There are over 40 recognised symptoms of the Menopause but digestive issues aren’t officially one of them. We’ve been convinced as clinicians for a long time that there is a link between the Menopause and digestive health. We are delighted that by working in partnership with Symprove we will be able to understand these links more clearly. We are also excited to work with partners in the NHS too so that more women can learn simple strategies to manage their digestive health.
Menopause symptoms can literally start at the top of your head with brain fog, memory problems and low mood and go right down to the tips of your toes with joint pain and poor balance (1). Essentially the symptoms of menopause can impact every system in a woman’s body. Symptoms occur largely because of a reduction in the sex hormone oestrogen (2). Oestrogen levels usually begin to decline in women around the age of 46, this is when symptoms like hot flushes, weight gain and itchy skin may start to appear. Initially oestrogen levels fluctuate, so symptoms come and go. This time is called perimenopause and can last between 6-10 years. It’s common for a woman to continue having periods during the perimenopause, although the regularity of periods may alter. The menopause is officially when it’s been 12 months since a woman has had a period. The average age for menopause is 51. It’s easier to just talk about the Menopause, but we are often referring to perimenopause and/or menopause.
The link with Digestive health
The impact of the perimenopause on the Digestive system has not been well researched (3). There is some evidence that another female sex hormone, progesterone, may have an effect on the gut, but little is understood about the role of oestrogen in gut health.
As nutrition professionals, seeing patients with gut issues, we have long felt there’s an association between menopause and digestive health symptoms. In our experience, some women with a history of IBS or digestive health problems find their symptoms increase or change at menopause. We also see other women who have never had issues with gut health until menopause begins. Do either of these groups ring any bells?
Introducing Harley Street at Home Menopause
Harley Street at Home Menopause (www.harleystathome.com) is an online community dedicated to supporting women in perimenopause and menopause. Content in the community ranges from evidence based medical masterclasses led by British Menopause Society Specialist Menopause Doctors, to daily live exercise classes and lifestyle courses including a 6-week digestive health programme. We recently carried out a survey amongst participants of the Digestive health programme. We wanted to find out more about their symptoms, when they started and to see if there was a correlation between symptoms and the menopause. The results confirmed our suspicions.
The Harley Street at Home Digestive Health Survey (n=59)
We asked them about their symptoms and bloating was cited as by far the most common symptom with 85% suffering. Stomach pain was experienced by 53%, constipation 52%, incomplete evacuation 39%, diarrhoea 38%, straining 34%, urgency 24%; and mucus 14%.
Almost 80% of women had experienced symptoms for more than 3 months and 60% of respondents had experienced symptoms prior to menopause but felt these had worsened at menopause. The women who had never had digestive issues before menopause but had experienced symptoms when their menopause began made up 28% of respondents.
By working with Symprove, our digestive health partners, we plan to extend this research to understand the best combination of management options to support women in menopause who experience digestive health symptoms.
Managing digestive health requires a holistic approach
Diet first
It’s always important to start with the basics. Looking at the pattern of symptoms along with a food and activity diary is often very revealing. Despite, feeling they are eating well people are often missing important elements from their diet including a mix of fibre from fruits, vegetables and pulses as well as wholegrains. We also need to look at fluid intakes to ensure there is sufficient fluid to allow the fibre to do its job.
Dietary exclusions
Sometimes it’s clear there are food triggers for specific symptoms. This might lead us to suggest an exclusion diet or even a trial of the low FODMAP diet where whole groups of fermentable carbohydrates are excluded from the diet for a period. Exclusion diets and the Low FODMAP diet need the support and supervision of an experienced Dietitian or Nutritionist.
Probiotics
It’s now standard practice to talk to all sufferers about their microbiome. Asking about the history of antibiotic use, food poisoning, gastroenteritis and also about abdominal trauma such as surgery can help to piece together when probiotic support might be helpful. We recommend Symprove to our patients because it has strong evidence supporting its efficacy.
Other lifestyle and medical issues
We are also keen to understand how stress is managed by sufferers, what their level of exercise and movement is like, and whether they have other medical issues which may interfere directly with their digestion, or where medications may have an impact. It’s important to understand the whole lifestyle to really suggest where the focus on management should be.
Currently, we don’t know if Hormone Replacement Therapy (HRT) or other prescribed non- hormonal medications to manage menopause symptoms have any impact on digestive symptoms. As we develop our research, we are keen to see whether HRT use has any impact on the prevalence of digestive health symptoms.
Partnerships to help drive more research into digestive health and the menopause
Harley Street at Home are delighted to be working with Symprove to broaden our understanding and build more evidence around digestive health and the menopause. Together we’ll combine our experience and knowledge so we can add to the evidence base.
Harley Street at Home Menopause & Symprove working with the NHS
We plan to work together to bring the Digestive health programme to the NHS through GP practices. Our partnership with Symprove has already enabled us to do this with the Back to Basics 12 week Weight Management and Lifestyle Programme.
Next, we want to take the Digestive Health programme into NHS practices. We would love to hear from any GPs or Primary Care Practitioners who would like to find out how their practice might get involved - for more information or to register your interest please contact nigel@harleystathome.com.
References
- https://www.harleystathome.com/blog/when-does-the-menopause-start-3
- https://www.womens-health-concern.org/help-and-advice/factsheets/menopause/
- Impact of progesterone on the gastrointestinal tract: a comprehensive literature review A Coquoz, D Regli , P Stute Climacteric 2022 Aug;25(4):337-361.
