The Surprising Link Between Menopause and Gut Health (2024)

Bloating, constipation, and other digestive dramas can become all too familiar in your 40s and 50s. One survey of 1,500 women found 91% reported changes to their gut health during this time. But before blaming your diet or stress, consider this: hormone shifts in menopause could be the culprit.

During perimenopause and menopause, estrogen levels fluctuate and eventually decline. While this hormonal shift is often associated with symptoms like hot flashes, mood swings, and night sweats, it can also affect the diversity and composition of your gut microbiome—the collection of trillions of bacteria that live in your digestive tract, says physician Katherine Hodgkinson, member of the British Menopause Society.

When your microbiome becomes disrupted, it can trigger new issues or worsen existing gut health problems, such as IBS, bloating, or even food intolerances.

And the gut-hormone relationship goes both ways; a struggling microbiome may even worsen menopause symptoms. Meaning: keeping your gut healthy may be a key component to feeling better during this transition.

About the Expert

Katherine Hodgkinson, a primary care physician, is a UK-based lifestyle medicine doctor, member of the British Menopause Society, and owner of Hampshire Health and Hormones.

The Link Between Gut Health and Menopause

The relationship between hormones and gut health is a two-way street, explains Hodgkinson. “Menopausal hormone changes, particularly fluctuating estrogen levels, can impact gut health, and vice-versa,” she says.

Emerging research agrees. One study of Latino women found that post-menopausal women experience shifts in their gut composition, often mirroring a male microbiome. Researchers think this shift, spurred by falling estrogen levels, may reduce microbial diversity, which may increase the risk for heart and metabolic issues (1).

Other research suggests that when estrogen dips, your gut can become more permeable, and your microbiome loses its diversity. This imbalance increases the risk of obesity and endometrial cancer (2, 3, 4). Fluctuating estrogen levels can also slow digestion, leading to bloating and gas.

This gut-hormone relationship works both ways: microbes in the estrobolome—a group of bacteria that influence estrogen levels—help recycle estrogen, which can moderate menopausal symptoms even as ovarian hormone production drops. However, when the gut balance is off, excess estrogen can worsen symptoms like hot flashes, sleep issues, and mood swings, says Hodgkinson.

How a Healthy Gut Might Reduce Menopause Symptoms

Research suggests a healthy gut can significantly improve menopause symptoms and lower the risk of chronic diseases in a few different ways.

Reduce chronic disease risk

Having a balanced gut microbiome enhances your immune system and decreases inflammation, helping lower risks of heart disease and diabetes, which rise after menopause.

Improve body composition

Gut health plays a critical role in metabolism and fat storage. Healthy gut microbes feed off of fiber, which can help you manage your weight. Poor gut health has also been linked to an increase in visceral fat, making it harder to keep menopause belly under control (5).

Reduce inflammation

A healthy gut produces anti-inflammatory short-chain fatty acids (SCFAs). These compounds can help alleviate menopause symptoms, arthritis, and heart-related health issues.

Improve sleep

Neurotransmitters like serotonin are also influenced by gut microbacteria. So having a balanced gut can improve your sleep patterns and reduce menopause-related insomnia.

Boost bone health

A healthy gut lining helps absorb nutrients like calcium and vitamin D, which are essential for bone health during menopause. Gut microbes also aid in mineral absorption, potentially boosting bone density and reducing osteoporosis risks.

How to Support Gut Health During Menopause

Since the gut and hormone fluctuations are tightly connected, prioritizing gut health could help manage perimenopause symptoms, says Hodgkinson. Here are five ways to promote a healthy gut:

1. Eat the rainbow

Plants (leafy greens, cruciferous vegetables like broccoli, kale, and cauliflower), fermented foods, fruits (such as berries and apples), legumes (like chickpeas, lentils, and kidney beans), and nuts and seeds (such as almonds, walnuts, chia seeds, and flaxseeds) enhance the diversity of your gut microbiome and are good sources of fiber, which aids digestion.

2. Add prebiotics and probiotics

Prebiotics (found in foods like garlic, onions, and asparagus) are non-digestible fibers that fuel probiotics—the good bacteria in your gut. (6, 7). Foods like kefir, kimchi, sauerkraut, and yogurt naturally introduce probiotics to the gut, supporting a balanced microbiome.

3. Nix the junk food

Ultra-processed, sugary foods and drinks, and alcohol are among the worst foods for gut health. These foods exacerbate imbalances in the gut microbiome and contribute to inflammation. Keep an eye on dairy and gluten, too—these foods don’t always cause gut problems, but they can be a trigger for some people.

4. Reduce stress

A myriad of research has linked chronic stress to worse gut and menopause symptoms (8, 9). To get a handle on stress, seek out practices like mindfulness, meditation, and seek professional help if needed.

5. Stay active

Regular physical activity—30 to 90 minutes of moderate-to-vigorous exercise three or more times a week—can have a positive impact on your gut health, according to a 2023 study published in Nutrients (10). Exercise can also offset menopause-related stress (11). Low-intensity exercises like yoga and stretching can also help relieve menopause symptoms.