Sex Differences, Menses-Related Symptoms and Menopause in Disorders of Gut-Brain Interaction

Abstract

Background: Disorders of gut-brain interaction (DGBI) predominate in women, but little is known about sex differences in menses-related or menopause symptoms.

Methods: Using data from the Rome Foundation Global Epidemiology Survey, we assessed Rome IV DGBI symptoms in individuals in 26 countries who met criteria for ≥ 1 of 5 DGBI: irritable bowel syndrome (IBS), functional dyspepsia (FD), functional constipation (FC), functional diarrhea (FDr), or functional bloating (FB). Participants included pre- and post-menopausal women with DGBI and age-matched men. Odds ratios estimated sex and age differences for symptom by sex or pre- vs. post-menopause in logistic regression; standardized mean difference (SMD) provided effect sizes.

Key results: 14,570 participants met criteria for ≥ 1 of the 5 DGBI. Women exceeded men in most symptoms. In FD, women stopped eating due to early satiety more than men (11.1 vs. 8.9 days/month, SMD 0.21). Symptoms were generally increased in premenopausal women and younger men compared to older counterparts; however, only premenopausal IBS, FD, and FC women reported increased constipation-associated symptoms. Compared to premenopausal women, postmenopausal women had increased accidental stool leakage in IBS and FDr, and increased digital manual maneuvers in FC (18% vs. 25% frequency, SMD -0.25). IBS and FD had the most menses-associated symptoms.

Conclusions and inferences: Women had higher symptom frequency across the 5 DGBI compared to men. Our findings suggest that premenopausal women have greater visceral perception than postmenopausal women, although increased outlet symptoms in postmenopausal women indicate greater anorectal/pelvic dysfunction. While age alone has some influence on symptoms, female sex hormones may also increase visceral perception.

Keywords: Bloating; Chronic constipation; Disorders of gut–brain interaction; Functional dyspepsia; Gonadal Steroid Hormones; Irritable bowel syndrome; Postmenopause; Premenopause; Sex Characteristics; Visceral Hypersensitivity.

FIGURE 1

Prominent Symptom Differences Between Women and Men across 5 Main DGBI. (A) IBS, (B) FD, (C) FC, (D) FDr, (E) FB. Percentage of time with the specified DGBI symptoms, where days per month (where applicable) were divided by 30 to approximate percentage of time to standardize units for graphing purposes. “*” denotes non‐overlapping 95% confidence interval bars between the groups thereunder. BM = bowel movement. (A) IBS, (B) FD, (C) FC, (D) FDr, and (E) FB.

FIGURE 2

Prominent Symptom Differences Between Pre‐ and Post‐Menopausal Women with Age‐Matched Men as a Comparison Group across 5 Main DGBI. (A) IBS, (B) FD, (C) FC, (D) FDr, (E) FB. Percentage of time with the specified DGBI symptoms, where days per month (where applicable) were divided by 30 to approximate percentage of time to standardize units for graphing purposes. Pre‐ and post‐menopausal women were compared, with differences between similarly‐aged men as a comparison. “*” denotes non‐overlapping confidence interval bars between the groups thereunder. Outside of Rome IV symptoms, any symptom where the pre‐ vs. post‐menopausal groups had SMD ≥ 0.2 was reported. Rome IV symptoms are contained in a bracket if additional non‐Rome symptoms were reported. BM = bowel movement.

FIGURE 3

Menses‐Associated Symptoms in Pre‐Menopausal Women. (A) Menses‐associated symptoms are increased in IBS and FD compared to the other DGBI. A “*” above a bar signifies that the 95% confidence interval bars do not overlap with any others in the figure. (B) Presence of mrenses‐elated symptoms increases odds of having > 1 DGBI diagnosis. Forest plot of odds ratios for greater than 1 DGBI diagnosis given specified variables. Dyspareunia and bothersomeness of menstrual cramps increased odds of > 1 DGBI.