It starts with a bloated belly, a foggy brain and a sleepless night. Then maybe it’s the weight creeping on despite doing everything ‘right’, or moods that swing like a weather vane in a storm. For many women navigating midlife, the signs of perimenopause and menopause don’t just show up in hot flushes and night sweats – they’re far more wide-ranging and, increasingly, they seem to point somewhere unexpected: the gut.
Yes, you read that right. That heaving, bustling community of trillions of bacteria living in our digestive tract, collectively known as the gut microbiome, might just be the unsung hero (or villain) of our menopausal journey.
A growing body of research, including a landmark review in Frontiers in Endocrinology, suggests that imbalances in gut microbes can worsen menopause symptoms, influence weight gain, mood instability, and even accelerate bone loss. And if that sounds dramatic – it is. But it’s also empowering, because it means that supporting our gut might just be one of the most strategic things we can do for hormonal harmony.
So how exactly does this all work?
Gut feelings: hormones and the microbiome
Let’s start with the basics. Your gut and your hormones are in constant conversation.
“There is a strong connection between our gut health and hormone health,” says Dr Shirin Lakhani, a leading women’s health and menopause expert. “Gut bacteria play a crucial role in hormone regulation, bone health and metabolism, for example.”
The gut isn’t just where food gets digested – it’s also where hormones like oestrogen are metabolised. This brings us to a fascinating little subset of your gut microbiome known as the estrobolome.
Think of the estrobolome as your body’s oestrogen management team. These specialised microbes produce enzymes, notably beta-glucuronidase, that determine whether oestrogen is recycled back into the bloodstream or eliminated from the body.
“Our estrobolome works a bit like a recycling centre for oestrogen,” says Elizabeth Sergeant, functional medicine practitioner and founder of Well Nourished Club. “It can allow oestrogen to be reabsorbed or help us convert oestrogen-like compounds in food into usable forms.”
Olianna Gourlis, biomedical scientist and naturopath, adds: “A high estrobolome means oestrogen is maintained, which can protect against cardiovascular disease and osteoporosis, but also raises the risk of oestrogen dominance.
“A low estrobolome can mean too little circulating oestrogen, increasing the risk of cognitive decline and low bone density.”
The domino effect of dysbiosis
When the gut microbiome falls into imbalance (a state known as dysbiosis), the consequences for menopausal women can be wide-ranging.
“Declining oestrogen during menopause contributes to a gut imbalance,” explains Shirin. “This can lead to inflammation and worsen symptoms such as bone and joint pain, brain fog, weight changes and mood disorders.”
This is backed by the Frontiers in Endocrinology review, which outlined how microbial imbalances increase the production of endotoxins, triggering inflammation and reducing short-chain fatty acids (SCFAs) like butyrate. SCFAs play key roles in protecting brain function, supporting immunity and regulating metabolism.
Post-menopausal women often show reduced microbial diversity. “This is linked to joint pain, mood instability, sleep disturbances, and increased visceral fat,” explains Olianna. “This is why it’s crucial to support the gut with targeted dietary and lifestyle strategies.”
Probiotics, prebiotics and the power of food
Here’s the hopeful part. We can support our gut – and by extension, our hormones – through diet and lifestyle changes that are refreshingly manageable.
Probiotics
Those live beneficial bacteria found in fermented foods or supplements, are a great place to start. “Probiotics help restore the natural balance of gut bacteria,” says Shirin. “Fermented foods like yoghurt, kefir, sauerkraut, and kimchi are brilliant.”
For targeted support, Olianna recommends spore-based probiotics, like MegaSporeBiotic.
“These help recondition the gut by promoting microbial diversity,” she says. Olianna suggests combining them with prebiotics – fibres that feed good bacteria – for a synbiotic effect.
Elizabeth adds: “Specific strains like Lactobacillus acidophilus have shown promise in supporting bone density, while L. gasseri may help with hot flushes and mood.”
Meet your estrobolome: the oestrogen whisperers
To keep your estrobolome in check, fibre is your best friend. “Try incorporating more whole grains and vegetables,” says Shirin. “Two kiwis a day with the skin on are a fantastic fibre source.”
Olianna recommends a fibre-rich diet packed with plant diversity.
“Aim for 30 different plant foods a week – this includes beans, legumes, nuts, seeds, herbs, and colourful fruits and vegetables.” This variety feeds different bacterial species, enhancing gut resilience.
She also suggests beta-glucuronidase inhibitors like calcium D-glucarate to prevent excessive oestrogen recycling when levels are too high. “This helps keep the balance right,” she says.
And don’t forget the power of healthy fats. Omega-3s from sources like wild salmon and flaxseeds support hormone production and microbial diversity.
Stress, too, has a role to play. “Our brain and gut are directly linked,” says Elizabeth. “Chronic stress reshapes the microbiome in unhelpful ways.”
Her tip? Reading for just six minutes a day has been shown to reduce stress by 68%. Sometimes the best medicine is the simplest.
Listen to your gut (literally)
If our gut is out of sync, it might be waving red flags that go beyond digestion.
“Symptoms like bloating, constipation, fatigue, mood swings and skin issues may all be signs of a gut-hormone imbalance,” says Shirin.
As Elizabeth puts it, “The connection between gut and hormones often gets overlooked because symptoms can seem unrelated.”
But as science evolves, one thing is clear: supporting our gut could be one of the most effective, accessible ways to navigate the hormonal shifts of midlife with more grace and less guesswork.
Signs your gut may be affecting your hormones
Think your gut might be throwing your hormones off course? These signs, shared by our experts, could be worth investigating:
- Persistent bloating, constipation, or diarrhoea
- Mood swings, anxiety or low mood that don’t respond to usual self-care strategies
- Fatigue that lingers despite rest, especially paired with brain fog
- Weight gain, particularly around the middle, or increased insulin resistance
- Skin issues such as acne, rashes or eczema flares
- History of antibiotic use, frequent UTIs, or yeast infections
- Irregular or heavy periods, worsening PMS, or signs of oestrogen dominance or deficiency
You don’t need to be a microbiologist to harness the power of your gut during menopause. But a little curiosity, and maybe an extra scoop of sauerkraut, could go a long way.
“The link between gut health and menopause isn’t straightforward,” says Elizabeth. “The changes in gut bacteria during this time can amplify symptoms like weight gain and mood shifts.”
So here’s to kefir smoothies, a rainbow on your plate, and tuning into your second brain. Your hormones (and your sanity) might just thank you.
