Digestive health and the menstrual cycle: a potential role for dietary fibre?

1. Digestive health and the menstrual cycle:a potential role for dietary fibre? Louise Dye Professor of Nutrition & Behaviour Human Appetite Research Unit Institute of Psychological Sciences University of Leeds

2. Overview • 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?

3. Hormonal Changes during the Menstrual Cycle Oestrogens Progestins LH FSH 1 7 14 21 28 Day of Menstrual Cycle

4. 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

5. Mechanisms • Sex Hormones • Progesterone -inhibitory effect on gut motility • Declines in late luteal/menstrual phase • responsible for the harder stools? • Estrogen - implicated in other symptoms eg breast tenderness, headaches, water retention Other common symptoms – feelings of bloating, abdominal discomfort, cramps

6. 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

7. Survey Methodology • Bespoke Internet survey • 1000 women representative of the UK population – age, SES • Sample characteristics: Record contraceptive use & whether they might have IBS

8. Geographical distribution of respondents

9. Demographic Characteristics • Premenopausal Women • Not pregnant/ breast feeding Total sample = 1014 Age Group N 18-24 180 25-34 320 35-50 500

10. 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

11. Marital Status

12. Educational Background (highest qualification)

13. 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

14. Assessing stool form • Respondents were asked to rate their stool form at 3 time points:- • Usually during the first few days of your period • Usually in the week before your period • Usually in the week after your period Using the Bristol Stool Form Scale

16. Changes in Stool Form during the cycle (Bristol Stool Form Scale) Hard Liquid

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

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

19. Changes in Stool Form during the cycle (Bristol Stool Form Scale) for each individual Persistent constipation Persistent diarrhoea Consistently normal (4)

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

21. Prevalence of Constipation & loose stools during the menstrual cycle

22. Cyclical Experience of Constipation & Loose Stools Clearer increase in loose stools during menses than constipation in the premenstrual phase

23. Cyclical Experience of Mood Swings, Breast Tenderness & Bloating

24. Cyclical Severity of Mood Swings, Breast Tenderness & Bloating

25. Dietary Strategies

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

27. Advice for digestive problems Frequency • 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

28. Talking about your bowel movements

29. Talking about your period

30. 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

31. 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

32. Thank you l.dye@leeds.ac.uk