‍Menopause is a significant milestone in a woman's life. Some people cruise through it, but for most, it is a daunting time of huge change, often accompanied by many unpleasant symptoms. A study done back in 2022 of 4,000 women showed that majority of women (77%) found at least 1 menopausal symptom “very difficult”, and over 60% of women stated it impacts their work negatively - why are we not talking about this more?Some think of it as a medical issue, whilst others feel it a natural process of life. Regardless of which view you’re of, it’s a significant worry for most women, and we need to be looking into better solutionsH.

Here's a possibility.

Increasing research has shown a link between menopause and the gut microbiome. Could this be a new non-medical solution to those unwanted symptoms? Could the key to a smoother menopause lie in the gut? I will start by saying that we’re still in the very early stages of research here, so evidence remains fairly patchy, but they present possibilities and offer a direction for further research.

Menopause is when menstruation (periods) stop. Officially, it is 12 months after your last period, and usually occurs between the ages of 45-55 years, but can be earlier for some. During this time, your ovaries stop producing reproductive hormones - oestrogen and progesterone.
‍

To set the scene, your gut microbiome undergoes 3 main stages of changes: when first switched from milk to food, and for women, when menstruation begins and ends. Hormonal differences may explain the broad differences between the microbiome of men and women, which seem to diverge during this age. Some evidence also suggests that post menopausal women have a more similar microbiome to men. These all point towards there being a clear link between the gut microbiome and your reproductive hormones.
‍

You may be wondering, what does the gut microbiome have to do with menopause, or vice versa? Have a think about some of the common symptoms of menopause - bloating, constipation, diarrhoea, wind, reflux and weight gain. Pretty gut-related aren’t they? So while their chief role is in regulating reproductive functioning, reproductive hormones also have a significant influence on gut health, which can help explain those notorious gut-related symptoms experienced in menopause.During perimenopause, oestrogen levels fluctuate, eventually plummet during menopause, and stay low post-menopause. The activity of our hormones however are influenced by our microbiome, as it is one of your body's sites for hormone processing and excretion.
‍

Recycling and maintaining hormone levels
‍‍- Oestrogen produced by your ovaries travels around your body in an activated state, and any excess is deactivated in the liver by binding it to a compound, switching it off.
- It then travels from there to the gut and is removed in faeces (poo).
- Some bacteria in your gut are able to reactivate this oestrogen by unbinding it, allowing oestrogen to be recycled back into your bloodstream. So your gut helps to boost hormone levels by preventing wastage and recycling them - particularly important when you start producing less!

Microbiome disruption
‍- During perimenopause, our gut microbiome appears to gets disrupted by fluctuating oestrogen levels, including the composition of bacteria.
- Increased levels of specific bacteria have been linked to inflammatory reactions in some types of tissues which can cause increase insulin resistance, weakening of the bones (osteopenia), and may increase risk of Alzheimers Disease.
- Certain gut bacteria are also involved in the production of short chain fatty acids, which allows us to digest and break down fibre. If this diversity is disrupted, it may make digesting certain fibre-rich foods (vegetables, pulses, lentils) a lot harder, leading to wind and bloating.

Bone Health
‍- Post menopausal women are at a higher risk of osteoporosis (weakening of the bones).
- Oestrogen regulates bone metabolism. It promotes the activity of cells that make new bone. So a shortage of oestrogen can lead to increased rates of bone breakdown.
- Treatment with isoflavones (phytoestrogens found in plants/soy) has been shown to reduce bone loss in postmenopausal women. While the mechanism isn’t clear, we know that some gut bacteria convert isoflavones into oestrogen-like compounds, which can mimic oestrogen, particularly when levels are low.

Increase diversity
‍‍After menopause, our gut microbiome tends to be less diverse. This may be due to ageing, but could also be influenced by the loss of oestrogen post-menopause. We can help support gut health by focusing on increasing microbiome diversity. This can be through eating enough fibre, adding probiotics, and focusing on incorporating lean protein and ‘good’ fats such as omega oils in your diet.

Get Moving
‍Exercise supports gut mobility. Movement stimulates muscles in your gut wall which helps the movement of food through, reducing constipation.

Think about HRT
‍In some cases, HRT has been shown to positively affect gut health, as lower oestrogen levels during the menopause reduces the diversity of the microbiome, and topping those levels up may help reverse that effect. Some studies suggest women taking HRT have a more similar gut microbiome to premenopausal women, so it’s plausible that HRT can help restore the gut microbiome. Before considering this, it is advisable to consult your clinician to discuss your individual circumstance.

While we are still in the early stages of unraveling the exact links between hormones, gut microbiome and menopausal symptoms, it is exciting to know there is hope for new treatments for the burdening symptoms many women experience, and possibilities that might just make the thought of menopause easier to digest.

‍Written by Dr. Julia Craggs, March 2024