Postmenopausal women with irritable bowel syndrome (IBS) have more severe symptoms than premenopausal women with IBS

Abstract

Background: Although irritable bowel syndrome (IBS) is more common in women, little is known about the role of hormonal changes and menopause in IBS. This study aimed to evaluate for differences in gastrointestinal (GI) and psychological symptoms between pre- and postmenopausal women with IBS compared to age-matched men with IBS.

Methods: Patients with Rome-positive IBS were identified. Premenopausal women were <45 years of age with regular menses. Postmenopausal women were ≥45 years without menses for at least 1 year. Younger men were <45 years, and older men were ≥45 years. Questionnaires measured severity of IBS symptoms, somatic symptoms, health-related quality of life (HRQOL), and psychological symptoms. Multivariable linear or logistic regressions evaluating relationships between age and sex were performed.

Key results: 190 premenopausal women (mean age 30.25 years), 52 postmenopausal women (mean age 54.38 years), 190 men <45 years (mean age 30.45 years), and 52 men ≥45 years (mean age 53.37 years) were included. Postmenopausal IBS women had greater severity of IBS symptoms (P = .003) and worse physical HRQOL (P = .048) compared to premenopausal women. No differences were observed between age-matched older and younger IBS men. Constipation increased with age for both sexes but was the principal IBS subtype in women only.

Conclusions and inferences: Postmenopausal women with IBS have more severe IBS symptoms than premenopausal women, while no comparable age-related changes were seen in IBS men. The modulatory effect of female sex hormones on brain-gut interactions which affect visceral perception and GI function likely contributes to these findings.

Keywords: estrogens; irritable bowel syndrome; menopause; menstrual cycle; progesterone; sex characteristics.

FIGURE 1

Predominant irritable bowel syndrome (IBS) bowel habits in premenopausal women, postmenopausal women, younger men, and age-matched older men. Constipation increased with age for both men and women with IBS but was the predominant IBS subtype in women only. There was no significant relationship between age and gender for bowel habit subtype (P = .300)

FIGURE 2

Overall irritable bowel syndrome (IBS) symptom severity in premenopausal IBS women compared to postmenopausal IBS women and younger IBS men compared to age-matched older IBS men. Bowel Symptom Questionnaire (BSQ) overall IBS symptom severity score distributions among younger vs age-matched older IBS men and premenopausal vs postmenopausal IBS women. Box plots show median and interquartile ranges. Postmenopausal IBS women had a greater severity of overall IBS symptoms compared to premenopausal women (P = .003). No difference in severity of overall IBS symptoms in age-matched older vs younger IBS men (P > .05)

FIGURE 3

Hospital Anxiety and Depression Scale (HADS) depression in premenopausal irritable bowel syndrome (IBS) women compared to postmenopausal IBS women and younger IBS men compared to age-matched older IBS men. Hospital Anxiety and Depression Scale depression score distributions among younger vs age-matched older IBS men and premenopausal vs postmenopausal IBS women. Box plots show median and interquartile ranges. Postmenopausal IBS women had higher depression symptom scores than premenopausal IBS women (P = .041), whereas depression scores were similar between age-matched older and younger IBS men (P = .316)

FIGURE 4

Physical quality of life in premenopausal irritable bowel syndrome (IBS) women compared to postmenopausal IBS women and younger IBS men compared to age-matched older IBS men. Short Form (SF-12) Physical Composite Score distributions among younger vs older IBS men and premenopausal vs postmenopausal IBS women. Box plots show median and interquartile ranges. Postmenopausal IBS women had lower physical health-related quality of life (HRQOL) scores compared to premenopausal IBS women (P = .048). There was no significant difference in physical HRQOL scores for age-matched older compared to younger IBS men