PMS: three little letters, one long list of symptoms women have the pleasure of enjoying before–and during–their menstrual cycle. Most common on the list? Digestive upset, cramps, mood changes, breast tenderness, and the star of today’s show: bloating.
It’s likely you’ve felt this uncomfortable sensation as your period approaches, but do you understand exactly why it’s happening? To get into the nitty gritty science of the matter like no one else can, we had a chat with Perelel Medical Co-Founder, Dr. Banafsheh Bayati, MD, OB/GYN, FACOG.
Read on for Dr. Bayati's explanation of why bloating occurs–and what we can do about it.
Is your bloating 'normal'?
“It is important to first note that all bloating symptoms should be addressed with your primary care physician as it may signal an important underlying process, including malignancies," says Dr. Bayati. "However, mild to moderate bloating that resolves a few days following the start of a menstrual cycle is very common. Women may experience recurrent symptoms following ovulation and through the first few days of each menstrual cycle. It is often felt in conjunction with other premenstrual symptoms,” Dr. Bayati says.
"If bloating or GI issues are severe, progressive, affecting your ability to function and/or not resolving with the end of the menstrual cycle, then you need to address this symptom with your healthcare provider."
What physical changes are causing this symptom?
“Bloating is a complex topic that for women involves their gastrointestinal (GI) and gynecologic (GYN) systems. It is affected by your age, genetics, diet, mobility and of course underlying health conditions,” Dr. Bayati explains.
“The classic physical changes occurring are changes in hormonal levels–both estrogen and progesterone–along with release of prostaglandins. As a result of these hormonal changes, the uterine lining begins to separate and shed, resulting in the menstrual cycle,” Dr. Bayati explains.
While estrogen and progesterone are widely known, prostaglandins may be less familiar to you. “Prostaglandins are chemicals that cause the uterine muscle layer to contract, causing cramps which are needed to ultimately stop the menstrual bleeding. These same prostaglandins that are meant to function locally at the site of formation can enter the bloodstream and affect other, surrounding smooth muscles, including our GI muscles, leading to nausea, increased gas formation, pain, as well as diarrhea,” Dr. Bayati says.
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So there’s a direct link between our hormones and bloating?
“Hormones are chemical messengers that are made by our bodies at one site and travel through the bloodstream to coordinate a range of complex processes in other sites. Hormones are involved in nearly every function of our bodies and thus changes to them can make us feel bloated and out of sorts,” Dr. Bayati explains.
“About a week prior to the start of the menstrual cycle, progesterone levels which have risen following ovulation begin to fall. This reduction of progesterone causes the uterus to shed its lining which results in the menstrual bleeding. During this time, estrogen levels are low and beginning to rise. This combination causes both retention of water as well as release of prostaglandins with the shedding of the lining which causes cramps and pain and for some will involve not only their GYN systems but also their GI systems resulting in the symptoms of bloating and pain,” Dr. Bayati continues.
How can you manage bloating and digestive issues during your period?
Simple dietary changes
"Reducing processed foods, excessive alcohol and caffeine, along with lowering dairy and animal fat products from the diet. Increasing fiber is key but best to do this slowly. Quickly increasing fiber can only exacerbate symptoms. Eating whole foods is best."
Increasing exercise
According to Dr. Bayati, the benefits of exercise cannot be overstated, especially prior to the start of the cycle. "Once the menstrual cycle starts, increasing gentle exercise is best. Minimizing stress is also key. A warm epsom salt bath, a gentle walk, calming activities such as knitting or meditation, or even acupuncture and massage, can help lower cortisol and stress levels.
“Starting the day with movement and a glass of warm water and continuing to have movement throughout the cycle, with adequate water intake can be beneficial."
Other steps you can take
"Certainly, a warm compress can help ease symptoms as well as certain teas and supplements along with medications. At Perelel, we have formulated a great bloat support supplement including ginger, fennel, lemon balm, peppermint and licorice root extract to gently help with bloating during this time," says Dr. Bayati.
"Medications can include over the counter products such as simethicone, or prescribed diuretics along with tailored NSAIDS and even hormonal management. A variety of GI medications addressing conditions such as diarrhea/constipation, IBS and gastroparesis can be tried as well which may include pre/probiotics, enzymes, vitamins and supplements."
Up next: decoding the 4 phases of your menstrual cycle, plus how to sync your routine with your menstrual cycle.
This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.
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