SOS for PMS gas

Q:

I’m 48 and perimenopausal. I’ve noticed a pattern that a day or so before my period, I feel constipated and I pass really smelly gas. It’s become so embarrassing! Is there anything I can do?

A:

Absolutely. Fluctuations in estrogen and progesterone before your period cause uterine cells to produce prostaglandins, hormone-like substances that trigger the muscles of the uterus to contract and shed its lining. But prostaglandins also relax the GI tract, which can lead to constipation. The slowed GI transit time adds to gas production and flatulence, and stool that sits in your colon longer can emit a strong odor. The odor may also reflect gut bacteria changes during your cycle, which raise levels of odorous sulfur.

I advise increasing your fiber intake and avoiding known trigger foods

(for many women, these are dairy or sugar) during this time. It’s also worth trying a probiotic for digestive health (like Align, Walmart.com) since studies find they can reduce flatulence. Some of my patients also find relief with over-the-counter anti-gas pills.

Q

I need a hip replacement, and there’s no way I’ll be able to get my feet in the stirrups at my upcoming checkup. What should I do?

A

Rest assured, your provider is used to accommodating patients with all types of mobility issues, and like you, many women can’t assume the rotated-hip position typical for a pelvic exam. One alternative is the M position, where you lie on your back and keep each foot on the table. A study of this position found that women felt more comfortable and Pap smear quality did not differ. Another option is to lie on your side, with your knees tucked into your chest.

Before your appointment, call your doctor to ask if you’re due for a Pap—guidelines from the American College of Obstetricians and Gynecologists call for them every three to five years. If you’re not due and aren’t having symptoms like bleeding, pelvic pain or abnormal discharge, your provider may agree to skip the pelvic exam.