Digestive Health Digestive Health Basics

The Cause of Inflation: Bloating Explained

There's nothing like bloating to make you feel sluggish and uncomfortable. Who feels like working or going out when you're convinced you're twice your normal size?

Although many women have had days where the skirt they wore yesterday no longer fits, the precise cause of this "full" feeling is sometimes unclear. That's because bloating can be caused by gynecological or gastrointestinal troubles, or a combination of the two.

Hormonal Bloating
For premenopausal women, bloating is often related to the menstruation. During the last two weeks of the menstrual cycle, known as the luteal phase, women can retain water, which causes swelling in not only the abdomen, but also sometimes in the hands, feet and breasts.

The rising levels of hormones also have a direct effect on the gastointenstinal tract. "This hormonal effect causes the GI tract not to empty as quickly and to produce gas," explains Dr. Grace Janik, director of Reproductive Endocrinology at St. Mary's Hospital in Milwaukee.

Because stool and gas are moving more slowly through the intestines, women often have constipation and bloating in the two weeks before their periods. When women get their periods, their hormone levels drop and they sometimes get diarrhea.

Although it's less common, women can also have hormone-related bloating from changing, starting or stopping birth control pills, or from the contraceptive Depo-Provera. Bloating due to these contraceptives, however, usually subsides after about three months.

Abdominal swelling may be a sign of early pregnancy, particularly in women who aren't using birth control. Older women who are taking hormone therapy for menopausal symptoms such as hot flashes may also have discomfort from bloating.

Dr. Linda Bradley, a gynecologist and director of hysteroscopic services at the Cleveland Clinic Foundation, says that after taking a younger woman's medical history, she often suggests the patient keep a diary of her symptoms to help determine the cause(s). If it appears to be related to the menstrual cycle, she may prescribe a mild diuretic or birth control pills. Exercising, avoiding gas-producing foods and adding bulk fiber to the diet may also ease premenstrual bloating.

Sometimes, Bradley says, women are not necessarily seeking treatment; many just want to know that the cause is nothing serious.

Gynecological Obstruction
If abdominal bloating is persistent rather then cyclical, it might be due to a mass such as an ovarian cyst or uterine fibroid. Women older than 50 need to be especially cautious and consult a doctor about any chronic bloating, because it could be a sign of an ovarian tumor. "Age makes a difference," Janik says. "An increase in abdominal size is much more concerning in women in the postmenopausal range."

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