Why women are more likely to have IBS

“Hot girls have IBS.” This declaration first became an unlikely rallying cry on social media in 2019—and its appeal has only continued to grow. 

Gut health figured prominently in a recent McKinsey report about the $1.8 billion global wellness market, and the demand for gut supplements to ease the symptoms of irritable bowel syndrome is expected to balloon from $9 billion to $19 billion by 2033. 

But “hot girls have IBS” is more than a trending hashtag—it’s an indication of a very real and growing problem: IBS affects up to 45 million people in the United States. And about two in three of those who suffer from it are women.

What is IBS?

IBS isn’t a disease, but a syndrome, or functional disorder, marked by a constellation of symptoms, like constipation, diarrhea, chronic abdominal pain, bloating, and changes in bowel habits. 

There’s no specific test for IBS but there are specific criteria around its various subtypes, as well as the frequency and duration of symptoms. For that reason it’s referred to as a diagnosis of exclusion since doctors will first rule out other possibilities. 

Roshini Raj, a New York-based gastroenterologist at NYU Langone, usually tests for celiac, lactose intolerance, or even Crohn’s or colon cancer first. “Once we’ve ruled out anything that could share similar symptoms, then you diagnose someone with IBS,” says Raj, who is also the founder of the fiber supplement brand Yayday.

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A nationwide study conducted by Cedars-Sinai in December 2023 found that IBS is even more prevalent than previously estimated. And at Parsley Health, a functional medical practice with locations in New York and L.A., gut and GI issues are one of the top conditions they treat—and most of those patients are women, says Robin Berzin, Parsley’s founder and CEO. 

“Nearly 70 percent of folks dealing with a GI symptom or condition are women,” says Berzin, adding that inflammatory bowel disease (IBD), which includes autoimmune disorders like Crohn’s and colitis celiac, takes it to 80 percent.

Why is IBS worse among women?

There are many theories for why women bear the brunt of IBS diagnoses, but one of the leading suggestions is that it may be hormonal. 

Symptoms tend to be most acute during the menstrual phase of your cycle, says Georgia Close, a gastroenterologist at Putnam Hospital in Carmel, New York. Post-menopause, she adds, women with IBS report a worsening of symptoms, plus more fatigue, anxiety, depression, and lower quality of life scores. 

There haven’t been many studies directly linking IBS to hormone levels or examining which hormones are in play—from your thyroid hormones to estrogen and progesterone, to hormones related to fertility. But there is some evidence to suggest how different hormones might play a role. 

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Chelsea McCallum, an accredited dietitian with Dietitians Australia, says that estrogen and progesterone fluctuations can influence gut motility (or how quickly things move through) and lead to increased bloating, abdominal pain, and changes in bowel habits. Studies also suggest that hypothyroidism, which is more common in women, can lead to small intestinal bacterial overgrowth (SIBO) and, in turn, may play a role in IBS. 

“There's research showing that caring for gut health can resolve symptoms related to thyroid dysfunction and that gut health impacts thyroid autoimmunity,” Berzin says.

Women in menopause who take hormone replacement therapy (HRT) often find that it doesn’t affect the symptoms of IBS—but it can affect the gut microbiome, says Mark Pimentel, executive director of Cedars-Sinai’s Medically Associated Science and Technology Program. “We published a study recently that women in menopause have a different gut microbiome compared to premenopausal women, and interestingly, adding HRT made their microbiome look younger,” he says. 

Women also have it worse when it comes to pain if they also have a gynecologic disorder. “There’s some new preliminary data that shows women with IBS and PCOS (polycystic ovary syndrome) and endometriosis tend to have more severe pelvic pain,” says Close. “Many young female patients are getting conflicting advice and are unsure whether their issue is gynecologic or genital urinary or GI.” 

Finally, a 2017 study found that the immune system may have a role in the development of IBS—and women are known to be more susceptible to autoimmune diseases.

Stress and the gut-brain axis

Chronic stress and anxiety are likely another significant factor in the rising numbers of IBS among women. Women are both more likely than men to experience stress and it affects them differently—including in the gut.

“When you’re in a constant state of fight of flight, your gut stops moving consistently,” says Berzin of the downstream effects of stress on the gut, and that can result in constipation, bloating, acid reflux, and SIBO (a frequent cause of IBS, that can also manifest on the skin as rosacea). 

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IBS and our mental health are so intertwined because of the gut-brain axis, essentially a message system running back and forth between the two. 

“When someone has a diagnosis of IBS, it’s well established that anxiety, depression, and overall stressors will trigger symptoms,” says Rabia de Latour, a gastroenterologist at NYU Langone, adding that the gut lining is one of the largest producers of serotonin. “There’s also a lot of data emerging about dysbiosis and deregulation within the gut exacerbating someone’s mental health issues.”  

How to treat IBS 

Because IBS expresses itself differently from one person to another, and comes with its own individualized triggers, treating it appropriately often requires a bespoke approach by your gastroenterologist, functional medicine doctor, or nutritionist. 

But while there is no one-size-fits-all solution, there is some advice that has broad appeal. Getting solid sleep and curbing stress levels are considered essential for gut health. “Poor sleep can impact hunger hormones and worsen digestive symptoms,” says McCallum, adding that finding your stress management technique, whether it’s meditation or cognitive behavioral therapy or exercise is key for keeping symptoms at bay. 

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Raj says that antidepressants, administered in low doses, are proven to be helpful because the same neurotransmitters are at play with depression and a disordered bowel. 

Then there’s the question of what you’re putting into your body. Following a low FODMAP diet is widely considered by experts to be an effective approach. “It involves removing certain short-chain carbohydrates (FODMAPs) that are poorly absorbed in the small intestine and can be rapidly fermented by gut bacteria,” says McCallum.

One of the first questions de Latour asks patients presenting with GI issues is a simple one: how much water are you drinking? The majority aren’t getting enough (she advises keeping an eye on urine to make sure it’s light, not dark) and it can have a ripple effect on your health, particularly on constipation. “People are very busy and there’s a lot of cognitive dissonance when it comes to hydration,” she adds. 

The other major gap in our diets is fiber. “We have an epidemic in our country of people not getting enough fiber in their diet,” says de Latour. Women should get 25 to 30 grams daily; most are barely hitting 10. Berzin points to diets rooted in high sugar and refined and processed foods as a culprit. “There’s not a lot of fiber or phytonutrients in those foods that are important to maintaining gut motility,” says Berzin. 

For those who don’t want to actively think about how much fiber is in their diet though, a wave of brands has emerged with supplements that bear little in common with the Metamucils of yore. 

Part of the reason may be that it’s an easy solution for optimizing gut health. But these brands are also destigmatizing a conversation once considered taboo. 

“A lot of women are experiencing discomfort but they’re just living with it,” says Berzin. She urges patients to get tested—after all, she adds, the gut is home to your second brain and 70 percent of your immune system. “Our digestive system is really smart, and we need to listen to it.”