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Bloating

Bloating is one of the most common symptoms of peri-menopause with up to 60% of women suffering from it. It is best described as a feeling of fullness or tightness in, predominantly, the abdominal area that results in a distended or swollen belly. It may also cause pain ranging from mild discomfort to severe. Some people refer to bloating during mid-life as “menopause belly”, and the 90% of women that have suffered from Premenstrual Syndrome (PMS) will likely already be very familiar with bloating. Bloating during menopause is generally the result of water retention, gas being trapped in the stomach, decreased bile production, or a combination of the three. Common causes are the fluctuation in and decrease of hormones, nutrition, or lifestyle changes.

30-60% of women in menopause or peri-menopause experience bloating and other abdominal discomforts

How long bloating will last and how severe it can be is different for each woman. While some women may experience it just for a few days and not again for a whole year, other women may not be so lucky and have to deal with this uncomfortable feeling pretty much daily several months at a time. There are several treatment options available for bloating, including prescription medication but over the counter products and dietary changes (including the use of dietary supplements) have proven to be effective for most women as well. Hormonal bloating is a fairly common symptom during peri-menopause, in post-menopauel women are less likely to (continue to) experience it as their levels of estrogen and progesterone are stable.

The Lowdown on Bloating

Why it happens and the science behind it, how it may impact your life, how you and your doctor can diagnose it and common triggers or risk factors.

It is not fully understood how changes in hormone levels lead to bloating, but there are clinical studies showing that estrogen affects how our body reabsorbs water, and that it is closely involved in bile production. 

‍Water retention

When your hormones are at normal levels and in balance, estrogen helps to increase water retention while progesterone helps the body get rid of excess salt water due to its diuretic effect. Now the problem is that during peri-menopause your hormones not just decrease but they start fluctuating which may lead to an imbalance. If Estrogen is at a higher level your body will retain more water, and the limited amount of progesterone will not be enough to help the body get rid of the excess water. This will result in bloating of the abdominal area, less common is bloating of other body parts such as the hands and feet (they would feel “puffy”).

‍Decreased bile production

Bile is a fluid that is stored in the gallbladder and plays an important part in how (well) our bodies digest food. It essentially has a lubricating effect for your intestines by breaking down fats into fatty acids which determines how smoothly the food we eat can move along our digestive tract. The medical community is not in complete agreement yet but there is emerging research that confirms that lower estrogen levels have a negative impact on how much bile your liver produces. This essentially results in harder stool, which often leads to constipation, which leads to bloating. 

‍Other causes

Bloating is something that most of us have experienced at some point in our lives, as it is frequently caused by a gas buildup in our abdominal area which in turn is caused by lifestyle choices. For example, changes in diet, stress, swallowing of air and other health conditions such as irritable bowel syndrome can all cause bloating as well. In the following sections we explain these factors in more detail.

Word of warning

Although bloating is a normal and common symptom and shouldn’t be a cause of concern, there are certain situations where you must seek immediate medical attention. Consult your doctor if you experience any of the following:

  • Chronic bloating, especially lasting longer than a week. Feeling bloated for weeks at a time may be a sign of abnormalities in the pelvic organs like the uterus and ovaries. 
  • Persistent or severe abdominal pain
  • Diarrhea lasting more than two days without improvement.
  • Bloody stool or changes in the color or frequency of your stool.
  • Change in bowel habits, this is an important symptom of bowel cancer

The perception of bloating may also increase during perimenopause and menopause because of body fat  composition changes, with more fat accumulating in the central region. For some women, bloating may also cause a negative perception she has of herself, which could take a toll on her social life. In addition, it had been found that women were 2-4x more likely to have depressive episodes than they did  before menopause, even if they had never had any previous episode of depression. Women who have a low body image due to bloating are likely to have it affect their mental health. If you are battling with depression due to your body image during menopause, ensure to see a therapist while you work towards addressing the underlying issues. 

Diagnosis is done based on self reported symptoms in combination with your medical history, lifestyle and likely age (to help determine if you are in peri-menopause).  However, as there may be a combination of factors, your doctor will likely perform a simple abdominal and pelvic examination to rule out any obvious masses or swelling.

Aside from hormonal fluctuation, several other factors may trigger bloating. Reducing or avoiding some of these factors may help in preventing bloating. Some of these factors include

  • Electrolyte imbalance/ Salt excess: electrolyte imbalance is another trigger for bloating, especially in cases of excess salt intake. Excess salt intake increases sodium levels, which makes your body retain water, leading to bloating. Additionally salt may also alter gut microbiome which in turn modifies gas-release, but this is currently still being studied.
  • Diet sensitivities: People who are lactose intolerant or have gluten sensitivity are at risk of bloating when they consume lactose or gluten due to serious digestive problems. 
  • Certain foods and beverages: certain foods like beans, broccoli, and lentils that release gas as a by-product may also trigger bloating, especially in parents with inflammatory bowel syndrome. Carbonated beverages also contain a lot of gas which can become trapped in the abdomen leading to bloating. And lastly high fiber diets are also a common cause for bloating.
  • Sugar substitutes: sorbitol, mannitol, and xylitol are all types of “sugar alcohols” that are commonly found in “sugar free” or diet products and certain prescription and OTC medicines may have it as part of their formulation as well (should be written on the label). Many people struggle with digesting these polyols which can lead to bloating and other GI discomfort.
  • Irritable Bowel Syndrome (IBS)studies have shown that 90% of patients with IBS report suffering from bloating. Women who suffer from IBS may experience a more pronounced bloating as their hormones fluctuate, especially in the perimenopausal phase.
  • Uterine fibroids/ Ovarian cysts and tumors/ Ovarian cancer: bloating is a common symptom of a number of pelvic medical conditions. If you are experiencing prolonged bloating or unusual abdominal pain it is advisable to have a physician examine you.

Physical health

Bloating

Bloating is due to homornal fluctuations is extremely common with up to 90% of women experiencing this as part of Premenstrual Syndrome (PMS), and 30 - 60% of women will continue to experience bloating and/or other abdomonial discomfort during peri-menopause. It is colloquially referred to as “menopause belly”. Nothing to be ashamed of, but can definetly be a frustrating symptom for many women.

Prevention and Treatment

Learn more about your options for prevention, management and treatment ofBloating. This is not an exhaustive list of the treatment options available, but a good start.

Several treatment options are available to reduce bloating or prevent it from happening. These treatments or remedies range from the use of natural supplements and OTC medication to the use of prescription medications like hormonal treatments that address the root cause of bloating. Others may prefer a mix of watchful waiting, lifestyle changes, or the use of holistic medicine to address bloating.  

The best treatment option will depend on the main underlying cause of the bloating, in addition to your own preferences, the severity of your condition, or how fast you need to see changes. Having said that, Irritable bowel syndrome is the most common cause and the first-line treatment is a combination of dietary modifications (low FODMAPS diet), lifestyle, exercise and probiotics. Women with other menopausal symptoms may find relief from their bloating symptoms too with HRT.

Nutrition can play a large part in causing AND reducing bloating. Making a few changes in your diet could have a big impact:

  • Changing your diet: certain foods may cause bloating for some people and especially those IBS. Limiting these foods or ideally completely cutting them out from your diet will likely significantly reduce bloating. Soaking your beans and legumes overnight and rinsing them well before cooking may help reduce bloating. Avoid dairy products if you are lactose intolerant. In addition, limit your intake of salt. You can use other flavored herbs instead of salt and reduce eating over-processed or packaged food.

  • Low FODMAPs diet: for people with IBS switching to a low FODMAPs diet is arguably the most effective change you could make. FODMAPs are a collection of short-chain carbohydrates (sugars) that when consumed will initially move slowly through the small intestine attracting water, before gut bacteria in the large intestine rapidly ferment the FODMAPs, producing gas as a result. FODMAPs are found naturally in many foods and food additives. For additional detailed information we suggest having a look at this website from Monash University.

  • Cut down chewing gum and carbonated beverages: chewing gum and carbonated beverages leads to more air and/or gas being trapped in the abdomen, causing bloating. 

  • Hydrate: while it might seem counterproductive to drink more water when you are bloated, drinking more water may help if your bloating is a result of dehydration. When you are dehydrated, your body retains water, which can lead to bloating. When you drink water, especially after a meal, you help your body balance sodium and give up fluid. 

It may not seem obvious - but, our gut and brain are connected. Scientists call this “the gut-brain connection.” This doesn’t mean that your bloating is imagined, but stress, depression, and other psychological factors may also contribute to gastrointestinal disturbances like bloating and abdominal pain. If you notice that you feel bloated when you are stressed, talk to your doctor so together you can choose stress-relieving techniques that may help you. 

Most people may feel bloated after being sedentary for a long time; this is because regular physical exercise may help strengthen your abdominal muscles, which can help improve digestion and hence ease bloating. In addition, for people who are bloated due to constipation, exercise can help move your bowel along. 

Whether it is a long walk, a bike ride, or even cardio—it doesn’t matter; just aim to have at least 15-30 minutes of mild to moderate exercise.

  • Probiotic supplements: your gut health is important for digestion, and poor gut health may lead to bloating. Probiotics help supplement the body with healthy bacteria that can help rebalance the gut flora and thus change the bacteria flora responsible for producing gas that causes bloating.
  • Phytoestrogenic supplements: Overall there is no clinical data supporting the efficacy of supplements containing phytoestrogens like black cohosh, chaste berry, and soy in reducing bloating. However, some women have reported finding some relief from taking them and it is frequently talked about online. There are no known interactions with other medicine, but liver problems have been mentioned as a potential serious side effect. Please speak with your physician before taking these supplements.
  • Activated charcoal pills have been frequently mentioned on online forums as a method to get rid of bloating that is due to a buildup of excess gas. However clinical studies have conflicting results on the effectiveness of its ability to help the body release gas, and it comes with a range of possible side effects with long-term use. It also interacts with acetaminophen (Tylenol) and other drugs, so we strongly suggest you speak with your physician before using this supplement. 

  • Simethicone may be effective if excess gas in your stomach is the cause of your bloating. It is considered an anti-flatulence medicine and it essentially works by bringing smaller gas bubbles together to form a bigger bubble. This allows the trapped air to escape your body more easily and will reduce the pressure and swelling of your abdomen. 
  • Peppermint oil is a type of medicine called an antispasmodic and may be effective in reducing bloating, especially if IBS is the underlying cause. It works by helping the bowel wall muscle to relax.

Diureticsor as they’re colloquially known as “water pills” help your body release sodium (salt) into your urine which results in your body getting rid of excess water as well. If water retention is the cause of your bloating these types of medicine could potentially be beneficial. However, Diuretics can significantly worsen electrolyte imbalances and cause blood pressure to fall. It should only be taken under supervision of a doctor and in many markets, Singapore being one of them, it is only available on prescription for this reason.

  • Birth control pills: Low dose birth control may help reduce bloating in perimenopausal women caused (in part) by PMS because they help stabilize their fluctuating hormones. 

  • Hormone replacement therapy (HRT): HRT may be used to treat the underlying cause of menopause bloating, when there are low levels of estrogen in the body. However it is not the first line of treatment for bloating.

FAQs

Are Asian women less likely to experience bloating?

An original study published in menopause involving 4 major racial/ethnic groups found that Asian women are less likely to experience severe abdominal pain or bloating than other racial/ethnic group.

Is bloating during peri menopause normal?

An australian menopause center found that 30-60% of women in menopause or perimenopause experience bloating and other abdominal discomforts

Abdominal issues and bloating in your 50s - what to expect

According to observations from the Seattle Midlife Women’s Health Study, Women in their 50s are more likely to experience gastrointestinal disturbances like abdominal pain, diarrhea, constipation, and bloating than men of the same age due to fluctuating hormones

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