Overview

Constipation is common in menopause. It is typically defined as being unable to have more than three complete bowel movements within a week. Constipation is considered chronic if it lasts for three months or longer.

When you are constipated, it can be difficult to completely void your bowels. You may feel the need for extra support to remove stool. Other symptoms of constipation include straining to void and having stools that are hard, small, and lumpy. You may be uncomfortable or have an overall sluggish feeling.

Occasional constipation is not unusual and has a wide range of causes in addition to menopause. You can even have multiple causes simultaneously.

What’s the link?

Menopause happens when your menstrual cycles have ended for at least a year. It’s earmarked by a drop in female hormones such as estrogen and progesterone. These hormones affect many areas of the body, including the digestive tract. As a result of this hormone drop, some postmenopausal women experience constipation. However, changes in bowel routine can begin even before menopause, during perimenopause.

Estrogen is responsible for many things including keeping cortisol levels low. Cortisol is a hormone associated with stress. When estrogen declines, cortisol levels rise. This can slow down the digestive process, lengthening the amount of time it takes for food to break down. This can make stool more difficult to pass.

Too little progesterone can cause your colon to slow down. The longer food waste remains in your colon, the dryer it gets. Stool also tends to be dryer when estrogen and progesterone levels are low.

Some postmenopausal women also have weakened pelvic floor muscles. This can make it difficult to eliminate stool, especially when it is hard and dry.

As women age, they may also need medications which have constipation listed as a possible complication. These medications include:

  • some blood pressure medications
  • iron supplements
  • thyroid medication
  • antidepressants
  • calcium channel blockers

What are my treatment options?

There are multiple ways to treat constipation. These include:

Dietary changes

Eating high-fiber food and drinking lots of water often helps speed up digestion. This can help reduce or eliminate constipation. Try substituting foods you normally eat with high-fiber options to see if there is a change. Some high-fiber foods to eat often include:

  • Whole grains such as bran flakes and brown rice
  • Fruits such as raspberries, pears, and apples
  • Vegetables such as peas and broccoli
  • Legumes such as lentils
  • Nuts and seeds

Medications

There are a number of over-the-counter and prescription medications which may help alleviate constipation. Talk with your doctor first to determine which of these may be right for you. Your doctor can give you guidance on how long you should take them and the time of day they will be most effective. Medications to try include:

  • stool softeners
  • osmotic laxatives
  • bulk-forming laxatives
  • fiber supplements
  • lubricants such as glycerin suppositories
  • prescription medications such as lactulose (Enulose, Kristalose), linaclotide (Linzess), and lubiprostone (Amitiza)
  • hormone replacement therapy, not specifically used as a constipation treatment, but may help to alleviate it and other symptoms

Lifestyle changes

Daily exercise can help regulate bowel movements and reduce constipation. Strive for a minimum of 30 minutes of daily aerobic exercise. Activities to try include:

  • walking
  • running
  • swimming
  • dancing
  • cycling
  • ice-skating
  • rowing

You may also benefit from pelvic floor exercises. Many of these are specifically designed to improve bladder and bowel function. Some Pilates exercises and yoga poses such as Malasana also strengthen your pelvic floor muscles.

When to talk with your doctor

It is important to rule out underlying medical issues which may be causing constipation. These may occur in addition to menopause and include diabetes and thyroid conditions. If your constipation is chronic or does not respond to at-home treatments, talk with your doctor. Seek out medical treatment sooner if you are unable to have a bowel movement within one week or if your constipation is accompanied by additional symptoms such as:

  • pain
  • nausea
  • vomiting
  • inability to pass gas
  • bloating

This may be a signal of a more serious condition such as a bowel obstruction.

The takeaway

Constipation is common in postmenopausal women. It may be the result of declining hormone levels such as estrogen and progesterone. It may worsen because of weakened pelvic floor muscles.

No matter its cause, constipation can often be treated by changes in diet and exercise. Some medications, many of which do not require a prescription, can also help. If your constipation becomes chronic, does not respond to at-home treatment, or is accompanied by the symptoms above, seek out a doctor’s care.