Constipation is one of the most common perimenopause symptoms and one of the least discussed. Recent survey data found 54% of perimenopausal and menopausal women report it, and 82% say it began or worsened during the transition. Clinically, constipation means meeting specific criteria, not just “going less than you used to.”
Nobody hands you a list when perimenopause starts. Hot flashes get mentioned constantly. Periods getting unpredictable gets mentioned too. What tends to go unsaid, almost entirely, is that your bowel movements might slow down, get harder to pass, or leave you feeling like you didn’t quite finish, and that this is common enough to have real numbers behind it.
You’ve probably already tried the obvious fixes. More water. A fiber supplement, maybe two different kinds, bought at different times when the first one didn’t quite work. An over-the-counter laxative you only use “when it’s really bad,” because you’re not sure it’s meant for regular use and nobody ever told you either way. If none of that has fully or reliably resolved it, you’re not doing it wrong. This is a genuinely common, under-discussed symptom, not a personal failure of hydration or willpower.
How common this actually is
Data presented at the Menopause Society’s 2025 annual meeting, from a survey of nearly 600 women aged 44 to 73, found digestive symptoms in 94% of respondents overall. Constipation specifically was reported by 54%, and 82% said their digestive symptoms began or got worse during perimenopause or menopause. Only 33% had ever received a formal diagnosis for what they were experiencing, and 58% of those who sought professional help said the support they got was inadequate.
That last number is worth sitting with. More than half of the women who actually asked for help with this felt like the help they got fell short of what they actually needed.
This isn’t a new observation, either. An older study comparing 170 postmenopausal women to 58 premenopausal women, using a standardized GI symptom questionnaire, found altered bowel function in 38% of the postmenopausal group compared with 14% of the premenopausal group, a difference too large to attribute to chance. Different decades of research, using different methods, converging on the same basic pattern: something about this transition specifically changes how your bowels behave, consistently enough to show up clearly in two separate datasets collected decades apart.
Only about a third of women in the more recent survey had ever received a formal diagnosis connecting their symptoms to perimenopause at all. Most had simply been living with it quietly, often for years, without a single doctor naming the connection out loud.
What actually counts as constipation
“I feel constipated” and an actual clinical diagnosis of constipation aren’t automatically the same thing, and knowing the difference helps you describe what’s genuinely happening more precisely, to yourself and to anyone you ask for help. The current diagnostic standard requires at least two of the following, present for the last three months: straining during more than a quarter of bowel movements, lumpy or hard stools more than a quarter of the time, a sense of incomplete evacuation more than a quarter of the time, needing to use manual maneuvers to help things along more than a quarter of the time, or fewer than three spontaneous bowel movements a week.
| Sign | Counts if it happens |
|---|---|
| Straining | More than 1 in 4 bowel movements |
| Hard or lumpy stools | More than 1 in 4 bowel movements |
| Feeling of incomplete evacuation | More than 1 in 4 bowel movements |
| Needing manual help | More than 1 in 4 bowel movements |
| Frequency | Fewer than 3 spontaneous bowel movements a week |
You don’t need all five to count. Two is the actual threshold, present consistently for three months, with symptoms that first started at least six months back.
Why more fiber doesn’t always fix it
Fiber is the near-universal first suggestion, and it’s not wrong exactly, but it’s incomplete advice for a slow-transit gut. The underlying mechanism has real hormonal drivers, and when transit is already slow, adding fiber quickly, before your gut has adjusted, means more material sitting and fermenting for longer, which can make bloating worse before bowel movements improve. The amount matters less than the pace of the increase, and that nuance rarely makes it into the “just eat more fiber” advice you’ll hear from nearly everyone, including well-meaning friends who found it helped them.
It’s not that fiber is the wrong direction. It’s that the standard advice skips the part about pace, and skips mentioning that a slower gut generally needs a slower ramp-up, not a sudden dose all at once. A change that genuinely helps most people can backfire, temporarily, in a gut that’s already struggling to keep pace with what’s already there.
What this looks like in practice
Not a treatment plan, since that depends on specifics a general article can’t know about you.
Match your symptoms against the actual criteria, not just a general feeling. “Constipated” covers a lot of ground and means different things to different people. Straining, hardness, incomplete evacuation, and frequency are four genuinely different things that can each be tracked and described separately.
If you’ve already tried fiber and hydration without real improvement, that’s useful information, not evidence you’re doing something wrong. Test results coming back normal doesn’t mean nothing is happening; it means the standard workup wasn’t built to explain this particular pattern.
Bring the specific criteria to an appointment, not just the word “constipated.” “I strain during more than a quarter of my bowel movements, and it’s been this way for six months” gets a more useful clinical response than a general complaint, and it signals that you’ve already done some of the diagnostic work yourself.
A dropped tolerance for wine follows a related logic. The mechanism there involves a different enzyme, but the same hormonal instability underneath it.
Common questions
How common is constipation during perimenopause?
Recent survey data found 54% of perimenopausal and menopausal women report constipation, with 82% saying digestive symptoms began or worsened during the transition. Older peer-reviewed research found postmenopausal women report altered bowel function at roughly twice the rate of premenopausal women.
What officially counts as constipation?
Meeting at least two of five criteria for three months: straining, hard or lumpy stools, a sense of incomplete evacuation, or needing manual maneuvers, each more than a quarter of the time, or fewer than three spontaneous bowel movements a week.
Why didn’t more fiber fix it?
In a gut where transit is already slow, adding fiber too quickly can increase fermentation and bloating before bowel movements actually improve. The rate of increase matters as much as the total amount, and which type of fiber you’re adding matters just as much as the pace.
Is this the same as IBS with constipation?
They overlap heavily and share some criteria, but functional constipation and IBS-C are evaluated somewhat differently, partly based on how much abdominal pain is involved relative to the bowel changes themselves. If you already carried an IBS diagnosis before this decade, the relevant research is a little different than for constipation appearing for the first time.
Should I just take a laxative regularly?
That’s a conversation worth having with a doctor rather than a default answer, since different types of laxatives work through different mechanisms and aren’t all appropriate for daily long-term use.
Why did nobody mention constipation when they told me about perimenopause?
Hot flashes and period changes tend to dominate the conversation, partly because they’re more visible and more discussed publicly. Digestive symptoms are common but rarely named on the same list, despite showing up in the majority of women during this transition according to recent survey data.
Does this eventually get better on its own?
The research doesn’t clearly answer that for constipation specifically the way it does for some other perimenopausal symptoms. What’s known is that the transition itself, with its hormonal volatility, is a major driver, and that volatility does eventually settle after the final period.
Is it related to the loud gurgling I sometimes get at night?
Possibly, since both trace back to the same underlying motility changes. The nighttime version has its own explanation worth reading on its own, separate from the constipation pattern itself.
Knowing how common this is and what it clinically means doesn’t explain why it’s happening in your particular gut. Progesterone is a large part of that mechanism, and it’s worth understanding on its own terms.
Fortylight is written by Nina Halvorsen, a food scientist, not a physician, dietitian, or licensed health professional. Nothing here is medical advice. Digestive symptoms can signal serious conditions. If you have blood in your stool, unexplained weight loss, persistent vomiting, difficulty swallowing, bleeding after menopause, or symptoms that began after age 50, see a doctor before trying anything on this site.