or blood mixed with stool
Unexplained weight loss or loss of appetite
Changes in bowel habits, such as prolonged constipation or diarrhea
A lump or swelling in the anal region that does not improve
Struggling with hemorrhoids during menopause? Discover if HRT is right for you.
HRT is not recommended solely for managing hemorrhoids. However, it’s commonly used to treat menopause-related symptoms and may help address underlying factors that contribute to hemorrhoidal issues, such as constipation, pelvic floor weakening, and changes in vascular function.
If you're experiencing menopause-related symptoms and wondering if HRT could be beneficial, take our quick menopause quiz to learn more.
