What causes menopause diarrhoea and what can help?

It may not be as talked about as some symptoms of perimenopause or menopause, but diarrhoea is something many women experience during this period of transition.

There’s good evidence linking menopausal diarrhoea to reduced levels of reproductive hormones like oestrogen and progesterone. These hormones also seem to be involved in the relationship between stress and diarrhoea.

Other causes of diarrhoea can include food intolerances, certain medications and even hormone replacement therapy (HRT). Diarrhoea can also be a symptom of disease, so if you have continuing or recurring symptoms you should see a doctor.

If you do have menopause-related diarrhoea, probiotic supplements could improve your symptoms by helping to rebalance your gut microbiome. We’ll look at this in more detail below.

We’ll also explore other ways to ease diarrhoea, including techniques for reducing stress, changes to your diet and over-the-counter drugs.

Find out more here about how The Better Gut probiotic supplements could help improve your menopause symptoms. And for expert tips on menopause health and nutrition – and10% off your first order – join our newsletter.

Can hormone changes cause menopause diarrhoea?

During perimenopause, levels of reproductive hormones like oestrogen and progesterone fluctuate, dropping permanently as you approach menopause. These changes have been linked to many of the symptoms of perimenopause and menopause, and there’s good evidence that they play a role in gastrointestinal issues like diarrhoea.

Both oestrogen and progesterone help to slow the muscles that move food through your gut. When levels are low these muscles may relax, allowing food to pass through much more quickly. This can lead to diarrhoea. Studies have shown that higher levels of oestrogen are linked to less severe diarrhoea symptoms.

Oestrogen may also impact digestive issues via its effects on other hormones. When oestrogen goes down, the stress hormone cortisol can go up. And higher levels of cortisol lead to the release of epinephrine – AKA adrenaline – the hormone that induces that panicky ‘fight or flight’ feeling. This may help to explain why increased anxiety and stress are also common symptoms of perimenopause and menopause.  

Stress has also been shown to increase the permeability, or ‘leakiness’ of your gut lining, another factor that can contribute to diarrhoea.

Anyone who’s experienced problems with their bowels before an important work meeting, or a major life event, will be well aware that symptoms like diarrhoea can be linked to stress. Studies confirm that increased stress during perimenopause and menopause is associated with worse diarrhoea.

Altogether, this evidence suggests that menopausal diarrhoea may be the result of complex interactions between a number of fluctuating hormones.

How probiotics can help

You’ve probably heard of the gut microbiome. This community of bacteria and other microorganisms lives in your gut and has an impact on all kinds of functions around your body. Having a more diverse range of bacteria in your gut microbiome is generally considered healthier.

Part of your gut microbiome is known as your estrobolome. These are the bacteria involved in breaking down and redistributing oestrogen around your body. There are bacteria that do the same for progesterone and other hormones.

During perimenopause and menopause, your gut microbiome can become less diverse and your estrobolome may not function as well. This is where probiotics come in.

Probiotics are friendly bacteria like those that live in your gut. Consume them regularly and they can improve the health of your gut microbiome, supporting beneficial gut bacteria and reducing the amount of unhealthy microbes. By rebalancing your gut microbiome – including your estrobolome – this may influence how reproductive hormones are processed in your body.

Because different bacteria have different functions, choosing the right probiotics is crucial. The Better Gut probiotic supplements contain six strains of bacteria chosen specifically for the impact they can have on perimenopause and menopause symptoms.

That includes helping with issues that can lead to diarrhoea: easing irritable bowel syndrome (IBS), protecting your gut lining, and reducing stress and anxiety.

Because these changes to your gut can take time, we recommend using our probiotic supplements for at least three months before you start to assess the results.

Find out more here. And get 10% off your first order here.

Other possible causes of diarrhoea and what to do

Along with hormonal changes and stress, a number of other factors can cause diarrhoea. Here’s what to look out for and what you can do to improve things.

Food intolerances

Diarrhoea and other digestive issues are among the most common symptoms of food intolerances.

The most widespread intolerance is lactose, found in dairy products, but you may also have problems digesting any of a number of plant sugars known as FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides And Polyols).

FODMAPs are found in a range of foods, including sweets and snacks, bread, pasta and grains, root vegetables, beans and pulses and some fruits.

You may be able to identify the particular foods that trigger you diarrhoea by keeping a food diary. You should then talk to your doctor or a nutritionist. They may suggest an ‘elimination diet’, where you stop eating certain foods and then gradually reintroduce them.

Medication

A wide range of medication has the potential to cause diarrhoea. This includes anti-inflammatories like ibuprofen, as well as several drugs used to treat other digestive symptoms such as acid reflux.

See a list of medications that may cause diarrhoea here.

Antibiotics are a particular risk because they can kill off beneficial gut bacteria. In this case, taking a probiotic supplement and eating fermented foods containing probiotics can help rebalance your gut.

Don’t stop taking any medicine you’ve been prescribed without talking to your doctor.

HRT

Hormone replacement therapy (HRT) can be a huge help with a wide range of menopause symptoms. However, side effects can include diarrhoea, especially if you’re taking tablets or capsules, as opposed to using a patch.

If your diarrhoea lasts more than a week, you should go back to your doctor who may change the dosage or type of HRT. You should also talk to a doctor or a pharmacist before taking any medicines to treat the diarrhoea.

Pelvic floor issues

Your pelvic floor is the group of muscles that support your bladder, uterus, vagina and bowels. You use these muscles when you go to the toilet and to prevent leaks. Problems with your pelvic floor can lead to urinary incontinence and diarrhoea.

If you need to strengthen your pelvic floor, the NHS recommends some simple exercises that involve squeezing and holding the muscles for a few seconds.

Other ways to stop diarrhoea

Depending on the cause, these tips could help relieve diarrhoea or reduce symptoms.

Eat more soluble fibre

The relationship between plants, the fibre they contain and diarrhoea can be complicated. In general, fibre is great for healthy digestion. But if you have a FODMAP intolerance, certain plants can cause diarrhoea. And for some people, too much insoluble fibre – which makes your gut secrete water and speeds up digestion – could also make symptoms worse.

Soluble fibre, on the other hand, actually absorbs water from your gut, so could help to prevent diarrhoea.

Soluble fibre is found in plants including:

• oats
• barley
• beans and pulses
• apples
• berries
• stone fruits
• nuts and seeds, especially flaxseeds
• lots of different vegetables

Many of these plants also contain prebiotics. These special types of carbohydrates act as fuel for friendly gut bacteria and could help to improve the balance of your gut microbiome. They’re also a great way to support probiotic bacteria if you’re taking a supplement.

Of course, plants high in soluble fibre also tend to contain some insoluble fibre so it’s about striking the right balance for your gut. If you’re not used to eating much fibre, it’s a really good idea to add more to your diet, but do so gradually to give your gut a chance to adjust.

Reduce stress

As we’ve seen, stress and diarrhoea can be closely linked, with changes during perimenopause and menopause potentially exacerbating both.

These lifestyle tips may help to tackle stress, which could in turn improve digestive problems:

• Exercise: Regular exercise can significantly reduce stress and boost your mood. Working out can also help you to process the things that are making you anxious, or give you a break from these negative thoughts.
• Mindfulness: Try meditation, yoga or deep breathing exercises to lower your levels of the stress hormone cortisol and reduce blood pressure. Relaxing hobbies that occupy your mind can also help.
• Talking: If something is stressing you out, the NHS recommends sharing it with a friend, family member or colleague. You could also try a talking therapy, such as cognitive behavioural therapy (CBT).

Medication

There are several over-the-counter medicines available to treat short bouts of diarrhoea. The most common active ingredient in these is loperamide hydrochloride, sold under brand names including Imodium, Diamode and Dioraleze, or as supermarket own-brands.

Loperamide comes in tablets or capsules, or as a liquid available on prescription. It’s generally for short-term use only – you shouldn’t take it for more than 48 hours without talking to your doctor.

Don’t use loperamide if you have:

• bad diarrhoea after taking antibiotics
• the inflammatory bowel disease ulcerative colitis
• heart rhythm problems
• constipation or a swollen stomach

How long does menopause diarrhoea last?

Diarrhoea during perimenopause can come in waves, especially if it’s linked to fluctuating hormones. Different women report experiencing these bouts for days, weeks and, unfortunately, sometimes months.

In the longer term, diarrhoea during perimenopause does tend to get better – but it may take time.

One study involving perimenopausal and menopausal women found that participants’ diarrhoea become less severe as they got older.

And a number of other studies suggest that IBS symptoms including diarrhoea improve significantly for women after they reach menopause.

However, for the majority of women perimenopause lasts for 4–8 years, which could feel like a long time if your diarrhoea keeps coming back. That’s why it’s important to try to minimise your symptoms by finding the right lifestyle changes and remedies for you.

When to see a doctor about diarrhoea

Although it’s a common menopause symptom, diarrhoea can also be a sign of other health conditions or illnesses.

You should talk to a doctor if:

• your diarrhoea is severe
• you get it often
• it lasts for more than 7 days 
• your poo is very dark or has blood in it 
• you’re also being sick
• you have a bad or continuing stomach ache 
• you also have unexplained weight loss
• you’ve had a lot of very watery diarrhoea 
• it happens at night
• you’ve recently taken antibiotics or been in hospital
• you feel lightheaded, drowsy or are peeing less than usual

Summary

There’s good evidence that lower levels of oestrogen and progesterone during perimenopause and menopause can contribute to diarrhoea, including by speeding up digestion. They may also trigger an increase in stress hormones, which can impact your digestive system.

Food intolerances, medication, HRT and pelvic floor issues are among other possible causes of diarrhoea. Identifying trigger foods, adding soluble fibre to your diet and finding ways to reduce stress could all help to prevent diarrhoea.

Over-the-counter medications such as loperamide hydrochloride can provide quick relief but you shouldn’t take them for more than 48 hours at a time. If you have diarrhoea often, or for more than 7 days in a row, you should talk to your doctor.

Probiotic supplements may improve symptoms of menopausal diarrhoea and reduce stress by rebalancing your gut microbiome.

The specific strains of bacteria in The Better Gut probiotic supplements have been shown to help with a wide range of perimenopause and menopause symptoms, including:

• irritable bowel syndrome
• gut wall permeability
• stress, anxiety and depression
• hot flashes and night sweats
• brain fog and mental fatigue 
• sleep quality
• bone density and risk of osteoporosis
• vaginal health 
• maintaining a healthy weight

To take the first step towards a better menopause, try The Better Gut probiotic supplements. And get 10% off your first order when you join our newsletter.