Menopause is the natural process marking the end of a woman’s reproductive years. Time building up to the menopause, known as peri-menopause, can bring about significant hormonal changes, particularly the decline in progesterone and oestrogen. Hormonal changes can have an impact on the gastrointestinal health – strong evidence has shown that hormonal fluctuations can impact composition and function of the gut microbes. This shows that there is a clear connection between our gut health and hormonal balance, and therefore improving the health of the gut and microbiome diversity can also support symptoms of menopause.
How are the microbiome and hormones linked?
When we discuss microbiome, we are discussing the trillions of microorganisms, bacteria, viruses, fungi and other microbes, that all reside in the digestive tract. Our gut microbiome has a role to play in many areas of our health, including mood regulation, appetite control, metabolism and immune function (to name a few). The microbiome is constantly changing and evolves depending on a person’s diet, age, health status and lifestyle factors.
We know that oestrogen and testosterone are two hormones that can influence the gut microbiome and environment. There is a reduction of oestrogen during both the perimenopause and post menopause stage, with testosterone levels also falling. The gut has a role to play in producing and excreting these hormones, making it a very important organ when it comes to managing menopause and perimenopausal stages.
What gut changes are seen during menopause?
Research shows that menopause is associated with reduced gut microbiome diversity, compared to premenopausal women. This reduction in the gut microbes could be a contributing factor to the various health concerns that are imposed on women through the perimenopause and menopause stage. Some of these include poorer metabolic health markers with increased risk of cholesterol, heart disease, bone loss and lower immune function. One study found that the intestinal microbiome of postmenopausal women had a higher abundance of Bacteroides species Prevotella and Sutterella, which have been previously associated with obesity in other studies.
There is a higher ratio of Firmicutes compared to Bacteroidetes bacterial types, which suggests that menopausal changes can lead to gut dysbiosis, which increases risk of certain health issues.
How is the change of oestrogen levels impacting the gut?
The estrobolome is a group of bacteria found in the gut, in charge of monitoring the oestrogen hormone. These bacteria produce enzymes that allow the reabsorption of free oestrogens into circulation. A balanced estrobolome helps to maintain optimal oestrogen levels. However, during menopause, there are alterations that disrupt the estrobolome’s function, which can contribute to oestrogen related issues.
The decline in oestrogen during peri-menopause is associated with weight gain, insulin resistance and changes in lipid metabolism, with the gut being linked to each of these metabolic processes.
Link between oestrogen, gut and health issues
There is a change in the microbes during menopause, which can contribute to energy and fat storage, leading to weight gain. Research shows that menopausal changes in gut microbes is associated with increased adiposity (fat tissue).
The gut also plays a role in insulin sensitivity, however the microbial changes during menopause can impact these processes, meaning there is an increased risk of insulin resistance and type 2 diabetes. There are certain bacterial species associated with better insulin sensitivity that decrease during menopause.
During perimenopause, the gut microbiome is disrupted with changing oestrogen levels, which can be associated with increased incidence of IBS, low energy, mood changes, bloating and loss of libido, as well as much more. Many of these are gastrointestinal related symptom changes. Therefore, in theory, improving gut health and diversity of microbes may support the difficulty of change at this time, to help reduce some of the severity of these symptoms.
What are the gastrointestinal symptoms linked to menopause?
Gastrointestinal (GI) symptoms and changes are commonly reported during perimenopause, including bloating, constipation and abdominal discomfort. Many of these symptoms can be linked to changes in hormonal levels and the influence these have on gut microbes.
Bowel habit changes
Menopausal women frequently experience symptoms similar to that of irritable bowel syndrome (IBS). Reductions in oestrogen and progesterone can influence the motility of the gut, leading to increased risk of constipation or even diarrhoea.
Gut barrier function
One of the roles of oestrogen is to help support the integrity of the gut barrier. Reduced levels of oestrogen during perimenopause and menopause can compromise this barrier, leading to increased intestinal permeability. This allows microscopic substances such as undigested foods and bacteria to pass through and enter the bloodstream, leading to inflammation and further gastrointestinal symptoms.
How can you best support your gut health during menopause?
Supporting your gut health should be seen as a daily focus. Many factors can influence the gut, including our environment, habits, food and drinks that we eat, as well as emotions. Here are the top areas that will make a big difference when looking after your gut during perimenopause and menopause:
Focus on fibre intake and prebiotics
Fibre is a type of carbohydrate naturally found in all plant derived foods. It cannot be broken down by our digestive enzymes, however fibre plays a number of crucial roles to keep us healthy. Not only does fibre help to bulk up the stools to prevent constipation, it also supports better blood sugar and blood cholesterol levels, both of which are of increased concern for women going through perimenopause.
Certain types of fibres are great for our gut microbes, as this is their food source, known as prebiotics. The gut microbes break down and ferment these specific fibres, which then produce by products known as short chain fatty acids, which are beneficial for our health. They can support in the reduction of inflammation, weight management, blood sugar control and help improve gut barrier function. This in turn can support immune function and contribute to a stronger immune system.
Some of the symptoms often reported by perimenopausal and menopausal women are gut changes, such as bloating, bowel changes, inflammation and problems with increased cholesterol and blood sugars. Increasing fibre intake can help to support all of these common symptoms. The guidance is to aim for an intake of at least 30g of fibre per day. This can be sourced from a diet rich in fruits, vegetables, whole grains, beans and legumes, nuts and seeds.
Consume healthy fats
Incorporating a regular intake of healthy fats can help to support symptoms and overall health, by reducing inflammation and supporting hormone balance. These fats are building blocks for hormones, which usually decline during perimenopause. Including regular sources of omega 3 fatty acids has also been shown to reduce inflammation, which is another common symptom of menopause.
Omega 3 fatty acids are sourced from oily fish like mackerel, sardines and salmon, though vegetarian sources include chia seed and walnuts. Omega 3 fatty acids have been linked to the improvement of mood, which is another factor in menopause, where there is an increased risk of anxiety and depression. Healthy fats are also supportive of a healthy heart, which again is linked to menopause with the increased risk of heart disease.
Foods rich in healthy fats include oily fish, nuts and seeds, avocados, olives and olive oil, eggs, as well as full fat dairy like Greek yoghurt. As with all fats, practicing moderation is key, as too much can contribute to an excess in calorie intake.
Regularly eat lean proteins
During perimenopause and menopause, muscle tissue breakdown (sarcopenia) can increase, as well as the increased rate of bone density loss. Therefore, a regular intake of protein is important to support muscle mass maintenance. It is common to find an increased rate of sarcopenia coupled with an increase in fat mass. Adequate protein intake can minimise this, to support muscle strength.
As well as muscle health, protein is also important to maintain bone density. With the decrease in oestrogen, bone density loss increases, so prioritising regular protein can support bone health.
Meals rich in protein can be more satisfying, leaving you feeling fuller for longer, which is supportive of weight management during this time. Higher protein meals also support a more stable blood sugar, which is important for maintaining consistent energy levels.
Best protein sources include lean meat, fish, poultry, eggs and dairy products like Greek yoghurt and cheese. Plant sources include beans, lentils, tofu and other unprocessed soy and some protein from nuts, seeds and whole grains, though the latter are not optimal sources.
Aim for around 1-1.2g of protein per kg of body weight e.g. a 70kg woman should aim for around 70-84g of protein per day, though requirements can vary depending on factors such as activity and lifestyle.
Include regular probiotic and fermented foods
Probiotics are different from the prebiotics. The probiotics are live microorganisms that we consume, which help to populate the microbes in the gut, and improve diversity and health. Fermented foods have undergone a microbial growth process known as fermentation. This not only improves the texture and shelf life, but many fermented foods are often rich in probiotic bacteria (most, but not all). These probiotics can support menopause in a number of ways.
Probiotic rich food can help improve digestion, including bloating and bowel habits which are common symptoms related to the perimenopause. Probiotics can improve the variety and diversity of the gut microbiome, which in turn has been shown to improve mood and anxiety. Probiotics can support immune function, which is important during menopause as the changes in hormones can otherwise impact immunity.
Foods that are rich in probiotics include live cultured yoghurts and kefir, as well as sauerkraut, kombucha and kimchi. Ensure the food products have not been pasteurised and that they are kept in the fridge.
Manage stress
High stress can negatively impact menopausal symptoms, including worsening of hot flushes, problems with sleep and mood swings. A woman’s mental health can be worsened at this time due to fluctuations in hormones, which can increase rates of anxiety and stress.
This is why looking at managing stress is very important. Practicing stress reduction techniques is key, and this will be individual to the woman, however a few examples include deep breathing exercises, mindfulness and meditation or yoga. Taking part in regular physical activity can support mood as well as improve sleep.
It’s good to be able to identify stress triggers, to see if there is a way to control or limit these triggers. Some triggers can even be diet and lifestyle related, such as caffeine, alcohol and smoking, all of which can make stress management worse.
Consider speaking to a professional for support, if you are struggling to manage your stress.
Improve sleep
Sleep disturbances, including insomnia and hot flushes, are more commonly reported during perimenopause. The decline in oestrogen and progesterone levels can negatively impact sleeping patterns, and the hormone melatonin (which helps regulate sleep wake cycles) is also impacted.
Ensuring you have a good sleep hygiene can help, with maintaining a regular sleeping schedule and creating a relaxing bedtime routine. The type of clothing worn to bed and the type of bedding and temperature of bedroom all make a difference too. Ensure you are limiting caffeine as this may impact sleep (ideally avoid caffeine after midday) and be mindful of how alcohol can have a big negative impact on sleep.
Be active
Engage in regular exercise to help gut motility, which can stimulate movement of bowel muscles, supporting regularity and reducing constipation. Exercise, even regular walking, can support muscle maintenance, so doing anything you can is always better than not doing anything.
Regular exercise promotes diversity of gut bacteria, which can in turn reduce inflammation and improve insulin sensitivity and cholesterol levels, all of which are important to keep in mind during the menopausal stage of life.
Menopause can have a big impact on gut health with the hormonal shifts that alter microbe diversity, gastrointestinal function and metabolism. The decline of oestrogen and progesterone can lead to increased risk of gut dysbiosis, however lifestyle modifications can support microbial balance and overall wellbeing during this stage in life.
If you find that you are struggling with symptoms during the perimenopause and menopause stage, particularly around your gut health, get in touch with our gut health and menopause dietitians today. We can support you with tailored recommendations with the goal to improve symptoms, improve gut health and overall quality of life.
