Gut health and perimenopause

The menopausal transition is marked by a number of changes – fluctuating and declining oestrogen levels drive symptoms including hot flashes, vaginal dryness, and mood changes, which are commonly experienced by many perimenopausal women. Perhaps a lesser-known change that occurs during the menopausal transition is the change in the gut microbiota. In fact, emerging research suggests that the gut microbiota may play a central role when it comes to menopausal symptoms as well as health outcomes.

Learn more about this topic in the HealthCert Professional Diploma program in Medical Nutrition Management – online nutrition training for GPs.

The estrobolome

Sex hormones and gut health are connected through the estrobolome. The estrobolome refers to the microbes responsible for supporting oestrogen metabolism and influencing circulating oestrogen levels. When the gut is imbalanced, it can disrupt this regulation and impact the amount of circulating oestrogen. However, this relationship goes both ways. A change in oestrogen levels, which occurs during perimenopause, can also disrupt the gut microbiota [1].

Reduced gut microbial diversity

While research is still in its infancy, there are studies to suggest lower oestrogen levels among other hormonal changes affects the composition of the gut microbiota and can lead to an imbalance of good and bad bacteria and reduced microbiome diversity [2]. Studies have shown that the gut microbes differ between pre-menopausal and post-menopausal women [3], and that the microbiome of post-menopausal women appears to resemble more similarly to a male gut microbiome [4].

Increased intestinal permeability

The sex hormones estradiol and progesterone may be important in limiting intestinal permeability and preventing dysfunction of the gut barrier. Some research suggests reduced estradiol and progesterone during perimenopause may lead to permeability of the gut barrier [5]. The reduction in microbial diversity and increased intestinal permeability may contribute to a range of gut issues including food intolerances, IBS, and digestive symptoms and may contribute to the pathogenesis of menopausal-related disease states, but more research is needed [6].

What can perimenopausal women do?

Fortunately, there are many factors which can influence the gut microbiota beyond changes in sex hormones. Research on animals has also found that when gut diversity is maintained, it may help alleviate menopausal symptoms [7].

While research is limited, probiotics may be a safe and feasible option to help restore normal functioning of the gut microbiota [6]. Additionally, perimenopausal women can support their gut microbiota by aiming for 25g of fibre daily and including a wide range of plants in their diet [8]. Including plenty of vegetables, fruits, whole grains, legumes, nuts, seeds, and spices can provide the gut microbiota with a diverse range of prebiotics, fibre, and other beneficial plant compounds.

Research shows that perimenopause is accompanied by a decline in gut health which may play a central role in associated symptoms and health outcomes. GPs can support perimenopausal women with safe and feasible dietary strategies to support gut health, which may have the potential to reduce symptoms associated with perimenopause and improve post-menopausal health outcomes.

Learn more with the online HealthCert Professional Diploma program in Medical Nutrition Management.

– Sarah Marko, Accredited Practising Dietitian

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Read another blog: IBS: Looking beyond the low FODMAP diet

References

[1] Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103:45-53. doi: 10.1016/j.maturitas.2017.06.025. Epub 2017 Jun 23. PMID: 28778332.

[2] Liu Y, Zhou Y, Mao T, Huang Y, Liang J, Zhu M, et al. The relationship between menopausal syndrome and gut microbes. BMC Womens Health 2022. https://doi.org/10.1186/s12905-022-02029-w.

[3] Zhao H, Chen J, Li X, Sun Q, Qin P, Wang Q. Compositional and functional features of the female premenopausal and postmenopausal gut microbiota. FEBS Lett. 2019;593(18):2655–64.

[4] Peters BA, Lin J, Qi Q, Usyk M, Isasi CR, Mossavar-Rahmani Y, Derby CA, Santoro N, Perreira KM, Daviglus ML, Kominiarek MA, Cai J, Knight R, Burk RD, Kaplan RC. Menopause Is Associated with an Altered Gut Microbiome and Estrobolome, with Implications for Adverse Cardiometabolic Risk in the Hispanic Community Health Study/Study of Latinos. mSystems. 2022 Jun 28;7(3):e0027322. doi: 10.1128/msystems.00273-22. Epub 2022 Apr 13. PMID: 35675542; PMCID: PMC9239235.

[5] Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. Int J Womens Health 2022. https://doi.org/10.2147/IJWH.S340491.

[6] Barrea L, Verde L, Auriemma RS, Vetrani C, Cataldi M, Frias-Toral E, Pugliese G, Camajani E, Savastano S, Colao A, Muscogiuri G. Probiotics and Prebiotics: Any Role in Menopause-Related Diseases? Curr Nutr Rep. 2023 Mar;12(1):83-97. doi: 10.1007/s13668-023-00462-3. Epub 2023 Feb 7. PMID: 36746877; PMCID: PMC9974675.

[7] Park S, Kim DS, Kang ES, Kim D Bin, Kang S. Low-dose brain estrogen prevents menopausal syndrome while maintaining the diversity of the gut microbiomes in estrogen-deficient rats. Am J Physiol - Endocrinol Metab 2018. https://doi.org/10.1152/ajpendo.00005.2018.

[8] McDonald D, Hyde E, Debelius JW, Morton JT, Gonzalez A, Ackermann G, Aksenov AA, Behsaz B, Brennan C, Chen Y, DeRight Goldasich L, Dorrestein PC, Dunn RR, Fahimipour AK, Gaffney J, Gilbert JA, Gogul G, Green JL, Hugenholtz P, Humphrey G, Huttenhower C, Jackson MA, Janssen S, Jeste DV, Jiang L, Kelley ST, Knights D, Kosciolek T, Ladau J, Leach J, Marotz C, Meleshko D, Melnik AV, Metcalf JL, Mohimani H, Montassier E, Navas-Molina J, Nguyen TT, Peddada S, Pevzner P, Pollard KS, Rahnavard G, Robbins-Pianka A, Sangwan N, Shorenstein J, Smarr L, Song SJ, Spector T, Swafford AD, Thackray VG, Thompson LR, Tripathi A, Vázquez-Baeza Y, Vrbanac A, Wischmeyer P, Wolfe E, Zhu Q; American Gut Consortium; Knight R. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018 May 15;3(3):e00031-18. doi: 10.1128/mSystems.00031-18. PMID: 29795809; PMCID: PMC5954204.