Menopause bloating is real — here’s what helps

Are you experiencing that puffy, full feeling in your midsection that makes your favorite jeans feel like they've suddenly joined a shrinking cult? That would be menopause bloating, and it’s one of the less-discussed but common symptoms of perimenopause and menopause. But just because it’s typical doesn’t mean you have to grit your teeth and bare it. This gassy feeling can often result from hormonal fluctuations. A few simple adjustments to your diet, activity levels, and stress management, however, can help you feel more comfortable. Because isn’t menopause challenging enough without feeling like you've swallowed a beach ball?

Is bloating a symptom of menopause?

Yes, that feeling of fullness and tightness in your abdomen coinciding with menopause isn't just your imagination. Dr. Monica Christmas, M.D., the associate medical director at The Menopause Society and director of the menopause program at the University of Chicago explains: “Bloating can be influenced by the menopause transition, be it in perimenopause or menopause itself.” To blame? The changes in hormones and other age-related factors.

Causes of bloating during menopause

Menopause bloating doesn't have a single cause, but rather results from several bodily changes that often overlap during this life transition.

Hormonal fluctuations

As with most menopause symptoms, your hormones are at least partly to blame. "The fluctuations of the hormones estrogen and progesterone during perimenopause and menopause can lead to fluid retention, which can cause bloating," says Carrie Eng-Mazur, a board-certified nurse practitioner based in New Jersey and lead practitioner/owner of the women’s health clinic Rejuvenate Women’s Wellness.

Your digestive system also responds to hormonal fluctuations. Both estrogen and progesterone can alter how quickly food moves through your digestive tract, which can cause bloating. There are also estrogen receptors located throughout your digestive system, so changes in hormones can make you more sensitive to the feeling of being bloated. And recent research shows that the gut microbiome can be influenced by perimenopausal hormonal changes, adjusting how your body handles food and possibly triggering more bloating.

Digestive changes

Beyond the changes due to hormones, your digestive system also becomes less efficient and slower as you age. As a result, many women find they can no longer tolerate certain foods they previously enjoyed without consequences like bloating. "Women may lose and gain certain bacteria in the gut microbiome that keep the gut balanced — it becomes less diverse,” says Eng-Mazur. “When the gut microbiome becomes altered, this can play a role in weight gain, slowing of the metabolism, and bloating."

Slowed metabolism

The slight slowing of metabolism that naturally accompanies aging (especially after age 60) can contribute to digestive issues. While there’s a lot that goes into your metabolism changing, it’s partly due to having less lean muscle mass, not being as physically active, and age-related changes to how your organs operate. The slower your metabolism, the slower your body moves food through your gastrointestinal tract, which raises the risk for gas, bloating, and constipation.

Stress

Research shows that the majority of women feel higher-than-typical levels of stress during perimenopause. This is partly due to general life stressors that are common during this stage — juggling a career with parenting teenagers and worrying about older parents, for example — and partly the result of other menopause symptoms, like feeling exhausted from not sleeping well and having to worry about hot flashes during the day. The cortisol surge that comes along with that stress can trigger stomach upset and bloating, as well as a tendency to store more weight around your midsection.

Menopause bloating prevention and treatment

Whether you're just starting to notice occasional bloating or it's become your unwelcome daily companion, these science-backed approaches can help minimize it.

Prevention

Preventing bloating during menopause focuses largely on lifestyle modifications:

• Adjust your diet: Certain foods or beverages may be making you more bloated than others, and identifying those can help you avoid them. Common culprits include beans, lentils, cruciferous veggies, dairy products (especially if you’re lactose intolerant), and carbonated beverages. High-fiber foods, onions, garlic, and artificial sweeteners can also cause bloating. As Christmas advises, "If certain things are triggering your symptoms, that may mean that you want to pull back or not eat as much of that." Note down when you feel symptoms and what you ate before so you can draw links and take steps to make changes. Don’t cut down too much on fiber, though. You need at least 25 grams of it a day during menopause.
• Stay hydrated: It may seem counterintuitive because water retention can lead to bloating, but drinking plenty of water can actually help. That’s because dehydration leads to constipation…which leads to bloating.
• Move your body regularly: Exercise helps maintain digestive regularity and reduces bloating, not to mention all the other benefits. "Regular exercise, especially weight resistance exercise, is extremely important at this stage of life and beyond," says Christmas.
• Manage stress: The more you can minimize cortisol’s impact on your digestive system, the better. What works best is super personal, but research shows mindfulness, meditation, and relaxation (whatever makes you feel the chillest) are most effective at bringing down levels of stress hormones.

Treatment

When prevention isn't enough, these treatments may help relieve menopause-related bloating:

• OTC medications: You can try something like Gas-X, which contains simethicone. It works by bringing together the small gas bubbles in your gut to form bigger bubbles, allowing trapped air to pass through your body more easily.
• Gentle exercise: Research shows that mild activity can help stimulate digestion, clear intestinal gas, and reduce bloating. Post-dinner stroll, anyone?
• Digestive enzymes: These treatments, available over the counter and by prescription, aid food breakdown and have been shown to help alleviate bloating. The best known one is Lactaid, for people who cannot digest lactose.
• Probiotics: While more research is needed, there have been some studies that find probiotics may help reduce bloating in people with IBS, so it’s something Christmas puts on the "give it a try” list. Two that seem promising: Lactobacillus and Bifidobacterium, which may help maintain healthy gut flora.
• Magnesium: This mineral can help by relaxing digestive muscles. A daily 200mg dose of magnesium can start to reduce premenstrual fluid retention and bloating after just a month.
• Alternative remedies: Just because research doesn’t prove something works doesn’t mean you shouldn’t try it. Some women find anecdotal relief with peppermint or ginger tea when they’re bloated.

Can HRT help with menopause bloating?

The relationship between hormone replacement therapy (HRT) and bloating is complex. HRT, which is sometimes also called menopause hormone therapy (MHT), works by releasing hormones into the bloodstream or vaginal tissues (depending on the type of HRT you are prescribed). While some women report relief from bloating on HRT, others experience more bloating as a side effect. As a result, HRT is not typically prescribed mainly to treat bloating. That doesn’t mean some women may not feel better on it, though. "HRT can help decrease bloating over time when the hormones are more optimized, but initially when starting HRT, it can cause some bloat and fluid retention," says Eng-Mazur.

For women experiencing other significant menopause symptoms alongside bloating, HRT might be worth discussing with a healthcare provider. Christmas outlines the four main reasons you might be prescribed hormone therapy:

1. Moderate to severe hot flashes and night sweats
2. Moderate to severe genital urinary symptoms, like vaginal dryness
3. To prevent osteoporosis
4. Early menopause (before age 45)

Even if a symptom isn’t on this list, if it’s related to menopause and is impacting your well-being, talk about it with your doctor to see if hormone therapy could help.

How long does menopause bloating last?

Menopause bloating follows no fixed timeline. For some women, it's a brief visitor during the height of hormonal changes; for others, it can be a more persistent companion throughout perimenopause, which can last anywhere from two to 10 years. "During the perimenopause transition, there are a lot of hormonal fluctuations that are happening that absolutely could be triggering some of the bloating," says Christmas.

Once hormone levels stabilize after menopause, many women find their bloating symptoms improve. However, age-related digestive changes — like the slowing down of your metabolism and your digestion — may continue to cause occasional bloating.

Bloating vs. weight gain

Many women wonder if their too-tight pants are caused by temporary bloating or actual weight gain, especially since both can occur during menopause. But there are some ways to distinguish between the two. "There are many symptomatic differences between bloat and weight gain in the midsection area,” says Eng-Mazur. “Bloating is temporary and usually will go away, the stomach is more distended and does not change the weight on the scale. Bloating can sometimes also occur with other symptoms, such as acid reflux, flatulence, and stomach upset/discomfort. Midsection weight gain does not cause any of the above symptoms. The stomach feels soft from fat accumulation, and the weight increases on the scale."

She adds that treatment approaches, such as weight-loss programs, weight-loss medication, or HRT, differ significantly: "Treatment for bloat would include education on diet changes, triggers, and possibly introducing HRT or supplements to relieve the symptoms. Treatment for weight gain would include diet and lifestyle changes, an exercise regimen, and possibly introducing HRT, supplements, or medical weight loss management."

When to see a doctor for menopausal bloating

While occasional bloating is normal, there may be certain signs that it's time to consult a healthcare provider:

• Bloating that is severe, painful, or doesn’t go away
• Bloating accompanied by other concerning symptoms like unexplained weight loss, blood in stool, severe abdominal pain, jaundice, or urinary symptoms
• Symptoms that significantly impact your quality of life
• Dramatic changes in bowel habits
• Bloating that doesn't respond to lifestyle changes

Eng-Mazur cautions that these symptoms can be signs of possible kidney or bladder infections, gastrointestinal conditions such as ulcerative colitis, ovarian cysts, fibroids, endometriosis, or certain cancers. Your healthcare provider can help determine if your bloating is related to menopause or if there might be another underlying cause requiring different treatment.

The bottom line

Menopause bloating, while uncomfortable, is a normal part of the transition for some women. It may be brought on by hormonal changes, age-related digestion issues, a slower metabolism, water retention, or increased stress. There are things you can do to avoid menopause bloating, like avoiding trigger foods, regularly moving your body, reducing your stress, and staying hydrated. While hormone replacement therapy can help with some menopause bloating, it’s not a guarantee (and in some cases may actually increase bloating). When in doubt, talk to your doctor about the bloating to see what they recommend.