Perimenopause and bloating: why it can start in your forties

Bloating is common in perimenopause, and changing hormones are one likely reason, though it’s not yet certain how menopause affects the gut. Menopause usually comes between 45 and 55, with perimenopause before it, so the forties are often when this starts. Frequent bloating is also a main symptom of ovarian cancer, so it needs a GP first.

That last sentence isn’t there to frighten you. The symptoms of ovarian cancer are common and can be caused by many different conditions. It’s there because the only way to know which yours is involves a GP, not a blog.

Is bloating a symptom of perimenopause?

It can be, although you won’t find it on the NHS’s list. The NHS symptoms of perimenopause and menopause run from changes to your periods, hot flushes and poor sleep to brain fog, aching joints and dry skin, and bloating isn’t named among them.

Specialists in menopause do describe it. A factsheet from Women’s Health Concern, the patient arm of the British Menopause Society, explains that the hormone changes of menopause may lead to digestive symptoms including acid reflux, tummy pain, bloating, constipation and diarrhoea. It also reports early findings from a 2024 survey of 564 women aged 44 to 73, a dietetics student project at Teesside University, in which 77 per cent said they had bloating. That’s a preliminary student survey rather than a clinical study, so treat the number as a sign of how common the complaint is, not a measure of it.

Why would changing hormones make you bloated?

Nobody knows for certain, which is worth saying plainly. Oestrogen and progesterone fall during the menopause transition, and your gut and brain communicate through a network known as the gut brain axis. One explanation is that falling oestrogen affects that network, the gut bacteria, how quickly things move through, and how sensitive the gut is to pain. More research is needed before anyone can say how much each of those matters.

Some of what you feel may have more familiar causes that happen to cluster in these years:

• Your periods are changing. One of the first signs of perimenopause is usually a change to your periods, and bloating or cramping is a common symptom before a period.
• Constipation. It can make you feel bloated, and it’s more common when you move less or your routine changes.
• Reflux. Acid reflux is among the digestive symptoms described around menopause, and bloating is one of reflux’s own symptoms.
• IBS. It can become more noticeable for some women around menopause, and stress, often running high in these years, can set off a flare.

Bloating in your forties: what needs a GP, and how fast?

This is the section I’d ask you not to skip. Ovarian cancer mostly affects women over 50, and bloating sits among its symptoms as well as among the complaints people expect from perimenopause. The NHS lists the main symptoms as frequently, roughly 12 or more times a month, having a swollen tummy or feeling bloated, pain or tenderness in your tummy or the area between your hips (pelvic pain), no appetite or feeling full quickly after eating, and an urgent need to pee or needing to pee more often.

At the appointment, tell the GP if anyone in your family has or had ovarian or breast cancer. The GP may arrange a blood test for a protein that’s sometimes linked to ovarian cancer, followed by a scan if the level is high. If you’ve had bloating for a while and aren’t sure whether it counts as persistent, bloating that will not go away goes through it.

What helps perimenopause bloating?

The ordinary bloating advice is a fair place to start, once anything on the list above has been checked. Eat smaller, more frequent meals instead of large ones, and don’t eat a big meal late at night. Exercise regularly, which helps digestion. Drink plenty of water, and if you’re constipated, add foods high in soluble fibre such as oats. Go easy on fizzy drinks, alcohol and caffeine in coffee and tea, and on foods known for causing gas, such as cabbage, beans and lentils.

Eat slowly and avoid long gaps between meals. If your fibre needs adjusting, a registered dietitian can help you work out which direction, because some women do better with less of it and others with more soluble fibre.

How do I tell hormone bloating from gut bloating?

Write it down, against your cycle. If your periods are still coming, the NHS suggests a symptom diary over at least two menstrual cycles for premenstrual symptoms, and bloating can go in the same diary. Note the day of your cycle, when the bloating starts and settles, what you ate, how your bowels were and how you slept.

A diary won’t diagnose anything. What it does is turn “I’m bloated all the time” into something a GP can read, and it shows whether your bloating follows your cycle or your plate. The difference is explained in period bloating or gut bloating, and if bloating has become your normal, why am I bloated all the time covers the other common causes. The which book quiz can help you decide where to start.