From the Guidelines
Gastrointestinal symptoms during menopause can be managed with a combination of lifestyle modifications and medication options, prioritizing the lowest effective dose for the shortest possible time, as recommended by expert groups 1.
Management Options
The management of gastrointestinal symptoms associated with menopause involves:
- Hormone replacement therapy (HRT) to alleviate GI symptoms by restoring estrogen levels, with typical regimens including estradiol 1-2mg daily orally or 0.025-0.1mg transdermal patches, often combined with progesterone for women with an intact uterus.
- Medications for specific symptoms:
- Acid reflux: proton pump inhibitors like omeprazole 20mg daily or H2 blockers such as famotidine 20mg twice daily.
- Bloating and gas: simethicone 80-125mg after meals as needed.
- Constipation: fiber supplements (psyllium 1 tablespoon daily) or osmotic laxatives like polyethylene glycol 17g daily.
Lifestyle Modifications
Dietary changes and lifestyle modifications are crucial and include:
- Eating smaller, more frequent meals.
- Avoiding trigger foods (spicy, fatty, acidic).
- Limiting caffeine and alcohol.
- Increasing fiber intake to 25-30g daily.
- Regular physical activity.
- Stress management techniques.
- Adequate hydration (at least 8 glasses of water daily). These approaches work because declining estrogen during menopause affects GI motility, acid production, and gut microbiome balance, while also potentially increasing visceral sensitivity to discomfort, as noted in studies on postmenopausal hormone replacement therapy 1.
From the Research
Gastrointestinal Symptoms of Menopause
The menopause transition can have multiple effects on gastrointestinal function, including:
- Altering gut motility 2
- Changing the composition of the gut microbiota 2 As a result, some gastrointestinal and hepatic conditions are more common among individuals in peri- and postmenopause, and people with these conditions before menopause might also experience greater symptom severity and worse health-related quality of life during this time 2.
Management Options for Gastrointestinal Symptoms
Management options for menopausal symptoms, including gastrointestinal symptoms, range from lifestyle assessment and intervention through to hormonal and non-hormonal pharmacotherapy, each of which has specific benefits and risks 3.
- Hormone replacement therapy (HRT) may be used to treat menopausal symptoms, but it can also affect gastrointestinal health and well-being 2.
- Non-hormonal options, such as selective serotonin reuptake inhibitors (SSRIs) and selective noradrenergic reuptake inhibitors (SNRIs), may also be used to manage menopausal symptoms, including gastrointestinal symptoms 4.
- Dietary changes, such as increasing calcium and vitamin D intake, can help reduce the risk of osteoporosis and other diseases associated with menopause 5, 6.
- Lifestyle modifications, such as regular physical activity and smoking cessation, can also help manage menopausal symptoms and reduce the risk of chronic diseases 6.