16: Why Your Gut Changes in Perimenopause

Why Your Gut Changes in Perimenopause: The Truth About Hormones, Histamine & Bloating

If you’ve been told your bloating is just a “cortisol belly,” this episode is for you.

On social media, it seems like every symptom in your 40s is blamed on cortisol. But the reality is much more complex. In this episode of Gut Girls, Dr. Christina Carew, ND, Dr. Whitney Baxter, ND, and Dr. Dominique Vanier, ND unpack what is actually happening inside your gut during perimenopause.

You’ll learn why estrogen and progesterone changes can dramatically affect digestion, gut motility, water retention, histamine release, and even how your brain interprets normal digestive sensations. We also explore the fascinating connection between the gut microbiome, the estrobolome, mast cells, and hormone metabolism—and why so many women suddenly feel bloated despite eating the same foods they’ve always tolerated.

Most importantly, we discuss the symptoms that should never be dismissed as “just hormones,” including persistent bloating, pelvic pressure, early fullness, unexplained weight loss, and changes in bowel or bladder habits that deserve further medical investigation.

Whether you’re waking up with a flat stomach but looking six months pregnant by dinner, struggling with worsening IBS symptoms, or wondering why your body suddenly feels different, this episode will help you understand the physiology behind these changes—and what you can do about them.

What You’ll Learn

• Why “cortisol belly” is an oversimplification
• How estrogen affects gut motility and digestion
• Why progesterone protects your digestive system
• The connection between histamine, MCAS and perimenopause
• How the estrobolome influences estrogen metabolism
• Why bloating often worsens later in the day
• How hormones can mimic IBS and SIBO symptoms
• When hormonal bloating becomes a medical red flag
• Practical strategies to support gut health during perimenopause
• Questions to ask your healthcare provider

In This Episode

00:00 – Cortisol Belly: Separating Social Media Myths from Reality

01:26 – Is Cortisol Really Causing Your Bloating?

02:31 – Cortisol vs. Hormones: What’s Actually Happening?

05:52 – Perimenopause Bloating Is Common—but It Isn’t Normal

07:38 – How Estrogen Slows Digestion and Gut Motility

09:38 – Water Retention, Fluid Shifts & Hormonal Bloating

11:17 – Histamine, Mast Cells & Why Your Gut Feels More Reactive

13:54 – The Estrobolome: How Your Gut Recycles Estrogen

16:55 – Why Everything Feels More Sensitive During Perimenopause

20:24 – Progesterone Declines First: Why That Matters for Digestion

26:18 – Why Symptoms Change Throughout Your Cycle

27:24 – The Gut-Hormone-Immune Connection

29:49 – Red Flags: When Bloating Needs Medical Investigation

33:58 – Practical Strategies to Reduce Hormonal Bloating

35:37 – How to Talk to Your Healthcare Provider

38:17 – Key Takeaways & Final Thoughts

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Transcript

16: Why Your Gut Changes in Perimenopause

Cortisol Belly Hype

Dr. Christina Carew, ND: If you’ve spent any time on Instagram lately, you’ve probably seen someone talking about cortisol belly, hormone belly, that mysterious bloat that seems to appear overnight in your 40s. Uh, one reel may tell you to stop eating. Another one says it’s gluten. Another one says you need a cortisol supplement or some kind of digestive bloating support or super belly.

So what’s actually happening is what we’re gonna talk about today.

Dr. Whitney Baxter, ND: And so many times my patients come in and tell me, “It feels like I woke up overnight and everything changed. I haven’t changed my diet, my exercise routine, but when I wake up in the morning, my stomach is flat, I feel good, but by the end of the day, I look six months pregnant.”

They’re asking, “Did my gut just stop working, or what has happened?”

Dr. Dominique Vanier, ND: Yeah. And social media, I feel like, has an answer for pretty much everything, so we’ll see a lot of terms [00:02:00] thrown around like cortisol, this may be parasites, this is, you know, estrogen dominance. And I feel like it can be quite confusing for the general public.

Dr. Christina Carew, ND: So today we’re gonna focus on perimenopause, separating what’s trending from what’s actually supported by physiology, and help you to understand a little bit more about how… why is bloating in perimenopause more common.

 

Trending Cortisol Myth

Dr. Dominique Vanier, ND: So we have a new recurring segment now going forward, and that is what’s trending this week?

So this week’s reel says, “Lowering cortisol fixes all bloating.” Let’s talk about that.

Dr. Christina Carew, ND: Yeah, so I’ve gotten this one in my feed as well. It, definitely stress certainly matters in all health conditions, not even just specific to bloating. But stress makes everything worse and also makes everything more accentuated, so stress does matter.

But bloating in perimenopause isn’t just only [00:03:00] because of stress. Certainly, it’s a time of more stress. Often women are finding themselves taking care of their parents and their kids, and also still working. But things like hormones, and gut motility, and microbiome, and histamine, and sleep, and stress all kinda contribute.

And so it’s a bit of like a snowball effect where, you know, all of these things have accumulated, and lots of times we’re able to accommodate one thing, you know, uh, over a period of time, but now things are starting to, like, all sort of accumulate all at once

Cortisol vs Hormones

Dr. Whitney Baxter, ND: All right, let’s shift back into our myth-busting segment. So I’ll start off here with something I think is so common. People hear about, talk about all the time, um, that this bloating is just a cortisol belly.

Dr. Christina Carew, ND: Yeah. So I think like yes and no, right? So there is cortisol’s influence on things like digestion, and so when we are in [00:04:00] fight and flight, we’re not resting and digesting, and I often explain this to patients as though they were animals hibernating for winter.

So when an animal is like in fight and flight and just like randomly trying to consume as much as it can before winter comes into place, we, you know, we see them walking around and there’s the raccoons, at least where I live, with the giant bellies. Um, and we know that they’re like kinda storing for winter, and that’s intentional.

But our bodies are made in a similar way even though we don’t have a similar drought of access to food. And so if we are running in a fight flight, hopefully not hibernating for the winter, but just in general, then our digestion really does slow. It’s rest and digest. And so if we’re not able to do that, then we are accumulating more, and it’s often in the abdominal area.

But we also know that perimenopausal bloating is driven by things like estrogen, um, which is more fluctuating, so will [00:05:00] seem like there’s more estrogen initially, although it might be the same amount you’ve always had, and then decreases over time. And part of that is because our progesterone, which is our second half of the menstrual cycle, which causes the, you know, ability for the body to retain baby, but also when it declines, rises and falls, that gives us menstrual bleeding.

And so over time, most women will find that their progesterone decreases first. Um, I always say that this is like a reallocation, so the body’s like, “Hey, you know, now is not the time to have a baby. We could use this progesterone over here to fight this stress,” or to support your thyroid or other things that are going on.

It’s sort of like your body’s natural mechanism to say, “Hey, now is not a good time to have a baby.” But in that decline of progesterone, we see estrogen rising, which is part of what marks perimenopause for many women. But estrogen also affects things like gut motility and water [00:06:00] retention and changes in visceral sensitivity, so, you know, how much are we feeling and what is going on in our bodies.

And so i- is cortisol belly a thing? It, it’s plays a role, significant role, in how our body is changing and shaping, but that’s something you can experience regardless of age based on, you know, this sorta fight flight that a lot of people are finding themselves in these days because we’re not really resting and digesting, and so our body’s just sorta holding on for dear life.

So I always think about it like it’s providing you like a seatbelt, which is maybe not the seatbelt you want.

Dr. Dominique Vanier, ND: I like that analogy. It’s, it’s also where we see the hormones, like, like you said, fluctuating significantly, right? So for example, when we’re, like, testing estrogen one month, we may see it a totally different number the next month, and so it’s these swings that end up, um, affecting people.

Bloating Is Fixable

Dr. Dominique Vanier, ND: Another myth we wanna chat about is bloating during perimenopause is normal, you just have to live with [00:07:00] it.

Dr. Christina Carew, ND: Yeah. So you don’t have to live with it. That’s why we’re here. That’s why we’re here to talk to you. Um, and as, uh, Dr. Dominique said, like estrogen really spikes and crashes, so it’s kind of like shifting all over the place.

It’s why one day you feel perfectly good and sane, and the next day you might feel a bit crazy. Um, estrogen, we know, affects gut motility, fluid retention. It’s why people will often feel like PMS type bloating. Uh, bile flow, histamine release, so estrogen drives more histamine, progesterone tends to calm it down.

We have less progesterone, we have more histamine. That visceral sensitivity, so just like the overwhelm of how we feel inside our abdominal area. And so if we’re kinda having our gut slow down and swell and feels like it’s overreacting, then we’re gonna [00:08:00] feel like that bloating is more pronounced maybe than it is.

But perimenopause can also create, like, almost, like, IBS symptoms, so it’s a driver between the hormones, the immune, and the gut, and it’s not really related to food. And so that’s where we find all these people who come into my office, and probably yours as well, where, you know, they’re looking for weight loss or…

And when you get to the route of, like, “Well, why do you think that you need to lose weight?” Or, you know, “What do you hope to accomplish?” It’s like, “I have this abdominal weight gain. You know, I’m going through all these hot flashes. I feel like I’m gaining weight.” And all of this is, like, a bit of a mix of things that are going on.

Estrogen Slows Motility

Dr. Dominique Vanier, ND: Yeah, let’s maybe talk a little bit more about how estrogen specifically affects gut motility, and that the question really being, like, is estrogen unbuffered? And so, uh, as it relates to higher estrogen, we know that that can slow digestion, meaning food can sit longer, it can ferment more, and then any time something is fermenting, we know that we’re gonna see [00:09:00] more gas production.

Um, and so, you know, when somebody says, “I wake up fine, but look pregnant by 7:00 PM,” that type of pattern, that’s a classic motility hormone mismatch, especially for someone in their 40s or 50s, like around that time when we’re expecting to see perimenopause. And so how estrogen plays a role in bloating, um, is as follows.

So the first point being estrogen directly will slow gut motility. Estrogen we know influences the enteric nervous system, which is like your gut’s second brain. And higher or fluctuating estrogen can slow gastric emptying, it can affect, uh, small bowel transit, so it can slow it. It can also reduce colonic movement.

And so what that means is, like, food is just hanging out, and it’s hanging out in places for longer where we don’t wanna see it hang out for longer. And then we’ll see this fermentation, like I mentioned, this gas production, and [00:10:00] that typically leads to bloating. And so this is why estrogen-driven bloating often feels progressive over the day, um, particularly worse after meals or, like, worse after a meal later in the day or just generally worse later in the day.

And then, um, also s- sometimes feeling, like, an increased pressure rather than pain.

Dr. Christina Carew, ND: So it looks a lot kind of like SIBO, right? And so- Hmm … as a consideration when we’re talking to women in this category, we need to also include the hormones as part of our consideration mix.

Dr. Whitney Baxter, ND: Yeah.

Water Retention Bloat

Dr. Whitney Baxter, ND: So point number two of how estrogen leads to bloating is it increases water retention.

So a lot of women will feel this, like, I feel like I’m retaining water. They’ll even verbalize that. Or the way I’ll kinda talk through where it shows up or how it shows up, it might resonate with how it feels or looks in your body. So estrogen [00:11:00] affects kind of fluid flow through the cells in our body and over the gut, um, the gut wall.

So it’s gonna affect a hormone called aldosterone, so that’s really important for fluid and sodium balance. And then the next point, sodium balance, um, and then vascular permeability. So just the opening and closing of our vascular walls to allow fluid shifts throughout the tissues. And so usually we think about fluid retention of in our ankles, swelling in our ankles, but it’s not just here with estrogen.

It can accumulate in the abdominal wall, the bowel lining, and the mesentery, which are the tissues that support the gut. So this is where you’re gonna feel that bloat and kinda getting worse throughout the day, like Dominique just mentioned. And this is why estrogen-related bloating can feel tight, puffy, um, so like in your hands, joints, you kind of feel it everywhere, and you feel like it’s difficult to pass [00:12:00] gas or even your bowel movements.

So maybe you are having regular bowel movements, but it just feels incomplete or you still feel that puffiness. And why it’s difficult to link up anything with food or digestive solutions, like more laxatives, for example

 

Histamine Mast Cells

Dr. Christina Carew, ND: So the third way that estrogen can affect bloating is that it stimulates mast cells, and we have an episode earlier where you can learn more about mast cells.

It’s episode nine, and we’ll link that in the show notes. Um, but mast cells are essentially this container that holds all kinds of cytokines, including things like histamine, and estrogen has been shown to increase histamine production. We see a lot of, uh, estrogen-related conditions like endometriosis having a high amount of mast cells and a high amount of histamine, and this is sort of research that’s been developing over the last few years.

And so when we know [00:13:00] there’s more histamine, we can often see more bloating, and so because the estrogen can stimulate more histamine, it might be that way that it is causing more bloating. And so, um, estrogen, as I mentioned earlier, sort of like drives this histamine piece, and progesterone tends to calm it.

And so when we are seeing one hormone showing up more than the other ’cause the other is declining first, we get more of this kind of histamine response. And histamine’s been shown, um, we talked about it in our leaky gut episode, in our disorders of gut brain interaction, about having like increase in visceral sensitivity, so just like the awareness of how things feel inside the abdominal region.

Also, um, increasing gut permeability, so that kind of leaky gut idea, and then triggering smooth, uh, muscle contractions. And so when everything starts to like get fired up, then we might see like, [00:14:00] aside from bloating, we might see more flushing, we might see more anxiety or jitteriness. So we often see women in this age category coming in and feeling more anxious or more heart palpitations.

It’s one of the reasons why often medical community will offer people anti-anxiety or antidepressant medications because they’re trying to calm some of the symptoms down, not really recognizing where they’re coming from. Um, we might see more onset of headaches or new food reactions, ’cause remember, everything’s just like kind of, um, over-driving in the system.

And so, um, this sort of mast cell activation patterns tends to overlap with the estrogen, and so that’s why you might be seeing some of the social media that talks about, you know, if you calm down histamine, maybe some of your perimenopause symptoms go away. And it might be if histamine is what’s creating those perimenopause symptoms.

 

Estrobolome Recycling Loop

Dr. Christina Carew, ND: You always wanna check in before, um, you experiment far, f- [00:15:00] far too much or go down too many rabbit holes, but can be like a flag of things to think about And then the fourth, um, area that estrogen might be affecting the bloating is that actually recirculates in our gut. So it’s called the estrobolome loop, which sounds crazy, but, um, we know that, uh, each

Our microbiome has all these components, and the estrobolome is a piece of the microbiome. And what we know about estrogen is that it’s sort of made and then, um, anything including estrogen, toxins, cholesterol, mold toxicity that we don’t need, our body sends out bile, and bile becomes this river that all of these toxins can, can flow on.

And so when the toxins flow on them and they move easily and they come out through the stool and you’re not constipated, then everything works smoothly. However, that’s not always the [00:16:00] case. And so, um, if you are constipated or you don’t make good bile or you’ve had a gallbladder surgery, which we’re gonna talk about in our next episode, um, then what happens is the estrogen gets c- back into circulation instead of being removed from the body.

And so I always think about it as like your broken or your crappy estrogen instead of being removed and your body getting a fresh start, just gets recycled back in ’cause your body’s like, “Hey, it’s still here. We’ll just, like, use that again.” And so that is a piece of where we get more slowing, more inflammation.

The more the estrogen is reabsorbed, the more it feeds into this, like creating higher amounts of estrogen, which then creates this, like bloating loop. And so if we … One of the ways that often people will find that the bloating reduces even though they don’t understand why it’s happening, is people will take fiber or have been directed to take fiber, [00:17:00] and then they’re like, “Oh, my bloating got so much better.”

Well, fiber’s job is to reabsorb or help to absorb some of these toxins and, um, things that are floating in the bile to prevent them from reabsorption. And so inadvertently, when people are using those types of tools, they may be actually preventing the recycling of this hormone as well as other things that may lead to some decrease in bloating

Dr. Dominique Vanier, ND: It’s so fascinating when we can see like a digestive approach then overlap and see benefits with what’s going on with somebody’s hormones, and fiber is, is definitely one of them.

I once had a patient where, um, her only perimenopause symptom was hives on her head, and yeah. And so we discussed like there’s a pretty common supplement that’s used to support perimenopause symptoms, and it was the only thing that helped. Um, so it’s interesting, right? When you have to see what symptoms look like and thinking outside the box.

Visceral Sensitivity Surge

Dr. Dominique Vanier, ND: Um, another point we wanna discuss more in detail is [00:18:00] that estrogen can increase visceral sensitivity, like, uh, Dr. Christina had, uh, alluded to earlier. So estrogen we know heightens how strongly the brain perceives gut signals. And so even like normal amounts of gas or distension can feel, um, more heightened.

So we can see things like higher pain, um, as well as feeling like it’s intolerable or even emotionally distressing, and this is why estrogen-driven bloating often comes with, um, you know, people saying, “I feel huge sensations,” or body image distress or even anxiety around meals. And the gut isn’t necessarily producing more gas.

It’s just feeling it more or feeling significant shifts that somebody otherwise would not be feeling

Dr. Whitney Baxter, ND: And we can feel that in our cycles too. Like if you’re, especially if you have a regular cycle or you track it, you get to, um, understand these points of estrogen kind of [00:19:00] rising and falling, and typically it’s only a couple days that we’re feeling this.

Um, going into our next point of how this estrogen bloating will start to get worse or change as your body transitions into perimenopause. So in the earlier years when we do have that cycle, um, estrogen is rising and falling predictably for the most part if our periods are regular, and then that progesterone is going to balance it.

So slow rise in the early phase of the cycle, and then the progesterone rise in that second phase of the cycle. So as you transition into perimenopause, when everything becomes a rollercoaster and very unpredictable, estrogen spikes can be higher than before, and that progesterone buffering ability becomes weaker.

So the timing becomes unpredictable, and we kind of start to feel things more, or it’s more confusing. So this bloating becomes less cyclical, maybe lasting more than just a couple days or a few days leading up to [00:20:00] your period. It’s more reactive. It can be more painful, um, or sharper, or kind of however people describe it in their body.

Um, yeah, harder to determine what’s going on with your diet. So harder to outsmart it with food, harder to take fibers and understand, you know, what used to work for your gut doesn’t really work anymore. And this is why a lot of people will come to us or start to talk with their friends how everything I used to do stopped working, and they’re not wrong.

Things are, things are confusing. Things are changing, and your body’s trying to send different messages

Dr. Christina Carew, ND: So estrogen is one reason why we might see more bloating in perimenopause, and just to, like, kinda put this all together again for you, it’s, like, bla- bloating that’s worse later in the afternoon or evening, symptoms worse around ovulation, erratic cycles, meaning, like, when your cycle becomes shortened or lengthened, um, bloating that might be accompanied with [00:21:00] things like breast tenderness or headaches, so really, like, accentuated perimenopause symptoms, um, maybe have some histamine symptoms, so go back to our Mast Cell episode and learn about those, and, um, bloating that’s maybe slightly improves with bowel movements or bowel activity.

But it’s not the only reason why we might be getting a hormonal change that is driving bloating.

Progesterone Drops First

Dr. Christina Carew, ND: So next we’re gonna talk about progesterone

Dr. Whitney Baxter, ND: Okay, so we’ve mentioned a couple times how progesterone has that buffering ability on that estrogen and what we’re feeling in our gut. So point number two that we wanna talk about is that progesterone loss is that less anti-inflammatory buffering.

So typically the hormone progesterone is our, our chill hormone. So it’s calming, relaxes smooth muscle, and it dampens that inflammation and that visceral or hypersensitivity that we’re feeling. So when it [00:22:00] drops, the gut’s gonna become more reactive, maybe tighter, just noisier. You’re gonna feel things more.

So this is how progesterone influences the bloat- bloating, and why as it declines, it’s going to matter and you’re going to feel it. So progesterone is your gut’s relaxation hormone. It helps, and it does this by relaxing the smooth muscles, including the muscles of the digestive tract. So as foods and, uh, fluids and foods and gases move through, you’re gonna feel it less, or it’s gonna be

It, it can accommodate more. So typically when our progesterone is adequate, the gut can do its job without us feeling every- everything down there. Um, it’s gonna contract in a more coordinated, rhythmic way, so we know that it kinda pushes fluids and foods through. The gases will move forward instead of getting trapped, and the abdomen will stay softer, less reactive, more [00:23:00] uncomfortable.

And then as our progesterone drops, which often happens first in the perimenopause transition, um, and then we see more of those estrogen spikes. So this motility of the gut becomes less coordinated. The gut can spasm or stall. So a lot of our listeners and our patients have felt this for sure, right? That it just feels more achy or sharp in weird places.

And then gases and things can get stuck, so bloating pressure distension, so that physical expansion of our gut. That’s why we feel six months pregnant after dinner or as the, a day goes on. So this is why a lot of people will say, “I’m not constipated. I’m having bowel movements, but I feel full and tight.”

So this is a movement or motility pattern of the digestive tract, not a fiber issue

Dr. Dominique Vanier, ND: Progesterone is so fascinating I find because, well, as it relates to pregnancy, it can lead to constipation, but I also have many cases where it can actually help [00:24:00] IBS, and there seems to be that relaxation component that we talked about, which can help with promoting more regular bowel movements. So it’s…

I- I- Progesterone’s a super cool hormone. Um, on that topic, so progesterone counterbalances estrogen’s bloating effects. I mean, we wanna think about progesterone and estrogen being happy together. Um, you’ve got the yin to the yang. So estrogen we know tends to increase fluid retention, slow gut transit, and stimulate mast cells.

But progesterone, on the other hand, normally acts like the brake pedal. And so in perimenopause, estrogen can spike unpredictably while progesterone stays low, and then we can see this, uh, we’ll call it a bit of an imbalance. And that then creates, like, a relative estrogen dominance, even if estrogen labs, uh, are normal.

And of course, normal is, like, a stretch, right? Like, the reference range for estrogen is massive. Um, and so we’re gonna see more water retention, more visceral [00:25:00] sensitivity, and more bloating with the same meals, not because estrogen is bad, but because progesterone isn’t buffering it like it previously did

Dr. Christina Carew, ND: And this is why sometimes when women support with additional progesterone, things just seem to get better.

And, um, that is actually true in the case of mast cells and progesterone too. So, um, progesterone is the mast cell calming effect. So sometimes people will say even with normal cycling, that as they get closer to their menstrual cycle, they get headaches, they get migraines, they get more bloating, they get uncomfortable.

They might not sleep very well. They might get more hives. Um, and some of that is the histamine connection. And so because the progesterone has gone from sort of keeping the estrogen in balance to this drop, drop or decline to initiate the menstrual cycle, then all of a sudden we’re getting more of these symptoms that were probably always [00:26:00] there, but just being held in place by having enough progesterone.

And so that’s sort of like flushing, anxiety, palpitations, uh, food sensitivities or even having, um, more reactions. And so, um, keep in mind that it’s not always just that the estrogen is pumping out the histamine. It’s that the progesterone, which had been keeping things in balance until this point, you know, declines.

And that might be tolerable for two or three days before a menstrual bleed. But what happens when it happens for, you know, two or three weeks or weeks to months? Um, that’s where we have to think about, you know, are there other ways that we can help someone?

Dr. Dominique Vanier, ND: We know progesterone also affects bile flow and digestion in the way that it supports, uh, gallbladder emptying, fat digestion, coordinated digestive signaling.

And so low progesterone can mean several [00:27:00] things. It can, um, result in fat feels heavier, meals will– can feel like they’re sitting longer, and upper abdominal bloating or pressure. So people often blame gallbladder or food intolerance, but the issue itself is more of like an upstream hormonal signaling and, and then that affecting things further down

Luteal Phase Clues

Dr. Whitney Baxter, ND: Okay, so why bloating often improves in the luteal phase until it doesn’t, so that second half of our cycle after ovulation. So earlier in the reproductive years when we have that cycle, that progesterone is going to rise after we ovulate. Bloating often improves mid luteal phase, so kind of like a couple weeks before your period there’s that relief, like everything feels calm, your mood is good, you feel a little bit more chill.

And then in perimenopause, this ovulation becomes more inconsistent, so we’re not getting that pretty typical predictable cycle. Um, the [00:28:00] progesterone peaks are weaker or not happening at all, so estrogen’s kinda left out there alone to make you feel more water retention, more aware of your symptoms, um, and just more bloated.

So that relief window disappears, and bloating can become more chronic instead of cyclical, so that’s a big clue. So always good to track your gut symptoms with your cycle, especially when things start to change

 

Immune Gut Ovary Loop

Dr. Christina Carew, ND: So, so far we’ve covered perimenopause and estrogen’s role in bloating, progesterone’s blo- role in bloating, and so then the third area is mast cells.

So we know that mast cell-type symptoms definitely are affected by estrogen, and we know that they’re affected by progesterone. But we also know that when we’re seeing more lowered histamine intolerance, this might be something that’s been underlying for a long time, uh, especially women that have endometriosis or adenomyosis or [00:29:00] fibroids.

We know that that histamine piece has probably been playing a pretty significant role for a long time. And so it’s almost like it exposes this mast cell piece that may have always been underlying but now has become more pronounced. It’s like, um, you have always had sort of a underlying anxiety or, or trust issue or something that’s going on in your life, and then you have an event that happens that just blows that up.

It’s… That it doesn’t come out of nowhere. It’s, like, always been a little bit underlying. So think about it in that way, like maybe it’s not that this is a new symptom for you, but now it just becomes really recognizable, um, because of some of the other changes that are happening. So that’s, uh, sort of area three.

Uh, area four is sort of this gut-ovarian immune system loop. And so this sort of all starts to play together. We know that inflammation increases in the gut, especially when [00:30:00] the estrogen recycling and the microbiome and all of those pieces aren’t flowing. And so all of the reasons that we’ve talked to today to…

for bloating is also accentuated when we have more inflammation. And so higher estrogen equals higher mast cells equals higher inflammation. And so then we’re now seeing the immune system being triggered in to support the inflammation. And so we now start getting this, like, loop where things aren’t really making anything better.

And so you’ve tried all the gut symptoms, you’ve tried all the bloating supplements, you’ve gone to see a bunch of clinicians, and things aren’t really getting better. It might be because of the hormones kind of triggering this loop that you’re stuck in, um, between the gut, the ovaries, and the immune system

 

Red Flags Workup

Dr. Dominique Vanier, ND: But on that topic of things not necessarily getting better is that bloating we know is not always benign, and this is definitely the part that we don’t wanna skip.

So, you know, [00:31:00] while most perimenopausal bloating is functional and hormonal driven, there’s the element that it could be persistent or progressive, and that absolutely deserves, you know, respect and, and further workup. And so things we wanna think about is, is this bloating new and worsening? Um, is it unrelated to meals?

Is it associated with pelvic pressure? Is it accompanied by early satiety or appetite loss? Um, and all of those things could mean red flags and certainly, you know, discussing with provider whether a transvaginal ultrasound or an abdominal pelvic ultrasound is indicated would, would be important

Dr. Whitney Baxter, ND: Yeah, and we wanna be clear about this, and this is really important.

This is our role as our naturopathic doctors to our patients, but also your medical care doctor. And sometimes bloating is talked about on social media as like, you know, just histamine related or food related or fiber related, and for sure, but we always wanna reiterate that it is very important to talk to your doctor when things are different or lasting for a [00:32:00] long time because the gut is so complex, and there’s so many hormones and, um, things acting on it, but also it’s a structural component, too, right?

So what’s around that area. So some things to keep in mind, um, daily bloating that’s lasting weeks to months, and you’re not really seeing a pattern here. So you haven’t changed your diet. You weren’t sick. Um, you’ve listened to these ep- other episodes, and it’s not really resonating with you. Um, but anything that’s lasting weeks to months you should talk to your doctor.

Abdominal distension, so that’s that firm expansion that you feel ab- at the end of the day, your pants get tighter. If this isn’t fluctuating, if it’s there when you wake up, it’s there during th- at the end of the day, or maybe it gets a bit worse, that’s something to bring up as well. If you feel full very quickly after eating or after a smaller meal or something that you would typically eat.

If you feel any lower back pelvic pressure, that’s something to bring up, too. [00:33:00] Unexplained weight loss, changes to bowel or bowel or bladder habits, so all of a sudden you’re getting up in the night to pee, or you feel like you need to pee but you can’t fully empty it. Um, more looser stools or constipation, anything that’s just different if, especially if you have a family history of o- any ovarian or breast cancer.

Um, ovarian cancer is very rare, but it’s often missed ’cause it can be very vague. It can present like bloating. Um, and so the symptoms are very gut-like. So doctor, Doc- Dominique just brought up, um, the pelvic floor ultrasound. So any imaging or gynecologic evaluation is helpful just to see the area, kind of rule things out, and, um, investigate these things, um, because bloating doesn’t behave like digestion deserves a little bit more investigation

Dr. Christina Carew, ND: I would say I have, I have two patients that had like sort of [00:34:00] irregular iron that just didn’t respond to things, kind of this chronic bloating, and then, um, hadn’t been sent for a pelvic ultrasound.

And coun- when I counseled, like, “Yeah, you really should ask your doctor about that,” both of them had grapefruit size fibroids and ended up having to have hysterectomies, um, because it was just so large. But neither of them… Both were pretty young, and neither of them thought anything about it ’cause they had had babies.

And so like, oh, they would’ve, they would’ve seen that. They would’ve known that. So certainly, um, it can be important, especially if you’re in, um, perimenopause and maybe have had eight or nine months of not bleeding and then suddenly get some bleeding. That may also be another thing that, um, instigates that w- alongside all the bloating symptoms.

So better to have more uncomfortable pelvic ultrasounds than not [00:35:00] know.

 

Practical Takeaways

Dr. Christina Carew, ND: Okay, some practical takeaways. So as everyone sort of emphasized, tracking the timing when bloating shows up during your cycle, even if your cycle is very erratic. Um, kind of timing it not about the days, but, you know, it was before bleeding or once I bled.

Um, you know, is it related to sleep or stress or hormonal shifts, so you’re only seeing at certain times of the month? Um, you know, making sure that you’re doing all the things that help support motility because this is a time in your life when motility’s gonna be constantly changing. And so, um, the things that you’ve always done, the breathing, the poop stools, the walking after meals, the meal spacing, all the supplements and, and medications that have been recommended by some of your providers are all things, uh, especially that help motility that can be really important to not forget about.

Um, lowering histamine [00:36:00] load if you’re finding that some of those symptoms overlap, and sometimes that means higher histamine foods or beverages. So we definitely know wine, for instance, can be a big trigger here. Um, and it’s not always that it’s a forever situation. It might be sort of you might start to see in the tracking, oh, if I also have wine when I’m right before my menstrual cycle, then I get my, a migraine, and things become much worse, and my bloating becomes much worse.

So it’s worth kind of starting to track. And initially, you may think that there’s nothing in there, but it’s always helpful to bring it to your provider because they might be looking for something different.

 

Talking to Your Doctor

Dr. Christina Carew, ND: And so, um, being able to kind of talk about how you feel or what you’re noticing or how often you’re urinating, all those things that we talked about so far can be really helpful So how do you talk to your practitioner about this?

Um, because, you know, it’s like everything else. If we just say, you know, “I’m feeling [00:37:00] bloated,” you’re probably gonna get a very generic response. But if we can give the provider that we’re seeing more information, then hopefully that will get us a little further down the road. And so, you know, saying, “My bloating has al- only worsened since my cycle started changing,” you know, “Could my hormones be affecting my gut motility?”

We know that the traditional medical system’s pretty reluctant to measure hormones. Some of that is just the providers don’t have a lot of education about hormonal changes. And so you just getting a hormone test and randomly going on a date may not help them with any information, because as Dr.

Dominique alluded to, the range is really big. And so they’re gonna say, “You look normal.” Um, but normal is very varied. Um, and so definitely if, if you’re not getting anywhere with your primary care provider, seeking someone who does know a lot about both gut health and hormones can be really helpful. Um, you may also notice that you’re getting some of that flushing and [00:38:00] anxiety after meals, and you might ask about, you know, is histamine or mast cells a bit involved in this bloating that seems to also be coming alongside my hormonal changes?

Another area where, you know, we’re starting to get more information into the mainstream media, but lots of times they still look like at you like you have two heads, it doesn’t mean that you can’t ask, because your providers are also not gonna learn about these things unless people keep asking them about them.

Um, is my, if my bloating is super persistent, it doesn’t seem to be meal related, maybe you’re having some of those symptoms, um, that Dr., uh, Whitney talked about, like having sort of this like hard belly that doesn’t seem to be moving, or getting some irregular bleeding, or having a history of, uh, hormonal cancers in your family, it’s always good to ask, “Can we rule out any pelvic causes and not GI ones?”

And so those are really important things. You have to often advocate for your own health, because someone else isn’t always [00:39:00] gonna come up with all those ideas. Um, but it’s important, and that’s what we’re hoping that this and all of our other podcasts teach you about is, how can you advocate for yourself and become more informed?

And hopefully your providers become more informed and able to help you

Wrap Up Key Points

Dr. Whitney Baxter, ND: So thank you so much for listening to another episode with Team Gut Girls. This is a great topic because I’m sure you’ve, as you’re listening, you’re like, “Yeah, that makes sense. I’ve noticed that change. It all started when my cycle started to change or started to notice these other symptoms.”

Um, so some main things we talked about were perimenopause changes digestion dramatically. Estrogen and progesterone shape the motility or the movement of the intestine, inflammation, and histamine in your gut.

Dr. Dominique Vanier, ND: And MCAS-type symptoms can emerge during hormone transitions, but we know persistent bloating deserves investigation, not dismissal, because better gut health [00:40:00] changes everything