The Link Between Gut Health and Menopause: How Nutrition Might Help

What comes to mind when you see or hear the word menopause? I know for most of my clients, menopause often provokes a gut-wrenching reaction being that it’s typically associated with uncomfortable symptoms, such as hot flashes, night sweats, migraines, and mood fluctuations. Well, believe it or not, this inevitable stage of a woman’s life doesn’t have to be as terrible as it’s normally depicted—actually, it’s not supposed to be terrible at all.

Researchers have shown medical interest in menopause since the 19th century, and transformational discoveries are still being made daily. In fact, a recent study from 2022 examined the complexities between menopause and gut health, suggesting that changes in sex hormones greatly reduce gut diversity during menopause. This reduced diversity creates not only hormonal imbalances that elicit physical and mental strain throughout the menopausal transition but also other potentially harmful risk factors. Examples include osteoporosis and insulin resistance, since the gut microbiota (the collection of bacteria in your large intestine) is connected to just about every other organ and system in your body.

The good news is that nutrition has the potential to revolutionize the menopausal experience for the better. With a more thorough understanding of the link between gut health and menopause and nutrition’s role, you can optimize your gut health to help you go through menopause with ease and come out even stronger and healthier.

How does menopause affect sex hormones?

In the years leading up to menopause, women undergo a phase of perimenopause (i.e., the transition from premenopause to postmenopause). This perimenopausal phase is characterized by irregular menstruation and heavy fluctuations in estrogen, progesterone, and testosterone levels as the body adjusts to a natural decline in its number of ovarian follicles. During perimenopause, levels of estrogen, the main female sex hormone, can sporadically shift from high to low until its production in the ovaries finally ceases in its entirety.

Although all the sex hormones go through changes during menopause, estrogen is the most affected sex hormone, therefore producing the most significant symptoms. High estrogen levels can cause bloating, breast tenderness, and heavy bleeding, whereas low estrogen levels can result in hot flashes, night sweats, palpitations, and vaginal dryness. The increased presence of these symptoms is a big factor in why menopause is often considered an unpleasant experience.

How do sex hormones affect gut health?

The term eubiosis describes a state of balance within the gut microbiota. The opposite of eubiosis is dysbiosis, which describes a bacterial imbalance. While eubiosis is always the goal, bacterial harmony can be easily disrupted by outside factors such as toxins, certain medications, and—you guessed it—hormonal changes. But what is it about hormonal changes during menopause, in particular, that cause a state of dysbiosis in the gut?

Within the gut microbiota are a variety of bacterial strains, each associated with certain health outcomes. One set of bacterial strains within the gut is the estrobolome, which specifically breaks down estrogen and produces an enzyme called beta-glucuronidase that acts on estrogen. However, when estrogen levels waver due to perimenopausal processes, beta-glucuronidase production and estrobolome balance are thrown off, leading to dysbiosis. The dysbiosis could be explained by the fact that the estrobolome and its enzymes have less estrogen to act on, so they become depleted, which reduces desired diversity and metabolic potential of the gut.

The previously mentioned study took this relationship one step further and revealed that shifts in menopause-related gut microbiota contribute to changes in cardiometabolic health during menopause. So, post-menopausal women have an increased risk of high blood pressure, dyslipidemia, insulin resistance, inflammation, and obesity. These conditions add even more stress to the body, perpetuating the detrimental cycle of hormone and gut imbalances.

How can nutrition help?

Nutrition can be used as a tool to help us address the root cause of menopausal dysbiosis and hormonal irregularities while omitting synthetic hormone replacement therapy. Future research is still needed to determine which foods best reduce menopausal symptoms. However, the link between menopause and gut health has been well-studied, and we have seemingly endless research highlighting the significance of prebiotic and probiotic foods as essential for optimal gut health. Consuming higher amounts of these gut-enhancing foods while consuming less processed foods strengthens the gut microbiota, which, in turn, alleviates menopausal symptoms and reduces the risk of cardiometabolic dysfunction.

Here are some foods you can incorporate into your diet during menopause (and throughout your life!) that can help strengthen the gut microbiota:

Prebiotic-rich foods