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How good gut health can improve menopause symptoms

A good diet is key for helping us thrive in the menopause but the latest research shows that looking after our gut health goes one further, both helping to alleviate and even stop some menopausal symptoms in the first place. Nutritional Therapist Joanna Lyall, co-founder and CEO of The Better Menopause wellness community, explains the science and reveals the simple lifestyle changes that can make all the difference.

Good news ladies: there is emerging evidence that there are powerful connections between our gut health and our hormones. The latest research suggests that improving our gut health – or to be more specific the diversity and balance of our microbiome (the community of microorganisms that populate our gut lining) – may improve common symptoms of menopause! 

The gut microbiome is important for our general wellbeing and is linked to a wide range of processes within our body, including how our brains, mood regulation, immune system and metabolism function. The biome is very sensitive and can change in response to factors such as diet, age and illness. There are many, many different types of microbes that make up the gut biome. When one particular type of microbe overgrows, the biome does not function normally – and this can impact on our body and mind. It’s unsurprising then that finding ways to keep the microbiome in a happy equilibrium is therefore a key area of medical research.

How does this fit in with the menopause? 

Well, oestrogen and testosterone are well-established regulators of both the gut tissue environment and the gut microbiome. In the perimenopause, oestrogen levels fluctuate and ultimately decrease and in the menopause and postmenopause oestrogen levels are low and stay low. Testosterone levels slowly fall from our 30s. Plus, the activity of hormones is influenced by the microbiome

How? Well, in addition to the gut being responsible for the digestion and absorption of key nutrients, it is also one of many places in the body where your hormones are processed and excreted – making the health of your gut and its functionality particularly important during perimenopause and menopause.

The science behind gut health and menopause

The estrobolome (pronounced istr-OBB-uh-lome) is a collection of bacteria in our gut that plays a key role in processing and modulating oestrogen. Ovaries produce oestrogens and they can travel around the body in an activated form. To clear oestrogens from our body, they are deactivated by the liver and removed through the bile duct and then into our gut and eventually our faeces (poo!). For conversion of oestrogens to the activated form, an enzyme called beta-glucuronidase is required and this can be secreted by microbes and so oestrogens can be ‘recycled’ – instead of losing them in our poo, they can be reactivated by the estrobolome. It is interesting that other hormones such as progestogens can be recycled in the same way.  The activation of oestrogen in the gut means that there is more oestrogen to, for example, help in gut repair. There is some evidence to suggest that this activity could also play a key role in influencing oestrogen activity outside the gut after the menopause – for example in the cardiovascular system and brain. 

There is also a growing body of evidence to suggest that the gut-hormone axis influences the amount of active oestrogen circulating in the body which, in turn, could impact our weight, libido and mood as well as our heart, brain and vaginal health. During the perimenopause it looks like our gut microbiome gets disrupted by fluctuating oestrogen levels, including the composition of bacteria in the estrobolome. The disruption of the microbiome may be directly associated with the common menopausal symptoms we are all familiar with, such as increased incidence of IBS, bloating, hot flushes, weight gain, anxiety, brain fog, low energy, mood swings, loss of libido, vaginal pain and dryness, urinary tract infections, and poor sleep.  

In practice, we see that by focusing on improving our gut health and supporting a diverse microbiome with specific strains of bacteria during this time of change, many of the unwanted symptoms of perimenopause and menopause may be alleviated

What’s more, certain gut bacteria are involved in the production of short chain fatty acids which allows us to digest and break down fibre. If our microbiome is low on these beneficial bacteria it can make the digestion of certain vegetables, lentils and pulses much more challenging which leads to wind and bloating. These are common symptoms found in menopausal women and are connected to the disruption of overall microbiome balance.  

But why is oestrogen so important to us? 

Oestrogen regulates many processes in the body, the brain, skin, musculoskeletal system, cardiovascular system and in the tissues of our renal tract and genital tract. When the gut microbiome is healthy, the estrobolome produces just the right amount of beta-glucuronidase to keep oestrogen levels balanced. However, when the gut biome is out of kilter, beta-glucuronidase activity may be altered which may alter active oestrogen levels in the gut and maybe throughout the rest of our body, impacting on symptoms and long term health consequences. 

After the menopause, the gut biome is less diverse. This may be a result of ageing, but could also be influenced by the loss of oestrogen as ovaries stop producing oestrogen in any significant quantity in the postmenopause.

What can you do to support gut health? 

Creating and maintaining good gut health is a daily task. Our gut responds to what we eat, and also our environment and emotions. There isn’t a silver bullet that will solve all gut problems at once but there are some important daily habits that will make a huge impact.

  • Eat enough fibre Fibre is essential for keeping our gut healthy, which in turn keeps us healthier. Fibre helps bulk up our stools, remove toxins, stop constipation and it feeds our beneficial gut bacteria. We need around 30g of fibre a day but the average person only eats 15-20g. Ground flaxseeds, onions, garlic, grains, beans, Jerusalem artichokes, leeks, bananas, and raspberries are excellent sources of fibre.
  • Eat probiotic and fermented foods Including these foods in your daily diet will support the gut and liver, improving hormone balance, mood, sleep, digestion and absorption. Additionally, supporting the gut microbiome will improve the beneficial bacteria levels in the vaginal and urinary lining too. Add fermented foods slowly to your diet as they may cause excess wind and bloating as your microbiome reacts and changes. If you get a strong reaction to fermented foods this could be a sign of dysbiosis (an unbalanced biome) or possibly histamine intolerance. Good sources include natural yoghurt, kefir, kombucha, miso and kimchi.
  • Eat protein in every meal We need protein to build hormones and neurotransmitters. 90% of the mood-boosting hormone serotonin is made in our gut and we need to consume foods containing the amino acid tryptophan to support this process. Protein keeps our energy levels stabilised and supports lean muscle development. Ideally, we need 1.2g a day per kg of body weight to support blood sugar and muscle mass. Try including lean meats such as chicken and turkey as well as any type of fish. Vegetarian sources include quinoa, nuts, seeds, legumes and pulses. You can also include good quality protein powders in a morning smoothie.
  • Eat good fats We need good fats in our diet every day to support better energy levels, hormone production, mood, skin, joints, hair, inflammation and brain function. When we include fat in our diet we feel more satisfied after a meal and less likely to want to snack. Good fat sources contain omega oils which nourish our body inside and out. Try including salmon, tuna, avocados, almonds, walnuts, pistachios and pumpkin seeds.
  • Move every day Moving your body every day supports better gut mobility because when we exercise the movement stimulates the muscles of our bowel wall which can support regularity and reduce constipation.  Exercising or walking in the morning will get everything moving and boost your metabolism and energy for the day. Just 20 minutes will make a big difference.
  • Manage stress The gut-brain connection is another important link and when we experience stress it causes our digestive system to slow down as our body goes into fight or flight mode. This can have a negative effect on digestion and cause IBS-like symptoms. Taking time to breathe deeply before you eat can calm the nervous system and promote digestion. Incorporating activities into your daily routine that promote calm will significantly improve your health and wellbeing. Whether it is yoga or medication or just taking a few minutes to breathe deeply and slowly throughout your day will all contribute to improving stress resilience.


The team behind The Better Menopause have created The Better Gut, the first probiotic supplement specifically tailored for women navigating the challenges of perimenopause and menopause. To find out more and to take advantage of an exclusive discount head to

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More information about the importance of fibre and the gut microbiome can be found  here
Cronin P, Joyce SA, O’Toole PW, O’Connor EM. Dietary Fibre Modulates the Gut Microbiota. Nutrients. 2021 May 13;13(5):1655.
Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. Int J Womens Health. 2022 Aug 10;14:1059-1072.
Dothard MI, Allard SM, Gilbert JA. The effects of hormone replacement therapy on the microbiomes of postmenopausal women. Climacteric. 2023 Jun;26(3):182-192.
Park MG, et al. (2023). Menopausal changes in the microbiome—a review focused on the genitourinary microbiome. Diagnostics (Basel).
Laniewski P, et al. (2023). Connecting microbiome and menopause for healthy ageing. Nature Microbiology. doi:
Shiwan Hu, Qiyou Ding, Wei Zhang, Mengjiao Kang, Jing Ma & Linhua Zhao (2023) Gut microbial beta-glucuronidase: a vital regulator in female estrogen metabolism, Gut Microbes, 15:1

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