Though they’re not as well known as hot flushes and night sweats, gut (gastrointestinal) symptoms are incredibly common during the perimenopause and menopause.
We’ll explain why bloating can occur in the perimenopause and beyond, what it feels like and, most importantly, how you can help manage your symptoms at home.
Bloating isn’t usually a cause for concern, but we’ll also outline some signs that might mean you should speak with your doctor.
Is bloating common in the perimenopause?
The perimenopause is the transition time leading up to the menopause, and it includes the 12 months after your last period. The perimenopause may begin at any point around your 40s or mid-50s, and it can come with disruptive symptoms.
Although gastrointestinal symptoms might not be the first sign of perimenopause that jumps to mind, they’re actually quite common.
For instance, one study, which included data from more than 14,000 people experiencing the perimenopause, found that 76% reported digestive issues.
Another study reported that the most common gastrointestinal issue during the perimenopause was bloating (35%), followed by constipation (16%) and diarrhoea (12%).
A different study recruited a diverse group of more than 1,000 mid-life women. The analysis showed that 32.1% of participants experienced bloating. Interestingly, the scientists also found that the prevalence of bloating varied by ethnicity:
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Hispanic: 40.4%
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Non-Hispanic white: 35.6%
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African American: 29.7%
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Asian: 20.7%
If you’re entering the perimenopause, it may be the first time you’ve experienced significant bloating. For people who already experience it, like those with irritable bowel syndrome (IBS), the bloating might get worse.
Because hormones can fluctuate significantly during the perimenopause, bloating and other symptoms can appear and disappear seemingly at random.
What does bloating actually mean?
Though most of us have used the term, it’s worth looking into what bloating is, what it isn’t and some related terms:
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Bloating: The sensation that your belly is uncomfortably full.
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Distension: A visible increase in the size of your abdomen that can accompany bloating.
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Gas or wind: An increase in farting can happen with bloating.
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Weight gain or body composition change: During the perimenopause, weight gain is common, particularly around the tummy. This isn’t bloating, but the two can be confused.
Why is bloating so common in the perimenopause?
Although around 1 in 3 people will experience bloating during the menopause transition, there’s been little research into why it happens, as with so many facets of women’s health.
Still, scientists do have a few theories:
Hormone fluctuations may affect fluid retention
As oestrogen and progesterone fluctuate less predictably during the perimenopause, they can cause changes throughout the body. For instance, when oestrogen rises and progesterone falls, it can cause fluid retention, which builds up in tissues and produces a feeling of fullness.
Hormone changes and gut motility
There are oestrogen and progesterone receptors in your gut, and changes in these hormones can influence how quickly food moves through your intestines (gut motility).
For some people, this might cause constipation, which increases the chances of bloating. It also gives your gut bacteria more time to ferment waste products, which produces more gas.
Hormones and the gut microbiome
Changes in hormone levels and gut motility may subtly alter the makeup of your gut microbiome. This, in turn, might increase the chance of bloating.
Gut-brain communication and IBS-like symptoms
Experts believe that IBS stems from miscommunication between the gut and brain, along the pathway known as the gut-brain axis.
IBS is more common in females than males, leading researchers to think that sex hormones play an important role in its development.
As hormones shift during the perimenopause, some people experience IBS-like symptoms for the first time, which can include abdominal pain and bloating. If you already have IBS, the symptoms might worsen, which can include bloating.
Stress and sleep changes can affect the gut-brain axis
The perimenopause can coincide with anxiety, mood changes, sleep disruption and higher levels of mental stress.
This can affect gut sensitivity, motility and stool frequency, potentially increasing gastrointestinal symptoms, like bloating.
Food patterns may change without you noticing
Mid-life can be a busy time. A hectic schedule combined with fluctuating hormone levels and physical changes can lead to disrupted sleep, psychological stress, changes in appetite, increased alcohol consumption and changes in diet. All of these factors can influence how your gut works, potentially increasing the chance of bloating.
Existing gut sensitivities may become more noticeable
Because of fluctuating hormones, food sensitivities or intolerances may become more pronounced for some people during the perimenopause. A common symptom of these issues is excess wind and bloating.
When bloating shouldn’t be ignored
Most often, bloating is uncomfortable but not a cause for concern. However, you should seek medical advice if:
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You've tried changing your diet, but it doesn’t get better.
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You also see blood in your poo.
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You’re losing weight without trying.
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You regularly feel bloated.
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You’re peeing more often than usual and feeling full quickly after eating.
You might need to book a more urgent appointment in some cases, for instance, if:
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You’re being sick or having diarrhoea or constipation.
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You also have acid reflux (heartburn).
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You can’t poo, fart or pee.
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There’s a lump in your abdomen.
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You also have a stomach-ache.
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You’re shivery or feverish.
And if you experience bloating, a swollen stomach and any of the following, call 999 or visit A&E:
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You have a stomach-ache that came on quickly and is really painful.
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You’re having trouble breathing.
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Your vomit looks like ground coffee or has blood in it.
What can help with perimenopause bloating?
Thankfully, there are things you can try at home to relieve perimenopause bloating. Though little research has specifically looked into bloating during this transition, general advice should still help.
Track patterns for at least 2 weeks
If your bloating only comes on every so often, it’s worth keeping track of, to try to understand what’s triggering it. For a couple of weeks to 1 month, note down when you feel bloated and:
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where you are in your menstrual cycle, plus any changes to your periods
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what you're eating and drinking, including alcohol and caffeine
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sleep and stress levels
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any exercise
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medications and supplements
After a few weeks, you might spot patterns. If there seems to be a link between bloating and drinking alcohol, for instance, you can try drinking less or none to see if symptoms improve.
If you see a link with certain foods, a gut-specialist dietitian can help you determine if a food intolerance is behind your bloating.
Support regular bowel movements
Because constipation increases the risk of bloating, staying regular may help. Ways to achieve this include:
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Eating more fibre: If you don’t eat much fruit and veg, increase your intake gradually. If you go too fast, it might make symptoms worse.
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Drinking enough fluids: If you’re dehydrated, your poo can get harder and more difficult to pass.
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Keeping active: Exercise is great for easing many symptoms, including bloating.
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Following the urge to go: Ignoring it can cause stool to dry and harden.
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Pooing in a healthy position: Squatting on the toilet with your knees up can help move poo along.
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Seeking medical advice if constipation is persistent: Medications may be necessary.
Eat for gut comfort
Shifting what, when and how you eat can help reduce your risk of bloating:
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Chew slowly: Eating quickly can mean swallowing more air, which can contribute to bloating for some people.
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Chew with your mouth closed: The rationale is the same as above.
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Avoid large meals late in the day: This is if your symptoms are worse at night.
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Eat smaller meals: Try eating smaller meals more regularly, rather than fewer large meals.
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Drink flat, not fizzy drinks: Carbonation can increase the amount of gas in your gut.
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Keep hydrated: This reduces your risk of constipation and, therefore, bloating. Adults need about 8–10 cups of hydrating fluid a day, with a cup measuring about 200 millilitres.
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Try foods containing soluble fibre: These can help soften and bulk out your poo. Oats, lentils, chickpeas, black and kidney beans, apples, pears, bananas, oranges, carrots, sweet potatoes, broccoli and Brussels sprouts are good examples.
Reduce stress when possible
Lowering stress levels can help some people reduce bloating. Evidence suggests that stress can influence gastrointestinal symptoms by disrupting the gut-brain axis.
Life is stressful, but it’s important to try to find ways to manage stress whenever you can. This could include:
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Doing physical activity, which could involve yoga positions that help clear wind
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Trying meditation
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Connecting with friends or family
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Carving out some time to do things you love
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Helping others boost their (and your) morale
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Trying gratitude, positive thinking and accepting what you can’t change
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Reducing or cutting out alcohol
On the last point: A drink may help in the moment, but it makes things worse the next day, as alcohol alters brain chemicals, which affect mood and anxiety levels.
Caffeine may also be worth considering. As we age, many of us become more sensitive to it. This sensitivity can creep up without you noticing, making you feel more anxious. So, try reducing your intake and see if it helps.
Focus on sleep
Surprisingly, there are close links between sleep and gut symptoms. This means that getting enough good-quality sleep might help improve bloating for some people.
However, during the perimenopause, many of us really struggle to get to sleep. If that’s you, don’t hyper-focus on it, because this can make it even harder to drop off.
Some of these lifestyle factors may help improve your sleep:
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Consistency: Try going to bed and getting up at the same times, 7 days a week.
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Duration: On average, people need around 7 hours each night, so really make room for it in your schedule.
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Physical activity: Regular exercise can help you drop off.
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Your rhythms: Each of us has a natural biological clock. Help yours stay aligned by getting outside into the sunlight every morning.
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Caffeine: The risk of increased sensitivity bears repeating. Try reducing your intake to see if it helps, and try to hold off entirely after lunchtime.
As bedtime approaches, here are some strategies to help improve your sleep:
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Start winding down and getting ready around 1.5 hours before bedtime.
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Take a warm bath in the evening.
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Try not to eat or drink anything (especially spicy foods, caffeine or alcohol) too close to bedtime.
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Try to avoid screens as the time nears.
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Keep your bedroom dark, cool, quiet and comfortable.
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Put your phone on silent or leave it in another room.
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Experiment with earplugs, an eye mask or both.
Consider your wider gut health routine
Looking after your gut can help ease gut symptoms, so consider trying probiotics. These are products that contain live microbes.
There’s some evidence that certain strains of probiotics might ease symptoms like bloating and gas, at least for some people. If you're trying a probiotic, take it for 4–12 weeks to see if it has any benefits.
FAQs
Here are answers to some frequently asked questions about bloating during the transition.
Is bloating a symptom of the perimenopause?
Possibly. Many people report bloating and other digestive symptoms during the perimenopause, though research is still catching up. It isn't yet clear whether the connection is directly driven by hormonal fluctuations, or by changes in your diet, lifestyle and sleep that the perimenopause can bring.
Why am I suddenly bloated in my 40s?
If you’re in your 40s and experiencing bloating for the first time, it may be linked with the perimenopause. It could also be due to constipation, IBS, stress, dietary changes, medications or other digestive conditions. If it’s persistent or severe, do speak with a doctor.
Is perimenopause bloating the same as menopause belly?
Not exactly. Bloating is usually a feeling of fullness, pressure, gas or swelling. ‘Menopause belly’ often describes changes in abdominal weight or fat distribution caused by declining oestrogen levels. These can happen at the same time and might feel similar, but they’re not the same.
Can gut health affect perimenopause bloating?
Gut health may influence digestion, how often you poo and how comfortable your gut feels, but bloating can be influenced by a wide range of factors. A consistent routine, with fibre, fluids, movement, sleep support and stress management may all help support digestive comfort.
Summary
Bloating is common during the perimenopause due to a range of factors, most importantly fluctuating hormone levels.
Changes in bowel habits, increased stress, poor sleep, your eating patterns and changes in gut sensitivity can also play a part.
Bloating can be incredibly uncomfortable, but it’s usually not a serious concern. However, seek urgent care if you also have a bad stomach-ache that came on quickly, if you’re also having trouble breathing, or if you’re being sick and it looks like coffee grounds or has blood in it.
There are a range of things you can try to reduce bloating, including staying hydrated, keeping physically active, reducing stress, improving sleep, gradually eating more fibre and trying probiotics.
To learn more about this and other gut health topics, visit Symprove’s Gut Hub.
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