Menstrual Bloating Before and During Periods

The time period from ovulation to menstruation is marked with various symptoms some of which can vary among women. Abdominal bloating is one of these symptoms that many women experience and loathe as it not only is uncomfortable but can also alter the female figure. It is often termed as fluid retention but there is no significant evidence to suggest that fluid accumulation within the lower abdominal cavity accounts for all cases of menstrual bloating. Although the fluctuation in hormone levels may affect fluid retention, abdominal bloating in menstruation is largely due to functional bloating. This means that there is bloating that is not a result of any disease and neither is it associated with functional bowel disorders like irritable bowel syndrome where bloating is a common symptom.

Causes of Menstrual Bloating

Menstrual bloating tends to occur just before and during menstruation. It may start as early as ovulation and persist until the end of menstruation. Abdominal bloating may be a visible and measurable enlargement of the abdomen (distension) with or without a sensation of fullness in the abdomen. It can be associated with other causes particularly gastrointestinal disorders.

In most instances menstrual bloating is functional in nature with evidence suggesting that it may associated with increased intestinal gas and the abnormal passage of this gas.  This does not remove the possibility of fluid retention, particularly if there are additional symptoms like swelling of the feet. However, functional bloating in itself is not clearly understood – neither why it occurs or how it happens.

Not all women experience this bloating and even when it occurs it may not be severe. Instead it may be more likely in women with menstrual irregularity and underlying gynecological disorders like endometriosis and polycystic ovarian syndrome (PCOS). In women who are experiencing secondary amenorrhea, which is the cessation of periods after menarche, there may be monthly bloating around the time of menses although the menstrual period does not occur. It is important to note that a significant distension that appears to be progressing over weeks may not be functional bloating and needs to be medically investigated.

Signs and Symptoms

Abdominal bloating is a symptom. Functional bloating is considered as a functional disorder although it is a not a diseased state. Typically the bloating lasts for just a few days, averaging between 3 days just before and during menstruation. In some women the bloating may start as early as ovulation, or occur at the time of ovulation, resolve and then occur again with menstruation. The bloating, apart from causing discomfort on its own, may also lead to further irritation of the skin as the undergarments or tight clothing may cause pressure and friction when there is  distension.

Treatment of Menstrual Bloating

There is a tendency by many women to use over-the-counter water pills (diuretics) to treat menstrual bloating. This should be avoided as far as possible. If the distension is due to fluid retention then it should be investigated further to identify any disorders associated with the kidneys and electrolyte levels. While a diuretic may help despite the bloating is not due to fluid retention, it is a dangerous practice as the additional fluid and electrolytes are lost unnecessarily and this can lead to dehydration.

Bloating should not be viewed as a symptom on its own but in conjunction with the changes that are occurring in the body at the time of menstruation. It is usually transient and should not be singled out for treatment on its own. Avoiding ‘gassy’ foods and carbonated beverages, exercising and eating smaller meals may all help to minimize bloating. Water should not be avoided because it can actually trigger fluid retention by the kidneys. Looser fitting clothing may reduce the discomfort. Treatment of menstrual irregularities or underlying gynecological disorders may significantly ease bloating along with other menstrual symptoms.

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