Bloating

A feeling of fullness, tightness or swelling in the stomach. The NHS website describes bloating as a tummy that feels full and uncomfortable.

It is on Roshara's symptom score because the Pakistan Menopause Society lists it in early perimenopause, alongside headaches, joint and muscle pains and breast tenderness, and with concern about weight (Table 1).

The NHS website lists a tummy that feels full or bigger than usual, tummy pain or discomfort, rumbling, and passing more wind than usual.

In Urdu it is pait phoolna, and it is easy to dismiss. A swollen stomach by late afternoon. A waistband you keep loosening. Feeling heavy before you have finished a meal.

Here the guidance is thin, and it is better to say so. The Pakistan Menopause Society lists bloating among the symptoms of early perimenopause but does not explain why it happens. The NHS bloating page does not mention menopause at all.

What the NHS website does say is that the most common reason for bloating is gas in the gut, from some foods and drinks or from swallowing air while eating, and that problems such as constipation, a food intolerance, coeliac disease or irritable bowel syndrome can cause it. It also notes that some women feel bloated around their period.

If you are on HRT, the Pakistan Menopause Society lists bloating among the side effects of estrogen (section 5.12).

The NHS website suggests:

• exercising regularly, which helps digestion
• eating smaller, more frequent meals, and chewing with your mouth closed
• foods high in soluble fibre, such as oats or linseed, if you are constipated
• not having large meals late at night, or slouching while you eat
• cutting down on fizzy drinks, alcohol, and the caffeine in tea and coffee
• not eating lots of foods known to cause wind, such as cabbage, beans or lentils, or lots of processed, sugary, spicy or fatty food

Read that list in a Pakistani kitchen and it is half the menu: dal, chana, chai, a late dinner. Nobody is suggesting you give up dal. Noticing which meals leave you worst can help, and gut health and chai and caffeine go further.

The NHS website says treatment is often not needed, and when it is, it depends on the cause. A pharmacist can suggest laxatives for constipation or a medicine to ease bloating. A GP may refer you to a dietitian, or for tests to find the cause.

If bloating started with HRT, the Pakistan Menopause Society's principle is the lowest dose that works (section 5.12). Adjusting the dose or type is a conversation for your prescriber; HRT risks and benefits covers the wider picture.

The NHS website says to see a GP if you feel bloated regularly, if changing your diet has not helped, or if bloating comes with weight loss you cannot explain or blood in your poo. It says to get an urgent appointment if bloating comes with vomiting, diarrhoea or constipation, a stomach ache, a fever, a lump in your tummy, or if you cannot pee, poo or pass wind.

Bloating that does not go away matters for one more reason. The NHS website lists frequently feeling bloated, roughly 12 or more times a month, among the main symptoms of ovarian cancer, along with pelvic pain, feeling full quickly or losing your appetite, and needing to pee more often or urgently. It asks you to tell your GP if anyone in your family has had ovarian or breast cancer. The NHS adds that these symptoms are very common and have many possible causes. Persistent bloating still deserves a proper look.