Gut health and menopause have a remarkable connection that affects millions of women worldwide. Women spend about three decades of their life after menopause, which makes learning about this relationship vital to managing health during this life transition. The body’s declining oestrogen and progesterone levels during menopause do more than just cause hot flushes and mood swings-they completely transform the gut microbiome.
Hormonal changes during perimenopause and menopause reduce gut bacteria diversity and trigger various digestive changes. Many women experience common menopause gut issues like bloating, IBS, insulin resistance and weight gain because of these gut imbalances. The link between perimenopause and diarrhoea, along with other digestive issues, can be traced to this evolving relationship between gut health and hormones.
Scientists have found that microbiome disruption directly relates to familiar menopausal symptoms. Hot flushes, anxiety, brain fog, mood swings, and sleep problems all connect to gut health. Better gut health can help ease these challenging symptoms. The body’s hormone levels and microbiome diversity both decrease during midlife, creating a two-way street where each affects the other’s function.
Let’s take a closer look at the complex relationship between the gut microbiome and hormonal changes during perimenopause and menopause. We’ll explore how this connection impacts women’s health and share practical ways to support gut health during this transition.
Understanding the Gut Microbiome and Hormonal Shifts
The digestive tract’s complex ecosystem is a vital part of our overall health, especially during times when hormone levels change throughout life. Scientists have given us an explanation of this intricate relationship that helps manage the hormonal changes during perimenopause and menopause.
What is the gut microbiome?
Our digestive system houses a community of microorganisms known as the gut microbiome. This remarkable ecosystem contains up to 10^11 bacterial cells per gramme of luminal content [1]. Scientists have found between 300 and 1000 different species [2]. The microbiome has viruses, fungi, and archaea that work together as key players in our metabolism [1].
Scientists often call it a “separate organ” because of its widespread influence [3]. The gut microbiome’s genetic footprint is 100 times bigger than the human genome [3]. These microorganisms help maintain our health by:
- Breaking down dietary components (fibre, amino acids)
- Creating essential vitamins and short-chain fatty acids
- Keeping the intestinal barrier strong
- Managing immune function
- Fighting off harmful bacteria
The body can develop various health issues when this balance gets disrupted—a condition doctors call dysbiosis. These problems range from digestive issues to widespread inflammation [1].
How hormones like oestrogen and progesterone interact with the gut
Sex hormones and gut microbiota work together in both directions [4]. Research shows that sex hormones shape the gut microbiome composition, creating what scientists call a “microgenderome” [5].
The gut microbiome looks different in males and females, which points to sex hormones’ influence on its makeup [4]. Research has found that women with higher oestrogen levels typically have more diverse gut microbiota. They show more Bacteroidetes and fewer Firmicutes [6], a balance that indicates a healthier gut.
The gut microbiota also shapes hormone levels through enzyme activities. Progesterone reduces immune system activity, which might make the body more vulnerable to pathogens [4]. Women experience changes in their gut environment after menopause because both progesterone and oestrogen levels drop [4].
This two-way communication affects many body systems and leads to menopause gut problems such as bloating, different bowel habits, and inflammation.
The estrobolome and its role in oestrogen metabolism
There’s an important link between your gut and hormones, especially oestrogen. It all comes down to something called the estrobolome—this refers to certain gut bacteria that help process and manage oestrogen in the body [4]. Here’s how it works:
Your liver first breaks down oestrogen and sends it to your gut through bile [7]. In the gut, some bacteria have special enzymes that can reactivate this oestrogen, allowing it to be reabsorbed and used again by the body [7].
Interestingly, research shows that about 50% of oestrogen goes into bile, but only 7–15% leaves the body through stool [4]. That means a large amount is being reabsorbed—thanks to the activity of gut bacteria [4].
The bacteria mainly doing this job come from two groups called Firmicutes and Bacteroidetes [7].
In women, the mix of these gut bacteria can change during perimenopause and menopause, which affects how well the body handles oestrogen. These changes can lead to some of the symptoms linked to hormonal shifts.
So, looking after your gut health during menopause might support hormonal balance alongside any traditional hormone treatments.
How Perimenopause and Menopause Affect Gut Health
Women’s gut bacteria undergo major changes during midlife as their hormones shift. These changes affect their digestive comfort, immunity, and metabolic health. Women going through perimenopause and menopause should learn about these mechanisms.
Hormonal decline and its impact on gut diversity
Sex hormone changes during menopause rearrange the gut microbiome completely. Studies show that postmenopausal women have less diverse gut microbiomes than premenopausal women [8]. This reduced diversity isn’t just a minor change-it shows how gut function changes and affects health systemically.
The gut microbiome becomes more similar to men’s after menopause [8]. Scientists have found specific bacterial changes. Postmenopausal women show higher levels of Bacteroides, Prevotella, Sutterella, Dorea, and Butyricimonas. They also have fewer beneficial Firmicutes and Ruminococcus [8].
Oestrogen plays a key role in regulating gut health. Both estradiol and progesterone help keep the gut barrier strong and working properly [9]. When these hormones decrease, the intestinal walls might become more permeable [9]. A study that looked at microbial movement found that signs of gut barrier problems increased a lot from pre- to post- menopause [6].
Common menopause gut problems: bloating, IBS, and weight gain
Digestive problems are common yet often overlooked during menopause. Research shows that 42% of perimenopausal women and 47% of menopausal women experience gastrointestinal symptoms [1].
Hormone changes during perimenopause and menopause affect the digestive system in several ways:
- Slowed digestion: Lower oestrogen and progesterone slow down food movement through the digestive system. This leads to more water absorption and constipation [2]
- Reduced digestive secretions: Lower hormone levels reduce stomach acid and bile production, making it harder to break down food [10]
- Increased inflammation: Changes in gut bacteria cause mild inflammation that relates to joint pain and fatigue [1]
- Altered metabolism: The gut microbiome can’t process oestrogen as well, which might lead to more fat gain, slower metabolism, and higher insulin resistance [11]
Women who already have digestive problems like IBS or IBD often feel worse [2]. A November 2022 study found that postmenopausal women had more bacteria linked to inflammation and obesity [11].
Many women deal with bloating, indigestion, acid reflux, cramping, gas, bowel changes, and nausea [2]. These gut changes can also affect vaginal and urinary health because these areas share similar bacterial communities [12].
Link between perimenopause and diarrhoea
Diarrhoea is just as common as constipation during perimenopause but individuals talk about it less. Research following women through menopause found that diarrhoea became a big concern, especially when hormone levels changed [5].
Several factors explain why this happens:
- Altered gut motility: Oestrogen and progesterone usually slow down digestive muscles. As levels drop, these muscles might relax and let food pass through faster [5]
- Stress-hormone interaction: Less oestrogen can raise cortisol and adrenaline levels, which make the gut more permeable [5]
- Microbiome disruption: The gut microbiome loses diversity, which might affect how the estrobolome works [5]
Studies confirm that women with higher oestrogen levels have milder diarrhoea symptoms [5]. Stress during perimenopause and menopause can make diarrhoea worse [13]. This shows how hormones, stress, and gut function are all connected during this time.
Women can manage these symptoms by changing their diet, taking probiotics, and using digestive enzymes while their bodies adjust to new hormone levels.
The Gut-Hormone Feedback Loop
The relationship between gut microbes and hormones works both ways and deeply affects women’s health. This complex feedback loop shapes hormonal balance and changes the types of microbes present during menopause.
How gut bacteria influence hormone levels
Gut bacteria do more than just respond to hormones – they help control hormone levels throughout the body. Studies show that the gut microbiome can affect how sex hormones are made and move through the body [14]. Scientists have found that sex hormones affect gut bacteria, and these tiny organisms can change hormone levels too [15].
The research behind this is clear. Scientists found that mice without gut bacteria had much lower levels of faecal oestradiol, progesterone, and corticosterone compared to normal mice [14]. Human studies tell a similar story. Men and postmenopausal women’s urinary oestrogen levels associate strongly with how rich and diverse their gut microbiome is [14].
Impact on vaginal and urinary health
The gut-hormone connection reaches beyond digestion to affect urinary and vaginal health. After menopause, the vaginal microbiota usually has fewer Lactobacillus bacteria and more anaerobic ones like Gardnerella and Prevotella [17]. These changes look like bacterial vaginosis in younger women, but postmenopausal women actually get BV less often because they have fewer bacteria overall [17].
These bacterial changes contribute to genitourinary syndrome of menopause (GSM). Women with GSM often feel urgent needs to urinate, deal with incontinence, and experience bladder discomfort [17]. The gut microbiota might affect these issues when increased gut permeability lets bacteria influence other body parts [6].
Scientific Insights and Research Findings
Key studies on menopause and gut health
A newer study, published in January 2025 by ZOE scientists analysed data from over 70,000 peri- and postmenopausal women. The research team found clear links between menopause symptoms and the gut microbiome [8].
Changes in microbial diversity post-menopause
Multiple studies confirm that postmenopausal women have reduced gut microbiome diversity [6]. A large study of Hispanic/Latino Individuals found that postmenopausal women’s gut microbiomes were less diverse than premenopausal women’s and looked more like men’s microbiomes [6].
Postmenopausal women’s bacterial levels typically show:
- Higher levels of Bacteroides, Prevotella marshii, and Sutterella wadsworthensis [6]
- Increased Odoribacter and Bilophila [18]
- Decreased Firmicutes/Ruminococcus abundance [17]
These changes affect both digestive function and broader metabolic health. Women who want to support microbiome balance might benefit from targeted probiotics to maintain microbial diversity during this transition.
Microbial translocation and immune response
The most worrying evidence shows that menopause increases intestinal permeability, which lets gut bacteria enter circulation—a process called microbial translocation [6]. A long-term SWAN study showed that markers of gut barrier dysfunction increased substantially from pre- to post-menopause [6].
This bacterial movement triggers systemic inflammation and immune activation [6]. Supporting gut barrier integrity through synbiotics could help postmenopausal women maintain better health.
Supporting Gut Health During Menopause
Your gut microbiome needs proactive care to help ease menopause symptoms and support your health during this transition. Recent research shows several ways you can maintain microbial balance while your hormone levels change.
Dietary changes to support microbiome
A Mediterranean-style, plant-rich diet builds the foundation for gut health during menopause. You should eat at least 30 different plant foods each week to boost microbial diversity [19]. This variety feeds good bacteria and helps with hormone metabolism.
Focus on:
- Fibre-rich foods like wholegrains, vegetables, fruits and legumes (you need 30g daily) [4]
- Colourful fruits and vegetables rich in polyphenols that work as prebiotics [4]
- Less processed foods, added sugars and artificial sweeteners since they can upset bacterial balance [4]
Probiotics and prebiotics for menopause gut health
Your gut thrives when you combine probiotics (beneficial bacteria) and prebiotics (food for these bacteria). Foods like yoghurt, kefir, sauerkraut and kimchi give you live beneficial bacteria [20]. You might need probiotic supplements with specific strains like Lactobacillus to maintain vaginal and gut flora.
Prebiotic foods nourish your beneficial bacteria. These include garlic, onions, asparagus, bananas and flaxseeds [1]. Fibre supplements can help if you struggle to get enough through food.
Lifestyle habits: hydration, exercise, and stress management
Your gut health depends on several lifestyle factors:
Drink plenty of water to help digestion and avoid constipation [20]
Move your body for 30 minutes most days to boost gut motility and bacterial diversity [1]
Keep stress in check through mindfulness, gentle yoga or meditation, since stress changes your microbiome faster [21]
When to consider hormone therapy
Research reveals something interesting – women who use hormone therapy during menopause keep gut microbiome patterns that look much like premenopausal women’s [22]. A 2022 study showed HRT users had more diverse gut flora with good bacteria like Prevotella and fewer inflammatory strains [23].
HRT shouldn’t replace good diet and lifestyle habits. However, it offers another way to support gut health during this transition, especially if you experience many symptoms.
Conclusion
The deep connection between gut health and menopause has emerged as a game-changer for women going through this natural life transition. Research shows that hormonal shifts during perimenopause and menopause change gut microbiome composition at its core. Gut bacteria also influence hormone metabolism through the estrobolome. This
two-way relationship helps explain many menopausal symptoms beyond the usual hot flushes.
There’s good news for women who face digestive issues during this time. Better gut health can lead to real symptom relief. A Mediterranean-style diet packed with different plant foods serves as the life-blood of this approach. Probiotics made specifically for women’s needs can help too. On top of that, fibre supplements can feed good bacteria when diet alone isn’t enough.
Science tells a clear story. Women after menopause show less microbial diversity if they don’t take steps to support their gut ecosystem. So, boosting this diversity through diet, supplements, and lifestyle changes might help with everything from digestive comfort to mood swings.
Your lifestyle choices are without doubt a vital part along with dietary changes. Exercise boosts microbial diversity. Stress management helps keep your gut barrier strong. If you’re dealing with serious digestive issues, digestive enzymes can offer relief while your body adapts to hormonal changes.
Women who think about hormone therapy might find extra benefits beyond the usual symptom relief. Studies show HRT users keep gut microbiome patterns that look like those of premenopausal women. This might help protect metabolic health during the transition.
The gut-menopause connection shows that women have more control over their menopausal experience than we used to believe. You can manage many tough symptoms effectively by supporting your gut microbiome with synbiotics and making the right lifestyle changes. This isn’t just about dealing with decline. It’s about embracing a natural transition that you can handle better with proper gut support.
FAQs
How does perimenopause affect gut health?
During perimenopause, hormonal changes can lead to reduced gut microbial diversity and an imbalance between beneficial and harmful bacteria. This shift in the gut microbiome can result in various digestive issues and may contribute to other menopausal symptoms.
What are common digestive problems during menopause?
Common digestive issues during menopause include bloating, constipation, diarrhoea, and increased gas. These problems often stem from hormonal changes that affect gut motility and the balance of gut bacteria.
Can supporting gut health help manage menopausal symptoms?
Yes, supporting gut health can potentially help manage menopausal symptoms. A healthy gut microbiome plays a role in hormone metabolism and can influence various aspects of health, including mood, weight, and energy levels.
What dietary changes can support gut health during menopause?
Adopting a Mediterranean-style diet rich in diverse plant foods, fibre, and fermented foods can support gut health during menopause. Aim to consume at least 30 different plant foods weekly and include probiotic-rich foods like yoghurt and kefir.
How does hormone therapy affect gut health in menopausal women?
Research suggests that hormone therapy may help preserve gut microbial health in menopausal women. Studies have shown that women using hormone therapy maintain gut microbiome compositions similar to those of premenopausal women, potentially offering benefits beyond traditional symptom relief.
References
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