Understanding Gut Health Changes in Midlife

This podcast episode explores how gut health is affected during midlife and menopause, delving into hormonal changes, stress, and lifestyle factors that contribute to gastrointestinal symptoms. 

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 https://whnlearninghub.thinkific.com/courses/MenopauseNutrition

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References:

1. Mehta, R. S., & Staller, K. (2018). Menopausal transition and bowel disturbances: A step in the right direction. Menopause, 25(6), 589–590. https://doi.org/10.1097/GME.0000000000001110
2. Heitkemper, M. M., & Chang, L. (2009). Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? Gender Medicine, 6(Suppl 2), 152–167. https://doi.org/10.1016/j.genm.2009.03.004
3. Yang, P.-L., Heitkemper, M. M., & Kamp, K. J. (2021). Irritable bowel syndrome in midlife women: A narrative review. Women's Midlife Health, 7(1), Article 4. https://doi.org/10.1186/s40695-021-00064-5
4. Nachtigall, L. E., & Nachtigall, L. (2019). Menopause and the gastrointestinal system: Our gut feelings. Menopause, 26(5), 459–460. https://doi.org/10.1097/GME.0000000000001316

Transcript

0:01

Hi, and welcome to the Fem Health Nutrition Podcast. I'm Milu Demi, a registered dietician and founder of the Women's Health Nutrition Learning Hub. A platform where dieticians and nutrition professionals can learn, connect, and collaborate on all things related to female health and nutrition. You can check out the website ATM learning. The link is also in the episode description below. This podcast is intended an educational for dieticians, healthcare professionals, and anyone interested in female health and nutrition. If you have questions or concerns about your health, please consult with your healthcare team. Before we get started, I did want to share that the menopause course for dieticians and nutritionists is live, and you can now enroll, and if you're listening to this before May 26th, you are able to get a. The discount menopause and you also website. In today's episode, we're taking a closer look at gut health in midlife, specifically examining the changes to gastrointestinal and IBS symptoms and perimenopause. So we'll talk about some of the key biological mechanisms and theories behind the changes. And we'll also review some of the current research gaps and how you can support your clients. Are commonly reported during midlife and often in the absence of any organic cause, and women may report either new or worsening digestive symptoms, particularly bloating, constipation, and abdominal discomfort. For those who have. I BS symptom. Severity tends to worsen during perimenopause and early post menopause. And these changes are often under recognized and not really spoken about in clinical care. And it's important to talk about these changes because ultimately they can lead to a lower quality of life. Greater risk of depression symptoms, even when compared to pre-menopause. As I mentioned, the most commonly reported gut concerns in midlife include bloating, early satiety, abdominal distension, post-meal discomfort, or functional dyspepsia and variable stool form and frequency. So. First, we will try to understand the mechanisms that are contributing to these changes. Now, a lot of this is actually based on theory or very limited data, and we really do need more research in this area. The first thing to consider is the role of sex hormones on digestive symptoms. Estrogen and progesterone are involved in modulating gut motility and smooth muscle contractions The perimenopause period is marked by declining and fluctuating estrogen and progesterone levels, symptoms like constipation and diarrhea may increase in severity during perimenopause, which kind of resemble happening. Menstruation in the luteal phase or in the second part of the menstrual cycle where these digestive symptoms are also quite common. So we'll first focus on estrogen. Estrogen, slows down GI transit by inhibiting smooth muscle contraction, which is why higher estrogen levels are associated with slower bowel movements or constipation. When there's a sudden decrease in estrogen, such as what we see in perimenopause, this may disrupt this regulation, and this potentially results in more variable or accelerated transit time especially when combined with stress responses. Now when we look at progesterone, progesterone generally slows gut motility and colonic transit time, which may contribute to constipation. And this is especially seen during the luteal phase of the menstrual cycle. So the second half of the menstrual cycle During perimenopause, progesterone levels similar to estrogen levels can be quite erratic and the eventually do decline and. This decline in progesterone may reduce the slowing effect it has on colonic transit and gut motility the other thing to consider is the gut brain access. so both hormones may interact with the gut brain access and influence visceral hypersensitivity. for example, estrogen modulates pain thresholds in both central and peripheral pathways, and in those who have IBS visceral pain thresholds tend to be lower during menstruation and early menopause. Withdrawal of hormones in perimenopause may exacerbate IBS like symptoms including both constipation and diarrhea. There's also research shows that women with higher retention and anxiety scores during perimenopause have a higher risk for constipation and diarrhea severity. And this is also related to that gut brain access dysregulation. Menopause transition may be a particularly vulnerable time for the dysregulation of the gut-brain access because stress levels are generally high during this time of life. For example, an individual may have competing responsibilities from caregiving roles to work to many other things that they're trying to juggle, and this can lead to high stress levels. In the menopause transition, menopause symptoms are also a factor to consider. So things like hot flashes and night sweats and symptoms of depression are more likely, and all of these may play a role in gut health as well. The next thing to consider is the gut microbiome shift, and this is very early and emerging research, but some data does suggest that estrogen plays a role in maintaining microbial diversity. And once people get into perimenopause and post menopause, there may be some dysbiosis of the gut microbiome. Now we're still learning about the impact of this dysbiosis. Whether it affects both digestive health and chronic disease risk in the long run. Now, there are gaps in the research. The first thing to consider is that most current data are based on cross-sectional studies, which limit our ability to map symptom progression or timing. There's a lack of clarity about when symptoms worsen most. Is it during perimenopause post menopause? Is it when hormones are fluctuating most? We're also learning about the role of hormone therapy and if this impacts gut symptoms. And while some studies are showing benefits, others are either showing no effect or worsening of symptoms. So menopause hormone therapy is of course not indicated for digestive health at this time, But it is an interesting area of research to follow. As always with menopause research, there is a lack of diversity in study participants. So usually the research studies are on Caucasians, cisgendered women, so we really do need more diverse populations and also more diverse diets to be studied. Now we'll just end with some practical tips to support your clients. From a diet perspective, it is a good idea to keep a food and symptom general, to identify unique triggers, to assess fiber and food intake, to look at things like meal timings and eating patterns.'cause these can impact gut symptoms. And sometimes in midlife, when I get so busy, it's hard to have a consistent meal pattern and also bowel routine. The low FODMAP diet may be a viable approach for some, and we also want to screen for disordered eating before recommending the low FODMAP diet and also restricted eating patterns themselves may contribute to gut symptoms as well. Does help improve gut and reduces symptom burden. So that is something to encourage clients to increase, and not just for gut symptoms, but also for metabolic health. Sleep disruption is another thing to consider as sleep disruption is quite common during menopause and is associated with worsening GI symptoms and IBS flare ups. Stress management, such as using techniques like cognitive behavioral therapy, mindfulness based interventions and gut directed hypnotherapy have also been shown to reduce symptom severity. Finally also to consider pelvic floor health as well. It is very common for individuals who have given birth to have challenges with pelvic floor health. So if you feel that that's an issue, then definitely referring to a pelvic floor physiotherapist for support. Thank you so much for tuning into today's episode. I hope that this information was helpful to you. As always, please feel free to reach out to me if you have any questions or feedback on the podcast.