Can I ask you a personal question?

What’s going on with our 💩

Per usual, we are not doctors and this is not medical advice :) But according to the UNC Center for Functional GI and Motility Disorders, Irritable bowel syndrome (IBS) impacts 8-20% of the US population with the gender breakdown coming out to 5-19% of men and 14-24% of women. A review of clinical studies reports that the difference is even more vast, with women being 3 to 20 times more likely to suffer from the chronic stomach pain and discomfort that comes with the abnormal bowel movements (aka diarrhea and constipation) associated with IBS. 

But why are women impacted more? The same UNC center did a survey to understand why. They found that menstruation is associated with exacerbation of IBS symptoms, with symptoms being most severe during postovulatory and premenstrual phases. Unsurprisingly, pregnancy provides temporary relief. But what is it about our periods that F with our bowels? A few weeks ago, we outlined the different phases of the menstrual cycle - and the hormonal fluctuations that come with each stage - in our “So…should we all by cycle syncing?” piece. And as you may remember, during the luteal phase (the premenstrual phase right before you get your period) estrogen and progesterone levels rise and then fall. This fluctuation in hormones creates a bit of a rollercoaster in your body, contributing to the typical PMS symptoms (mood swings, irritability, skin flare ups, and of course, gastrointestinal problems).

Because some receptor cells for female sex hormones (cells that receive and send signals to different parts of our body) are located in our gastrointestinal tract, when our hormone levels fluctuate, they send signals that can affect our gut. First, high levels of estrogen and progesterone (the two hormones that rise in the premenstrual luteal phase) obstruct “smooth muscle cells”, which contract during digestion, thus slowing down our gut motility, causing constipation. Then, at the same time that progesterone and estrogen fall, the hormone-like substances called prostaglandins are released to help break down the uterine lining but they also tend to act on the nearby smooth muscle cells in the intestine, causing an increase in gut motility (aka diarrhea or the “period poop”).  For IBS sufferers specifically, it makes the symptoms all the more uncomfy.

So what’s the catch? 

As is classic when it comes to women’s health, there hasn’t been enough research to make all of these findings 100% conclusive. Some argue that more women have IBS because women are more likely to seek medical care and get the diagnosis. Others say that women are often diagnosed with IBS because the medical system ignores their pain and they are really suffering from something more dire, like endometriosis (throwback to our article on women’s pain being dismissed). But as there are more women than men included in many IBS clinical trials, some of the findings are agreed-upon by the medical community. For example, we do have clarity that an increase in female sex hormones leads to constipation. As for the looser stool, there’s some debate, but there is agreement that premenstrual symptoms include an increase in anxiety levels, and as the gut and brain are intimately connected, it’s common to experience gastrointestinal issues alongside anxious thoughts. So while we can’t necessarily be certain about it all, it’s safe to say there is at least some biological connection between women and IBS. 

So what do we do? 

Whether you have IBS, think you have IBS, or just deal with the monthly period poop probs, there’s some hope. First, following a low FODMAP diet (which avoids hard-to-digest sugars) can help. This means you may want to cut the cauliflower, asparagus, apples, cherries, watermelon, legumes, cashews, pistachios, and more (so many hot girl snacks banned - sad!). Speaking of low-FODMAP and hot girls, you can thank Belli Welli  - a low FODMAP snack brand - for the iconic “Hot girls have IBS” billboard. In fact, Belli Welli co-founder Katie Wilson started the company after interviewing her network and finding that 70% had some kind of regular gut problem. She calls gut health a “women’s health issue” and has built a movement around it. And it’s caught on. In May 2022, there was over 80 million views for #IBSTiktok and #HotgirlswithIBS on TikTok. 

As for other remedies, good old-fashioned exercise can also help as it has stress-reducing qualities and can break that “Stress-IBS” loop that happens as a part of the gut-brain connection. To pick the perfect workout for your premenstrual luteal phase, you may want to consider cycle syncing, which we covered in a recent piece. If you’re feeling bloated, period-tracking app Clue also has some suggested yoga exercises to free your trapped wind. 

Other stress and anxiety-reducing solutions are also appearing on the market. Multitude, a company that launched earlier this year, is building a solution for women with IBS and other digestive issues as they report that 67% of IBS sufferers are women. Their 10-week program is based on Cognitive Behavioral Therapy (CBT), a mental health intervention that has been shown to induce changes in the gut microbiome. 

As with most things women’s health related, as more people talk about the issue, the more attention (and thus potential solutions) it gets. So we say keep talking about it, keep advocating for yourself, and just maybe we’ll be able to help the next generation have a little less upset tummies.

Let us know what you think by voting in our poll and leaving an anonymous comment.

  💭 Our two cents

I’m not going to lie, it felt weird writing a public article about poop. What inspired this post for me was seeing Multitude come across my LinkedIn a few months ago and sending it to a few of my fellow regularly upset tummy girlfriends. While I’ve never gotten a proper IBS diagnosis, I did have a doctor once dismiss my chronic stomach pain by saying something like “you probably just have IBS.” Over the years, I’ve figured out what I can and cannot eat and feel like it’s all pretty manageable, even with the expected upticks when I’m extra anxious or on my period. But what’s a little jarring to me is that no doctor over the years has ever pointed out the period connection. The more I’ve gotten immersed in women’s health, the more I find it shocking how little we know about our bodies, especially when it comes to our periods, which we experience 12 times a year and roughly 480 times in our lifetimes across 40 years - probably more than any other biological event. It leaves me wondering what other conditions, problems, etc. we experience simply because we menstruate.

💃 The girls have spoken

See last week’s poll results from “So...should I move to a new city?” below. :) 

💌 Up Next

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Up next: So…how did AI girlfriends actually become a thing?

💖 S & J