Sex Hormones & IBS

The weight of evidence supports an influence of sex hormones on IBS and other pain-related symptoms.

Women out number men with IBS 2:1.

In specialist care settings where symptoms tend to be more severe, the ratio is 5:1.

Some examples that indicate a potential link are...

During the late luteal phase (premenstrual) and menstruation when oestrogen and progesterone levels decline sharply to their lowest point in the cycle, there can be an exacerbation of bowel symptoms and increased abdominal pain/discomfort and bloating.

During pregnancy when oestrogen and progesterone levels are quite high there is often reduced pain sensitivity, but there can be exacerbation of constipation due to slower bowel transit.

Gynaecological conditions involving hormonal disturbance such as endometriosis and PCOS are both associated with an increased prevalence of IBS.

In menopause when there is a decline in ovarian hormones there is a decrease in IBS incidence, but also a higher prevalence of constipation. However commencing HRT can be associated with increased and prolonged IBS to a later age.

Finally, female sex is an independent risk factor for the development of post-infectious IBS.

Why is this?

It is complicated. Science is still trying to figure that out. For example, ostrogens may influence both pro-inflammatory and anti-inflammatory pathways depending on many different factors.

One interesting line of inquiry is that there may be more mast cells in the colon in female IBS patients vs male. Mast cells have both sex hormone and CRF (hormonal stress response) receptors. Mast cells are also involved in other disorders that overlap with IBS AND occur more commonly in women such as fibromyalgia, chronic fatigue syndrome and migraines. (Mulak, 2014)

No, we don't exactly have all the answers just yet. But if you've been questioning whether there is a link between hormone changes or dysregulation and IBS symptoms, the answer is yes, it seems likely.

We are in the era of acknowledging the gender pain gap is real and research into the influence of sex hormones on health experiences is worthwhile.