Constipation During Perimenopause: Causes and Practical Solutions
Constipation is a common but underreported perimenopause symptom. This guide explains the hormonal causes and shares effective dietary, lifestyle, and medical options.
Why Perimenopause Causes Constipation
Constipation becomes more common during perimenopause for several overlapping reasons. Progesterone, which rises and falls unpredictably during this transition, has a relaxing effect on smooth muscle throughout the body, including the muscle of the bowel wall. When progesterone is high relative to estrogen, gut motility slows and food takes longer to move through the digestive tract, allowing more water to be absorbed and stools to become harder and more difficult to pass. Declining estrogen also affects the gut microbiome in ways that can reduce the production of short-chain fatty acids, which normally help keep bowels moving.
Recognising Constipation Beyond the Obvious
Constipation is not just about going less frequently. It also includes passing stools that are hard, lumpy, or painful, needing to strain, feeling that the bowel has not emptied fully, or needing to use fingers or pressure to help pass a stool. Many women accept these experiences as normal when they are actually signs of a sluggish gut that can be improved. Bloating and abdominal discomfort often accompany constipation, and some women also notice that slow digestion affects their energy levels and general sense of wellbeing.
Dietary Changes to Get Things Moving
Fibre is the foundation of constipation management, but the type matters. Soluble fibre, found in oats, flaxseed, chia seeds, cooked vegetables, and fruits like pears and kiwi, absorbs water and softens stools. Studies on kiwi fruit in particular show consistent benefits for increasing stool frequency and reducing straining. Insoluble fibre from wholegrains and bran adds bulk. Aim for 25-30g of fibre daily, increasing gradually to avoid gas. Hydration is equally important: fibre without adequate fluid can worsen constipation. Aim for at least 1.5 to 2 litres of water daily.
Movement and Bowel Habits
Physical activity stimulates the muscles of the digestive tract and can significantly improve bowel regularity. Even a 20 to 30 minute walk after meals encourages gut motility. Establishing a consistent toilet routine, sitting at the same time each day (typically after breakfast when the gastrocolic reflex is strongest), and not ignoring the urge to go all help train a more regular pattern. Using a footstool to raise your feet when sitting on the toilet places the bowel in a more natural position for easier passage.
Supplements and Short-Term Remedies
Magnesium citrate or magnesium glycinate taken in the evening can have a gentle osmotic effect that draws water into the bowel, softening stools. Many perimenopausal women find this helpful as a regular supplement that also supports sleep and muscle relaxation. Psyllium husk is another well-tolerated fibre supplement. For short-term relief, osmotic laxatives like macrogol (Movicol) are safe and effective. Stimulant laxatives such as senna should be used sparingly. Probiotic strains including Bifidobacterium lactis have some evidence for improving transit time.
When to See Your GP
Occasional constipation is common, but some signs require prompt medical attention. These include blood in the stool, unexplained weight loss, a significant change in bowel habits after age 50, abdominal pain that does not improve, or constipation that does not respond to dietary and lifestyle measures over several weeks. Your GP may recommend blood tests, a stool test, or a referral for further investigation. Do not delay getting assessed if your symptoms feel different from previous digestive issues, or if they are accompanied by fatigue and anaemia.
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