Hot flushes, brain fog, weight gain and profuse sweating – we’ve all heard how women can find these intensely uncomfortable and embarrassing during perimenopause.  But has bloating, heartburn or constipation come as an unwelcome surprise for you too?

The taboo symptoms of perimenopause

OK, so there are some other pretty sensitive symptoms that we’re a bit reluctant to shout from the rooftops.  Take vaginal dryness, low sex drive and stress incontinence, for example.  But what gets as little airtime, are bloating and changes in toilet habits.

As if you haven’t already got your work cut out with changes to your skin and body shape. Add in aches and pains, a bloated tummy, difficulty going to the toilet and heartburn every time you even look at your favourite food or drink which can make life pretty challenging.

So what’s going on with your gut?

Ageing and gut health

Part of the issue is a universal problem – men are not immune!  As we age, we start to produce less stomach acid and digestive enzymes which break down food.  This means that food takes longer to digest, we might absorb fewer nutrients from it and for some people it can lead to new food intolerances developing.

Stomach acid has the job of keeping the friendly bacteria in the right place – mostly in your colon and preventing it from overgrowing further up.  So, less acid provides an invitation for bacteria to thrive in the wrong place.  This can result in bloating, gas and either constipation, diarrhoea, or both as the bacteria ferment the carbohydrates in your food.

But that’s only part of the story.

Changing hormones can lead to changing digestive health

You may have noticed that just before your period, constipation might kick in for a couple of days, sometimes followed by an upset stomach and swinging the opposite way.  Oh the joys!  This in part relates to a drop in progesterone, which causes bowel movements to slow down.

When food sits in your digestive system for longer, it tends to ferment, causing more gas.  And to top it off, the water in your stools gets reabsorbed through the gut lining.  This can create hard to pass and sometimes painful bowel movements.

Oestrogen production also reduces, and the double whammy with decreased progesterone causes a range of further side-effects:

• Reduced stomach acid, giving rise to heartburn, acid reflux, constipation and/or diarrhoea. These symptoms are often considered to relate to Irritable Bowel Syndrome (IBS), or assumed to be caused by excess stomach acid and treated with proton pump inhibitors (PPIs) such as omeprazole, which further reduce stomach acid production.
• Reduced bile production in the liver, limiting the ability to digest fats. Many vitamins are fat soluble and so this can also lower absorption of key nutrients, particularly vitamins A, D, E & K.
• Nausea which can often affect your appetite, especially in the morning. Many women however find themselves dealing with being over-hungry and strong cravings later in the day.
• More cortisol (the stress hormone) and increased blood pressure, wreaking all manner of havoc with the gut, mental wellbeing and your general health.

The effect of all this on your wellbeing

Often, clients will tell me their gut symptoms alone can really bring them down.  They might report concerns such as:

Sadly, depression can be common during perimenopause.  As well as changes to serotonin (your happy hormone) and the effects of chronically high cortisol, changes to womens’ bodies and the effect of digestive problems on quality of life can all play a part.

Getting help when you need it

I work with countless women going through perimenopause and digestive health problems.  Working with a nutritional therapist can really help to get some specialist support and guidance on what to do to feel more like your old (or young!) self.

Sometimes, I refer clients to see their GP and would always recommend that you speak with yours if any of the following apply to you:

• Blood in your stools
• Persistent pain in the abdomen, or elsewhere in the body
• Recurrent diarrhoea that lasts for more than a week
• Reduced appetite or feeling full quickly when eating

Improving your digestive health can take time and making improvements to your food intake and lifestyle is best done gradually.  That way you know what is working for you, and what your body doesn’t like so much, plus it allows you time to embed healthy habits.

Here are a few ideas you can action now to improve your digestive symptoms:

5 Steps to a Healthy Gut During Perimenopause

1. Eat a broad variety of plant-based foods – variety in your diet creates diversity in your gut bacteria, which is what you need for a healthy microbiome. Eating the rainbow maximises the different vitamins, minerals and polyphenols (powerful antioxidant compounds in plants) that you can benefit from.  Many plants also provide phytoestrogens, which help to stabilise the effects of fluctuating oestrogen.  And of course, the fibre and water content will help to get things moving!

WAYS TO FIT THEM IN – fill around half of your plate with brightly coloured veggies – salads, sauteed, steamed, roasted, or stir-fried.  Aim for 2-5 different types with each meal.  Using veggie sticks and dips can help to up your daily intake. Phytoestrogens include: soy beans (preferably miso and tempeh as fermented forms), flaxseed, sesame seeds, alfalfa sprouts, legumes (beans, peas, lentils)

2. Use bitter foods to get your digestive juices flowing – these stimulate bile production, stomach acid and enzymes to break your food down. Good options include rocket, watercress, kale, chicory, Brussels sprouts, citrus, turmeric, and ginger.  The best time to have these is at the beginning of your meal.

WAYS TO FIT THEM IN – a teaspoon of apple cider vinegar (ACV) in water before a meal can really help.  Having a side salad or starter drizzled in a little extra virgin olive oil and some lemon juice can be quick to put together.  Throwing other ingredients such as turmeric and ginger into recipes can help too.

3. Mind the alcohol, caffeine and sugar – not only do these interfere with your stress hormones and immunity, but they can also be inflammatory for your gut and contribute to aches and pains. Notice that you could once have a few wines and now half a glass gives you a headache?  That is because your liver may be struggling to detoxify alcohol, caffeine and sugar in the way that it used to.  So best to minimise and crowd out with goodness where you can.

WAYS TO REDUCE YOUR INTAKE – try good quality decaf or non-caffeinated drinks if you have a little too much caffeine.  Kombucha or flavoured water kefir can be a refreshing way to skip the alcohol (don’t worry, the sugar in the ingredients has been mostly fermented!).  Look for naturally lower sugar foods when you fancy something sweet – for example choosing quality chocolate or using fruit to sweeten foods.

4. Eat healthy fats, rather than low fat – getting the right types of fat in small amounts is really important for hormonal balance and can take some of the inflammatory load away from your gut. As well as monounsaturated fats found in avocado, olives, nuts, seeds and their oils, we need the essential fat omega 3 found in oily fish.  Flaxseed oil contain small amounts of omega 3 fats also.  If you don’t eat fish, the best way to get enough would be from either a fish oil or plant-based oil such as algae-based omega 3.  Where you can, opt for leaner cuts of meat and use full fat dairy products sparingly.

WAYS TO FIT THEM IN – drizzle oils (avocado or extra virgin olive) on salads and warm veggies, add avocado to meals and if you like fish, include 2-3 portions a week.  Remember SMASH – salmon, mackerel, anchovies, sardines, herring.  Nuts, seeds and nut butters are all great as snacks and to improve the nutrient content of meals.

5. Have some gut-soothing foods to hand – turmeric, ginger, fennel, oats, bone broth, peppermint and bananas can all be great for your digestive system. Some have a calming effect on the muscles lining your gut, some reduce inflammation, while some coat the inside of your digestive tract and allow repair to happen.  What works for you might be different to what works for others, so use what is helpful to you.  Make sure you include these 5 gut-healing plant foods

WAYS TO FIT THEM IN – banana is versatile as a snack or an ingredient in breakfasts – pancakes, banana bread or added to porridge.  Oats often therefore go nicely with bananas!  Juicing or grating ginger or adding to hot water is delicious. Turmeric can be used in savoury dishes or mixed with milk to make a turmeric latte (this drink covers points 2,3 & 5).

To understand which symptoms (within the digestive tract and outside) are common when your gut, immune system & hormones are out of sync, watch my FREE masterclass 3 Steps To Control Your Gut (And Still Eat Your Favourite Food).

Jane Barrett is a registered nutritionist and expert in digestive health helping women & children with digestive issues take control of their health through food. She offers support through meal plans, online courses & personalised 1:1 programmes on Zoom.