The

Novel Journal

Q: Why do hemorrhoids get worse with age?

As estrogen declines during perimenopause and menopause, the connective tissue and blood vessel walls that support hemorrhoidal cushions weaken. Combined with slower bowel motility and reduced tissue elasticity, this creates conditions where hemorrhoids are more likely to swell, prolapse, and take longer to heal.

Q: Is it normal to get hemorrhoids for the first time in menopause?

Yes. Many women develop hemorrhoids for the first time during perimenopause or after menopause. Estrogen loss reduces structural support in the anorectal region, making hemorrhoidal tissue more vulnerable to straining, prolonged sitting, and hard stools, all of which contribute to hemorrhoid development.

Q: Do hemorrhoids get better after menopause is complete?

Not automatically. Tissue changes that contribute to hemorrhoids are related to sustained low estrogen, not to the transition itself. Without targeted management like stool consistency, skin barrier support, and possibly local estrogen, symptoms typically persist or worsen over time.

Q: Can hormone replacement therapy help with hemorrhoids?

Local estrogen therapy (applied topically to the vaginal or perianal area) may help restore tissue integrity that contributes to hemorrhoid flares. Systemic hormone therapy’s effect on hemorrhoids specifically is less studied. This is worth discussing with your healthcare provider as part of a broader menopause management plan. If you are in need of a menopause-trained provider, The Menopause Society’s database of certified practitioners is a good place to start.

Vol. 1.2

05.04.2026

Why Hemorrhoids Get Worse After Menopause

By Sarah Lunsford, PhD
Co-Founder & Chief Science Officer

Medically Reviewed by Candace Westgate, DO

Updated June 11, 2026

Quick Answer

Hemorrhoids often worsen after menopause because estrogen loss causes blood vessel walls and connective tissue to weaken and lose elasticity, making hemorrhoidal tissue more prone to swelling and slower healing.

The good news: understanding why this happens makes it much easier to manage.

If you’re in perimenopause or menopause and your hemorrhoids have suddenly gotten worse, or appeared for the first time, you’re not imagining it. Estrogen decline directly affects the tissue integrity, blood vessel walls, and bowel function that govern anorectal health. The relationship between menopause and hemorrhoids is underreported, underresearched, and almost entirely absent from mainstream menopause conversations. This article explains what’s actually happening and what helps.

“The relationship between menopause and hemorrhoids is underreported, underresearched, and almost entirely absent from mainstream menopause conversations.”

What Happens to Hemorrhoids Tissue After Menopause

Hemorrhoids are cushions of vascular tissue that sit inside and around the anal canal. In a healthy state, they help with continence and cushioning. The problem occurs when that tissue becomes swollen, inflamed, or prolapsed. Menopause accelerates exactly the conditions that cause this.

Estrogen and connective tissue strength

Estrogen plays a critical, often overlooked role in maintaining connective tissue throughout the body. A 2010 study confirms that estrogen receptors are present in anal sphincter and perianal tissue, meaning the drop in estrogen during menopause directly weakens the structural support around hemorrhoidal cushions.

Without adequate estrogen, the connective tissue and smooth muscle that hold hemorrhoidal tissue in place loses elasticity and strength. Cushions that were once well-supported become more prone to swelling, slipping out of position (known as prolapse), and healing poorly after irritation.

Why blood pools more easily

Estrogen also helps blood vessel walls maintain their tone, the ability of blood vessel walls to contract and push blood back toward the heart. As estrogen declines, that process slows. In the tissue around the anal canal, blood pools more easily in hemorrhoidal cushions, which increases how often they swell and how severely.

Bowel changes that compound the problem

Menopause frequently brings changes how the gut moves. Progesterone, which also declines during menopause, slows intestinal movement, making stools harder and bowel movements more effortful. Straining is one of the most direct drivers of hemorrhoid development and flares.A study published in the journal Women’s Health found that 38% of postmenopausal women reported altered bowel function compared to 14% of premenopausal women, a pattern that includes constipation, straining, and sluggish motility, all of which contribute to hemorrhoid flares.

WHAT THE RESEARCH SHOWS

Estrogen receptors exist in anal sphincter and perianal tissue.

Postmenopausal women have a higher rate of bowel dysfunction than premenopausal women.

Connective tissue throughout the pelvic floor weakens as estrogen declines.

Hemorrhoidal tissue recovery after irritation is slower when tissue integrity is compromised.

Why Perimenopause Is Often When Symptoms First Appear

Many women first notice worsening hemorrhoid symptoms during perimenopause, years before their last period. Estrogen levels don’t drop in a straight line. They fluctuate erratically during the years leading up to menopause, which can cause unpredictable flares in tissue that’s already under hormonal stress.

If you’ve had hemorrhoids before and noticed them becoming more frequent or more severe in your 40s, perimenopause is a likely contributor. If hemorrhoids are appearing for the first time, the same mechanism applies: the tissue has less support than it used to, even if circulating estrogen is still present.

KEY DEFINITION

Perimenopause: The phase leading up to the menopause, typically lasting 4-10 years, during which estrogen levels fluctuate and decline. Menopause itself is defined as 12 consecutive months without a period.

Symptoms That Are More Common After Menopause

The same hemorrhoid symptoms exist at any age, but postmenopausal women may experience them differently, or experience a cluster of symptoms that hadn’t appeared together before.

Increased frequency of flares, often without an obvious dietary or behavioral trigger
Hemorrhoids that take longer to calm down after a flare
External hemorrhoids that prolapse more easily
Anal itch that persists even without active inflammation (related to tissue thinning)
More pronounced bleeding with less straining than before
Pain that lingers after bowel movements, a sign that tissue recovery is slower

Rectal bleeding should always be evaluated by a healthcare provider, not because it is necessarily serious, but because it warrants a proper diagnosis.

What Actually Helps

Use topical products strategically

Most OTC anorectal products are designed for acute symptom relief. That’s appropriate during a flare, but for menopausal women, the tissue needs support between flares.

Evidence supports two distinct roles for topical care. Skin protectants help maintain barrier integrity on an ongoing basis, reducing the baseline vulnerability that makes flares more frequent and severe. Products with active ingredients like lidocaine and hydrocortisone address pain and inflammation when symptoms are acute. These are different jobs, and using only one means only doing half the work.

Talk to your healthcare provider about which ingredients are appropriate for your symptom pattern and how often to use them.
Stool consistency is the most important mechanical factor

If stool is consistently hard or difficult to pass, hemorrhoids will continue to flare regardless of what you apply topically. High fiber intake (25-38g per day for women), adequate hydration, and avoiding prolonged sitting on the toilet are the most evidence-supported behavioral changes you can make.
Ask your healthcare provider about local estrogen

Local vaginal estrogen therapy, applied topically rather than taken systemically, can help restore tissue integrity in the vulvovaginal and perianal region. Research suggests that it reduces menopausal symptoms without the systemic absorption concerns associated with oral hormone therapy. This is a conversation to have with your OB/GYN or primary care provider. For women whose hemorrhoid frequency is driven primarily by tissue thinning, it can make a meaningful difference.
Consider pelvic floor support

Pelvic floor physical therapy isn’t just for bladder leakage. Postmenopausal changes affect the entire pelvic floor, including the anal sphincter complex. A pelvic floor physical therapist can assess whether sphincter tension or pelvic floor dysfunction is contributing to constipation, straining, or hemorrhoid persistence.

Frequently Asked Questions

Why do hemorrhoids get worse with age?

Is it normal to get hemorrhoids for the first time in menopause?

Do hemorrhoids get better after menopause is complete?

Can hormone replacement therapy help with hemorrhoids?

Medical Disclaimer: This content is educational and does not constitute medical advice. Consult a qualified healthcare provider for diagnosis and treatment.