Food Science and Human Nutrition Department, University of Florida, 572 Newell Dr, Gainsville, FL, 32611, USA.
Sensical Science, LLC, 3104 Sneed St #316, Dallas, TX, 75204, USA.
BMC Womens Health. 2020 Jun 29;20(1):136. doi: 10.1186/s12905-020-01000-x.
Little is known about how the menstrual cycle affects gastrointestinal function and self-reported stress in young, healthy women taking oral contraceptives (OC). This study prospectively characterized gastrointestinal function and symptoms on each day throughout the menstrual cycle.
Healthy women aged 18-35 years (n = 78) who took OC participated in the 5-week observational study. Stool frequency, self-reported stress, stool form measured by the Bristol Stool Form Scale (BSFS), and gastrointestinal symptoms measured by a modified version of the Gastrointestinal Symptom Rating Scale (GSRS) were assessed daily. GSRS scores were reported (1 = no discomfort at all, 7 = very severe discomfort) and were averaged for individual syndrome scores or summed for the total score. The validated, weekly version of the GSRS was completed at two time points to reflect menstruation and 1 week prior to menstruation (n = 72). Outcomes were analyzed in linear mixed models with the Dunnett's post hoc test against day 1 of menstrual bleeding or with nonparametric tests.
Daily stress (P = 0.0018), BSFS score (P = 0.0493), stool frequency (P = 0.0241), abdominal pain (P < 0.0001), diarrhea (P = 0.0022), constipation (P = 0.0446), reflux (P = 0.0193), and indigestion (P < 0.0001) all varied significantly by the day of the menstrual cycle. Dunnett's post hoc tests showed that scores (mean ± SEM) on the first day of bleeding (day 1) for daily abdominal pain (2.6 ± 0.2), diarrhea (1.7 ± 0.1), and indigestion (2.1 ± 0.2) symptoms were higher than scores on all other days of the menstrual cycle (P < 0.05) with scores not on day 1 falling under 1.5, or between no discomfort at all and slight discomfort. Reflux, stool frequency, BSFS, self-reported stress, and constipation were higher on day 1 (P < 0.05) than on 12, 8, 6, 4, and 2 other days of the menstrual cycle, respectively. The median (IQR) GSRS score was higher during the week of menstruation than the week prior to menstruation for diarrhea [1.50 (1.00-2.33) vs 1.33 (1.00-2.00), P = 0.002] and abdominal pain [2.00 (1.33-2.67) vs 1.67 (1.33-2.33), P = 0.011] syndrome scores.
Bowel habits appear to vary across the menstrual cycle and suggest more gastrointestinal discomfort on day 1 of menstrual bleeding in healthy women taking OC. Future interventional studies could identify ways to improve gastrointestinal symptoms in healthy women during menstruation.
关于口服避孕药（OC）使用者的月经周期如何影响胃肠道功能和自我报告的压力，知之甚少。本研究前瞻性地描述了整个月经周期中每天的胃肠道功能和症状。
年龄在 18-35 岁的健康女性（n=78）服用 OC 参加了这项为期 5 周的观察性研究。每天评估粪便频率、自我报告的压力、粪便形态（Bristol 粪便形态量表（BSFS））和胃肠道症状（改良胃肠道症状评分量表（GSRS））。GSRS 评分报告为（1=一点也不不适，7=非常严重不适），并对个体综合征评分进行平均，或对总评分进行求和。在两个时间点完成了经过验证的、每周一次的 GSRS，以反映月经和月经前一周（n=72）。使用线性混合模型分析结果，并使用 Dunnett 事后检验与月经出血第一天或非参数检验进行比较。
每日压力（P=0.0018）、BSFS 评分（P=0.0493）、粪便频率（P=0.0241）、腹痛（P<0.0001）、腹泻（P=0.0022）、便秘（P=0.0446）、反流（P=0.0193）和消化不良（P<0.0001）均随月经周期的天数而显著变化。Dunnett 事后检验显示，出血第一天（第 1 天）的每日腹痛（2.6±0.2）、腹泻（1.7±0.1）和消化不良（2.1±0.2）症状评分高于月经周期的所有其他天数（P<0.05），第 1 天的评分不低于 1.5，或介于无不适到轻微不适之间。反流、粪便频率、BSFS、自我报告的压力和便秘在月经出血的第一天（P<0.05）高于月经周期的其他 12、8、6、4 和 2 天。腹泻[1.50（1.00-2.33）vs 1.33（1.00-2.00），P=0.002]和腹痛[2.00（1.33-2.67）vs 1.67（1.33-2.33），P=0.011]综合征评分的中位数（IQR）在月经周高于月经前一周。
肠道习惯似乎在月经周期中发生变化，在服用 OC 的健康女性中，月经出血的第一天胃肠道不适更明显。未来的干预性研究可以确定在女性月经期间改善胃肠道症状的方法。
