Gut health in perimenopause
Did you know that the health of your gut can influence how your body experiences perimenopause? While the gut microbiome has become a popular topic in recent years—and rightly so—its impact extends far beyond digestion. In fact, the trillions of bacteria living in your gut play an active role in regulating hormones, managing inflammation, and even shaping how you feel day to day. This connection means that your gut health may be more closely tied to your perimenopausal symptoms than you realise.
The gut microbiome
The gut microbiome is made up of the trillion of microbes (bacteria, archaea, fungi and viruses) that reside in the small and large intestine. Our gut microbiome changes over our lifespan and is unsurprisingly heavily influenced by what we eat and what environmental factors we are exposed to. When we eat a diet that contains plenty of fresh food, have minimal stress in our lives, sleep well and are not exposed to environmental toxins, our guts are in a pretty balanced state. However, modern life often means that we don’t eat so well, stress a lot, don’t sleep well and are exposed to plenty of environmental toxins and the result is an unbalanced gut. Research has shown that poor gut health is associated with many diseases and chronic conditions like inflammatory bowel disease, diabetes, cardiovascular disease, depression, obesity, colorectal cancer and others. When our gut is healthy, this not only positively impacts our digestion but also hormone balance, immunity, skin etc.
The gut microbiome and perimenopause
Estrogen and progesterone support a diverse microbiome, so when there are fluctuations in estrogen and a steady decline of progesterone - like what we experience in perimenopause - our microbiome becomes less diverse. That means that we experience a reduction in beneficial bacteria while the not so beneficial bacteria increase. This can impact nutrient absorption and digestion and can contribute to fatigue, low energy, brain fog, bloating, flatulence and irregular bowel habits (constipation/diarrhoea).
Increased gut permeability
Lower estrogen affects tight junction protein expression (these proteins help seal the spaces between intestinal cells), meaning the junctions loosen, which then leads to intestinal permeability (aka ‘leaky gut’). Intestinal permeability is a problem because larger food particles, toxins and bacterial fragments can now move through the junctions into the bloodstream, travel through the blood to anywhere in the body and trigger immune responses and inflammation.
Altered gut microbiome
As mentioned above, estrogen supports a diverse, balanced microbiome. With less estrogen, diversity reduces and opportunistic/pathogenic bacteria can increase. These bacteria produce metabolites that are harmful to gut lining integrity. In addition, less beneficial bacteria mean less short-chain fatty acids (SCFAs) are produced, which is another problem as they are needed to feed colon cells and strengthen barrier function. The result is a less diverse microbiome and a more permeable lining.
Slower motility
Many women complain about getting more constipated during perimenopause, and one reason for this can be declining progesterone levels as those affect bowel regularity. You can be constipated for lots of other reasons, too, but this is one factor to take into consideration.
As a result of all these changes, we experience more gastrointestinal symptoms like bloating, flatulence, constipation/diarrhoea, increased food sensitivities, reflux and others.
The gut and weight gain
The gut microbiome plays a central role in metabolism and weight regulation. Low microbial diversity has been linked to obesity, insulin resistance, and difficulty losing weight. When the gut barrier becomes more permeable, bacterial fragments such as lipopolysaccharides can enter the bloodstream. This triggers low-grade inflammation, which disrupts insulin signalling, promotes fat storage, and increases the risk of type 2 diabetes.
Gut microbes also influence our hunger hormones, helping to regulate appetite and satiety. When the microbiome is imbalanced, these signals may become distorted, leading to increased cravings and overeating.
During perimenopause, hormonal fluctuations can intensify these processes, making women more vulnerable to inflammation, insulin resistance, and weight gain.
The gut-hormone connection
An imbalanced gut can also lead to altered estrogen metabolism. This happens because of the estrobolome. The estrobolome is a subset of the gut microbiome involved with estrogen metabolism and detoxification. After your cells have utilized estrogen, it’s sent to the liver for detoxification and then released into the gut via bile. You remove unneeded estrogen metabolites via regular bowel movements (one reason why it is so important to have a bowel movement every day!).
Bacteria that compose the estrobolome produce an enzyme called beta-glucuronidase. This enzyme can “unpack” detoxified estrogens/toxins in the gut, preventing them from being excreted, and allowing them to re-enter the body and being re-circulated. High beta-glucuronidase levels can be one reason for estrogen imbalances. Altered estrogen metabolism can then contribute to PMS, heavy or painful periods, fibroids, hot flushes for example
So what can I do to improve my gut health?
Good question! The short answer is that there is plenty you can do. I have listed my top ones below
Increase fibre intake – fibre supports the growth of beneficial bacteria. Fibre also feed bacteria that lower beta-glucuronidase (the enzyme we don’t want). Fibre is found in wholegrains, vegetables, fruit, legumes, nuts & seeds. Aim for 30g of fibre each day and try to have as much variety as possible – ideally 30 different plant foods a week!
Add polyphenols (berries, green tea, olive oil, dark chocolate) to your diet to feed the beneficial bacteria. Added benefit of many of these is that they inhibit beta-glucuronidase.
Stay hydrated – water helps the digestive system moving (goodbye constipation!)
Limit ultra processed foods (ideally avoid all together!) – consumption of processed foods and sugar (including artificial sweeteners) can disrupt the bacteria balance and encourage harmful bacteria to grow and they contribute to ‘leaky gut’
Exercise and sleep well – both help to diversify your microbiome
If you’d like more personalised support with your gut health, I offer 1:1 consultations.
I often recommend comprehensive microbiome testing, which allows us to understand exactly what’s happening in your gut. From there, I create a treatment plan tailored to your unique needs. This typically includes targeted dietary and lifestyle guidance, along with nutritional and herbal support to help restore gut function and promote a diverse, resilient microbiome.
