So last week I took you guys through the ways in which inflammation, gut health and hormone levels can increase bloating in the lead up to your period.
This week I want to give you some tools to actually alleviate that bloating, now you know why it’s happening. I’m going to give you two types of tools, one set to deal with in the moment of bloating and another set for which are long-term strategies to help you to address the root cause.
So, let’s start with the tools you can use in the moment. Many of these tools I’m about to share are based on my training with world leading SIBO doctor, Dr Allison Siebecker. I’m using her doses, which are safe and effective and if you’d like a reference for these doses, they are actually available on her website, under handouts, in a handout called Symptomatic Relief Guide. So these doses are available publicly, you don’t need a prescription for them, but always consult your doctor before starting new supplements.
1. Number one is using a prokinetic. A prokinetic is either a pharmaceutical drug or natural supplement which improves gut motility in the small intestine, so it increases transit time in the small intestine and also stimulates the migrating motor complex in the small intestine, which is the wave like motion that clears bacteria from food out of the small intestine and into the large intestine. When the migrating motor complex is slowed, this is when we are at risk of developing SIBO and one study actually found that 100% of participants with endometriosis had gut motility dysfunction.
A prokinetic doesn’t stimulate a bowel movement by the way, so it’s not a laxative. It doesn’t get to work on your large intestine, but on your small intestine, so it’s essentially aiding you to digest and move your food into the large intestine, and to clear gas and bacteria out of the small intestine too.
To stimulate the migrating motor complex, we can use a prokinetic at night, but for bloating, you can take it during the day, and this will support healthy transit time of gas accumulating in the small intestine. This can be really helpful in the second half of our cycle, when progesterone is naturally causing things to slow down!
So the two natural supplements you could try are ginger and STW5, which is also known as iberogast. For ginger, there are many different prokinetic formulas and I’ve put some of the best ones in the show notes, and you would just take the label dose, twice a day, one to two hours after meals or as needed, just be sure not to exceed the recommended dose on the label or to exceed 2000mg of ginger per day.
STW5 is a tincture, and you would take 20 drops with meals as or as and when needed.
I do just want to caution here that some of the ginger formulations can cause ginger burn, which is like a hot burning sensation in the diaphragm area, so if you have acid reflux this may not be the best option for you. You can normally get rid of the feeling through drinking water, but some formulations are less ‘ginger burn’ causing and I’ve highlighted which ones in the show notes. Ginger, being a spice, can also irritate bladder symptoms if you have interstitial cystitis, so this is something to consider and normally, I find the formulas which cause less ginger burn, cause less bladder problems.
Secondly, because STW5 also contains alcohol, I find this to also irritate the bladder in people with interstitial cystitis, so just be cautious with these two and experiment until you find a formula that works for you.
Finally, if you experience pain with prokinetics, it’s normally due to motility actually starting to get to work, which can cause muscle contractions at first, but if the pain is severe or persistent, it may be that you have an obstruction or adhesions disrupting the motility flow and working against it. If that’s the case, stop using and see a visceral manipulation therapist who can access your gut for adhesions and obstructions.
2. Peppermint oil
Next up is peppermint oil. Peppermint oil is actually a smooth muscle relaxant and is great for abdominal pain, if you get pain with your bloating and generally, it’s really wonderful for pretty much all IBS symptoms. Recent research has shown its effectiveness in multiple symptoms of IBS, so this is a great option if you have IBS issues frequently with endo and in the lead up to your period.
So, you could of course try the tea, and some people do find that to be effective, but generally, peppermint oil tends to be stronger. If you wanted to go for tea, I would make sure it’s strong for it to work!
For capsules, you want enteric coated peppermint oil, which are capsules that have a coating on them which protects them from stomach acid, so that the peppermint is released lower down in the intestines where we want it.
You would just follow the label dose and take as needed, though you could take them every day during the second half of your cycle as the effects are stronger when taken consistently.
However, if you have acid reflux, peppermint may not be the best option for you as it can sometimes cause acid reflux. Another possible side effect is nausea. You could test yourself on one dose and see how you respond of course and take it from there, but if you’re prone to acid reflux or nausea, you might want to consider some of the others. If you do want to give peppermint a go, pills are less likely to cause acid reflux or nausea as opposed to peppermint tea or say, a tincture.
Lastly, peppermint oil can slightly slow down motility, so if you are noticing sluggish motility already due to progesterone in the second half of your cycle, either use one of the other options or if you really want to take peppermint oil, also take a prokinetic.
Oddly, if you have interstitial cystitis, it appears peppermint oil may help or it may actually irritate. There’s some research going on at the moment, specifically on peppermint oil for the treatment of interstitial cystitis, and some practitioners advise using the tea, etc. whereas I’ve heard others warn against it. Personally, applying topical peppermint oil helps with my interstitial cystitis pain, and this would be because it’s a smooth muscle relaxant, so it’s calming down any contractions and cramping, but if I drink the tea, I find it causes a burning feeling inside my bladder, so I think you’ll have to see how you respond personally, but I’m very curious to find out the outcome of this study!
3. Number three is activated charcoal. Activated charcoal absorbs gas, so is really helpful for any bloating which is being causing by gut issues during the second half of our cycle.
You can take activated charcoal in supplement or powder form, you would just mix the powder into water, as and when needed, but you do need to ensure that you’re taking it at least 30 minutes before a meal and an hour after a meal, because it doesn’t just absorb gas, it absorbs nutrients too! This would be the same for supplements. You don’t want to be spending money on lovely supplements for the charcoal to be absorbing it all!
You can take up to 1000mg per dose or just follow the label dose, and you can do so four times a day, spacing the doses out by at least two hours, just don’t exceed more than 4 grams of charcoal a day.
Lastly, charcoal can sometimes cause constipation, so of course, we don’t want to worsen that if you already struggling with sluggish bowels in the second half of your cycle. If you are, then you can take magnesium in addition, which I’ll share in the next point.
4. Magnesium
Whilst magnesium won’t directly help with your bloating, it is great for constipation, so if this is one of the root causes of your bloating in the second half of your cycle, magnesium is a good tool to aid with this.
Magnesium is also a nutrient that most of us are deficient in and gets used up with chronic stress and during menstruation, and when we’re low in magnesium it can worsen PMS, pain, and fatigue so this is a great supplement for endometriosis.
The best options for constipation would be citrate or oxide, and I personally prefer oxide for anyone with interstitial cystitis, as the magnesium citrate can be irritating to the bladder for some.
You can take between 500mg to 1000mg in the evening, at bedtime, and it’s best to start at a lower dose, like 500mg, to see how you react to it, as if you take too much you may get diarrhea. The aim is to have a bowel movement come the morning, so that’s the sign you want to know it’s working and normally, it takes about 2-3 days to get to work, so be patient. If you don’t have a bowel movement in this time, move up to a higher dose. Often, 1000mg is the dose most people find works for them, however, as I said, you can go higher, you just can’t exceed 2000mg and you need to ensure you’re increasing your dose slowly.
Finally, make sure you take your dose two hours after food because otherwise this can interfere with the effects.
Hopefully, by supporting your gut to keep to a healthy flow during the second half of your cycle, you’ll experience lessened bloating as waste and gas isn’t hanging around for so long.
5. Number five is abdominal massage and for the purposes of bloating you could use either the I Love You massage or Arvigo Therapy, both of these you can do at home by yourself. Additionally, these massages are great for constipation and sluggish motility, so if you’re noticing those to be an issue in the second half of your cycle, I would recommend trying one of these. They also put your body into the rest and digest state, so if you’re working on trying to calm your nervous system down so your pain decreases over time (which I’ve been talking about a lot recently over on Instagram), then these are a great addition to your routine. You don’t need to do both, one or the other is fine, however, if you want the added benefit of adhesion release and better periods and less endo pain, Arvigo Massage is the way to go.
The I Love You massage is a simple massage where you literally trace the letters ‘I’, ‘L’ and ‘U’ over your intestines repeatedly. There are free YouTube videos on how to do this and I’ve linked to one in the show notes.
With Arvigo Therapy, you first need to be taught how to do it on yourself by a practitioner. The sessions are usually pretty affordable and can be taught in about 30-45 minutes, after which you don’t need to pay for anyone more sessions, you can just start performing the massage on yourself. I’ve linked to a wonderful practitioner in the show notes and to the practitioner directory.
You can do these massages daily, and I personally recommend using them in the evenings before bed, which is when the migrating motor complex really gets to work and as these help to stimulate it, they’ll give your motility a nice boost overnight. Of course, if you’re feeling bloated in the moment and want some instant relief, if you feel like it’s not painful to do, you could perform these massages when needed. Both of them take just 10-15 minutes at the most, so they’re quick to do.
6. Number six is a slightly different one and that’s lymphatic drainage. We’re not addressing the bloating directly but more the water retention and fluid build-up in the body, which could in turn help to reduce the bloating, depending on whether your bloating is coming from water retention or from fermentation in the gut.
So the lymph system is a collection of vessels that run like a map across the body, under the skin and around organs. They are connected to lymph nodes which can be found in places like your armpits and groin, they’re the small shaped bumps you feel when you’re unwell.
The lymph vessels contain fluid that collects waste products, toxins, bacteria, viruses, etc. from around the body. These products are then delivered to the lymph nodes, which attack any pathogens (baddies), and this is usually when the swelling occurs if you have a really active infection - that’s why you’ll get raised bumps under your arms when you have a virus for example.
Once the most harmful pathogens have been killed off, these toxins, waste products and dead bacteria are sent to the liver and kidneys through the blood stream, where they’ll eventually be filtered out of the body.
What’s important to note here is that the lymph system cannot transport waste on its own - the fluid begins flowing with assistance from movement, such as massage or exercise and if we don’t assist it, it can stagnate, like a stream that’s become blocked.
Helping to get the lymph system moving will help to shift any build-up of excess fluid and water retention, and it can help to get rid of the excess LPS which may be circulating in our blood stream before menstruation and would certainly be adding to our inflammation levels.
There are multiple ways to get lymph fluid moving, but two lovely self-care methods you could try are dry brushing before your shower and then using a sort of lymphatic drainage paddle after your shower on your skin.
So before your shower, you would use a dry body brush and starting at your ankles, brush upwards in short bursts, going over them same area three to five times before moving to the next section of your leg. The brush strokes should be fairly firm, and short, so say from your ankle to mid-calf and then from mid-calf to your knee. You would work your way up your legs, bum, torso, all moving up towards your heart, and then you would go to your arms, starting at your wrists, and working your way up to your shoulders. The process should take about 5-7 minutes.
Then you can jump in the shower, and you can totally stop here if you like. A body brush is about £10, so it’s a nice and affordable option.
If you want to add another layer, you can get a lymphatic drainage body tool, which looks a bit like a paddle and is made of wood. I think it originates from the gua sha technique. You would essentially follow the exact same pattern you took with the body brush, but this time more lightly, it can be very gentle, and you would apply oil first, so you don’t pull your skin. I tend to use coconut oil and my paddle was £18 from Amazon. I’ve linked to it so you know the kind of thing you’re looking for.
Now of course, this process is most effective when done every day but honestly, I struggle to fit it in, so you could try a couple of times a week or whatever works for you!
7. Number seven is taking an anti-inflammatory supplement. Now as we discussed last week, I don’t think the swelling and bloating is purely down to inflammation alone, but it certainly plays a role as inflammation is
