There is something deeply unreasonable about putting on a perfectly comfortable pair of jeans in the morning and discovering that, by lunchtime, they’ve apparently shrunk.
Not gradually.
Not over several months.
Since breakfast.
You leave the house feeling perfectly normal.
Have a cup of tea.
Eat something.
Go about your day.
And somewhere around lunchtime, your waistband begins behaving as though it’s trying to cut you in half.
You discreetly loosen a button.
Perhaps rearrange yourself in your chair.
Consider whether anyone would notice if you simply removed the jeans altogether.
Because apparently, in addition to hot flushes, sleepless nights, aching joints and a brain that occasionally forgets the word table, we now have another delightful midlife development.
Bloating.
Excellent.
Just what we needed.
Is it bloating, weight gain, or have I swallowed a beach ball?
One of the first things I wanted to understand was what bloating actually meant.
Because we tend to use the word for several different things.
Sometimes our stomach feels uncomfortable and full.
Sometimes there’s pressure.
Sometimes our abdomen visibly expands.
Sometimes there’s excessive wind.
And sometimes our clothes simply feel tighter than they did a few hours earlier.
But bloating isn’t necessarily the same as gaining body fat.
That’s an important distinction.
Body fat doesn’t suddenly appear between breakfast and lunch.
Gas, digestive contents and changes in abdominal distension, however, can make your tummy feel considerably bigger over the course of a day.
Which explains why a waistband can feel perfectly reasonable at eight o’clock and become your mortal enemy by two.
The NHS describes bloating as a feeling of fullness or discomfort in the abdomen, sometimes accompanied by swelling, rumbling or increased wind.
And it turns out there are several possible explanations.
Some ordinary.
Some related to digestion.
Some that deserve medical attention.
So, naturally, I started investigating.
Apparently menopause can affect the gut too
At this point I was beginning to wonder whether there was a single part of my body that menopause hadn’t attempted to reorganise.
My hair?
Changed.
My skin?
Changed.
My sleep?
Changed.
My joints?
Complaining.
My brain?
Occasionally on annual leave.
And now my digestive system wanted a meeting.
Research suggests that the hormonal changes occurring around menopause may influence digestive function.
Oestrogen and progesterone interact with systems involved in digestion, and researchers are investigating how hormonal changes affect gut movement, sensitivity and the community of microorganisms living in our intestines.
That community is called the gut microbiome.
You’ve probably heard of it.
It’s become rather fashionable.
Apparently we all have trillions of tiny tenants living in our digestive systems.
Most of them are doing useful jobs.
Unlike actual tenants, they don’t pay rent.
But they do contribute to digestion and other aspects of health.
Research suggests the gut microbiome changes across different stages of life, including menopause.
What scientists haven’t established is a simple formula saying:
Less oestrogen = more bloating.
It’s more complicated than that.
And studies are still trying to untangle the relationship.
Which means I can’t blame every uncomfortable afternoon on my ovaries having retired.
Tempting though that is.
The gut has its own timetable
Something else I discovered was that digestion is influenced by far more than hormones.
How quickly food moves through the digestive system matters.
Constipation matters.
What we eat matters.
How we eat matters.
Stress matters.
Medication can matter.
And sometimes the digestive system simply doesn’t appreciate what we’ve given it.
A perfectly ordinary meal can leave one person feeling absolutely fine and another feeling as though they’ve swallowed an inflatable dinghy.
Our digestive systems aren’t identical.
Which is slightly inconvenient when the internet keeps insisting that one particular eating plan will fix everybody.
Constipation: the subject nobody puts on Instagram
We need to talk about constipation.
I know.
The glamour of this book is becoming overwhelming.
But constipation is one of the common causes of bloating.
When bowel movements become less frequent or stools are difficult to pass, people may experience discomfort, fullness and abdominal swelling.
And constipation isn’t always as obvious as simply not going to the toilet for several days.
You might go regularly but still struggle or feel you haven’t emptied properly.
I hadn’t appreciated how much constipation could contribute to that uncomfortable, swollen feeling.
The practical advice is annoyingly familiar.
Enough fluid.
Appropriate fibre.
Regular movement.
Not ignoring the urge to go.
And seeking advice if the problem persists.
Apparently my digestive system, like my muscles, would prefer that I stop sitting still for quite so long.
Everyone’s a critic.
Fibre: wonderful, but perhaps don’t go from zero to lentils overnight
This was another interesting discovery.
We’re constantly told to eat more fibre.
And generally, that’s good advice.
Fibre supports normal bowel function and can help with constipation.
Foods such as vegetables, fruit, oats, beans, lentils and wholegrains provide different types of fibre.
But here’s the catch.
If you suddenly increase your fibre intake dramatically, you can end up with more gas and bloating.
Which is rather unfortunate when you’re eating all those healthy foods specifically because you’re trying to feel better.
Imagine deciding that Monday is the beginning of your new healthy lifestyle.
Breakfast: enormous bowl of high-fibre cereal.
Lunch: lentil salad.
Dinner: beans, vegetables and wholegrains.
By eight o’clock you’re sitting on the sofa wondering whether your digestive system is attempting to communicate in Morse code.
Too much enthusiasm. Too quickly.
Increasing fibre gradually gives the digestive system more opportunity to adjust.
And drinking enough fluid matters too.
I found this rather reassuring.
Because sometimes a healthy change can be sensible in principle but uncomfortable if you launch into it like an overexcited contestant on a wellness programme.
Why do the healthy foods make me windy?
This feels deeply unfair.
You make an effort.
You eat your vegetables.
You choose beans.
You add lentils.
You congratulate yourself on being a responsible adult.
And your digestive system responds by producing enough gas to power a small village.
Some foods contain carbohydrates that aren’t completely digested in the small intestine.
When they reach the large intestine, gut bacteria break them down.
Gas can be produced during that process.
This is normal.
But some people are more sensitive to it than others.
Beans, lentils, onions and certain vegetables are common examples of foods that can increase wind.
That doesn’t make them bad foods.
Quite the opposite.
Many are nutritious sources of fibre and other useful nutrients.
It simply means that tolerance varies.
The answer isn’t necessarily to stop eating every food that produces gas.
It’s to notice patterns, consider portion sizes and make changes sensibly.
Because eliminating half the supermarket every time your stomach makes a noise isn’t much of a long-term nutrition strategy.
Then I discovered FODMAPs
Another acronym.
Of course.
Apparently menopause research comes with an unlimited supply.
FODMAPs are certain types of carbohydrates that can be poorly absorbed or fermented in the gut.
For some people, particularly those with irritable bowel syndrome, they can contribute to bloating, abdominal pain and changes in bowel habits.
This is where the internet gets enthusiastic again.
Suddenly there are lists of foods to avoid.
Foods to replace.
Foods to reintroduce.
Foods that apparently need written permission before entering your kitchen.
But a low-FODMAP diet isn’t something everyone with a bloated stomach needs.
It’s a structured approach sometimes used for IBS, ideally with support from a suitably qualified dietitian.
It isn’t a general menopause diet.
And I don’t particularly want to spend midlife frightened of onions.
I’ve got enough going on.
The gut microbiome: fascinating, but please stop trying to sell me things
Once I started reading about gut bacteria, I discovered an entire industry waiting to welcome me.
Probiotics.
Prebiotics.
Fermented foods.
Gut cleanses.
Microbiome resets.
Powders.
Capsules.
Drinks.
Tests.
Apparently my intestines had become a business opportunity.
Now, the microbiome is genuinely fascinating.
Researchers are investigating how gut microorganisms interact with hormones, metabolism, inflammation and overall health.
There is growing interest in how these relationships change around menopause.
But there’s a difference between:
Scientists are investigating an interesting relationship.
And:
Buy this expensive powder and fix your menopausal gut.
Those are not the same statement.
Probiotics may help some specific digestive conditions, but their effects depend on the strains used, the condition being treated and the individual.
We can’t assume that every product labelled gut health will improve bloating.
And there’s no established ideal menopausal microbiome that we can simply purchase in a bottle.
Interesting. Not magic.
There it is again.
I’m beginning to think that sentence should appear on every supplement label.
Eating slowly sounds ridiculous until you think about it
Another possible contributor to bloating is swallowing air.
Which sounds like something you’d have to do deliberately.
Apparently not.
Eating quickly, drinking fizzy drinks and certain habits can increase the amount of air we swallow.
And that air has to go somewhere.
I began thinking about how often we eat while doing something else.
Standing in the kitchen.
Working.
Looking at our phones.
Trying to finish lunch before somebody needs us.
Teaching has certainly never been a profession that guarantees a leisurely midday meal.
Sometimes lunch is less of a meal and more of a timed event.
So slowing down when possible isn’t necessarily bad advice.
Not because we need to turn every sandwich into a mindfulness retreat.
But because eating at a slightly less frantic pace may help some people.
I draw the line at thanking every lettuce leaf before consuming it.
Stress and digestion are apparently on speaking terms
Another connection I hadn’t properly appreciated was the relationship between the brain and the gut.
The digestive system and nervous system communicate constantly.
Stress can affect digestive symptoms.
And digestive discomfort can make us feel more stressed.
Wonderful.
Another circular relationship.
Poor sleep can make the day harder.
A difficult day can increase stress.
Stress can affect the gut.
The gut becomes uncomfortable.
Now you’re lying in bed worrying about your stomach.
And there goes your sleep again.
Honestly, my body’s departments need to stop holding meetings without me.
This doesn’t mean digestive symptoms are imaginary.
Quite the opposite.
The gut–brain connection is physiological.
And it helps explain why stress management can sometimes be part of managing digestive symptoms.
Not the whole answer.
But one piece of the puzzle.
Do I need to stop eating everything I enjoy?
This was a question I found myself returning to.
Because every time you research a symptom online, somebody appears with a list of forbidden foods.
No dairy.
No gluten.
No sugar.
No carbohydrates.
No caffeine.
No anything remotely enjoyable.
At this rate, dinner will consist of three lettuce leaves and a motivational quote.
But unless there’s a diagnosed medical reason or a clearly identified intolerance, cutting out entire food groups isn’t automatically necessary.
For example, coeliac disease requires a strict gluten-free diet.
But that diagnosis should be investigated properly, and testing needs to be done while gluten is still being eaten.
Simply removing gluten because you’re bloated can complicate the process of finding out whether coeliac disease is actually present.
Likewise, lactose intolerance may explain symptoms for some people, but not everybody needs to abandon dairy.
I wanted a way of eating that supported my health.
Not one that turned every meal into an obstacle course.
A food diary without becoming a food detective
This was where I found the idea of tracking symptoms useful.
Not obsessively.
Not recording every crumb as though I were preparing evidence for a criminal trial.
Just noticing patterns.
When did the bloating happen?
Was it occasional or frequent?
Was I constipated?
Had I eaten unusually quickly?
Were certain foods consistently associated with discomfort?
Was I experiencing other symptoms?
Sometimes a pattern becomes obvious.
Sometimes it doesn’t.
But having a little information can be useful when talking to a GP or dietitian.
It also stops us relying entirely on memory.
And as we established in Chapter Seven, my memory is currently outsourcing several responsibilities to my phone.
Bloating isn’t the same as weight gain
I want to return to this because it matters.
Menopause can be associated with changes in body composition and fat distribution.
But that is different from temporary abdominal bloating.
One involves longer-term changes.
The other may fluctuate over hours or days.
It’s possible to experience both.
It’s also possible to experience neither.
And I don’t want to turn this chapter into another discussion about how women should make their stomachs smaller.
We’ve had enough of that.
A comfortable, functioning digestive system is the goal.
Not achieving a perfectly flat stomach at fifty.
I’m much more interested in whether my gut is healthy and comfortable than whether my abdomen looks exactly the same at eight in the morning and eight in the evening.
Bodies change throughout the day.
That’s normal.
Persistent discomfort, however, is something worth understanding.
Now for the important bit
This is where the jokes stop for a moment.
Because bloating is common.
And most of the time, it has a relatively ordinary explanation.
But persistent or frequent bloating can occasionally be a symptom of something more serious.
Including ovarian cancer.
I know.
That’s not a particularly cheerful turn in the conversation.
But it’s important.
The NHS advises women to seek medical assessment for frequent or persistent bloating, particularly when accompanied by symptoms such as pelvic or abdominal pain, feeling full quickly, loss of appetite or needing to urinate more often.
These symptoms are common and can have many causes.
Having them does not mean you have cancer.
But they shouldn’t simply be dismissed as menopause either.
Especially if they’re new, persistent or unusual for you.
And I want to be very clear about the difference between occasional bloating after a meal and a new pattern of persistent abdominal swelling.
They’re not automatically the same thing.
Other warning signs include unexplained weight loss, blood in your poo, persistent changes in bowel habits or significant abdominal pain.
These deserve medical advice too.
I learnt this lesson with my unexpected postmenopausal bleeding.
I’d gone a full year without a period.
Then I started bleeding again.
I could have assumed it was hormonal.
Instead, I went to my GP.
I was referred for investigations.
The results were clear.
And I was extremely grateful that the NHS had taken it seriously.
So I’m applying the same principle here.
Don’t ignore a persistent change simply because you’re menopausal.
There’s that rule again.
Menopause can explain a lot. It doesn’t explain everything.
So what am I actually going to do about my gut?
By this point, I had accumulated quite a collection of information.
Some useful.
Some interesting.
Some clearly designed to separate women from their money.
But the practical conclusions were surprisingly straightforward.
I didn’t need to begin an elaborate gut-reset programme.
I didn’t need seventeen new supplements.
And I certainly didn’t need to apologise for having a stomach.
I needed to pay attention to what was happening.
Eat a varied, nutritious diet.
Include fibre and increase it gradually if necessary.
Drink enough.
Keep moving.
Notice whether certain foods consistently caused problems.
Avoid unnecessary restrictions.
And seek medical advice when symptoms were persistent, unusual or worrying.
None of this was particularly revolutionary.
There was no secret ingredient.
No expensive powder.
No miraculous three-day transformation.
Just a collection of sensible habits that support digestive health.
Which, now I think about it, seems to be becoming a theme.
I don’t want another complicated health project
That’s probably the biggest lesson I’m taking from this entire research journey.
At the beginning, I thought looking after myself through menopause would involve discovering the correct collection of products.
The right supplements.
The right foods.
The right exercises.
The right sleep routine.
The right everything.
But the more I learn, the more I realise that health isn’t a puzzle with one perfect solution.
It’s a collection of things that work together.
Food.
Movement.
Sleep.
Strength.
Medical care when needed.
Understanding our bodies.
And recognising when something isn’t right.
I don’t want to spend the next twenty years constantly trying to optimise myself.
I want to feel well enough to enjoy them.
I want to eat good food.
Move comfortably.
Sleep reasonably well.
Keep my muscles strong.
Look after my bones.
And occasionally enjoy a meal without conducting a detailed analysis of what it might do to my digestive system.
Surely that’s not too much to ask.
And what about the jeans?
Well.
Sometimes the answer really is as simple as wearing something comfortable.
Not every change requires a solution.
Not every fluctuation in our bodies needs investigating.
And certainly not every uncomfortable waistband is a personal failing.
But when bloating becomes frequent, persistent or painful, it’s worth finding out why.
Because the goal isn’t to squeeze ourselves back into yesterday’s jeans.
It’s to understand what’s happening and feel comfortable in the bodies we’re living in today.
Preferably without having to undo a button under the restaurant table.
Although I reserve the right to do that occasionally.
For entirely legitimate reasons.
By now, I’d researched muscles, bones, joints, supplements, skin, sleep, brain fog, sexual health and digestion.
I’d learnt a remarkable amount.
I’d also discovered that almost every menopause-related internet search eventually leads to somebody trying to sell you something.
But there was one subject I still needed to tackle properly.
HRT.
Hormone replacement therapy.
Three little letters capable of starting an argument in almost any online menopause discussion.
Some women swear by it.
Some are frightened of it.
Some can’t take it.
Some don’t want it.
Some have been told conflicting things by different people.
And I was already taking it.
So I wanted to understand what the evidence actually said.
Not the headlines.
Not the horror stories.
Not the miracle claims.
The facts.
Because if there’s one thing this whole menopause adventure has taught me, it’s that making informed decisions is considerably easier when you understand what you’re deciding about.
And HRT deserved more than a quick Google search.
