Sex hormones in the modulation of irritable bowel syndrome

Table 1 Correlation between hormonal status and irritable bowel syndrome symptoms expression[36]

Status	Hormone levels	IBS and pain related symptoms expression	Ref.
Late luteal phase (premenses)	Rapid decline in estrogen and progesterone levels	Exacerbation of bowel symptoms	[33,34]
		Increased bloating
Menstruation (menses)	Lowest levels of estrogen and progesterone	Exacerbation of bowel symptoms	[34,35,37,38,40]
		Increased abdominal pain/discomfort
		Lower rectal sensitivity threshold
Dysmenorrhea	Disturbances in hormonal interactions at different regulatory levels (lower progesterone level)	Exacerbation of bowel symptoms	[41]
Pregnancy	Physiological hyperestrogenemia and hyperprogesteronemia	Reduced pain sensitivity and alleviation of many chronic pain syndromes	[27,51,73]
		Exacerbation of constipation (prolonged gastrointestinal transit)
Menopause	Decline in ovarian hormones	Decrease in IBS incidence	[26,53,54]
		High prevalence of constipation and somatic discomfort syndromes
Oral contraceptives	Estrogen and progestin administration	Reduced abdominal symptoms at menses	[55]
Hormone replacement therapy	Estrogen (and progesterone) supplementation	Increased prevalence of IBS in postmenopausal women during HRT	[58]
		Prolongation of IBS symptoms to a later age
Oophorectomy	Ovarian hormone deficiency	Exacerbation or occurrence of gastrointestinal symptoms after gynecological surgery	[60]
Men with IBS	Lower level of luteinizing hormone in middle-aged men	Generally more prevalent diarrhea (compared to women with IBS)	[66,70]
	Elevated level of sex hormone-binding globulin in young men
Transsexual women (male-to-female subjects)	Estrogen/anti-androgen treatment	Development of chronic pain including visceral pain	[72]

IBS: Irritable bowel syndrome; HRT: Hormone replacement therapy.