Gut health is the cornerstone of overall well-being, yet an alarming number of women silently battle with digestive issues daily. From bloating and irregular bowel movements to chronic fatigue and mood swings, the signs often go overlooked or misdiagnosed.
What makes it more complex is that women’s gut health is influenced not only by diet and lifestyle but also by hormonal fluctuations, stress levels, and even societal expectations around body image and eating habits. As a result, many women find themselves caught in a cycle of discomfort without fully understanding the root cause.
The female gut is uniquely sensitive and intricately connected to the endocrine and nervous systems. Hormones such as estrogen and progesterone can directly impact digestion and gut motility, particularly during menstruation, pregnancy, or menopause. Add to that the impact of chronic stress, irregular eating patterns, and the overuse of antibiotics or birth control pills, and it becomes clear why women are disproportionately affected by gut-related issues. In conversation with The Daily Jagran, Dr. Varun Teja, MD, DM (Madical Gastro), Consultant Medical Gastroenterologist Apollo Hospitals, Visakhapatnam, shares the science behind female gut health struggles and offers actionable insights to help women restore balance from within.
Women And Gut Health Issues
Irritable Bowel Syndrome Has A Hormonal Component
Women in India are significantly more likely to experience IBS, particularly forms characterised by constipation and bloating. According to a 2023 meta-analysis, women are 2.5 times more likely than men to be diagnosed with IBS. The predominant subtypes among Indian women are IBS-C (constipation-dominant) and IBS-M (mixed), both exacerbated by hormonal fluctuations during menstruation, pregnancy, or perimenopause.
Estrogen and progesterone influence gut motility and pain sensitivity. Dr. Varun Teja states, “These hormonal shifts contribute to cyclical symptoms that often align with the menstrual cycle. During perimenopause and menopause, some patients report worsening of symptoms previously dismissed as “functional” or stress-related.”
IBS remains a clinical diagnosis, and its management requires personalized attention to diet, psychological health, and bowel pattern. Indian diets, particularly those high in fermentable fibers or spices, can trigger or worsen symptoms. For women, these effects often fluctuate based on hormonal cycles, complicating both diagnosis and treatment.
Acid Reflux In Women May Not Present As Heartburn
In clinical consultations, reflux-related symptoms in women are more likely to include throat discomfort, dry cough, hoarseness, or nausea rather than classical retrosternal burning. Dr. Varun Teja states, “Pregnancy and menopause increase the risk of lower esophageal sphincter dysfunction, contributing to reflux symptoms.”
A multicenter Indian study on gastroesophageal reflux disease found that fewer than 10 per cent of patients with symptomatic reflux had visible mucosal damage during endoscopy. This underscores the need for diagnosis based on symptom clusters, especially in women, and not solely on imaging findings.
Fatty Liver Disease Does Not Always Show Up In Blood Reports
According to the Apollo Health of the Nation report, 65 per cent of individuals screened were found to have fatty liver. Among these, 85 per cent had non-alcoholic fatty liver disease (NAFLD). In Telangana and Andhra Pradesh, 47 per cent of people showed signs of Grade I fatty liver. These findings were not limited to patients with elevated liver enzymes.
More than half of the individuals diagnosed with fatty liver through imaging had normal blood test results. This indicates that reliance on transaminase levels alone can delay diagnosis and subsequent lifestyle intervention. Several women who came in for non-specific digestive concerns were ultimately found to have NAFLD, despite no reported alcohol intake or abnormal labs. For Indian women, many of whom consume high-carb, low-protein diets, fatty liver is often the first visible sign of metabolic dysfunction.
Post-Menopausal Transition Intensifies GI Risk
Among women beyond menopause, the data shows a significant increase in metabolic burden. The prevalence of fatty liver rises from 54 per cent to 70 per cent, obesity increases from 76% to 86 per cent, and Type 2 diabetes climbs from 14 per cent to 40 per cent. These shifts reflect changes in body composition, visceral fat distribution, and insulin resistance that follow the hormonal transition.
Dr. Varun Teja mentions, “Fatty liver and gastrointestinal motility disorders often co-exist with these metabolic alterations. The reduction in estrogen affects bile flow and gut barrier function, which may contribute to dysbiosis, inflammation, and subtle nutrient malabsorption.” These issues may not present as acute illness, but they increase the risk of long-term complications, including cirrhosis and colorectal disorders.
Gut Health Issues In Women (Image Credits: Canva)
Normal Tests Might Not Mean Normal Health
Clinical observations and findings from national screening programs highlight a significant gap in identifying early gastrointestinal and metabolic conditions. For instance, many individuals with non-alcoholic fatty liver disease (NAFLD) present with normal blood test results, showing that routine diagnostics, such as liver enzyme tests, may not always capture early signs of liver dysfunction.
In one study, it was found that over 50 per cent of individuals with NAFLD had normal liver enzyme levels, underscoring the need for more advanced imaging techniques to detect the condition. Similarly, digestive issues like bloating, gas, and indigestion are commonly reported in clinical practice, and in some screening programs, over 60 per cent of individuals exhibit these symptoms. These patterns point to a broader spectrum of metabolic and gastrointestinal disturbances that are often overlooked by standard diagnostic protocols.
Lifestyle Modifications Must Be Contextual And Specific
Generic advice about eating less fried food or walking more does not suffice. Women require tailored nutritional and metabolic guidance. For example, the gut microbiota fluctuates across the menstrual cycle, and symptoms of bloating or irregularity may intensify premenstrally. This requires a rhythm-based approach to fiber and probiotic intake.
Dr. Varun Teja states, “Women entering menopause need focused screening for fatty liver, bone health, and glucose metabolism. Liver ultrasounds or FibroScans should be considered even in the absence of symptoms.”
Women’s gastrointestinal health is a field still catching up with the evidence. The gut is not isolated from hormonal, metabolic, and cultural variables. It is time for our healthcare approach to reflect this reality.
Gastrointestinal care for women must be predictive, preventive, and personalised. We are no longer treating symptoms in isolation, but patterns within a larger physiological and social context. Screening early, listening carefully, and treating beyond the obvious are the next steps forward.