Q1. How does perimenopause affect IBS? I have lived with IBS most of my life, but it seems to be getting worse as I age (I'm 52). Is there a connection?

While there is clearly a connection between irritable bowel syndrome (IBS) and menopause, not enough studies have been done to explain it. When you have IBS, your nervous system releases substances known as neurotransmitters that can change the function of your colon (large intestine), leading to diarrhea, constipation, diarrhea alternating with constipation, and bloating. We also know that IBS is more common among women and that the female hormones responsible for menstrual periods frequently change IBS symptoms, often making them worse.

During menopause, your hormone levels change. Some studies have shown that IBS symptoms improve with menopause, while others have reported that IBS symptoms worsen. Some studies have also reported that the onset of perimenopause can trigger the onset of IBS. Estrogen replacement therapy does not appear to improve IBS symptoms, so I recommend using remedies that worked for you previously. Some newer agents that are effective in constipation-predominant IBS include Miralax; probiotics work for some patients with other forms of IBS.

Q2. Can birth control pills trigger IBS symptoms?

— Dawn, Indiana

Symptoms of irritable bowel syndrome (IBS) do vary along with the menstrual cycle, due in part to fluctuating hormones. However, there is no evidence that oral contraceptives alter these symptoms. In fact, one study found that women on birth control pills have fewer symptoms of IBS (including anxiety or depression) compared with women not taking birth control pills. However, with any medication, including birth control pills, patients may have adverse side effects that can include intestinal symptoms. You may want to try a holiday from the pills to see if the symptoms improve. If your symptoms reappear when you start taking your pills again, you may want to speak to your doctor about finding an alternative form of birth control.

Q3. Can IBS cause pancreatitis? I had three weeks of severe abdominal bloating and pain and then an X-ray revealed that I had pancreatitis. My doctor told me to stop eating dairy and eat less fiber. I feel better, but still nauseous, bloated, and have pain in my upper abdomen. I have been out of the hospital for four weeks now, on a bland diet, and still feel sick. What should I eat?

— Julie, California

IBS, also known as irritable bowel syndrome, does not cause pancreatitis. Pancreatitis is an inflammation of the pancreas, an organ that secretes proteins that are important for the breakdown of nutrients and the metabolism of sugar. The most common causes of pancreatitis include gallstones, alcohol and certain specific medications. If gallstones are the cause, then the gallbladder should be removed by an operation called a cholecystectomy. If alcohol consumption is the cause, then alcohol should be completely avoided. Some patients have evidence of chronic pancreatitis with their first episode; such evidence includes calcifications of the pancreas on X-ray. Chronic pancreatitis is often much more difficult to treat than acute pancreatitis; episodes of pain take much longer to improve. In addition to a bland, low-fat diet, pancreatic enzymes taken before each meal often help the pain and bloating in pancreatitis and also aids in the digestion of food.