Endometriosis is a painful disorder characterized by the presence of endometrial (uterine) tissue in locations outside the uterus. This can include on or around the ovaries, on other structures within the pelvic cavity, and even in other locations around the body. Endometriomas, also described as hemorrhagic cysts, can be intrusive and adhesive to surrounding structures; and because they are made of endometrial tissue, they respond to cycling ovarian hormones. There are many different stages and severities of endometriosis depending on infiltration of tissue, adhesion to surrounding organs and structures, the number of lesions and the symptoms experienced. As a result,
Constipation is defined by infrequent bowel movements, hard, dry stools, straining and pain with defecation, and can lead to the development of hemorrhoids. There are many different causes of constipation, including intestinal dysbiosis, lack of dietary fiber, dehydration, food sensitivities and medication use such as opioids and antihistamines. Constipation could also occur due to structural issues of the intestines, or due to hormonal responses.
The occurrence of hormonal constipation is more common in females. Women tend to have changes in stool consistency throughout the menstrual cycle as hormone levels fluctuate. It’s not uncommon for women to experience firmer stools and less frequent bowel movements in the luteal phase or premenstrually, and then to have looser and/or more frequent bowel movements during menses. As well, constipation is common during pregnancy, when progesterone levels are highest.
An additional hormonal cause of constipation is hypothyroidism, which also more commonly affects women.
It has been suggested that due to the prevalence of constipation during pregnancy, and the menstrual cycle’s luteal phase, progesterone is the influencing hormonal cause. Progesterone is known to impair smooth muscle contraction,1 which could lead to slower colonic transit time. However, some studies have shown that females with slow transit constipation can have completely normal progesterone levels.
So although progesterone can cause slower transit times in the colon, it doesn’t seem to cause constipation in all women. When progesterone receptors are overexpressed in the colon (specifically in the colon’s circular muscle and epithelial cells) this can cause abnormal muscle contractions.1 Therefore it may be that individual women may have different sensitivities or progesterone receptor function, within colonic muscle cells.1
Other hormone variations have been linked to constipation as well. In one study, women with idiopathic chronic constipation were found to have lower levels of cortisol, testosterone and DHEAS in the follicular phase of their menstrual cycles; while in the luteal phase they had low estrogen, testosterone and cortisol.2
How do we resolve hormonal constipation?
In the case of hypothyroid-related constipation, the goal is to treat the thyroid condition. When thyroid-stimulating hormone (TSH) levels are abnormally elevated, often accompanied by lower levels of the thyroid hormones T3 and/or T4, conventional treatment is a medication called levothyroxine, a synthetic T4. Alternative and complementary therapies may include natural desiccated thyroid (NDT), and supplementation with minerals such as zinc, selenium and iodine.
Note that treatment of hypothyroidism should be under the supervision of a qualified healthcare practitioner. Large deviations in TSH levels (both high and low) can cause multiple symptoms and can even be dangerous, especially in pregnancy.
Slow-transit constipation due to progesterone sensitivity is limited to the elevations in serum progesterone. This means that in a menstruating female, constipation is limited and bowel movements will normalize, typically within a week or so. In pregnancy, progesterone levels remain elevated for months, but will become normal again in the postpartum period.
Even though these bouts of constipation are limited in duration, they can still cause extreme discomfort and the formation of painful hemorrhoids. Therefore, supporting the bowels and helping improve elimination is important.
First, increase fiber intake. In some cases, adding 1 to 2 tablespoons of either ground flaxseeds to the diet, or psyllium husk mixed into water can help support elimination.
Second, increase water intake to prevent dehydration and to help move along dietary fiber. Other substances that can help with intestinal lubrication include flaxseed oil, slippery elm and marshmallow root (not to be confused with marshmallow candy).
Third, it’s time to get moving! Try including more exercise into your week. Body movements during exercise not only increase circulation throughout the body, but the use of abdominal muscles can exert additional supporting pressure to help with intestinal movement. Additionally, non-pregnant females can try abdominal massage or use castor oil packs locally over the lower intestinal tract to support intestinal blood flow and movement.
1. Guarino M, Cheng L, Cicala M et al. (2011). Progesterone receptors and serotonin levels in colon epithelial cells from females with slow transit constipation. Neurogastroenterol Motil. 23(6): 575-e210
2. El-Tawil AM. (2010). Is the DHEAS/cortisol ratio a potential filter for non-operable constipated cases? World J Gastroenterol. 16(6): 659-62