School of something FACULTY OF OTHER Digestive health and the menstrual cycle: a potential role for...

School of somethingFACULTY OF OTHER

Digestive health and the menstrual cycle:

a potential role for dietary fibre?

Louise DyeProfessor of Nutrition & BehaviourHuman Appetite Research UnitInstitute of Psychological SciencesUniversity of Leeds

Louise Dye, HARU, Leeds

Research Questions

• Is there a link between the menstrual cycle and digestive discomfort?

•Do female bowel habits and function change across the cycle?

•How are these altered by hormonal contraception?

•What dietary strategies do women use to manage digestive discomfort?

•Can we give better targeted advice to alleviate menstrual cycle related fluctuations in digestive discomfort?

Overview


FSH

LHProgestins

Oestrogens

Hormonal Changes during the Menstrual Cycle

1 7 14 21 28

Day of Menstrual Cycle


Previous Research

Most studies pre 2000:

• Luteal phase:

• stools harder,

• decreased frequency,

• faster small bowel transit

• Menstrual phase:

• higher frequency

• looser consistency

compared to follicular (post menstrual) phase


Mechanisms

Sex Hormones

Progesterone -inhibitory effect on gut motilityDeclines in late luteal/menstrual phaseresponsible for the harder stools?

Estrogen - implicated in other symptoms eg breast tenderness, headaches, water retention

Other common symptoms – feelings of bloating, abdominal discomfort, cramps


Is this an issue for women?

Lots of web based posts regarding this issue

Increased bowel frequency with menstruation

http://answers.yahoo.com/question/index?qid=20090407051215AA1wfI3

http://answers.yahoo.com/question/index?qid=20080218172359AAcUYnW

http://answers.yahoo.com/question/index;_ylt=As2hcpsmQ1iiNOekJBpROcPZxQt.;_ylv=3?qid=20080218112122AA1kKf2

http://www.fluther.com/4459/why-do-i-poo-so-much-during-my-period/

Increase in bowel function during menstruation and also a looser consistency.

http://www.thestudentroom.co.uk/showthread.php?t=1164841

Change in bowel consistency during menses.

http://www.bbc.co.uk/slink/advice/dr-mel/periods-give-me-diarrhea

http://www.everydayhealth.com/digestive-health/diarrhea-and-your-period.aspx


Survey Methodology

•Bespoke Internet survey

•1000 women representative of the UK population – age, SES

Sample characteristics:

Record contraceptive use & whether they might have IBS


Geographical distribution of respondents


Demographic Characteristics

Total sample = 1014

Age Group N 18-24 180 25-34 320 35-50 500

•Premenopausal Women

•Not pregnant/ breast feeding


Socio-economic Status

Socio-economic status (actual)

Freq Percent

A 44 4.3

B 234 23.1

C1 294 29.0

C2 204 20.1

D 154 15.2

E 84 8.3

Total 1014 100.0


Marital Status

Marital Status Frequency %

Married 418 41.2

Single 248 24.5

Widowed 4 0.4

Divorced/Separated 44 4.3

Living with partner 237 23.4

In a relationship but not living with partner

61 6

Prefer not to say 2 0.2


Educational Background (highest qualification)

Qualification Frequency %

NVQs 89 8.8

GCSE's / O'levels CSE /School Certificate / BTEC

270 26.6

A Levels / ONC or Highers 250 24.7

HNC / BA / BSc 268 26.4

MA / MSc / MBA/ Postgraduate Qualification

106 10.5

PhD 8 0.8

None of the above 23 2.3

Total 1014 100


Irritable Bowel Syndrome

Do you think that you might have Irritable Bowel Syndrome (IBS)?

•Yes and this has been confirmed by my doctor 115

•Yes but this has not been confirmed by my doctor 124

•No 566

•Not sure/don’t know 207


Assessing stool form

Respondents were asked to rate their stool form at 3 time points:-

1.Usually during the first few days of your period

2.Usually in the week before your period

3.Usually in the week after your period

Using the Bristol Stool Form Scale


Changes in Stool Form during the cycle (Bristol Stool Form Scale)

Hard

Liquid


Changes in Stool Form from premenstrual to during menstruation (Bristol Stool Form Scale)


Changes in Stool Form during the cycle (Bristol Stool Form Scale) for each individual


Changes in Stool Form during the cycle (Bristol Stool Form Scale) for each individual

Persistent

diarrhoea

Persistent

constipation

Consistently

normal (4)


BSFS -percentage frequency of stool type during the menstrual cycle for women taking and not taking hormonal contraception


Prevalence of Constipation & loose stools during the menstrual cycle


Cyclical Experience of Constipation & Loose Stools

Clearer increase in loose stools during menses than constipation in the premenstrual phase


Cyclical Experience of Mood Swings, Breast Tenderness & Bloating


Cyclical Severity of Mood Swings, Breast Tenderness & Bloating


Dietary Strategies

daily weekly monthly 3monthly yearly Never

Laxatives 18 23 40 49 69 815

Fibre Gel 9 12 20 23 29 919

Stool Softeners 9 7 22 27 24 923

Antidiarrhoea 6 16 30 62 100 798

Milk of Magnesia 4 7 24 24 24 929

Painkillers 18 32 88 35 37 802

Probiotics 78 81 65 50 28 710

Peppermint tea 30 61 54 35 23 809

Aloe Vera 11 12 27 22 26 914

HF Fruit/Juice 39 70 55 47 55 766

Fibre Supplements

32 68 44 39 22 810

HF BF Cereal 168 162 95 34 21 532


Fibre consumption and Stool form during the menstrual cycle in regular HF BF consumers


Advice for digestive problems

Your doctor / GP 330

I wouldn't go to the doctor with a minor problem 296

Your friends 89

Family 204

The chemist / pharmacist 215

I would do research on the internet 306

I would look in a medical text book at home 33

No one, I wouldn't seek help 69

I never or rarely suffer from digestive problems 145

Frequency


Talking about your bowel movements

Extremely comfortable

Verycomfortable

Somewhat comfortable

Neither comfortable nor

Uncomfortable

SomewhatUn

comfortable

VeryUn

comfortable

ExtremelyUn

comfortable

DR147 156 252 161 165 69 62

Partner173 173 185 210 128 73 70

Femalefriends/sister

102 152 211 200 152 104 91

Male friends/brothers

42 56 76 206 209 166 257

Mother179 163 182 186 127 79 96

Father63 63 91 224 178 151 242


Talking about your period

Extremely comfortable

Verycomfortable

Somewhat comfortable

Neither comfortable nor

Uncomfortable

SomewhatUn

comfortable

VeryUn

comfortable

ExtremelyUn

comfortable

DR259 242 251 127 73 29 31

Partner266 229 217 165 57 36 42

Femalefriends/sister

256 249 243 139 54 29 42

Male friends/brothers

45 43 102 194 203 160 265

Mother258 198 178 166 81 50 81

Father46 42 74 213 171 155 311


Comments

Positive Comments n=37

Interesting

thank you, that was a different survey indeed, but very interesting and with quite important question

very interesting topic makes you think about things

Negative n=6

Personal

Ikky

I have never discussed this before


Conclusions

•Bowel Function is a sensitive topic for many women

•Stool form varies with menstrual cycle phase – but there are large variations in experience

•Generally firmer stools before and looser stools during menstruation

•Hormonal methods of contraception have very mild effects of stool form compared with naturally cycling patterns

•More women who eat HF breakfasts tend to report stools in the healthy range during the cycle.

•More prospective studies are needed to understand this important aspect of health

School of somethingFACULTY OF OTHER

Thank you

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School of something FACULTY OF OTHER Digestive health and the menstrual cycle: a potential role for...

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