Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome?

Abstract

Background: An increase in gastrointestinal (GI) symptoms, including bowel discomfort, abdominal pain/discomfort, bloating, and alterations in bowel patterns, has been reported during premenses and menses menstrual cycle phases and the perimenopause period in women with and without irritable bowel syndrome (IBS).

Objective: This article reviews the literature related to one possible physiological mechanism-declining or low ovarian hormone levels--that may underlie the occurrence or exacerbations of abdominal pain/discomfort at times of low ovarian hormones (menses, menopause) in women with or without IBS.

Methods: To identify English-only review and data-based articles, PubMed was searched between January 1980 and September 2008 using the following terms: irritable bowel syndrome, functional gastrointestinal disorders, gastrointestinal motility, immune, pain, hyperalgesia, menstrual cycle, menopause, pregnancy, estrogen, estradiol (E(2)), and progesterone. Studies in animals and in humans were included; drug trials were excluded.

Results: From our review of the literature, 18 papers were identified that were related either to the mechanisms accounting for menstrual cycle fluctuations (n = 12) or to the impact of menopausal status on symptoms of IBS (n = 6). One study reported that visceral pain sensitivity was significantly higher during menses than at other menstrual cycle phases in women with IBS (P < 0.05). Other menstrual cycle phase-linked symptoms, dysmenorrheal symptoms (cramping pain) in particular, were more intense in women with IBS. Animal studies have shed some light on the relationship of ovarian hormones to GI sensorimotor function.

Conclusion: The increase in GI symptoms around the time of menses and early menopause occurs at times of declining or low ovarian hormones, suggesting that estrogen and progesterone withdrawal may contribute either directly or indirectly. This review highlights the need for confirmatory preclinical and clinical studies to unravel the role of ovarian hormones in women with IBS.

Figure 1

Patterns of mean (A) gastrointestinal (GI) symptoms (constipation, diarrhea, alternating) and (B) abdominal pain alone (constipation, diarrhea, alternating) in Rome II subgroups across 6 menstrual cycle phases in women with and without irritable bowel syndrome. The definitions of Rome II subgroups are based on 3 symptoms of constipation (hard stools, <3 stools/wk, straining) and diarrhea (loose or watery stools, >3 stools/d, urgency). Follic = follicular phase; Pre-Ovul = preovulatory phase; Early-Lut = early-luteal phase; Mid-Lut = midluteal phase; Pre-Mens = premenses phase. Adapted with permission.

Figure 2

Sex differences in rectal thresholds at baseline (Pre-Sig) and after noxious sigmoid distention (Post-Sig) in patients with irritable bowel syndrome (IBS) and healthy controls (Ctrl). There was a significant interaction between sex and disease group (P < 0.01), and sex and condition (P < 0.05). Adapted with permission.

Figure 3

Scatterplots of percent of days (n = 28) when (A) gastrointestinal (GI) pain/discomfort, (B) somatic, and (C) anxiety/depression symptoms were rated as moderate to severe in men and women with irritable bowel syndrome. Reprinted with permission.