Menopause may mark the end of your periods, but the hormonal shifts, particularly falling oestrogen and progesterone affect every part of the body. Your gut included.
Around 38% of postmenopausal women report changes in bowel habits, with constipation being one of the most common and disruptive symptoms¹.
It’s not just uncomfortable. Constipation can drag down your mood, energy, productivity, and your overall sense of self.
Let’s unpack why it happens, and how to feel better.
Why Hormonal Shifts Disrupt Digestion
Many women experience constipation during both perimenopause and menopause, and not because of something they’re doing “wrong.” These are hormone-driven changes, and they’re completely valid.
Here’s how they show up:
- Hard, dry stools: Lower progesterone slows gut motility, which means stool sits in your colon longer, drawing in more water and becoming harder to pass.
- Pelvic floor weakening: Oestrogen supports muscle tone. As levels drop, pelvic floor strength can decline, making full bowel movements more difficult and increasing the risk of straining or incomplete emptying.
- Stress and cortisol spikes: Oestrogen plays a regulatory role with cortisol (your stress hormone). When oestrogen drops, cortisol rises and digestion slows in response².
- Reduced mobility: Aches, fatigue, or joint pain during menopause can mean you’re less active. But movement is essential for healthy digestion.
Importantly, research from the Seattle Midlife Women’s Health Study shows that stress and tension, more than reproductive hormone levels are significantly linked to constipation severity in midlife women³.
Why Constipation Matters
Constipation isn’t just a gut issue. It can touch every part of your life:
- Pain and pressure: Including haemorrhoids, abdominal discomfort and, in some cases, faecal impaction or incontinence⁴.
- Mood symptoms: Constipation is significantly associated with higher rates of depression and anxiety⁵,⁶.
- Reduced quality of life: Many women report it interferes with productivity and enjoyment of everyday life, with up to 12% taking time off work due to symptoms⁷,⁸.
Signs It Might Be Hormonal Constipation
You might notice:
- Fewer than 3 bowel movements per week
- Hard, lumpy or dry stools
- Straining to pass stool or a feeling of incomplete emptying
- Bloating, cramps, or nausea
If these symptoms are persistent, or if you see blood, lose weight unintentionally, or experience fatigue, it’s worth speaking to your doctor.
Managing Menopause-Related Constipation
1. Lifestyle First
- Hydration: Aim for at least 6–8 cups of water a day.
- Movement: Gentle walks, yoga, core and pelvic floor exercises can all improve gut motility.
- Stress reduction: Deep breathing, mindfulness, and prioritising rest support both your nervous system and digestion.
2. Dietary Support
- Fibre: Whole grains, legumes, fruit and veg. Aim for ~25g daily.
- Probiotics and prebiotics: Think yogurt, kimchi, kefir (probiotics), and garlic, onions, bananas (prebiotics).
- Sorbitol-rich fruits: This is a natural sugar found in prunes, apples and berries has a gentle natural laxative effect.
3. Natural Aids
- Ground flaxseed: Adds moisture and fibre.
- Magnesium: Supports muscle relaxation in the gut.
- Herbal options: Fennel and senna teas, or castor oil (used cautiously and occasionally).
When Lifestyle Isn’t Enough
Over-the-counter options
Bulk-forming, osmotic, stimulant laxatives or stool softeners can help short-term. But chronic use isn’t advised without supervision.
Prescription relief
Medications like Prucalopride may be prescribed if symptoms persist beyond 6 months and other approaches haven’t helped⁹.
How HRT Supports Gut Health
Hormone Replacement Therapy (HRT) replenishes falling oestrogen and progesterone, and with that, can ease gut symptoms too.
- Oestrogen supports gut motility and microbial balance.
- Progesterone supports smoother digestion and regulates muscle tone.
- Studies also suggest HRT may reduce risk of bowel cancer in postmenopausal women¹⁰.
The British Menopause Society and NHS both acknowledge that HRT is an effective treatment for menopause-related symptoms, including constipation¹¹.
When to Seek Support
If your constipation is affecting your life, you’re not overreacting.
Track your symptoms, hydration, diet, and emotional health. Then speak to a menopause specialist who can help you build a personalised, evidence-based treatment plan.
¹- British Menopause Society. Nutrition in Menopause
, 2023. https://www.womens-health-concern.org/wp-content/uploads/2023/07/28-WHC-FACTSHEET-Nutrition-in-Menopause-JULY2023-A.pdf
²- Ko J, Park YM. Menopause and the Loss of Skeletal Muscle Mass in Women. Iran J Public Health. 2021 Feb;50(2):413-414. doi: 10.18502/ijph.v50i2.5362. PMID: 33748008; PMCID: PMC7956097. https://pmc.ncbi.nlm.nih.gov/articles/PMC7956097/
³- British Heart Foundation. Menopause and Heart Health, 2023. BHF https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2023/october/menopause-mandate-unite-with-bhf-to-encourage-women-to-learn-more-about-heart-risk-in-menopause
⁴- PubMed. Dietary Patterns and Menopausal Symptoms, 2019. PMID: 30363011 Soleymani M, Siassi F, Qorbani M, Khosravi S, Aslany Z, Abshirini M, Zolfaghari G, Sotoudeh G. Dietary patterns and their association with menopausal symptoms: a cross-sectional study. Menopause. 2019 Apr;26(4):365-372. doi: 10.1097/GME.0000000000001245. PMID: 30363011
⁵- PubMed. Vegan Diets and Menopause, 2018. Beezhold B, Radnitz C, McGrath RE, Feldman A. Vegans report less bothersome vasomotor and physical menopausal symptoms than omnivores. Maturitas. 2018 Jun;112:12-17. doi: 10.1016/j.maturitas.2018.03.009. Epub 2018 Mar 14. PMID: 29704911.
⁶- PMC. Ketosis and Appetite Regulation, 2019. Harvey CJDC, Schofield GM, Williden M. The use of nutritional supplements to induce ketosis and reduce symptoms associated with keto-induction: a narrative review. PeerJ. 2018 Mar 16;6:e4488. doi: 10.7717/peerj.4488. PMID: 29576959; PMCID: PMC5858534.
⁷- WHI Observational Study. Diet and Weight Gain Postmenopause, 2018. Ford C, Chang S, Vitolins MZ, Fenton JI, Howard BV, Rhee JJ, Stefanick M, Chen B, Snetselaar L, Urrutia R, Frazier-Wood AC. Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women's Health Initiative Observational Study. Br J Nutr. 2017 Apr;117(8):1189-1197. doi: 10.1017/S0007114517000952. Epub 2017 May 16. PMID: 28509665; PMCID: PMC5728369.
⁸- AIMS Public Health. Systematic Review: Mediterranean Diet and Menopause, 2024. Carla Gonçalves, Helena Moreira, Ricardo Santos. Systematic review of mediterranean diet interventions in menopausal women[J]. AIMS Public Health, 2024, 11(1): 110-129. doi: 10.3934/publichealth.2024005
⁹- British Menopause Society. Nutrition and Weight Gain in Midlife Women, 2023. https://www.thebms.org.uk/wp-content/uploads/2023/06/19-BMS-TfC-Menopause-Nutrition-and-Weight-Gain-JUNE2023-A.pdf
