Irritable bowel syndrome (IBS) can be especially common and uncomfortable for women. When considering IBS symptoms, females may especially experience discomfort. Abdominal pain that intensifies to severe bloating and cramping during menses (and possibly after menopause) is just the tip of the iceberg.
Women may experience more intense symptoms of IBS because female hormones affect digestive function (and vice versa).
This article will shed light on the IBS-female hormone connection and provide insights to help you relieve discomfort and gain a better quality of life.
What Is IBS?
IBS (irritable bowel syndrome) is a diagnosis based on symptoms rather than testing. A combination of abdominal pain and altered bowel movements  are the standard markers of IBS. However, patients typically experience many other digestive and non-digestive symptoms.
IBS is further sub-categorized into:
- IBS-D (with diarrhea)
- IBS-C (with constipation)
- IBS-M (a mix of constipation and diarrhea)
- IBS-U (unspecified IBS)
While IBS is not gender-specific, statistics show that IBS is 67% more prevalent in women than in men. Women are also 1.5-3 times more likely than men to exhibit symptoms of IBS .
IBS Symptoms: Female and General
Common digestive symptoms of IBS include:
- Abdominal pain 
- Altered bowel habits 
- Bloating 
- Cramping 
- Indigestion 
- Heartburn 
- Reflux 
- Flatulence (gas) 
Non-digestive symptoms of IBS may include:
- Fatigue (including chronic fatigue syndrome) [9, 10, 11]
- Depression and anxiety [12, 13, 14, 15, 16, 17]
- Migraine headaches [18, 19]
- Respiratory symptoms [20, 21]
- Fibromyalgia (widespread body pain) 
- Temporomandibular joint disorder (lockjaw) 
- Chronic pelvic pain [24, 25]
Many women experience a worsening of the IBS symptoms during their menstrual cycle . Gynecological conditions (like endometriosis) may also worsen IBS symptoms.
Why Are IBS Symptoms More Prevalent in Females Than Males?
The gut-hormone connection is the most likely reason for the greater prevalence and severity of IBS symptoms in females.
One study says estrogen and progesterone “inhibit smooth muscle contraction” in the digestive tract . This may contribute to poor gut motility, i.e., movement of food through the gut . This may be why women are more prone to constipation-related symptoms (IBS-C) than men .
The Link Between Your Gut Health and Hormonal Health Problems
The two-way interaction between female hormones and intestinal processes means that women with IBS may experience more symptoms related to female hormone imbalances, including PMS and painful periods.
Here are two ways that the gut abnormalities typically found in IBS patients can influence your hormonal health:
- Gut dysbiosis (an imbalance between healthy and unhealthy bacteria) may affect your body’s ability to process and remove estrogen, resulting in estrogen buildup (also called estrogen dominance) [38, 39].
- Low diversity (fewer types of intestinal bacterial flora) is associated with female health conditions including polycystic ovary syndrome (PCOS), obesity, endometriosis, heart disease, and breast cancer .
Improving your gut health is a necessary step for effectively managing IBS symptoms and can also help to improve hormonal function in women.
How Hormonal Changes Affect Symptoms of IBS in Females
Low levels of female sex hormones during menses are associated with worsening IBS symptoms.
One systematic review highlighted that abdominal pain and bloating intensify in almost 50% of women with IBS during menses . Additional research also shared that women with IBS:
- Have more frequent bowel movements during their period 
- Are more likely to experience menstrual cramps [43, 44]
Endometriosis refers to abnormal tissue growth outside of the uterus. Women with endometriosis experience severe period pain.
Research has found close links between IBS and endometriosis :
- Endometriosis patients may be two to three times as likely to have IBS when compared to controls.
- Some studies report “a threefold risk” of endometriosis in women with IBS.
- Endometriosis shares several features with IBS, such as low-grade inflammation and visceral hypersensitivity (an experience of pain in the inner organs).
During menopause, the production of estrogen and progesterone tapers off. The resulting low levels of these sex hormones may potentially intensify IBS symptoms in females.
While more research is needed, a 10-year follow-up study in Iceland found that IBS-affected women had more severe IBS symptoms post-menopause .
A surge of estrogen and progesterone during pregnancy may improve some IBS symptoms in females. For example, in one study, 67% of 1,300 pregnant women found that their migraines “disappeared during pregnancy” .
How To Manage IBS Symptoms: Female-Specific Solutions
Even though IBS-specific functional remedies work for both genders, women may benefit from additional treatment approaches.
Western medicine usually recommends antispasmodics, laxatives, and antidepressants to counter IBS symptoms in females. While medications have their place, they do not treat the root causes of IBS and may come with unwanted side effects. In fact, research shows that women are associated with a higher risk of drug-related side effects than men [50, 51].
If you’re interested in getting to the root of the gut-hormone problem through more natural means, here are some simple solutions to try.
Diet is a very important part of managing IBS symptoms.
Switch to an anti-inflammatory diet free of problematic foods, like the paleo or Whole30 diet to reduce IBS and female hormone symptoms. We recommend this as a starting point to reduce the overall inflammation that drives symptoms.
If symptoms still persist after 30 days, try a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet next. FODMAPs refer to fermentable starches that are “slowly absorbed in the small intestine rather than digested,” increasing the likelihood of bloating and gas .
Pursuing a healthy diet may sometimes be challenging, particularly if it’s more restrictive diets like the low FODMAP diet. In cases where you need extra support or guidance on the best diet to achieve symptom relief, feel free to consult a functional medicine doctor.
2. Healthy Lifestyle Changes
Stress is a big IBS trigger and healthy lifestyle changes can positively impact IBS symptoms. Use these tips to boost your physical and mental health:
- Sufficient sleep — aim for 7-9 hours every night
- Regular exercise like walking, cycling, and swimming
- Stress management and relaxation techniques like meditation, hypnotherapy, or yoga
3. Supplement With Probiotics
Aside from healthy eating and positive lifestyle changes, probiotics supplements are also immensely helpful for IBS symptoms in females.
In fact, The Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS) recommends a trial of multi-strain probiotics for IBS patients .
- Abdominal pain
Notably, probiotics go one step further to alleviate non-digestive symptoms that IBS patients commonly struggle with. Key examples include fatigue [63, 64], joint or body pain [65, 66, 67], and brain fog [68, 69].
While there’s not much research data related to female hormones and probiotics, one recent meta-analysis found that probiotic supplements improved hormonal and inflammatory markers for women diagnosed with PCOS .
4. Herbal Hormone Support for Women
IBS symptoms and female hormone imbalances go hand-in-hand. While working to improve your gut health is the priority here, research-backed herbal supplements can help to gently balance your hormones and reduce symptoms of hormonal imbalance.
For example, research supports taking a herbal blend that includes licorice root, white peony, and chaste tree berry (vitex) These herbs have been shown to:
- Regulate menstrual cycles in women with absent or infrequent periods 
- Alleviate PMS symptoms [72, 73]
- Help treat PMS and PMS mood disorders 
- Improve symptoms for women with Polycystic Ovarian Syndrome (PCOS) 
- Alleviate menopausal symptoms and hot flashes [76, 77]
Austin FM Can Help Improve IBS Symptoms
Irritable bowel syndrome is known to be more common and more severe in women. The link between IBS and women’s fluctuating hormones means that women may experience worsening symptoms at different points in their menstrual cycle or their stage of life. It also means that some women with IBS experience more gynecological and hormonal problems.
There is no good reason to struggle with unmanaged IBS because help is available. Simple yet powerful remedies include anti-inflammatory diets, healthy lifestyle changes, and gut-healing probiotics you can easily incorporate into your everyday life. Herbal supplements can help to balance female hormones. Other more advanced treatments are available for those patients who need them.
If you need professional medical advice, Austin Functional Medicine has a dedicated team of functional medicine doctors and a nutrition coach that can help you resolve IBS symptoms and hormonal imbalances. If you’re looking to treat the root cause of your health issues and want to improve your quality of life, book a consultation to learn more.