If you have found yourself straining more, going less often, or passing hard, lumpy stools that never used to be a problem, you are not alone in noticing it. In perimenopause forums, people describe bowels that seem to have slowed down, fewer trips to the toilet each week, more straining, and the frustration of feeling they never fully empty. Some mention knock-on problems such as piles (haemorrhoids). Constipation is common, it is under-discussed in conversations about menopause, and there are sensible, evidence-based ways to approach it.
The short answer
The short answer: constipation in menopause usually has more than one cause. A 2022 review in the journal Climacteric (Coquoz, Regli and Stute) concluded that progesterone slows gastrointestinal motility, the coordinated contractions that move food along, so the hormonal shifts of perimenopause may play a part, although the same review notes that the role of sex hormones in many gut symptoms has not yet been studied. Alongside hormones, the NHS (2023) lists the most common causes of constipation as not eating enough fibre, not drinking enough fluids, not moving enough, often ignoring the urge to go, changes to diet or routine, side effects of medicine, and stress, anxiety or depression. The result can be slower, harder, less frequent bowel movements, often with straining and a sense of incomplete emptying. The NHS says constipation can usually be treated at home with simple changes to diet and lifestyle. Some bowel changes, however, do need to be checked by a doctor, and we set those out clearly below using the NHS and NICE wording.
Why does menopause cause constipation?
Estrogen (oestrogen) and progesterone are not only reproductive hormones. Researchers have long been interested in how they act on the digestive tract, and the evidence so far is clearest for progesterone.
According to the 2022 review by Coquoz, Regli and Stute, which pulled together 37 articles on sex hormones and the gut, progesterone slows down gastrointestinal motility. When the contents of the bowel move more slowly, stools can become harder and more difficult to pass, which is the pattern the NHS describes as constipation.
The picture for estrogen is less settled. The same review points out that for several gastrointestinal symptoms and conditions, no studies have yet looked at the effect of sex hormones, so it is not possible to say exactly how falling or fluctuating estrogen affects the bowel. Be cautious with any source that presents a single, simple hormonal explanation as established fact.
What is well established is that everyday factors matter. The NHS (2023) lists stress, anxiety and depression among the common causes of constipation, along with being less active, spending long periods sitting, and changes to diet or daily routine. Many of these overlap with midlife: broken sleep, busy schedules, and shifts in eating and exercise habits. So while hormones may contribute, it makes sense to look at the whole picture rather than any one cause.
Is constipation really a menopause symptom?
It can be part of the picture, although it rarely appears on the headline lists next to hot flashes (hot flushes) and night sweats. Because constipation has so many possible causes, it is not always easy to say how much of it is hormonal for any one person.
What counts as constipation is more than frequency. According to the NHS (2023), it is likely to be constipation if you have not had a poo at least three times during the last week or you are going less often than usual, the poo is unusually large or small and is dry, hard or lumpy, you are straining or in pain when you go, or you feel you have not fully emptied your bowels. The NHS adds that you may also have a stomach ache and feel bloated or sick.
If several of those describe your experience, you may be dealing with constipation even if you still go most days. The texture and effort matter as well as the count.
It also helps to know that your normal is yours. Notice the NHS wording “less often than usual”: the comparison is with your own baseline rather than a single number. Equally, a change in your bowel habit that is not usual for you is one of the symptoms the NHS asks you to get checked, so do not assume a new pattern is hormonal without speaking to a doctor.
How is this linked to bloating?
Constipation and bloating often travel together. The NHS (2023) notes that people with constipation may also feel bloated, and it advises seeing a GP if you are regularly constipated or bloated.
Because the two overlap so much, people often cannot tell where one ends and the other begins. They are related but distinct, and some of the practical steps overlap.
If bloating is your dominant symptom, our guide to menopause bloating goes deeper. For the wider picture of how hormones and the gut interact, see gut health in menopause.
What does the pelvic floor have to do with it?
A great deal. The pelvic floor muscles support the pelvic organs, including the bowel. The NHS says pelvic organ prolapse, where the womb, bladder or bowel bulges into the vagina, is more common as you get older, particularly after the menopause, and it lists long-term constipation and straining among the causes. Problems pooing, such as constipation, are also listed as a symptom of prolapse.
Straining can feed a difficult cycle. The NHS lists constipation and pushing too hard when pooing among the things that make piles (haemorrhoids) more likely, and it notes that constipation is a common cause of anal fissures in children; in adults the cause is not always clear.
This is why squeezing harder is rarely the answer. The NHS lists physiotherapy and pelvic floor muscle training, usually with a specialist women’s health physiotherapist, as a treatment option for prolapse, and recommends regular pelvic floor exercises. If straining has become a pattern, a pelvic health physiotherapist is worth asking about.
Position can help too. The NHS (2023) suggests resting your feet on a low stool while going to the toilet and, if possible, raising your knees above your hips. It also advises keeping to a regular time and place and giving yourself plenty of time to use the toilet. Small mechanical changes like these sound minor, but they are simple to try.
Can medications and supplements make it worse?
Often, yes, and this is easy to overlook. The NHS (2023) lists the side effects of medicine among the common causes of constipation, and specifically mentions opioid painkillers. The NHS lists constipation as a common side effect of codeine and of ferrous sulfate, an iron tablet.
Calcium supplements, taken by many for bone health at this stage, can also list constipation as a possible side effect in their patient information leaflets. None of these should be stopped on your own, but they are worth reviewing with your practitioner if constipation has become a problem.
The NHS is clear: do not stop any prescribed medicine without speaking to your GP first. There may be an adjustment that helps while keeping the benefit you need, and a pharmacist or doctor can talk you through the options.
It also helps to bring a short list to your appointment: what you take, when you started it, and when the constipation began. That timeline can point to a likely cause and saves a lot of guesswork.
When should I be worried about bowel changes?
Constipation is common and usually manageable at home. But some bowel changes need to be checked, and knowing the official advice lets you act without panicking over the everyday version. The NHS (2026) says the main symptoms of bowel cancer include the items below, and that you should see a GP if you have any of them.
| See a GP if you have any of these (NHS) | Get help urgently (NHS) |
|---|---|
| Changes in your poo, such as having softer poo, diarrhoea or constipation that is not usual for you | Ask for an urgent GP appointment or get help from NHS 111 if your poo is black or dark red |
| Needing to poo more or less often than is usual for you | Ask for an urgent GP appointment or get help from NHS 111 if you have bloody diarrhoea |
| Blood in your poo, which may look red or black, or bleeding from your bottom | Call 999 or go to A&E if you are bleeding non-stop from your bottom |
| Often feeling like you need to poo, even if you have just been to the toilet | Call 999 or go to A&E if there is a lot of blood or you see large blood clots when you poo |
| Tummy pain, a lump in your tummy, or bloating | |
| Losing weight without trying, or feeling very tired or short of breath (signs of anaemia, which can be caused by bowel cancer) |
The NHS adds that some of these symptoms are very common and can be caused by other conditions. Having them does not definitely mean you have bowel cancer, but it is important to get checked, because finding it early may make it easier to treat.
For clinicians, NICE guideline NG12 (updated 2023) recommends offering a faecal immunochemical test (FIT) to guide referral for suspected colorectal cancer in adults with a change in bowel habit, among other features. NG12 also recommends testing for ovarian cancer in women aged 50 or over who have had symptoms within the last 12 months that suggest irritable bowel syndrome (IBS), because IBS rarely presents for the first time at this age. If you are over 50 and your bowel habits have recently changed, that is a good reason to book an appointment rather than wait and see.
What actually helps menopause constipation?
The basics are where the NHS starts, and they tend to work better as daily habits than as emergency fixes. The NHS (2023) advises gradually increasing the fibre in your diet and suggests adding some wheat bran, oats or linseed (flaxseed). For context, UK government guidelines say adults should aim for 30 grams of fibre a day, according to the NHS.
Hydration matters alongside fibre: the NHS advises drinking plenty of water and other fluids and avoiding alcohol. Regular movement helps too, and the NHS notes that a daily walk or run can help you poo more regularly.
The British Dietetic Association published its first evidence-based dietary guidelines for chronic constipation in adults in 2025 (Dimidi and colleagues, Journal of Human Nutrition and Dietetics). Based on 75 randomised controlled trials, it made recommendations on psyllium fibre supplements, kiwifruit, prunes, rye bread and high mineral-content water, among others. It made no recommendations on whole-diet approaches because of a lack of evidence, and most of its statements rested on low or very low quality evidence, so these are options to discuss rather than guaranteed fixes.
Try not to ignore the urge when it comes; the NHS advises not delaying when you feel the need to go. If diet and lifestyle changes are not helping, the NHS says a pharmacist can recommend a suitable laxative, and laxatives should only be used for a short time. See a GP if constipation is not improving with treatment, and your practitioner can look at the whole picture, including any medications. Not sure where your symptoms fit? Yellow’s Symptom Impact Check can help you map what is changing.
Frequently Asked Questions
Is constipation a sign of perimenopause?
It can be part of the picture, but it has many causes. A 2022 review in Climacteric found progesterone slows gut motility, so hormonal shifts may contribute. The NHS also lists low fibre, too little fluid, inactivity, stress and medicines as common causes. A change that is not usual for you should be checked by a GP.
Why am I suddenly constipated in menopause when I never was before?
Several things can combine. Research suggests progesterone slows gut motility, and the NHS lists low fibre, low fluid intake, less activity, changes in routine, stress and medicine side effects as common causes. Because a new change in bowel habit is also on the NHS list of bowel cancer symptoms, it is worth seeing a GP.
Does HRT help with menopause constipation?
There is little research looking specifically at hormone therapy and constipation, and this article does not recommend for or against it. Some people notice changes in their digestion on treatment and others do not. If constipation is affecting your life, discuss it with your practitioner alongside your other symptoms so you can weigh the options.
How is menopause constipation different from bloating?
They overlap but are not the same. Constipation means going less often than usual, hard or lumpy stools, straining, or feeling you have not fully emptied. Bloating is a tight, full, swollen feeling in the tummy. The NHS notes people with constipation may also feel bloated, and advises seeing a GP if either is regular.
Can straining on the toilet cause lasting damage?
According to the NHS, pushing too hard when pooing makes piles more likely, and long-term constipation and straining are among the causes of pelvic organ prolapse. Resting your feet on a low stool with knees above hips and giving yourself plenty of time can help. A specialist women’s health physiotherapist can help with pelvic floor problems.
What foods help relieve constipation in menopause?
The NHS suggests gradually increasing fibre, adding wheat bran, oats or linseed, and drinking plenty of fluids. The British Dietetic Association’s 2025 guidelines also made recommendations on kiwifruit, prunes, rye bread and psyllium supplements, mostly based on low quality evidence. If diet changes do not help, a pharmacist can advise on short-term laxatives.
Further Reading
- NHS. Constipation (reviewed 2023). https://www.nhs.uk/conditions/constipation/
- NHS. Symptoms of bowel cancer (reviewed 2026). https://www.nhs.uk/conditions/bowel-cancer/symptoms/
- NICE. Suspected cancer: recognition and referral (NG12). https://www.nice.org.uk/guidance/ng12
- Coquoz A, Regli D, Stute P. Impact of progesterone on the gastrointestinal tract: a comprehensive literature review. Climacteric, 2022. https://pubmed.ncbi.nlm.nih.gov/35253565/
- Dimidi E, et al. British Dietetic Association guidelines for the dietary management of chronic constipation in adults. Journal of Human Nutrition and Dietetics, 2025. https://pubmed.ncbi.nlm.nih.gov/41081513/
This article is for general information and education only and is not a substitute for personalised medical advice. If your bowel habits change in a way that is not usual for you, you notice blood in your poo or bleeding from your bottom, or you have unexplained weight loss or tummy pain, speak to a qualified practitioner.