More than 80% of women experience worsening gut symptoms during the menopausal shift. Of those women, more than half say it impacts their quality of life, causing them to avoid certain social situations due to gastrointestinal issues. These women report feeling under-treated, uninformed, and frustrated. Helping women learn more about gut health could improve their daily lives. However, is there more happening in the gut? Is gut health a factor in women’s perimenopausal and menopausal symptoms?
Gut health is more than how well you can digest and eliminate food. The extend to the immune system, mental health, and numerous metabolic markers related to menopause symptoms, such as elevated LDL cholesterol levels.
Let’s explore the role gut health and the microbiota that live there are impacting various systems of the body. Some of these systems play a role in the symptoms of perimenopause and menopause in women.
Data from the , 2026
The microbiome is a community of microorganisms that live in and on the body. Over one hundred billion microbes exist in the microbiome. The makeup of the microbiota in the microbiome impacts wellness. A healthy microbiome contains microbiota that support health. An unbalanced microbiome, a condition called dysbiosis, can lead to symptoms and disease.
Once food leaves the stomach, where pepsin breaks down proteins, it enters the . This is where the body processes and absorbs nutrients. It’s also the key area to find the cells that are able to interact with the gut’s contents – these cells can then send messages that impact the immune system, neurological system, and hormone release.
The health of this interface influences the signalling and response of the body in many ways. An unhealthy gut microbiome hosts more pathogenic or opportunistic microbes, which tend to release toxins into the gut, triggering inflammation and disrupting gut lining health and function. The result can impair digestion, absorption, immune responses, the production of helpful neurotransmitters, and the natural balance of LDL cholesterol and estrogen cycles.
The challenge with the microbiome is that it changes daily. Factors including diet, travel, medication and age impact the types of microbiota present. Not to mention, most of the feces you excrete is actually microbes leaving the gut. This constant flux in population creates a dynamic environment.
How do you know if your gut microbiome is unbalanced? There can be a variety of symptoms, which may include:
In menopause, research women are more likely to experience bloating, stomach pain, constipation or acid reflux.
In the gut, there are about 60 bacterial types that in the gut. These bacteria produce an enzyme called B-glucuronidase that’s able to support the body’s estrogen recycling program. As women age, there is a shift in the types of microbes found in their gut – a shift that results in fewer of the number and type of these bacteria. The lower amounts of B-glucuronidase means when the body breaks estrogen into smaller pieces, it gets eliminated, not recycled. This, added to the lower estrogen production of the ovaries in perimenopause, adds to the total decline in estrogen in the female body.
When levels of estrogen (estradiol) are lower, women can experience:
It’s been suggested that a greater diversity could promote hormone retention and optimization of the levels of systemic sex hormones.
According to reports from Western menopausal women, hot flashes interfere with their sleep. A investigated whether a dietary shift could impact the frequency and severity of hot flashes, as well as its impact on gut microbiota diversity. Over 12 weeks, 84 postmenopausal women with 2 or more hot flashes per day were asked to eat a low-fat, vegan diet that included ½ cup of cooked soya beans per day. The women reported their nighttime hot flashes were reduced by 94%. Soya beans are a dietary source of phytoestrogens, known to selectively interact with estrogen receptors.
The shifts in the gut microbiota were interesting among the women who ate a more plant-based diet. They had higher numbers of the types of bacteria associated with gut health, and lower amounts of those associated with hot flash severity.
The percentage of women experiencing anxiety symptoms during perimenopause is almost double that of those who experience them during reproductive years of life. In British Columbia, noted that more than half of women experienced either anxiety or depressive symptoms above a clinically acceptable threshold. Does gut health play a role in mental health?
The are constantly in communication. It makes sense as the brain needs to be told food has arrived, triggering it to release digestive enzymes into the digestive tract, alter peristalsis, and alter hunger signals. But, there’s more than just a few signals going back and forth.
The gut lining contains specialized cells (endochromaffin cells) that communicate with nerve endings of the vagus nerve – a direct pathway to the brain. This is part of the gut-brain axis. The endochromaffin cells are able to communicate, as they produce serotonin, a neurotransmitter. is known as the happy neurotransmitter. It’s been estimated that 90% of the serotonin in the body is produced in the gut. A lot of neurotransmitters are influenced by the gut microbiota:
in the United Kingdom have been looking at the impact of probiotics in women (aged 45-65 years). When 50 women were given either 50 billion CFUs of a multistrain probiotic or a placebo, they found changes in menopausal symptoms, sleep, and quality of life. In particular, there was a 40% reduction in anxiety in those who took the probiotic supplement, compared to placebo. Hot flashes and night sweats were also improved.
The vaginal tract is a unique microbiome that, when healthy, hosts a wide variety and number of Lactobacillus bacteria. The vaginal tract microbiota levels are intimately linked to estrogen. Lower estrogen levels, such as those experienced in perimenopause and menopause, alter the vaginal microbiome. The shift is associated with bacterial vaginosis.
While the vaginal microbiome is not the most well-researched area of women’s health, it appears that there are some predominant bacterial species here, including Lactobacillus genesii, Lactobacillus gasseri and Lactobacillus crisparus.
Some clinical studies have used oral probiotics and observed a beneficial shift in the vaginal microbiota, but only with some strains and dosages. More research is needed.
Of note, a fascinating new research study found a correlation between the types of microbiota in the vaginal microbiome and .
Gut health is an under-recognized factor in perimenopause and menopausal health. The hormonal shifts that occur during perimenopause and menopause directly alter the gut microbiome. Since the gut-brain-hormone axis influences mood, sleep, and cognition, the health of the gut microbiome could be impacting the severity of perimenopause symptoms.
Luckily, lifestyle factors can shape the microbiome, with a focus on a diet rich in plants, including phytoestrogen sources, reducing stress and including . Probiotics can be a tool in supporting gut health in perimenopausal and menopausal women, with some suggesting possible improvements in hot flashes, sleep and . But evidence shows probiotics have strain-specific benefits, emphasizing the importance of choosing probiotic products that contain strains that have been clinically proven to deliver the results you seek.
Shifts in the gut microbiome as a woman ages impact her wellness – incorporating holistic nutrition strategies to improve gut health may play a supportive role.
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