Menopause and Constipation: What You Need to Know

Many women entering the perimenopausal and menopausal phases experience more than just hot flashes and sleep disturbances. Digestive changes-including constipation-are common. Fewer than three bowel movements a week is a warning sign. Many women find their digestion slows down, making it harder to pass stools.

In this article, we will look at why constipation often happens during menopause. We will discuss how it relates to gut health and hormonal changes. We will also share practical tips to help reduce constipation during this time.

Why constipation often appears during the menopausal transition

Hormonal shifts and the digestive system

During the transition to menopause, levels of estrogen and progesterone decline. These hormonal swings impact many body systems-including the digestive system. A study found that many women in perimenopause and menopause have digestive health issues. About 94% reported gastrointestinal symptoms, and 54% mentioned constipation.

Lower estrogen may slow gastrointestinal motility: research indicates slower colon transit when estrogen declines. The slower movement of stool allows the body to absorb more water, which makes stools harder and more difficult to pass.

The role of stress, age, and other symptoms

Hormonal changes don’t act in isolation. A key study found that stress, especially how people feel about it. Strongly linked to the severity of constipation. Sometimes, this link was even stronger than the hormone levels themselves.

Women who have hot flashes, mood swings, and other stomach issues may find their gut health is not as stable. The drop in estrogen can affect bowel patterns. Changes in pelvic floor muscles also play a role. Additionally, shifts in mobility or lifestyle can disrupt normal bowel habits in midlife.

What exactly qualifies as “constipation” during this time?

Constipation during the menopausal transition can manifest as:

• Having fewer than three bowel movements per week.
• Hard or lumpy stools that are difficult to pass.
• A feeling of incomplete evacuation and straining to pass stools.
• The need to use stool softeners or other aids more frequently.

If not treated, this can lead to chronic constipation. This condition causes strain and discomfort and can lower quality of life.

How menopause-related constipation impacts daily life

When bowel movements slow down, it’s not just the gut that suffers. Poor gut health can influence mood, energy and even exacerbate other menopause symptoms. For example:

• Women with fewer bowel movements or harder stools reported more severe hot flashes and more intense menopausal symptoms overall.
• Slow transit time can lead to harder stool, and thus more pelvic floor strain when passing stools.
• A feeling of being “backed up” often affects comfort, sleep and general well-being during a time already rife with change.

Many women pay attention to classic menopause symptoms like hot flashes and vaginal dryness. However, digestive issues are also common and may be overlooked.

Contributing factors: Beyond hormones

While hormone shifts are central, there are additional contributors leading to constipation that many mid-life women face:

• Low intake of high fiber foods: Fiber helps bulk stool and supports regular bowel movements. A diet low in high fiber foods can slow stool transit.
• Dehydration or low fluid intake: Less fluid means stool becomes harder and more difficult to pass.
• Reduced physical activity: Exercise stimulates the digestive system. A sedentary lifestyle can hamper gut motility.
• Pelvic floor muscles: With ageing and changes in hormonal support. The pelvic floor muscles may weaken, making it harder to coordinate stool passage.
• Existing conditions such as irritable bowel syndrome (IBS). Women who already have IBS may find their symptoms worsen during menopause or throwing their digestive system off‐balance.
• Medications: Some medicines commonly used in midlife (pain relievers, antidepressants, antihistamines) may contribute to slower bowel movements.

Strategies for treating constipation during the menopausal transition

Here are evidence-informed strategies to help improve gut health and make stool easier to pass:

1. Boost intake of high fiber foods

Aim to increase fiber via whole grains, legumes, fruits, vegetables, nuts and seeds. Fiber adds bulk to stool and promotes movement through the colon. For example: oats, berries, beans, lentils, leafy greens. Studies suggest that increasing dietary fiber is a key recommendation for managing constipation in the context of menopause.

2. Stay well‐hydrated

Fluid is vital. Water helps keep stool soft and easier to pass. Combine increased fiber with enough fluid to support the digestive system.

3. Prioritize regular exercise

Regular exercise is shown to support gut motility and overall digestive health. Activities like brisk walking, yoga, swimming or strength training help support the digestive system in midlife.

4. Address pelvic floor strength

Strengthening the pelvic floor muscles contributes to better stool passage. Working with a pelvic‐floor physical therapist can be particularly helpful for women experiencing constipation during the menopausal transition.

5. Consider stool softeners or laxatives when needed

For some women, when lifestyle changes aren’t enough, use of over-the-counter stool softeners may help. But these should be a short-term measure while working on underlying habits.

6. Manage stress and support gut-brain health

Stress and anxiety are linked to constipation during menopause. Practicing stress-reduction techniques like mindfulness, breathing, and gentle yoga can help improve gut function.

7. Establish a bowel‐movement routine

Encouraging the digestive system to move at roughly the same time each day helps. After meals, sitting quietly on the toilet for a few minutes can help you have regular bowel movements each week.

When to consult a healthcare provider

If you have ongoing constipation during menopause, it’s important to see a doctor. This is especially true if:

• Passing stools is painful.
• You see blood in your stool.
• You have unexplained weight loss.
• You have fewer than three bowel movements a week.

If lifestyle changes aren’t helping, seek medical advice.

While many gastrointestinal symptoms during the menopausal transition are benign, underlying conditions such as colon disorders, IBS or pelvic floor dysfunction may need evaluation.

FAQs

Q: Is constipation a normal part of menopause?

A: Yes, it is relatively common for women in the perimenopausal and menopausal phases to develop altered bowel habits. However “normal” doesn’t mean it should be ignored. Many women benefit from addressing it proactively.

Q: How many bowel movements per week should I aim for?

A: Generally, if you are passing stools fewer than three times per week, you may have constipation. However, “normal” can vary by individual; the key is comfort and ease of stool passage.

Q: Does hormone replacement therapy (HRT) help with constipation?

A: The evidence is mixed. Some GI symptoms improve with HRT; others don’t. One study found that hormone levels weren’t strongly predictive of constipation severity during the menopausal transition.

Q: What if I also have irritable bowel syndrome (IBS)?

A: If you have IBS, it may worsen during the menopausal transition. Working with a specialist to tailor fiber intake, manage triggers and support gut health is key.

Conclusion

The connection between menopause and constipation is real-and deserves attention. Hormonal changes during the perimenopausal and menopausal phases affect the digestive system and gut health. Factors such as reduced physical activity, stress, low‐fiber diets and weakened pelvic floor muscles all contribute.

The good news is that many women find relief by making lifestyle changes. They can add high-fiber foods, stay hydrated, and move regularly. Strengthening pelvic floor muscles helps too. Using stool softeners wisely and managing stress can also make a difference.

If constipation remains persistent or severe, seeking professional help is crucial. Your gut deserves care as much as any other part of your health journey.

References

1. Callan, N. G. L., Mitchell, E. S., Heitkemper, M. M., & Woods, N. F. (2018). Constipation and diarrhea during the menopause transition and early postmenopause.
2. Jesrani, S. (2024, September 23). Navigating the silent storm: Menopause and constipation.
3. Medical News Today. (2023). Menopause: Could stress and constipation worsen symptoms? Medical News Today.
4. Whelan, C. (2024, October 16). Menopause constipation: Connection, treatment, and more. Healthline.
5. Solt Kirka, A. S., Korkut Oksuz, S., Gul, D. K., & Bulut, S. (2021). Constipation and its effects on quality of life in menopausal women. International Journal of Caring Sciences.