Irritable bowel syndrome affects women more often, why?

“Hot girls have irritable bowel syndrome.” The statement first became an unlikely rallying cry on social media in 2019, and its appeal has only grown.

IBS is not a disease but a syndrome or functional disorder characterized by a number of symptoms such as constipation, diarrhea, chronic abdominal pain, bloating and changes in bowel habits.

There is no specific test for IBS, but there are specific criteria for its different subtypes, as well as the frequency and duration of symptoms. This is why it is called a diagnosis of exclusion, as doctors first rule out other possibilities.

Roshini Raj, a gastroenterologist at New York University Langone in the US, typically first tests for celiac disease, lactose intolerance, or even Crohn’s disease or colon cancer. “Once we rule out anything that might have similar symptoms, then someone is diagnosed with IBS,” says Raj, who is also the founder of fibre supplement brand Yayday.

“Almost 70% of people who have some kind of gastrointestinal symptoms or disease are women,” says Berzin, adding that inflammatory bowel disease (IBD), which includes autoimmune diseases such as Crohn’s disease and celiac disease, reaches 80%.

There are many theories as to why women in particular suffer from IBS, but one of the main ones is that the condition may be hormonal.

Symptoms tend to be worse during the menstrual phase of the cycle, says Georgia Close, a gastroenterologist at Putnam Hospital in Carmel, California. She adds that after menopause, women with IBS experience worse symptoms, as well as increased fatigue, anxiety, depression, and a decreased quality of life.

There haven’t been many studies directly linking IBS to hormone levels or looking at which hormones play a role, from thyroid hormones to estrogen and progesterone to hormones related to fertility. But there is some evidence to suggest that different hormones may play a role.

“There are studies showing that taking care of your gut health can improve symptoms associated with thyroid dysfunction and that gut health impacts thyroid autoimmunity,” says Berzin.

Menopausal women who take hormone replacement therapy (HRT) often find that it doesn’t affect their IBS symptoms, but it can affect their gut microbiome, says Mark Pimentel, executive director of the Health Science and Technology Program at Cedars-Sinai in the US. “We recently published a study that found that menopausal women have a different gut microbiome than premenopausal women, and interestingly, when they added HRT, their microbiome became younger,” she says.

Women also suffer from pain if they have a gynaecological condition. “There is some new preliminary data showing that women with IBS, PCOS (polycystic ovary syndrome) and endometriosis tend to have more severe pelvic pain,” says Close. “Many young patients are getting conflicting advice and are unsure whether their problem is gynaecological, genitourinary or gastrointestinal.”

Chronic stress and anxiety are likely another major factor in the increase in IBS cases among women. Women suffer from stress more often than men, and it affects them differently, even in their gut.

“When you’re constantly in a state of fight or flight, your gut stops moving constantly,” says Berzin of the effects of stress on the gut, which can lead to constipation, bloating, acid reflux, and SIBO (the cause of the common irritable bowel syndrome, which can also manifest on the skin as rosacea).

IBS and our mental health are so intertwined because of the gut-brain axis, essentially a messaging system that moves between the two.

“When IBS is diagnosed, anxiety, depression, and stressors in general have been shown to trigger symptoms,” says Rabia de Latour, a gastroenterologist at NYU Langone, adding that the gut lining is one of the largest producers of serotonin; “There’s also a lot of emerging data about dysbiosis and dysregulation of the gut that contribute to mental health issues.”

Because IBS manifests differently in each person and has its own triggers, proper treatment often requires an individualized approach from your gastroenterologist, functional medicine doctor, or dietitian.

But while there’s no one-size-fits-all solution, there are a few tips that can be helpful. Getting good sleep and reducing stress are considered essential for gut health. “Poor sleep can impact hunger hormones and worsen digestive symptoms,” says McCallum, adding that finding a stress management method, whether it’s meditation, cognitive behavioral therapy, or exercise, is key to keeping your body healthy.

Raj says antidepressants taken in low doses have proven helpful because the same neurotransmitters are involved in depression and bowel disorders.

The question then becomes what you’re putting into your body. Experts say following a low FODMAP diet is an effective approach. “It involves eliminating certain short-chain carbohydrates (FODMAPs), which are poorly absorbed in the small intestine and can be quickly fermented by gut bacteria,” explains McCallum.

One of the first questions de Latour asks patients with gastrointestinal issues is simple: How much water are you drinking? Most people don’t drink enough (he advises monitoring your urine to make sure it’s clear, not dark), and this can have a knock-on effect on your health, especially if you’re constipated. “People are so busy, and there’s a lot of cognitive dissonance when it comes to hydration,” she adds.

Another big gap in our diets is fiber. “We have an epidemic in this country of people not getting enough fiber in their diets,” says de Latour. “Women should be eating 25 to 30 grams a day, but most barely get 10.” Berzin points to a high-sugar diet and refined and processed foods as culprits. “These foods are low in fiber and phytonutrients, which are important for maintaining good bowel movements,” says Berzin.

However, for those who don’t want to think too much about the amount of fiber in their diet, there has been a wave of brands offering supplements that have little in common with the Metamucils of yesteryear.

Part of the reason may be that it’s a simple solution to optimizing gut health. But these brands are also destigmatizing a conversation that was once considered taboo.

“A lot of women are uncomfortable, but they live with it,” says Berzin. He encourages patients to get tested; after all, he adds, the gut is home to a second brain and 70 percent of the immune system: “Our digestive system is really smart, and we need to listen to it.”