Which hormones cause constipation?
When the word constipation is mentioned, what usually comes to mind can vary from infrequent bowel movements to the inability to have a bowel movement and/or the passage of hard stools, which may involve pain and straining.1,2 Dorland’s Pocket Medical Dictionary defines constipation as infrequent or difficult evacuation of faeces.3
Constipation affects between 1% to 80% of the general population worldwide, with a prevalence that varies widely between geographical locations and sexes.4,5 Constipation can be caused by a variety of factors such as inadequate fluid intake, low fibre diet, a sedentary lifestyle, medications, hormonal imbalance, and by conditions such as irritable bowel syndrome (IBS) and pregnancy.1,4
Having 1-2 bowel movements per day is optimal for individuals with a healthy gut.6 However, this "standard" can vary from person to person and depends on lifestyle factors and predisposing conditions.1,6
The link between hormones and constipation appears to function like a vicious cycle, where constipation can lead to an imbalance in hormone levels, and hormone imbalance can cause constipation.7 Hormones are chemicals produced by glands called endocrine glands, which are distributed throughout the human body.8 The major endocrine glands include the pituitary, pineal, thyroid, parathyroid and adrenal glands, the ovaries (in women), testes (in men), and the pancreas.8
Studies have shown that oestrogen, progesterone, and thyroid hormones can cause constipation.6 In addition, constipation can result in an imbalance affecting these hormones.6 The female hormones oestrogen and progesterone, are produced by the female endocrine gland, the ovaries, while the thyroid gland produces the thyroid hormones (T3 and T4).8 The production of thyroid hormones is controlled by the thyroid stimulating hormone (TSH), which is secreted from the pituitary gland.8
Why does hormonal constipation happen?
Having regular bowel movements is how our body gets rid of excess toxins, hormones, and indigestible materials, thereby keeping the body in optimal working order and in a balanced state of homeostasis.2,6
The excretion of toxins and hormones from the body involves the largest internal organ in humans, the liver.7 The liver plays a key role in preparing toxins and hormones for excretion outside the body.6,7 This detoxification process involves converting hormones from their fat-soluble versions to water-soluble versions through a process called methylation.6 Following methylation in the liver, the hormones travel to the gut to be excreted from the body.7
When constipation occurs, this transit of hormones for excretion from the gut to outside the body, following detoxification by the liver, is delayed.6This leads to an accumulation of toxins and hormones in the gut.7 Regarding oestrogen, this delay in bowel transit time can cause oestrogen to accumulate to toxic levels in the gut.7,9 This can lead to a state known as oestrogen dominance.6,7
The state of oestrogen dominance is defined by hormone imbalance, and individuals affected can experience symptoms such as bloating, headaches, acne, mood swings, and heavy and painful periods.6 In addition, the state of oestrogen dominance can result in an imbalance in other sex hormones, which, if left unchecked, creates an environment that can potentiate infertility, autoimmune diseases, and oestrogen-dependent breast or uterine cancer.6,7
Additionally, the accumulation of hormones in the gut due to constipation can lead to their reabsorption back into systemic circulation.7 The saying gut health is an indicator of general health applies here. An imbalance in the gut micro-environment, the gut flora, can increase the production of an enzyme called β-glucuronidase (Beta-glucuronidase).7
The enzyme beta-glucuronidase can reverse the liver's detoxification process by converting the accumulated oestrogen in the gut from the water-soluble version back to a more toxic fat-soluble version that is readily reabsorbed back into circulation.7 This contributes to the development of oestrogen dominance.7
Between the sexes, constipation appears more common in females than males, especially in younger individuals.4 This is attributed to the influence of hormones of the menstrual cycle, oestrogen and progesterone, which can affect bowel transit time.5
Although there is conflicting evidence on the role of progesterone on bowel transit time and the ability to cause constipation, the incidence of constipation during early pregnancy suggests that progesterone is also a significant risk factor for constipation in women.5
Another stage of life when the hormones of the menstrual cycle can affect bowel transit time is during menopause.9 Menopause signals the end of menstrual cycles, typically from 40 and above to 60 years,11 characterised by a decline in oestrogen and progesterone levels.11 Earlier on, we mentioned that high oestrogen levels affects bowel transit time and can cause constipation; therefore, you would expect the reverse to occur as oestrogen levels start to decline during menopause.5,11
During menopause, the decline in oestrogen levels brings the actions of other hormones, which can cause constipation, into play. This includes the stress hormone cortisol, secreted by the adrenal glands, and the thyroid hormones (T4, T3) secreted by the thyroid gland.8
The level of cortisol is observed to increase with age. High cortisol levels support the secretion of the inactive form of the thyroid hormones, which needs to be converted through a series of processes to its useable form before it can stimulate metabolic processes.11,12 This can contribute to the development of hypothyroidism.12
Hypothyroidism is a medical condition associated with low levels of thyroid hormones.12 Thyroid hormones are metabolic hormones that can affect the gut's motility, affecting bowel transit time.7 When present in low amounts, the transit of waste materials, such as toxins, excess hormones, and indigestible materials along the gut, can be sluggish, resulting in chronic constipation.7
High cortisol levels negatively affect gut motility and, in turn, bowel transit time. This contributes to the development of hormonal constipation in menopausal women.
Additionally, there appears to be an association between the development of hypothyroidism and vitamin D deficiency in individuals with autoimmune hypothyroidism, also called Hashimoto’s Disease.13
How do I treat hormonal constipation?
As with all ailments and conditions, treating the root cause gives the best results. Constipation due to hormone imbalance is usually chronic and is treated by determining which hormone(s) is out of balance.
Hormonal constipation due to hypothyroidism can be managed first by running blood tests to check the levels of the thyroid hormones, free T3, free T4, TSH, and anti-thyroglobulin antibodies, after which supplementation with synthetic thyroid hormones and vitamin D can be offered to improve bowel transit time and ease constipation.7
Temporary relief from constipation due to hormone imbalance can be achieved with laxatives, which can aid to soften and stimulate the removal of feces.1,6 Lifestyle changes may include increased fibre and fluid intake, which may also provide relief.1,6
How do I prevent hormonal constipation?
Hormonal constipation can be prevented in a variety of ways.1,6 The goal is to ensure that we improve the number of bowel movements to the optimal 1-2 per day to prevent the development of constipation.6,7 This increase in bowel movements correlates with an increase in the removal of toxins, hormones, and indigestible materials from the body, which will result in a healthier gut and balanced hormone levels.6
While increasing the number of bowel movements is the goal, the appearance of the faeces is also worth monitoring.7 Healthy bowel movements should not contain mucus, blood, or undigested food.7 If any of these are observed, a visit to the GP is advised.7
Lifestyle changes that can help prevent hormonal constipation include increased fluid and fibre intake (25 – 35g of fibre/day), regular exercise, and supplements.7
Supplements such as magnesium are sold in various versions called salts. These include magnesium oxide, magnesium glycinate, and magnesium taurate and work by increasing the rate of gut transit, which will improve the speed of eliminating toxins and waste from the body.7 Liver-supportive supplements such as N-acetylcysteine (NAC), glutathione, and alpha-lipoic acid (ALA) help to support the liver to carry out its detoxification function optimally and work to counteract the action of the enzyme beta-glucuronidase.7
Additionally, maintaining a balance in the gut microenvironment – the gut microflora, can help improve hormonal constipation.6,7 Daily probiotic supplements help introduce good bacteria into the gut, supporting a healthy, balanced gut.7 A healthy balanced gut keeps the levels of the enzyme beta-glucuronidase in check.7
Constipation disproportionately affects women compared to men, and as observed in hormonal constipation, the cause can be multifactorial and the duration chronic.4,5 The effect of the menstrual cycle on bowel transit time resulting in constipation is observed to vary between age groups, from a young female to a menopausal woman, and in conditions such as pregnancy.5 The treatment goals for hormonal constipation involve interventions that support a healthy gut.1,6 This may involve medications and/or lifestyle changes that promote gut health, subsequent to accurate history taking and assessments by qualified healthcare practitioners.1,4,6
- Johns Hopkins Medicine. Constipation [Internet]. [cited 2023 Jan 11]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/constipation
- Eckelkamp S. How Often Should A Healthy Person Poop Per Day? Doctors Weigh In [Internet]. [cited 2023 Jan 11]. Available from: https://www.mindbodygreen.com/articles/how-often-should-you-poop-per-day-to-be-considered-healthy
- Dorland. Dorland’s Pocket Medical Dictionary. 28th ed. Philadelphia: Elsevier Saunders; 2009. 934 p.
- Brenner DM, Shah M. Chronic Constipation. Gastroenterol Clin North Am. 2016;45(2):205–16.
- Oh JE, Kim YW, Park SY, Kim JY. Estrogen rather than progesterone cause constipation in both female and male mice. Korean J Physiol Pharmacol. 2013;17(5):423–6.
- Longoria J. What Poop Has to Do With Your Hormones + 3 Tips to Relieve Constipation [Internet]. [cited 2023 Jan 10]. Available from: https://www.jennalongoria.com/blog-archive/poop-hormones-tips-relieve-constipation
- Eckelkamp S. Why Pooping Every Day Is Crucial For Women’s Hormonal Balance [Internet]. 2020 [cited 2023 Jan 10]. Available from: https://www.mindbodygreen.com/articles/why-pooping-every-day-is-crucial-for-womens-hormone-balance
- National Cancer Institute. Endocrine Glands & Their Hormones [Internet]. SEER Training Modules. [cited 2023 Jan 11]. Available from: https://training.seer.cancer.gov/anatomy/endocrine/glands/
- Mount Sinai. Bowel transit time [Internet]. [cited 2023 Jan 12]. Available from: https://www.mountsinai.org/health-library/tests/bowel-transit-time#:~:text=Normal Results&text=The average transit time through,up to around 100 hours.
- Kirka AS, Oksuz SK, Gul DK, Bulut S. Constipation and its Effects on Quality of Life in Menopausal Women. Int J Caring Sci [Internet]. 2021;14(1):270–5. Available from: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=150568768&site=ehost-live&custid=ns221502
- BCNH. Chronic Constpation – Part 2 [Internet]. [cited 2023 Jan 13]. Available from: https://bcnh.co.uk/chronic-constpation-part-2/
- National Institute of Diabetes and Digestive and Kidney Diseases. Hashimoto’s Disease [Internet]. 2021 [cited 2023 Jan 13]. Available from: https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease