Ruth x Phyla: Understanding the Connections Between IBS and Menstruation
This blog was written in collaboration with Phyla, an app that helps people with IBD and IBS understand how their diet, symptoms, and microbiome are all connected. Check out their website to learn more!
Before the 19th and 20th century little was known about menstruation. Although there have been improvements in how we understand female anatomy, there’s still much naivety on the subject. One unexpected result of having a uterus that bleeds each month is a change in how our guts and stomachs can feel. For me, one sure-fire way I know I am about to start my period is those dreaded cramps, not in my uterus like regular period pain, but in my large intestines, more specifically in my *drum roll please*… butt.
A more concise term for these monthly grumbles is: Period Poops. I knew that some women in my family had the same experience as me, but I had no idea this was a widespread issue because when I did end up going to google to figure out why this was happening to me, nothing of value ever came up to satisfy my curiosity. I have always prided myself on having a tough stomach, so whenever I got these gut issues I was able to correlate the symptoms to the onset of my period. However, many menstruators with irritable bowel syndrome have not had the same experience.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, which means it’s characterized by abnormal gut activity that leads to recurring gastrointestinal symptoms such as abdominal pain, nausea, constipation, and diarrhea. It’s a very common intestinal issue, but it can’t be diagnosed by a medical test; it’s a diagnosis of exclusion, meaning if all other lab tests don’t lead to another cause for these symptoms, like inflammatory bowel disease or a stomach bug, it’s essentially IBS. Plus, there’s a sex and gender component to IBS: women and people assigned female at birth are more likely get IBS, suggesting that there are biological, psychological, and sociological factors that contribute to the development of IBS (1). However, what causes this to occur hasn’t been totally figured out, leaving a lot of people--mostly women--in the dark.
What we do know, though, is that we have sex hormone receptors on the gastrointestinal tract that are impacted by the menstrual cycle, which can lead to issues with gut motility--how easily things you’re consuming and excreting make their way through the gut. Estrogen and progesterone are some key hormones involved in the changes someone who menstruates goes through during their cycle. These hormone levels both drop as menstruation begins, which can affect gut motility and lead to diarrhea (2). Although there is a general lack of data on how IBS affects periods, recent research has also demonstrated that female IBS patients who menstruate can also experience worse symptoms during their menstrual cycle. Oftentimes this means more bloating, more bowel habits due to abdominal pain, or other symptom exacerbations (2). So IBS and periods are overlapping phenomena--they’re both often misunderstood in the medical community, they can cause similar symptoms, and the menstrual cycle can affect IBS symptoms (2). Armed with this information, I decided to talk to some menstruators who have IBS and understand their journey dealing with periods and gut issues.
It comes as no surprise to the two women I interviewed that IBS can be related to stress. They both said that their first IBS attack was brought on by school-related “stress and pressure”. Even when women seek help for their symptoms, they are often not taken seriously. Historically, the study of health and medicine is male– from whom research has been done on, to who has the positions of authority in healthcare. Women’s symptoms were seen as outliers, an anomaly, and this issue still lingers in some big ways.
For one interviewee named Danny, her IBS symptoms were too intense. She gets flare ups around her period each month, and although to some they may sound like ‘normal period problems’, we have to challenge that stigma and stereotype. No one should have to deal with severe pain, during their period or otherwise. She was experiencing intense nausea, pain, and pressure from her upper stomach and had cramping, twisting pains all around her abdominal area and back. It got so bad that she thought her appendix had burst. This warranted a trip to the emergency room. “They told me I was just stressed and put me on morphine. They also insinuated that I was faking it to get out of an exam and just wanted a deferral letter.” These are people who you’re supposed to turn to in a medical crisis, and they just dismissed her pain. When another attack came, she wasn’t even let into the emergency room at all and her university’s clinic dismissed her, as they just thought she was stressed again. Since our healthcare system is not perfect and equitable care is not always guaranteed, how can we empower ourselves to pick up where the doctors left us?
My other interviewee Zara brought up the idea that women are more affected by stress, and they tend to feel the effects of stress on their bodies. She said, “Maybe more women come forward with IBS symptoms because they feel more societal stress on a day to day basis.” This argument really resonated with me. I thought back to my own mother’s stress exceeding my father’s even though they both worked and came home from work around the same time. Women are expected to do more emotional and domestic labor than men and realistically this can cause more fatigue and stress in women.
The symptoms and experiences that Danny and Zara brought up aren’t arbitrary; they’re actually backed up by science. Not only are the relationships between period and IBS symptoms overlapping, but they also overlap with psychological factors such as stress and anxiety. Mental health affects gut health, and vice versa. The scientific term for this is the brain-gut axis, and it is being studied at length by scientists. It’s like having a second brain in your gut, one that can cause symptoms when you’re feeling anxious, overwhelmed, or in another form of distress. Research suggests that these symptoms of IBS are actually modulated by the gut microbiome, a vast community of microorganisms that inhabit the gut. The gut microbiome depends on a diverse, balanced population of microorganisms, most notably bacteria, to protect your body from stressors, illnesses, and anything else that can threaten your health. So when the microbiome is disrupted (which can happen for a number of reasons including poor sleep, poor diet, stress, medications, and more), it doesn’t happen in a vacuum. It can affect your mood, physical health, and well-being, and if you have IBS, it can trigger symptoms and IBS-related anxiety. (3)
My interviewees are well aware of this brain-gut axis effect because they’ve experienced it. One interviewee recalled how the brain-gut axis acts as a snowball effect: “When I am stressed, I will start to have stomach issues, then, realizing I have stomach issues that keep me from being as productive as I want will cause me more stress. And on, and on it goes.” The other interviewee recalled that, “When my mental health is suffering I tend to get flare ups.” So there is anecdotal evidence here that supports studies on the brain gut axis and how it affects sufferers.
With all the challenges these women have faced, I had to ask them how they’ve coped and learned to manage their gut health. Both interviewees expressed that whole grains, fresh produce, low red meat, low to no dairy, and unprocessed food helps them with their symptoms. While diet is a very personal thing, with each person having a different response to what they eat, these food types are commonly considered healthy and gut-friendly. They both also found that seeing a chiropractor and acupuncturist helped ease some of the pain. More cultural methods can provide relief as well; both Zara and Danny recommended different cultural beverages that can temporarily aid in some of the discomfort of IBS. One method is drinking strong ginger tea, and the other is drinking Persian mint water. In addition, consulting a dietitian helped them coordinate a personalized diet, giving them a sense of control of their health that doctors couldn’t provide, which can be incredibly empowering. Speaking of which, being able to monitor your health and educate yourself are ways to feel empowered in your health journey. While this doesn’t discount the necessity of a healthcare professional, having enough independence to take care of yourself where possible is valuable. Danny and Zara both benefited from recording how they feel day-to-day to account for how stress levels, food, and other factors were affecting their IBS symptoms. Also one way to feel more comfortable while on your period if you also experience IBS is investing in quality overnight pads, like Ruth’s Night Pack. They will help avoid any accidents as these two bodily processes unite.
However, sometimes recording these symptoms manually can be tedious. I remember when I first got my period my sister drew me a menstrual cycle tracker on a piece of graph paper. I was grateful for her effort, but that piece of paper stayed in my drawer for months without a mark on it. Then when I was older and discovered the importance of tracking my period and monthly symptoms I began to use an app. Luckily, there’s a better way to keep a record of your health-related events, which can help you bypass some of the trial and error that Danny and Zara had to go through. Our favorite option is Phyla’s digital health app, which is specifically designed to support those with IBS. The daily check-in allows you to evaluate your symptoms, mood, and physical activity every day, and there’s options to log all the details you want about food and drink, menstruation, medications, bowel movements (including period poops!), symptoms, and more, all in one place. It truly is a one-stop shop for all things IBS and menstrual health self-monitoring. And as a plus, there’s a built-in resource library full of carefully curated articles to help you learn more about living with and managing your IBS.
Overall, being able to stay attuned to your body and mood will be able to help paint a better picture of your overall health. Empowering ourselves to be our most knowledgeable and fierce advocates is the only way we will be able to grapple with our changing bodies in a healthy way. Luckily, you’re not alone, as both Phyla and Ruth provide ways to help you manage your menstrual and gut health on your own terms.