Menopause & Gut Health: Does Menopause Change the Gut?
Does menopause change the gut? Do women going through menopause experience more digestive symptoms? Read on for more details.
In this blog you will learn:
- How menopause affects gut health & how the gut affects menopause symptoms
- Do the gut changes caused by menopause last forever?
- How can you improve your gut health while going through menopause?
Menopause marks the end of the reproductive years when menstrual cycles stop. It comes with symptoms like hot flashes, night sweats, sleep issues, weight gain, cognitive issues, sexual issues, metabolic body changes, cardiovascular disease risk, osteoporosis risk and potentially other symptoms.
It also can affect digestive health. Common gut symptoms of menopause are bloating, excessive gas, constipation, acid reflux, IBS, diarrhea and stomach cramps.
In this blog we will focus on how menopause affects gut health and how we can support good gut health throughout menopause.
Gut Health
A diverse population of different gut bacteria is required for a healthy gut microbiome. The diversity of gut bacteria influences many health conditions like obesity, inflammatory-related diseases, colorectal cancer, depression, anxiety, diabetes, cardiovascular disease and many others (Peters BA, 2022). The gut strongly affects the immune system because about 80% of the body’s immune cells are located in the gut.
The gut microbiome is like a biomarker for disease. Changing and improving the gut microbiome can change the onset or progression of disease (Peters BA, 2022).
Menopause can change the gut microbiome. In menopause, the reproductive hormones estrogen and progesterone decrease. Estrogen and progesterone feed and increase some species of gut bacteria and increase diversity. These female reproductive sex hormones influence the gut microbiome from the age of puberty and throughput a woman’s life (Peters BA, 2022). Their decline changes the gut microbiome.
The Estrobolome
The estrobolome is the bacteria in the gut which metabolize and modulate estrogen levels. They affect estrogen levels by metabolizing estrogen. Estrogen metabolism enhances immune function and wound healing and protects against inflammation and cancer risk (Lephart ED, 2022). The estrobolome can impact weight, libido, mood and many other symptoms common in menopause.
Gut bacteria in the estrobolome turn estrogen that’s already been used back into an active form that can be redistributed around the body. There are bacteria that do the same for other reproductive hormones, including progesterone. The higher gut bacteria diversity helps to recycle hormones for use in the body. This is done by passing the hormones back into the bloodstream to be reused.
Postmenopausal women have very low levels of estrogen and progesterone. The hormone recycling performed by gut bacteria can be useful to maintain or possibly increase estrogen and progesterone levels in the blood.
The estrobolome needs estrogen to function well. A healthy estrobolome has higher levels of circulating estrogen. Low estrogen levels can disrupt the estrobolome and lead to less good bacteria in the gut to recycle estrogen.
How Menopause Affects Gut Health
Change In Gut Bacteria & Possible Dysbiosis:
Low diversity of gut bacteria can cause dysbiosis and contribute to various diseases. Dysbiosis is an imbalance with too many unhealthy vs healthy bacteria in the gut. Dysbiosis can contribute to bloating, indigestion, gut inflammation and other health problems. The change in the gut bacteria composition affects the immune system. It can increase vulnerability to infections and chronic disease. Dysbiosis is associated with increased oxidative stress, inflammation and damage to DNA repair (Lephart ED, 2022).
Menopause (due to low estrogen) is associated with lower gut microbiome diversity and greater similarity to the male gut microbiome (Peters BA, 2022). In fact, the gut microbiome of post-menopausal women is less diverse than pre-menopausal women and more similar to that of men (Peters BA, 2022).
Estrogen increases the enzymes that metabolize estrogen. Some gut bacteria have beta glucuronidase activity. This enzyme reactivates estrogen. This reactivation allows unbound estrogens to be recirculated through the bloodstream. Estrogen increases gut microbiome diversity and decreases beta glucuronidase activity. This increases healthy estrogen excretion.
Conversely, low estrogen levels decrease gut microbiome diversity and increase beta glucuronidase activity. This increases the re-circulation of estrogen (Lephart ED, 2022). If there is too much beta glucuronidase activity and too much recycled estrogen, it can lead to hormonal disorders like breast cancer and endometriosis.
Further, dysbiosis and low gut diversity usually cause postmenopausal women to have increased levels of inflammatory gut bacteria (Bermingham KM, 2022). These types of bacteria are more closely associated with obesity and gut inflammation (Bermingham KM, 2022).
Decreased Gut Barrier Function:
Estrogen supports the integrity of the intestinal lining. Low estrogen and dysbiosis can increase intestinal permeability or ‘leaky gut’. With leaky gut, the cells called tight junctions of the gut lining become loose, reducing gut barrier function and increasing the permeability of the intestinal gut lining. This condition allows potentially harmful chemicals and bacteria to leak out of the gut where they should be processed for elimination. Instead, they leak out of the gut and into the bloodstream.
What are the Consequences of a Leaky Gut?
With leaky gut, microbial translocation occurs. Microbial translocation is when the bacteria (or bacterial products) that should remain in the gut translocate or move across the tight epithelial barrier or gut lining into systemic circulation or the bloodstream. Here they can contribute to inflammation and pathogenesis. In research we see signs or markers of microbial translocation (translocation of microbes out of the gut and into the bloodstream) increase significantly during menopause, in line with lower estrogen (Peters BA, 2022).
This microbial translocation influences symptoms and disease risk during menopause (Shieh A, 2020). Consequences include increased systemic inflammation, food sensitivities/ allergies, generalized fatigue and digestive issues.
Progesterone also helps prevent leaky gut. It upregulates the expression of tight junction proteins which keep the gut lining ‘tight’ (Zhou Z, 2019). Progesterone is important for avoiding gut permeability, systemic microbial translocation and inflammation (Zhou Z, 2019).
Changes in Gut Motility & Slower Digestion:
Bloating, gas and abdominal discomfort are relatively common symptoms in menopause. Hormone fluctuations can impact how muscles in the digestive tract work. This can slow down the motility, or the movement of food from the mouth through the entire digestive tract (throat, esophagus, stomach, small and large intestines) and out of the body. Slower motility may lead to constipation, diarrhea or stomach pain and conditions like SIBO and leaky gut.
Reduced estrogen slows down bowel movements and increases the risk of constipation. Progesterone also influences the speed at which food travels through the gut. With lower estrogen and progesterone, changes to gut transit time can negatively affect the gut microbiome.
Higher Risk of GI Issues:
Some women experience worsening digestive symptoms during menopause due to the hormonal changes. Bloating, excessive wind and gas, constipation, acid reflux, IBS and SIBO are the most common symptoms experienced (Peters BA, 2022). Menopause can cause systemic inflammation. This inflammation can be in the gut, affect the gut lining and lead to conditions like IBS, SIBO, gastritis or leaky gut.
How Gut Health Affects Menopause Symptoms
The menopause-induced disruptions to gut health can worsen typical menopause symptoms:
Mood Swings & Anxiety:
Gut dysbiosis can decrease serotonin production in the gut. Lower serotonin in the gut can worsen mood, cause mood swings and increase anxiety and depression during menopause.
Stress & Gut Health:
The fluctuating levels of estrogen during this time can raise the stress hormone cortisol. More cortisol prompts the release of adrenalin, which can cause anxiety. Stress and anxiety are common in perimenopause and menopause. Higher cortisol levels and stress are also linked to digestive issues like diarrhea and constipation in menopausal women (Peters BA, 2022).
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Hot Flashes & Sleep Issues:
Dysbiosis is inflammatory. It can increase the frequency and intensity of hot flashes. Intense hot flashes and especially night sweats can negatively affect sleep quality.
Nutrient Absorption:
Menopause can worsen digestion and nutrient absorption. Compromised gut function raises the risk of nutrient deficiencies. Important nutrients, like vitamin D, calcium and magnesium, may be low which can worsen menopause symptoms such as bone density, muscle cramps and mood issues.
Inflammation:
Poor gut health increases inflammation in the gut. Gut inflammation can increase systemic inflammation, which can worsen menopause symptoms, such as joint pain or weight gain.
Weight Gain & Metabolism:
Gut health and the gut bacteria affect how fat is stored and burned. Gut issues and changes in hormones can negatively affect weight and body distribution in menopause. A healthy gut can better support healthy metabolism and fat distribution, decreasing the risk of postmenopausal weight gain.
Can the Gut Recover After Menopause?
It is not clear if the gut microbiome recovers after menopause. There is no research or long-term studies looking at how things develop post menopause. In general, age-related changes in physiology, diet, medication and lifestyle leads to declining gut microbiome diversity (Deng F, 2019). In women, lower diversity is compounded by lower estrogen. We can assume that post menopause gut diversity and health will depend on lifestyle factor affecting gut health like diet, medications, stress, sleep, etc.
Can the Gut Recover Post Menopause with Hormone Replacement Therapy?
It is currently unclear how HRT might influence the gut microbiome and whether it would increase diversity or improve gut health. To date, there has no research conducted on humans.
Mice experiments with estrogen replacement therapy show that changes in gut microbiome due to surgical removal of ovaries can be reversed with estrogen treatment (Peters BA, 2022). In female mice, lower gut diversity was restored with estrogen replacement treatment (Peters BA, 2022). However, it is not clear if HRT reverses menopause-related changes in the human gut microbiome because there is no research in this topic (Peters BA, 2022).
A study in women with POI or primary ovarian insufficiency (when the ovaries stop functioning normally before age 40) reported that hormone therapy partially reduced dysbiosis (Peters BA, 2022). But POI is not the same as menopause so this is not conclusive (Peters BA, 2022). Research on HRT and gut health in naturally menopausal women is needed to see if HRT improve gut diversity and health post-menopause.
In the absence of conclusive research on menopause and the gut microbiome, we recommend following a healthy diet and lifestyle habits to optimize gut health.
How to Optimize Gut Health During Menopause
Focus on Diet:
Diet changes can significantly improve gut health. Gut bacteria need plant fiber and anti-inflammatory foods to thrive. A diet high in different plant foods supports the gut microbiome and feeds the good gut bacteria.
- Increase vegetables for the fiber content. Fiber supports the gut. A high-fiber diet of varied fruits, vegetables, legumes, whole grains, nuts and seeds can improve digestion and decrease constipation and other GI issues. Try to eat 30 different plant foods per week. Things like coffee, teas, dark chocolate count as plant foods.
- Increase anti-inflammatory foods: Foods like fatty fish (rich in omega 3 fats), nuts, seeds and leafy greens can reduce gut inflammation and support hormonal balance during menopause.
- Reduce caffeine, alcohol and gluten. Caffeine can worsen some menopause symptoms like hot flashes, night sweats and anxiety. Alcohol and gluten are damaging to the gut and contribute to leaky gut and gut inflammation. This can worsen menopause and GI symptoms.
- Avoid processed foods & added sugars: Excess sugar, additives and chemicals found in processed foods are damaging to the gut and can contribute to leaky gut and gut inflammation. Both of these conditions will worsen any menopause, or other health related, issues.
Add Probiotics & Prebiotics:
Probiotics are live beneficial gut bacteria and prebiotics are the food these good bacteria eat. Probiotic foods are fermented foods like natural yoghurt, sauerkraut, kefir, kimchi, etc. Taking pre and probiotic supplements can improve gut health and potentially reduce menopause-related symptoms like bloating or digestive discomfort.
Benefits of probiotic supplements:
- Better calcium absorption in the gut: This supports bone health. Better calcium absorption can reduce the risk of low Bone Mass Density and possible bone damage. These are frequently seen issues in menopausal women at risk of osteoporosis or osteopenia (Barrea L, 2023)
- Lower Breast Cancer incidence: Probiotics have a protective role against breast cancer in pre- and postmenopausal women (Barrea L, 2023). Lactobacillus casei shirota and soy isoflavone-containing products (miso soup and tofu) taken on a regular basis is inversely linked to breast cancer incidence (Barrea L, 2023). In research breast cancer risk decreases significantly with a higher intake of yogurt, due to the probiotics (Barrea L, 2023).
- Reduce vaginal pH and pathogenic bacteria: High vaginal pH and harmful bacteria are risk factors for endometriosis (Barrea L, 2023). Taking pre and probiotics to lower these can reduce the risk of endometriosis.
- Better insulin resistance, cholesterol and inflammation: Improving metabolic factors like blood sugar, insulin sensitivity, cholesterol and inflammation can decrease cardiometabolic risk in post menopause (Barrea L, 2023).
Manage Stress:
Mindfulness techniques like yoga, meditation, tai chi or deep breathing can help reduce stress, improve gut function and better manage menopause symptoms.
Exercise:
Regular physical activity can improve gut motility, reduce stress, support a healthy microbiome and help manage menopause symptoms.
Hydration:
Drinking enough water is important for good digestion and gut function and helps to prevent constipation seen more commonly in menopause.
Menopause hormonal changes and gut health are closely linked. Following good lifestyle habits like a healthy anti-inflammatory diet, regular exercise and stress management can support both hormonal and gut health. This can help to reduce menopause symptoms and optimize gut health during this phase of life.
If you are suffering from menopause symptoms, then get in touch with us at the Medicine with Heart clinic. We can help to manage symptoms, improve your menopause experience and get your health back on track!
