Perimenopause can bring unexpected digestive changes, including diarrhea. Hormone shifts may play a role, and this stage of life can also trigger or worsen conditions that affect the gut.

In this article, we explain possible causes of diarrhea during perimenopause and share tips for managing this symptom.

Defining Diarrhea and Perimenopause

Diarrhea means having loose, watery bowel movements three or more times a day. The many possible causes of diarrhea include viruses, contaminated food or water, food intolerances, certain medications, parasites, and some health conditions. For most people, diarrhea is short term and goes away on its own.

Hormonal changes during perimenopause may increase the risk of diarrhea. Perimenopause is the transition between the reproductive years and menopause (when menstrual periods have stopped for at least 12 months). Perimenopause usually begins in your 40s or 50s and can last for several years. During this time, hormone levels shift, leading to changes in the body. The ovaries make less estrogen and progesterone, which may affect how the digestive system works.

How Are Perimenopause and Diarrhea Related?

Hormonal changes during perimenopause may affect the gastrointestinal (GI) tract and contribute to diarrhea. The GI tract has receptors for estrogen and progesterone. During perimenopause, you may notice several GI symptoms, including:

• Diarrhea
• Constipation
• Nausea
• Vomiting
• Abdominal pain
• Bloating
• Cramping
• Heartburn
• Incontinence

Hormonal Changes in the Gut

During perimenopause, hormone levels drop and fluctuate. This can affect the gut and may lead to diarrhea. Estrogen and progesterone influence gut motility — how quickly food moves through the digestive tract. When food moves too quickly, diarrhea can result. When food moves too slowly, constipation can occur.

Lower levels of estrogen and progesterone may also affect the gut microbiome (the community of microorganisms in the digestive system). A healthy balance of these organisms supports gut health and digestion. When this balance is disrupted, it can lead to uncomfortable GI symptoms.

A 2022 study found that people going through menopause tend to have less diversity in their gut microbiome. Less diversity means fewer types of microorganisms, which may negatively affect digestion.

Chronic Digestive Issues

Perimenopause may be linked to irritable bowel syndrome (IBS) and changes in GI symptoms, though experiences vary widely. IBS symptoms include constipation, diarrhea, cramping, pain, bloating, and gas.

Perimenopause may also be linked to symptom changes in people with inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease. IBD causes chronic inflammation in the gut. Common symptoms include diarrhea, belly pain, rectal bleeding, fatigue, and weight loss.

People with IBD may experience menopause earlier than those without it. Some women going through menopause may also notice worsening IBD symptoms. Hormone therapy, a treatment for menopause symptoms, may reduce IBD flare-ups for some women, but not all.

Other Causes

Many unrelated conditions and factors can also cause diarrhea, such as:

• Infections
• Food poisoning
• Travel to areas with poor sanitation or unsafe water
• Medication side effects
• Food intolerances
• Health conditions that affect the GI tract
• History of abdominal surgery

How Is Diarrhea Treated?

Fortunately, diarrhea is treatable. The first step is to focus on hydration. Losing fluids through diarrhea puts you at risk of dehydration. You may benefit from drinks with electrolytes to help replace lost fluids.

If you can’t manage diarrhea at home, it’s important to see your healthcare provider. Seek care if you have any of the following symptoms along with diarrhea:

• Fever
• Worsening abdominal pain
• Rectal bleeding
• Fatigue
• Weakness
• Unintended weight loss
• Confusion

Diet Changes

Making changes to your diet may help improve symptoms. Talk with your healthcare provider if you have chronic diarrhea. Increasing your soluble fiber intake may help. Fiber is a plant-based nutrient that supports gut health and digestion.

Your healthcare provider may also recommend a probiotic supplement. Probiotics are live microorganisms that support healthy gut bacteria and may help with some types of diarrhea.

When you’re experiencing diarrhea, try to avoid these foods and drinks:

• Alcohol
• Coffee and tea
• Diet soda
• Dairy products
• Highly processed foods
• Sweets

Lifestyle Changes

In addition to diet changes, other habits may support gut health and ease symptoms. Lifestyle changes to consider include:

• Exercising most days
• Managing stress
• Getting enough quality sleep
• Avoiding smoking

Medications

Several medications can help treat diarrhea. Loperamide is an over-the-counter (OTC) antidiarrheal that slows gut movement to reduce diarrhea. Bismuth subsalicylate is another OTC option that helps balance fluid in the digestive tract.

For severe diarrhea that can’t be managed at home, your healthcare provider may recommend IV fluids and prescription medications.