From the Guidelines
Constipation is a common symptom during perimenopause, and managing it typically involves increasing fiber intake, staying hydrated, and considering over-the-counter laxatives or supplements. To manage perimenopausal constipation, it is recommended to increase fiber intake to 25-30 grams daily through fruits, vegetables, and whole grains, while drinking at least 8 glasses of water daily 1. Regular physical activity helps stimulate bowel movements. Over-the-counter options include fiber supplements like psyllium husk (Metamucil) taken with plenty of water, stool softeners like docusate sodium (Colace), or osmotic laxatives like polyethylene glycol (Miralax) for short-term relief 1. Magnesium supplements (300-400mg daily) may also help. Some key points to consider in managing constipation during perimenopause include:
- Increasing dietary fiber intake to promote regular bowel movements and prevent constipation 1
- Consuming an adequate amount of fluids, particularly water, to help soften stools and ease bowel movements 1
- Using bulk-forming agents, such as psyllium husk or methylcellulose, which are safe to administer during pregnancy and perimenopause due to the lack of systemic absorption 1
- Avoiding stimulant laxatives, as safety data on these medications are conflicting 1
- Considering the use of osmotic laxatives, such as polyethylene glycol or lactulose, which can be administered safely during perimenopause 1 If constipation persists despite these measures, becomes severe, or is accompanied by concerning symptoms like blood in stool or significant weight loss, it is essential to consult a healthcare provider as it could indicate other health issues requiring medical attention.
From the Research
Constipation in Perimenopause
- Constipation can be a common issue during the perimenopausal period, with studies suggesting that altered bowel function and irritable bowel syndrome (IBS)-type complaints are more prevalent in postmenopausal women compared to premenopausal women 2.
- A study found that 38% of postmenopausal women reported altered bowel function, which is significantly higher than the 14% reported by premenopausal women 2.
- However, the same study found that the prevalence of constipation, diarrhea, and abdominal pain did not differ significantly between postmenopausal and premenopausal women 2.
- Another study suggested that stress perception, tension, anxiety, and cortisol levels may play a significant role in constipation severity during the menopause transition, rather than reproductive hormones 3.
Treatment and Management
- Fiber supplementation, particularly with psyllium, has been shown to be effective in improving constipation symptoms in adults 4.
- A systematic review found that polyethylene glycol (PEG) and senna are recommended as first-line laxatives for chronic constipation, with moderate evidence supporting the use of fiber supplements, fruits, stimulant laxatives, and magnesium-based products 5.
- However, it is essential to note that individual results may vary, and the optimal type and regime of fiber supplementation may depend on various factors, including treatment duration and dose 4.
Gastrointestinal Symptoms
- Gastrointestinal complaints, such as abdominal bloating, laxative usage, gaseousness, and heartburn, are common among postmenopausal women 2.
- A study found that the prevalence of IBS-type complaints peaks during the climacteric period, with 36% of women reporting such symptoms 2.
- Estrogen use does not appear to affect gastrointestinal symptoms in postmenopausal women 2.