What Really Causes Perimenopause Constipation?

If you are a woman in her 40’s like me, I’d like to officially welcome you to the incredibly erratic time known as perimenopause!  I’ve experienced all of the “fun” such as hot flashes, sleeplessness, irregular periods, brain fog and bouts of perimenopause constipation. 

Oh, you didn’t realize that constipation can be a symptom of perimenopause?  Neither did my gynecologist who is a National Certified Menopause Practitioner and wrote a book on the subject of perimenopause and menopause.  In fact, she was quite dismissive of this symptom when I let her know it was a struggle.  Ugh! 

So, what is the deal with constipation during perimenopause?

Well, constipation is a common problem for many women, but it can be especially difficult to manage during perimenopause. Hormones are changing and the body’s metabolism slows down with age, both of which can lead to constipation.

This blog post will discuss how perimenopause impacts constipation and what you can do about it!

What is perimenopause?

Peri is a prefix that means ‘around’, just like a periscope lets you see around an obstacle.

Perimenopause is the transition period around menopause. You’re starting to transition but aren’t fully in menopause just yet. For many women, this begins in your 40s but perimenopause can happen in your 30s as well.  

Perimenopause is the time leading up to menopause when hormones are fluctuating and women may begin experiencing some of the symptoms of menopause. How long does perimenopause last?  Up to 8 years.  This can be a long transition.  You’ve made the progression from perimenopause to menopause once you’ve stopped having a period for a full year (1).

Signs of perimenopause can vary from one woman to another, but might include:

  • Irregular periods
  • Mood swings, anxiety or depression
  • Hot flashes and night sweats
  • Bone loss
  • Cholesterol changes
  • Constipation and other digestion issues, including bloating
  • Difficulty sleeping

What is the textbook definition of constipation? Let’s cover that, next.

Define constipation

Constipation is no fun and certainly no joke. But is there a standard definition for how much irregularity is too much? Turns out, there is!

Constipation is defined as having fewer than three bowel movements per week. It is often accompanied by painful, hard stools.

Here’s a less known fact: did you know that you can have regular bowel movements and still be considered constipated? Take a peek at this chart: if your BMs look like the first two on the chart, you’re still struggling to go and might be increasing your risk of hemorrhoids because of the pressure to relieve yourself (2).

Ideally, you’re able to pass a bowel movement most days and the consistency and shape are a 3 or 4 on the chart linked above.

So, what can cause constipation?

Causes of constipation

There are many possible root causes of constipation (3). Accurately identifying what is contributing to your constipation is important to be able to have a comprehensive and effective solution.

Causes of constipation can include:

  • Slowed motility along the digestive tract
  • Dehydration
  • Being sedentary
  • Inadequate fiber intake
  • Medication or supplement side effects (for example, birth control)
  • Another disease process, such as depression, hypothyroidism or Multiple Sclerosis (MS)

Unfortunately, going through perimenopause can make having regular bowel movements a more difficult goal to – er – pass. Let’s chat about why!

How are perimenopause & constipation related?

Constipation affects many women during perimenopause. What causes constipation during perimenopause?

Hormonal changes are one reason why you may have more trouble with constipation during perimenopause and menopause. Specifically, estrogen levels decline as your body is moving towards menopause. Because so many changes are happening to the body’s hormones during this time, it is often difficult for women to have regular bowel movements.

How Estrogen Affects Motility

The hormone estrogen affects digestion in a few different ways. It helps to promote motility of your digestive tract, so as levels of estrogen go down, so too does the muscular movement of your digestion (4).

Estrogen can also impact the microbiome – that community of organisms in your GI tract and beyond. We feel best (and so does our digestion) when we have a robust and diverse community in our microbiome. Interestingly, the changing levels of estrogen as you go through perimenopause can impact this community, possibly increasing your risk of constipation (5).

How Progesterone Affects Motility

Another key hormonal player is progesterone. Lowered levels of progesterone can also impact your ability to have a bowel movement. Less progesterone can mean slowed transit time for waste along your colon (6).

There is also reason to believe that it is not just the absolute levels of hormones that cause constipation or not, but rather the ratio of hormones to one another.

What can we do about perimenopause & constipation?

Luckily, there are many tools in the toolbox to help ease your constipation woes, even when you’re experiencing perimenopause & constipation at the same time.

Increase fiber (slowly)

A great first place to start is with increasing your fiber intake, preferably from whole foods instead of a supplement. Most adults in the US are getting less than half of the daily recommended amount of fiber, largely due to not eating enough fruits and vegetables.

Fiber from whole foods is preferred because the fiber is already hydrated. Fiber from a supplement is dried and may actually cause constipation as it absorbs water from your digestive tract. A fiber supplement also doesn’t have all of the vitamins, minerals and phytochemicals that the fruits and veggies do. While a fiber supplement might be a tool to try, it isn’t the first place to start.

A few high-fiber favorites from food? Berries, oats, avocados and pears (7). But really, all fruits and veggies have fiber in them naturally, as well as whole grains, nuts, seeds and legumes.

Another note about IBS and fiber: if you’re already struggling with IBS, fiber can be a bit more challenging to navigate. Certain foods – for example, apples – may trigger IBS symptoms, if they’re high in FODMAP. Increasing fiber too quickly can make anyone’s digestion irritable; be especially cautious if you have IBS to boot.

For more information about IBS in general and how we help, visit our IBS page.

Increase water consumption

Along with eating more fiber, it is also important to stay hydrated! Staying well-hydrated helps prevent the body from absorbing too much water and concentrating your stool. Drinking about ½ an ounce for every pound you weigh will help keep things moving along.

If you’re growing bored with plain water, try herbal teas to keep your body hydrated. Bonus: some teas have additional digestive benefits! Teas for Digestive Distress: Bloating, Gas, Nausea, Reflux & More.

Include phytoestrogens

Phytoestrogens are compounds that occur naturally in certain plants. You may have noticed the word “estrogen” contained in the word, and that is because phytoestrogens mimic the estrogen hormone that our body makes, but less so during perimenopause (8). Consuming phytoestrogens can help with symptoms management, including constipation and hot flashes.

Soy is one of the best sources of phytoestrogens (we recommend organic soy), but you can also find them in flax seeds, broccoli, legumes, oats, barley and lentils (9).

Gentle movement

Finding exercise that you enjoy, and can do regularly, helps to reduce stress and keep your digestion moving along. From walks to Zumba, bike rides to yoga, any movement that you can regularly include in your day-to-day schedule can help to increase your, er, regularity.

For more on exercise and digestion, check out this article: How Exercise Can Affect IBS, SIBO & Reflux.

Get more sleep

Did you know that good quality sleep (and enough sleep) are both crucial to optimal digestion?

When you don’t get enough sleep, your body produces more cortisol (a stress hormone) which can cause indigestion and slow down transit time. Make sure to prioritize at least seven hours of quality zzz’s every night in order to keep things moving along.

Sleep is not a luxury, it is a necessity to feel your best on a day-to-day basis. For more on the sleep and digestion connection: Is Poor Sleep Causing Your Digestive Symptoms?


If you find yourself constipated and it is impacting your quality of life, speak to a doctor about medications. Many prescription and over-the-counter (OTC) drugs can cause or exacerbate constipation as a side effect.

Even vitamin and herbal supplements occasionally come with side effects related to digestion and constipation. Did you know that iron can cause constipation?

You may also try OTC options for treating constipation. These options include laxatives, stool softeners, enemas, and suppositories. Just keep in mind that these medications may provide welcome relief for your symptoms, but they are not identifying or treating any underlying root causes. Without that information, and a plan to address it, your constipation will likely return.

Reduce stress

Your brain and digestive system are interconnected through many pathways. When you’re stressed out, your body goes into fight or flight mode. Your body’s energy, blood flow and attention are focused on your muscles – this helps your body to stay safer during physical danger.

Unfortunately, your body cannot tell the difference between physical causes of danger – like a tiger – and our modern-day stressors – like a looming deadline or a global pandemic. When your body is stressed, digestion and absorption take a back seat. This can cause painful constipation…even more so when you’re in perimenopause!

Finding ways to work through and manage stress does help to improve digestion. What works is different for everyone, but might include exercise, journaling, therapy, delegating, time with friends laughing, gardening, breathing exercises, meditation, or having a gratitude practice.

For more on the stress and digestion connection: Is Stress Causing Your Digestive Symptoms?

Use a bathroom stool

Did you know that with a position change, your body is more able to easily have a BM?

One popular brand for toilet stools is the Squatty Potty. The idea is that your feet are propped up on a stool, raising your knees above your waist. This change in position makes it easier for your body to release your stool, without straining.

Key takeaways: perimenopause & constipation

You might be feeling frustrated that your perimenopause & constipation seem inextricably linked. But take heart, there is a lot that you can do to manage your constipation symptoms and find lasting relief.

While perimenopause can often be a bumpy road for many women, supporting your digestive health, managing stress and improving sleep can help make this a more gentle transition. 

And if you’re ready for support and answers, schedule an appointment! We’d be glad to help you to identify your root causes of constipation and make a comprehensive plan for relief. What a relief!

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