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Mechanism of Fluid retention and IBS type symptoms of bloating with HRT use; practical tips to relieve symptoms

Updated: Dec 28, 2023



Women on Hormone Replacement Therapy (HRT) may notice an increase in weight. It’s important to clarify that this weight gain is typically not attributed to an accumulation of fat. Instead, there are two main factors that can contribute to this phenomenon:


1.Fluid Retention:

Explanation: HRT, particularly estrogen-based therapy, can influence fluid balance in the body. Not every woman gets fluid retention. If you have a history of fluid retention or older when you start HRT you may be more likely to get fluid retention. The good news is that, the fluid retention is temporary. Typically, it is reported at 6 weeks of using HRT and improves gradually over the next 1-2 weeks. By week 12 of using HRT, the fluid retention symptoms should have compleatly resolved. If not, you may need to address the dose of estrogen, add on prometrium if you've had a hysterectomy and are not taking progesterone or further investigate the cause of fluid retention.

Mechanism: Estrogen has an impact on sodium and water retention, leading to increased fluid levels in the tissues.

Result: The perceived weight gain may be due to the retention of fluids, causing temporary swelling or bloating.



2.Reduced Gut Movement (Motility):

Explanation: Hormones, including estrogen and progesterone, play a role in regulating gut motility—the movement of food through the digestive tract.

Mechanism: Changes in hormone levels during HRT, especially if progesterone is involved, might slow down the transit of food through the intestines.

Result: Food may take longer to exit the bowels, contributing to a feeling of bloating and potentially leading to an increase in overall weight.




Hormones like estrogen, testosterone, and progesterone influence Irritable Bowel Syndrome (IBS), but the exact reasons aren't completely clear, and responses can vary. Here's a simple breakdown:


Estrogen:

- Gut Movement: Estrogen helps move the digestive tract, and changes during the menstrual cycle or menopause can affect gut movement, possibly causing IBS symptoms.

- Sensitivity: Estrogen influences how the gut feels and reacts to things. Higher levels might make the gut less sensitive, offering some protection against IBS symptoms.


Testosterone:

- Not Fully Explored: We know less about how testosterone affects IBS compared to other hormones.

- Potential Impact: Some studies suggest testosterone might reduce inflammation, which could influence the gut's immune response.

Progesterone:

- Gut Movement: Progesterone relaxes the muscles in the digestive tract. High levels may slow down gut movement, leading to constipation or changes in bowel habits.

- Sensitivity: Progesterone can make the gut more sensitive, possibly causing increased pain or discomfort.


Addressing Fluid Retention and Gut Health on HRT: Practical Tips

Improving gut motility and addressing fluid retention due to Hormone Replacement Therapy (HRT) involves adopting healthy lifestyle habits. Here are some general suggestions:


INITIAL GO TO STEPS TO HELP FLUID RETENTION AND BLOATING:


A) FOR FLUID RETENTION, THE FIRST STEP IS TRY AND ADD FOODS THAT ARE NATURAL DIURETICS TO YOUR DIIET

B) 2ND IS- TRY PRACTICE INTERMITTENT FASTING

C) FOR BLOATING, ACTIVATED CHARCOAL - Once - Twice a week, if necessary. Activated charcoal binds toxins as well as nutrients and medication. For this reason, activated charcoal is taken on an empty stomach and max twice a week. If you use more than twice a week, you may get constipation. Activated charcoal caps work better than tablets. Follow instructions on the product.

D) SHORT TERM USE OF WATER TABLETS CAN BE USEFUL, PROVIDED YOUR KIDNEY FUNCTION IS GOOD.


1. Stay Hydrated:

- Paradoxical as it may sound, drinking plenty of water can actually help reduce fluid retention. It helps maintain proper fluid balance in the body.


2. Balanced Diet:

- Fiber-Rich Foods: Include high-fiber foods in your diet, such as fruits, vegetables, whole grains, and legumes. Fiber promotes regular bowel movements and helps prevent constipation.

- Limit Sodium: Reduce your intake of high-sodium foods, as excessive sodium can contribute to fluid retention.


3. Regular Exercise:

- Physical Activity: Engage in regular exercise. Physical activity stimulates bowel movements and helps maintain a healthy digestive system.

4. Probiotics:

- Probiotic Supplements or Foods: Probiotics can support gut health by promoting a balance of beneficial bacteria. Consider incorporating probiotic-rich foods or supplements with your healthcare provider's guidance.


5. Manage Stress:

- Stress Reduction Techniques: Practice stress-reducing activities such as mindfulness, meditation, or deep breathing exercises. Stress can affect gut motility, and managing stress may help alleviate symptoms.


6. Small, Frequent Meals:

- Meal Timing: Instead of large meals, try eating smaller, more frequent meals throughout the day. This can help regulate digestion and minimize bloating.


7. Discuss Medication Adjustments with Your Healthcare Provider:

- Consultation: If fluid retention persists, discuss it with your healthcare provider. They may adjust your HRT dosage or recommend other medications or interventions to manage symptoms.


8. Regular Check-ups:

- Follow-up Appointments: Keep regular follow-up appointments with your healthcare provider to monitor your overall health and address any concerns related to HRT.


Always consult with your doctor before making significant changes to your diet, exercise routine, or medications. They can provide personalized advice based on your specific health needs and circumstances.


Remember, IBS is complex, and hormones are just one part of the puzzle. Factors like genes, stress, diet, and gut health also play a role. If you're dealing with IBS symptoms or worry about how hormones affect you, talking to a healthcare professional is a good idea. They can understand your situation and help you figure out the best plan for you.


By Dr Purity Carr

Gp & Menopause Doctor

Harvey,WA

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