The Menopause Exchange Blog

DIGESTIVE PROBLEMS

Digestive problems such as indigestion, heartburn, bloating and constipation are common reasons why people visit their GP surgery. There’s evidence to suggest that these digestive problems become more common at the menopause. A study of a group of pre-and post-menopausal women in Sweden showed that those on HRT were more likely to be using an antihistamine for allergies and taking medicines to treat excess stomach acid.

Normal fluctuations in progesterone levels around the time of a period may make women feel bloated and uncomfortable, often with a sluggish bowel. It’s not surprising that these problems appear to add to the discomfort of menopausal hot flushes and night sweats. Because of concerns about underlying cancers by middle-aged women, symptoms that may be dismissed as ‘nothing to worry about’ in your early 20s are more likely to worry you in your 40s or 50s. So it’s always important to get any new, serious or ongoing symptoms checked out by your GP.

Bloating
The most common symptom to cause anxiety during the menopause is that of abdominal bloating. This can be simply due to a fluctuation in the level of progesterone before periods but more noticeable due to the increasing irregularity or heaviness of periods.

The most common digestive cause of bloating is irritable bowel syndrome (IBS). This is a long-term condition and normally develops in people in their 20s and 30s. It’s twice as common in women than in men. IBS sufferers have abdominal pain, bloating and constipation and/or diarrhoea. There’s no specific test for IBS so the condition is usually diagnosed based on the symptoms above with normal blood and other tests.

If your symptoms have been present for at least six months with no significant weight loss and no lumps on examination of your tummy, your GP may suggest that you have some blood tests to rule out other problems such as iron deficiency or pernicious anaemia, non-alcoholic fatty liver, an underactive thyroid and coeliac disease. Many GPs will also suggest you have a CA125 test for ovarian cancer. An abdominal ultrasound or pelvic ultrasound to rule out gallstones or ovarian cysts can help confirm IBS and reassure you that nothing else is making you feel so unwell.

If you have unexplained weight loss, a lump in your tummy or pelvis on examination, bleeding from your back passage or anaemia on blood tests, then you’re likely to be referred to hospital for further tests or a colonoscopy to exclude bowel cancer. This is especially likely if you have a family history of bowel or ovarian cancer or are over 60 with diarrhoea for more than six weeks.

Ovarian cancer is a rare cause of abdominal bloating but an important one. A CA125 blood test will be raised in most cases of ovarian cancer although I should emphasise that there are other causes of raised levels, such as endometriosis. This is why a raised level should always be repeated with an ultrasound scan of your pelvis to look at your uterus and ovaries. The ‘BEAT’ questionnaire helps to rule out ovarian cancer for women with abdominal symptoms and is available on the NHS Choices website.

There’s no specific treatment for IBS as there’s no abnormality as such in the bowel, but avoiding wheat can help as can the FODMAP diet, which excludes foods that ferment and make gas. You may find that taking medicines that relax the bowel (Buscopan (hyoscine) and Colofac (mebeverine)) helps your symptoms. Lifestyle changes, such as eating regularly, trying to avoid/manage stress and avoiding fizzy drinks, are advisable.

Sometimes symptoms of inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis can mimic IBS. Your doctor may send off a small sample of your faeces to check for calprotectin, as raised levels are present in inflammatory bowel disease but not IBS.

Reflux/indigestion
The second most common digestive symptom is that of acid reflux or indigestion. There are many confusing medical terms applied to the various symptoms of excess acid in the stomach or slow emptying of the stomach of its contents into the lower digestive system. You may feel like you have a lump stuck in the middle of your chest between your ribs (‘epigastrium’), or a burning sensation at the epigastrium or up in to your throat or even your mouth (‘acid brash’). This can be worse after you’ve had acidic, fatty or spicy foods or alcoholic drinks and can lead to continual burping or a feeling of pressure or pain in your upper stomach. If your reflux is happening at night, then you may notice a bad taste in your mouth the next morning.

The causes of these symptoms are very variable but the most common is a hiatus hernia. This is where the hole in your diaphragm where your gullet (oesophagus) passes through to your stomach isn’t quite tight enough and either allows just stomach contents to move upwards (gastro-oesophageal reflux), or even part of your stomach, which is then called a hiatus hernia. Hiatus hernias are very common and permanent, causing acid reflux particularly when you’re bending forwards or after meals.

Small meals and avoiding trigger foods can reduce reflux, as well as losing weight. The most common medicines for reflux are proton pump inhibitors (PPIs), i.e. omeprazole or lansoprazole, or H2 antagonists such as ranitidine. Sodium alginate (i.e. Gaviscon) and antacid tablets such as Rennies can also be prescribed or bought over the counter from a pharmacy. Stopping smoking is a good idea.

Any persistent reflux that hasn’t improved after a course of a PPI or is worsening after four weeks, and is associated with food sticking in your gullet or weight loss, must be reported to your GP, as these could be signs of oesophageal or stomach cancer.

As with all symptoms, if they worry you, and are constant, seek medical advice. Reassurance may be all you need, but it’s always best to check.

About the author
Dr Jenifer Worden is a GP in Dorset, specialising in women’s health and wellbeing, including sexual health and contraception. She also has an interest in complementary medicine.

Created Autumn 2017

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