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Key takeaways:
- IBS is more prevalent in women than men, with a pooled odds ratio of 1.67 across community studies worldwide.
- A 2025 Science study in mice found estrogen amplifies a colonic gut-pain pathway involving L-cells, PYY, and serotonin.
- In a 2025 Menopause Society survey, 82% of midlife women said digestive symptoms began or worsened around menopause.
- New data presented at ACG 2026 shows men make up 26.8% of digital gut-brain therapy users but only 20.0% of clinician referrals.
IBS is up to twice as common in women as in men. Three things drive the gap: estrogen-sensitive gut-pain signaling, hormonal shifts across the menstrual cycle and menopause, and higher post-infectious risk.¹ New data we presented at ACG 2026 adds a twist: men with IBS are less likely to be referred to gut-brain therapy by their clinicians.²
In October 2026, gastroenterologist Dr. Trisha Pasricha’s Washington Post column put the sex gap in IBS back in the headlines.¹
For clinicians, the bigger question is what that gap changes in practice. Which symptoms matter most at which life stage, when should you look beyond IBS, and which patients are slipping through the referral net?
How much more common is IBS in women than men?
IBS is roughly 1.7 to 2 times more common in women than in men. A meta-analysis of community studies found a pooled odds ratio of 1.67 (95% CI 1.53–1.82).³
The gap opens around puberty and narrows later in life. That’s one of the strongest clues that sex hormones are involved.¹
Infection risk differs too. After infectious enteritis, women have more than twice the odds of developing IBS (OR 2.2, 95% CI 1.6–3.1).⁴
How estrogen drives visceral hypersensitivity in IBS
Estrogen appears to amplify gut-pain signaling, according to a 2025 Science study from UC San Francisco.⁵
In mice, estrogen acted on L-cells in the lower colon. It increased their sensitivity to short-chain fatty acids from bacterial fermentation and triggered release of PYY. PYY then prompted neighboring enterochromaffin cells to release serotonin, which activated pain-sensing nerve fibers.⁵
Removing the ovaries reduced gut pain sensitivity in female mice. Giving estrogen to male mice raised theirs to female levels.⁵ This is animal data and still needs confirming in humans.
Earlier human research points the same way. In a study of 29 women with IBS, rectal sensitivity rose at menses, along with worse abdominal pain and bloating. Healthy women showed no such cyclical change.⁶
Applying this in practice
Ask women with IBS how their symptoms track with their cycle. A flare at menses fits hormone-sensitive visceral hypersensitivity and doesn’t mean management is failing.
The fermentation link may also explain why certain foods provoke pain in some women. If you’re not a dietitian yourself, refer to one who specializes in gut health. They can assess whether a time-limited dietary trial is the right fit.
IBS and menopause: what the Menopause Society data shows
Digestive symptoms are common and under-recognized through the menopause transition, according to two consecutive years of data presented at The Menopause Society’s annual meeting.
In a 2025 survey of nearly 600 women aged 44–73:⁷
94% reported digestive symptoms
bloating affected 77%, constipation 54%, and stomach pain 50%
33% had a formal IBS diagnosis
82% said their symptoms began or worsened at perimenopause or menopause
of those who sought professional help, 58% found it inadequate
In 2026, the MOMENTUM Canadian cohort of more than 1,800 women aged 40–60 linked GI symptoms with anxiety across the menopause trajectory.⁸ Bloating and gas were the most common symptoms, with 65.6% of women scoring above the normal severity range. Moderate to severe anxiety rose from 14.6% in premenopause to 19.2% in perimenopause.⁸
Dr. Stephanie Faubion, medical director of The Menopause Society, said “fluctuating and declining hormone levels create a disruptive bidirectional interaction” between gut and brain.⁸
These findings don’t conflict with IBS rates narrowing later in life. Population prevalence and one woman’s symptom trajectory through perimenopause measure different things.
Applying this in practice
New or worsening symptoms in a midlife woman still need a positive diagnostic workup. That means checking alarm features and making sure age-appropriate colorectal cancer screening is up to date.⁹
Given the gut-anxiety link in this age group, screening for anxiety alongside GI symptoms gives you a fuller picture of what’s driving the presentation.
When to look beyond IBS in women: a quick differential
The diagnosis isn’t always IBS. Endometriosis is the most common mimic in women and can delay the right diagnosis for years.¹
| Clinical clue | Consider | Next step |
|---|---|---|
| Severe pain around menses, pain during sex, or no response to IBS management | Endometriosis | Gynecology referral¹ |
| Alarm features (rectal bleeding, weight loss, iron deficiency anemia, family history) | Colorectal cancer, IBD | Colonoscopy⁹ |
| Diarrhea-predominant symptoms | Celiac disease | Celiac serology⁹ |
| Symptoms began after gastroenteritis | Post-infectious IBS | Manage as IBS; risk is higher in women⁴ |
“Especially in our current medical infrastructure and the fast-paced nature of our clinics, patients – especially women with IBS-D – are more likely to have that initial IBS diagnosis overturned.”
– Dr. Emily Ward, Gastroenterologist, Founder of GutsyRX
Is IBS underdiagnosed in men? New referral data presented at ACG 2026
Men with IBS are less likely to be diagnosed and less likely to be referred for gut-brain therapy. So part of the female predominance may reflect who reaches care, not only who has symptoms.
A 2026 US survey of more than 88,600 adults looked at people who met Rome IV criteria (the version used in that study, before Rome V). Among them, 36.5% of women had a physician diagnosis of IBS, compared with 26.2% of men.¹⁰ Men were also slightly less likely to seek care (68.7% vs 73.3%).¹⁰
Our own research with Mayo Clinic shows the same gap further down the pathway.
In our DDW 2026 analysis of 22,821 users of a digital gut-brain therapy program, men were less likely to be clinician-referred than women (26.2% vs 35.1%).¹¹ But 74% of men came on their own, which suggests strong interest.¹¹ Men also disengaged earlier: Day 30 retention was 59.3% vs 65.9% for women.¹¹
The analysis we presented at ACG 2026 went bigger, with 790,304 users. Men made up 26.8% of all users but only 20.0% of clinician-referred users.²
Provider gender mattered too. Female providers referred 16.4% male patients, while male providers referred 31.3%. Female providers made up 81.3% of referrers.²
Gender concordance between provider and patient didn’t improve conversion or completion. Provider patterns may partly reflect practice mix, which the data couldn’t fully account for.²
| Women | Men | |
|---|---|---|
| Community IBS prevalence | Higher (OR 1.67)³ | Lower |
| Physician-diagnosed, among those meeting Rome IV criteria | 36.5%¹⁰ | 26.2%¹⁰ |
| Share of all digital gut-brain therapy users | 72.1%² | 26.8%² |
| Share of clinician-referred users | 78.7%² | 20.0%² |
| Day 30 program retention | 65.9%¹¹ | 59.3%¹¹ |
Applying this in practice
Raise gut-brain therapy with your male IBS patients directly. Many are already looking for it on their own, and the data shows you don’t need to be the same gender as your patient for the referral to work.¹¹ ²
Men tend to drop off in the first week, so an early check-in in the first one to two weeks can help them stay engaged long enough to benefit.¹¹
Where gut-brain therapy fits for women and men with IBS
Gut-brain therapy targets visceral hypersensitivity and altered gut-brain signaling. That shared mechanism keeps IBS symptoms going, whether hormones, infection, or stress started them.
The ACG clinical guideline recommends gut-directed psychotherapies, including gut-directed hypnotherapy, for global IBS symptoms.⁹ Gut-brain therapy can be introduced at any point in the pathway: first line, alongside diet and medication, or later.
Nerva is a digital gut-brain therapy program, delivered via an app in 15–20 minutes a day. In a peer-reviewed RCT, 81% of Nerva users achieved a clinically meaningful improvement on the IBS Symptom Severity Scale, compared with 63% on an active control.¹² In the same trial, 71% had a clinically significant reduction in abdominal pain, compared with 35%.¹²
To bring it into your practice, you can refer patients or simply recommend Nerva.
Frequently asked questions
Do IBS symptoms differ between men and women?
Women with IBS are more likely than men to report abdominal pain and constipation-related symptoms, while men more often report diarrhea-related symptoms.¹³ A meta-analysis described these differences as modest, so symptom pattern alone shouldn’t steer diagnosis.¹³
Is gut-directed hypnotherapy effective for men with IBS?
Gut-directed hypnotherapy trials have enrolled predominantly women, often 85–90%, so male-specific efficacy data is still limited.¹¹ Real-world data shows men seek out gut-brain therapy but disengage earlier, which makes early follow-up especially useful.¹¹
How long does gut-directed hypnotherapy take to work for IBS?
Gut-directed hypnotherapy benefits typically emerge after several weeks of consistent practice, which is why structured programs run for at least 6 weeks.¹¹ In the Nerva RCT, improvements were broadly maintained to 6 months.¹²
What percentage of IBS patients are women?
Women make up most diagnosed IBS patients, and in a digital program of 790,304 users, 72.1% were women.² That share rose to 78.7% among clinician-referred users, a gap the data we presented at ACG 2026 suggests is partly about referral patterns rather than prevalence alone.²
How do you refer a patient to a digital gut-brain therapy program?
A referral to Nerva can be made through the clinician form or simply by recommending the program to a patient. Referrals don’t expire, so patients can start when they feel ready.
The DDW 2026 and ACG 2026 analyses were led by Austin Hoeg, with Mauricio Jin and Xiao Jing (Iris) Wang of Mayo Clinic, and Claire Hall and Alex Naoumidis of Mindset Health.
References
Pasricha T. New clues point to why IBS is twice as common in women as men. The Washington Post. October 26, 2026. Link
Hoeg AJ, Jin M, Hall C, Naoumidis A, Wang XJ. S1322: Provider and patient gender differences in clinician referral to digital brain-gut behavioral therapy for IBS [ACG 2026 abstract]. Am J Gastroenterol. 2026. doi:10.14309/01.ajg.0001214540.06371.2b
Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712-721.e4. doi:10.1016/j.cgh.2012.02.029
Klem F, Wadhwa A, Prokop LJ, et al. Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis. Gastroenterology. 2017;152(5):1042-1054.e1. doi:10.1053/j.gastro.2016.12.039
Venkataraman A, Figueroa EE, Castro J, et al. A cellular basis for heightened gut sensitivity in females. Science. Published online December 2025. doi:10.1126/science.adz1398
Houghton LA, Lea R, Jackson N, Whorwell PJ. The menstrual cycle affects rectal sensitivity in patients with irritable bowel syndrome but not healthy volunteers. Gut. 2002;50(4):471-474. doi:10.1136/gut.50.4.471
The Menopause Society. Digestive health issues more common during perimenopause and menopause. Press release. October 21, 2025. Link
The Menopause Society. Excessive bloating and gas plague women throughout the menopause transition. Press release. October 20, 2026. Link
Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036
Almario CV, Liu J, Higgins C, et al. Disparities in health care seeking and physician diagnosis of irritable bowel syndrome: results from a United States survey. Clin Gastroenterol Hepatol. 2026;24(10):2826-2838. doi:10.1016/j.cgh.2026.03.008
Hoeg A, Jin M, Wang I. Gender differences in early attrition during digitally delivered brain-gut behavioral therapy for IBS [DDW 2026 abstract]. Gastroenterology. 2026. doi:10.1016/S0016-5085(26)04738-4
Anderson EJ, Peters SL, Gibson PR, Halmos EP. Comparison of digitally delivered gut-directed hypnotherapy program with an active control for irritable bowel syndrome. Am J Gastroenterol. 2025;120(2):440-448. Link
Adeyemo MA, Spiegel BMR, Chang L. Meta-analysis: do irritable bowel syndrome symptoms vary between men and women? Aliment Pharmacol Ther. 2010;32(6):738-755. doi:10.1111/j.1365-2036.2010.04409.x
