When to stop and get medical care. Some symptoms need a doctor, not a routine. Contact a medical provider promptly if you have severe abdominal pain; fever or persistent vomiting; rectal bleeding or black, tarry stool; unexplained weight loss; a new, unexplained change in bowel habits, especially from age 45 onward; or recent abdominal surgery within the last six weeks. If symptoms are severe, call your physician or go to the emergency department.
You are flat in the morning and bloated by the afternoon. The waistband that was comfortable at breakfast is not comfortable at four o’clock, and by evening you have changed into something looser. You ate what you normally eat. Nothing about the day accounts for it.
Almost nobody comes to me about their bowels. They come about the bloating, about being tired in a way that sleep does not fix, about not being able to hold a thought the way they used to. The bowel part surfaces later, usually as an aside, usually apologetically.
In the perimenopausal years it surfaces very often.
How common this actually is
Research presented at the 2025 Menopause Society meeting surveyed nearly 600 women aged 44 to 73 about digestive symptoms. Ninety-four percent reported them. Seventy-seven percent reported bloating and 54 percent reported constipation. Eighty-two percent said their symptoms either began or got worse around perimenopause or menopause.
The part that should be more surprising than it is: only about a third had received any formal diagnosis, and of the women who sought professional help, 58 percent described the support they got as inadequate.
That is a lot of people with a real, daily, quality-of-life problem being told there is nothing much to say about it.
Why constipation shows up as bloating
Two different things get called bloating, and separating them is useful here.
One is the feeling: pressure, fullness, the sense of being inflated. The other is the visible part, the increase in girth that changes how your clothes fit. They travel together often enough that most people use one word for both. Clinicians separate them and call the second one distension. The distinction earns its place because the two sort differently. The sensation is reported more often with irritable bowel syndrome. Visible distension is reported more often with chronic constipation.
Once the two are separated, the connection to a slow bowel is mechanical rather than mysterious. Three things are going on at once.
Volume. Stool that moves slowly spends longer in the colon, and it occupies space while it is there. Stool held in the rectum can also impede the passage of gas, which slows transit further. The two problems feed each other.
Fermentation. Residue that sits gets worked on. Colonic bacteria ferment carbohydrate that was not absorbed further up, and that fermentation produces gas. When transit is slow, the same meal spends longer being fermented, and the additional gas can contribute both to the feeling of fullness and to the distension itself.
Transit. Among people whose bloating and distension are persistent, colonic transit is slower on average than among people without those symptoms. That finding lines up with the first two.
This is also why the complaint keeps the hours it does. Bloating and distension tend to be lowest in the morning and after a night’s sleep, and highest after meals and into the early evening. Fine at breakfast, uncomfortable by four, is the shape most people describe.
Bloating and constipation occur separately as well as together. When they occur together, they are worth looking at as one problem rather than two.
The usual explanation, and a better one
The standard answer is hormones, and hormones are genuinely part of the picture. Sex hormones act on smooth muscle, and the effect on transit is well documented elsewhere: transit slows later in pregnancy when progesterone is high, and it shifts across the menstrual cycle in the same direction.
The menopause transition itself is less tidy. The most careful study of this question followed women prospectively for years, tracking daily symptom diaries alongside hormone measurements. It found that reproductive hormones showed no significant relationship with constipation severity. What did predict it was tension, and lower cortisol.
Their conclusion was that stress perception and tension mattered more than reproductive hormones for these symptoms.
That is worth sitting with, because it points somewhere different from where most of the conversation points. It suggests the digestive part of perimenopause is not simply a hormonal fact to be endured until it passes. It tracks with load, and load is something you can moderate.
It also fits what perimenopause tends to coincide with. Careers at their most demanding, parents needing more, children needing different things, sleep already fragmented. The years when the load is heaviest and the reserve is thinnest.
To be direct about the boundary: hormone questions belong with your physician or gynecologist. What follows is about the other half.
Why elimination is worth checking
You already treat sleep as a rhythm that matters. You know what a bad week of it does to you. Eating and movement get the same respect.
Elimination belongs in that group and rarely gets there, partly because it is unglamorous and partly because people do not raise it. A body that is not clearing on a reliable rhythm is carrying that, the same way it carries short sleep.
These things travel together in this population, and elimination is usually the most changeable of them. It is also the one nobody asks about. If you have been working on sleep and food and movement and something still is not right, this is the piece that tends to be overlooked.
What actually moves it
The routes stress takes into bowel function are specific and worth knowing: a pelvic floor that guards rather than releases, the urge overridden because there is no convenient moment, a schedule that removes the regular cues the bowel depends on. All three are more common in exactly the demographic reporting these symptoms.
Rebuilding the rhythm starts with the daily anchors: a consistent morning, meals at roughly consistent times, movement after eating. And before adding more fiber, which is the usual first move, it is worth understanding when fiber helps and when it makes things worse.
The key takeaway
If you are in this stretch of life and dealing with bloating and a tiredness that sleep does not fix, elimination is more likely to be part of the picture than not, and it is more likely to be modifiable than the rest of it. It is also the piece least likely to have been asked about. Ask about it.
Questions about your specific situation?
If this describes your experience, a discovery call is a free, short conversation about what is worth looking at first. Book one at dryarondaom.com/discovery.
Dr. Yaron practices in Maryland, Virginia, DC, Georgia, and New York.
References
- Denby N, et al. Menopause and the Gut: Uncovering a Hidden Health Burden. Poster presented at: The Menopause Society 2025 Annual Meeting; October 2025; Orlando, FL.
- Callan NGL, Mitchell ES, Heitkemper MM, Woods NF. Constipation and diarrhea during the menopause transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause. 2018;25(6):615-624. PMID: 29381667.
- Mari A, Abu Backer F, Mahamid M, et al. Bloating and Abdominal Distension: Clinical Approach and Management. Adv Ther. 2019;36(5):1075-1084. PMID: 30879252.
- Wald A, Van Thiel DH, Hoechstetter L, et al. Effect of pregnancy on gastrointestinal transit. Dig Dis Sci. 1982;27(11):1015-1018. PMID: 7140485.
- Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144(1):218-238. PMID: 23261065.
DISCLAIMER: The information in this article is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Dr. Yaron Cohen is a licensed acupuncturist and a doctor of acupuncture and Oriental medicine (DAOM) practicing integrative care. This content is general health education. It is not a substitute for consultation, diagnosis, or treatment from your physician or another qualified healthcare provider, and reading it does not create a patient-practitioner relationship. Individual medical needs vary. Always consult your physician about any medical condition, symptoms, or treatment options. Do not start, stop, or change any prescribed medication, and do not change any treatment directed by your physician, based on information you have read here. Do not disregard or delay seeking professional medical advice because of something you have read here.
