Constipation may not be one of the first symptoms that comes to mind when you think about menopause. But for many women, it’s a serious problem. Constipation can make daily life more uncomfortable.

During the menopause transition, hormone changes can affect digestion. As women get older, they may be more likely to develop health conditions that cause constipation.

The good news is that constipation can often be treated. Here’s what could be causing it and how to get relief.

What Is Constipation?

Everyone’s bathroom schedule is a little different. The normal range of bowel movements can be anywhere from three times a day to three times a week, depending on the person. If you notice big changes in what’s normal for you, there may be a problem.

In general, doctors define constipation as having fewer than three bowel movements a week and stools that are harder to pass. Constipation can cause bloating and discomfort. It can also make you strain too hard when trying to have a bowel movement. When the stool finally does pass, it may be hard, dry, and painful.

Most people experience occasional constipation for simple reasons, such as not eating enough fiber, not drinking enough water, or waiting too long to have a bowel movement when you’re traveling or staying in an unfamiliar place. However, if constipation keeps happening, it’s time to do something about it.

Possible Causes of Constipation in Menopause

Menopause may directly cause constipation. But it’s also possible that something else is to blame. Here are some of the most likely scenarios.

Hormones and Slower Digestion

Hormone levels change in the years before and during menopause. Many women have hormone levels that rise and fall before estrogen and progesterone settle at lower levels. Because these hormones also affect digestion, constipation may be more common during this time.

Estrogen and progesterone can affect how quickly waste moves through the digestive tract. Lower hormone levels may mean stool moves more slowly, which can lead to constipation. Hormone changes during perimenopause may also affect how well the gut works, which could play a role in constipation.

Some studies have linked constipation to higher cortisol (the stress hormone) levels in women during menopause. Other studies have found the opposite. Still, tension and anxiety may be risk factors for constipation. This may vary from person to person.

Hormones can also affect the balance of bacteria in the gut, called the microbiome. The microbiome helps your body digest food and get rid of waste. Hormone changes may also affect these bacteria.

Weaker Pelvic Floor Muscles

The pelvic floor muscles help you push out stool when using the bathroom. If these muscles get weak, they don’t work as well. This condition is called pelvic floor dysfunction.

Constipation affects about half of people with pelvic floor dysfunction. Other symptoms can include painful urination, painful sex, and pain in the lower back and pelvic area. Women in midlife are more likely to have pelvic floor dysfunction. It’s linked to aging, pregnancy, childbirth, and hysterectomy.

Your healthcare provider can use a pelvic exam and other tests to diagnose pelvic floor dysfunction. Fortunately, this condition can improve over time with consistent physical therapy and other treatments.

Reduced Physical Activity

Menopause can cause many symptoms that may put a damper on your exercise routine. Some women have fatigue, trouble sleeping, and mood changes that could keep them from being active.

If menopause symptoms have made you less active, that may lead to constipation. Exercise helps keep bowel movements regular, so moving more may help.

Higher Risk of Certain Health Conditions

As women get older, they may be more likely to develop health conditions that affect digestion. For example, type 2 diabetes and thyroid disorders can lead to constipation.

If you take medicine for ongoing pain, high blood pressure, anxiety, or depression, constipation may be a common side effect. Your healthcare provider can help you manage this side effect while still getting the treatment you need.

Other Common Causes

Constipation has many causes. It’s not necessarily because of menopause, even if both are happening at the same time. You may have constipation if you:

• Are dehydrated
• Don’t eat enough fiber
• Eat too much fiber at once, especially if you’re not used to it
• Have a digestive tract disorder, like irritable bowel syndrome (IBS)
• Take antacids for heartburn
• Use iron supplements

Constipation Prevention and Treatment Tips

If there’s no clear cause of your constipation, simple lifestyle changes can help. Here are some of the usual recommendations.

Eat Fiber

Fiber adds bulk to stool and helps it move more easily through the intestines. There are two types, soluble and insoluble. Both are essential for good health.

You can increase your fiber intake by having more plant foods, such as:

• Beans — Lentils, black beans, chickpeas
• Fruits — Prunes, pears, apples (with skin), berries
• Vegetables — Broccoli, carrots, leafy greens, Brussels sprouts
• Nuts and seeds — Chia seeds, flaxseed, almonds
• Whole grains — Oatmeal, brown rice, whole-wheat bread, quinoa

Prunes and prune juice are known to help relieve constipation. They contain fiber and sorbitol, a natural sugar alcohol that may help get things moving.

Increase your fiber intake slowly. Your body needs time to adjust. Getting too much fiber too fast can cause constipation and other unpleasant effects. Drink plenty of water, and add fiber gradually.

Be Active

Regular physical activity, such as walking, yoga, or swimming, can help you have regular bowel movements. Even 20 to 30 minutes of moderate movement most days can make a big difference.

It can be tough to stay active if you’re dealing with the symptoms of menopause. You may need help sleeping better or managing menopause symptoms before regular exercise feels doable.

Consider Home Remedies

Sometimes, having a bathroom routine can help. Try sitting on the toilet at the same time each day, ideally after meals when you’re not in a hurry to get out the door. And if you have to go, go. Don’t ignore the urge.

Supplements can also help, but check with your doctor first. You can consider:

• Magnesium supplements to promote bowel movements
• Fiber supplements, if you’re not getting enough fiber in your diet
• Probiotics to help balance your body’s natural bacteria

A laxative or stool softener may help relieve constipation. Some laxatives should be used only occasionally because they can make it harder for your body to have bowel movements naturally.

When Is Constipation an Emergency?

In rare cases, severe constipation can be serious. It may be related to a blockage that requires emergency medical care. Constipation may also signal a significant health concern, like colon cancer. Call your doctor right away if you have:

• Constipation lasting more than three weeks
• Severe abdominal pain
• Blood in the stool
• Unexplained weight loss
• Changes in the shape or color of stool

Although constipation is common, you don’t have to just put up with it. Sometimes, it can be a sign that something else is going on. If it does not get better, talk with your healthcare provider.