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Menopause & microbes: can your gut help ease your symptoms?

6 October 2025

By The Gut Health Doctor Team

Dr Megan Rossi in a lab looking through a microscope

Hot flushes, bloating, 3am wakeups, brain fog, mood dips and that frustrating weight gain that seems to creep in no matter what you do? Perimenopause and menopause can bring more than 40 different symptoms. For years, most of these changes were attributed solely to shifting hormones, such as oestrogen and progesterone. But there’s another key player that science is now spotlighting – your gut microbiome.

The trillions of microbes in your gut don’t just influence digestion, they also help regulate hormones, immunity, inflammation and even body temperature. Which begs the question: could your gut actually help ease menopause symptoms? Let’s explore what the latest evidence says and, more importantly, how you can use it to support yourself during this big life transition.

4 ways hormone changes affect the gut

Your gut microbiota is linked to almost every system in your body. So it’s no surprise that fluctuating hormones ripple through your digestive system too. Here’s what tends to happen:

1. Microbiome diversity

Lower oestrogen levels are linked to reduced bacterial diversity (remember diversity is a good thing) and fewer anti-inflammatory species. A 2022 population-based study involving 2,300 participants found that postmenopausal women had significantly lower diversity compared to premenopausal women. Interestingly, no differences were seen between younger and older men, suggesting this shift is due to menopause rather than age alone.

2. Gut lining strength

Your gut lining has oestrogen receptors (think of them as checkpoints that get activated by oestrogen). When oestrogen falls, the lining tends to become more permeable (‘leakier’) and more sensitive in some women. This means unwanted particles can pass from the gut into the bloodstream, triggering low-grade inflammation. Clinically, this can show up as a greater susceptibility to bloating and reflux.

3. Immunity shifts

Around 70% of your immune system lives in the gut. Pre-menopausal women tend to have stronger immune responses to viruses (have you ever noticed that men often report ‘worse’ flus?). But as oestrogen falls, this protective effect tends to diminish, leaving some women more prone to harder-hitting cold and flu seasons as well as recurrent infections, including vaginal thrush.

4. Gut motility

Progesterone influences gut movements, as progesterone receptors are also found throughout the digestive tract. This explains why, during the menstrual cycle, when progesterone levels fluctuate, many women experience changes in their bowel habits. In perimenopause and menopause, falling progesterone slows gut motility, increasing the risk of constipation. This slower transit can also lead to excess fermentation in the gut (think microbes “over-eating”), which can further exacerbate bloating and reflux.

In short, menopause doesn’t just affect reproductive health, but it reshapes digestion too.

The estrobolome: your gut’s hormone helper

But here’s the good news. The gut:hormone connection works both ways. When oestrogen finishes circulating around the body, it heads to the gut. There, one of two things can happen. It’s either excreted in stool or a specific group of gut bacteria (known as the estrobolome) produces an enzyme, beta-glucuronidase, that reactivates it. This ‘recycled’ oestrogen is then absorbed back into the bloodstream, where it can continue doing its job.

That’s why, as oestrogen production declines in your 40s and 50s, having a thriving estrobolome may not only help delay the onset of peri-menopause but help buffer against more aggressive symptoms, like hot flushes, when it does hit.

Beyond hot flushes: weight, mood and sleep

Emerging research also shows that supporting your gut may ease other hallmark symptoms of menopause too:

Weight changes
From age-related muscle loss to hormonal shifts that make us more prone to carrying weight around the belly, weight gain can feel inevitable. But your gut microbiota can also play a role in helping to combat these changes. Feeding your gut microbes dietary fibre stimulates the gut lining to release GLP-1, an appetite-regulating hormone (and the same target of weight-loss medications like Ozempic and Mounjaro), helping you to feel more satisfied with just the one cookie as opposed to the whole packet.

Mood
The SMILES trial, one of the first landmark studies on diet and depression, found that following a gut-nourishing, Mediterranean-style diet led to clinically meaningful improvements in mood compared to a control group. This, and several follow-up studies, reinforce the power of the gut:brain connection and its amenability to diet strategies.

Sleep
Animal research has shown that transferring the microbiome of sleep-deprived people into mice led to impaired cognition (think slower brain speeds), compared to animals that received the microbiome from well-rested people. This highlights how gut health can have a direct impact on brain function and sleep quality. Clinically, this aligns with what’s often observed in practice — women who support their gut tend to report better quality sleep.

8 gut-targeted strategies to ease menopause symptoms

Here’s where science meets action. Try these practical, evidence-backed ways to support both gut and hormone health during perimenopause, menopause and beyond:

1. Fill up on fibre

Aim for at least 30g a day from a wide variety of sources across the ‘Super Six’: vegetables, fruits, wholegrains, legumes, nuts and seeds, plus herbs and spices. Not only does this mix of fibres keep things moving and help combat constipation, but when your gut microbes ferment fibre, they produce short-chain fatty acids. These clever compounds signal to your body that you’re full — lowering ghrelin (your hunger hormone) and boosting leptin (your fullness hormone). This is one reason why a higher fibre intake (independent of calorie intake or diet type) has consistently been linked to a healthier weight, as shown in the 2019 POUNDS LOST study.

2. Maximise plant diversity

Different plants feed different microbes. The more variety you eat, the more resilient and diverse your gut microbiome becomes. Over the next three months, work towards: 5 portions of vegetables, 2 portions of fruit, 3 portions of wholegrains, plus 1–2 portions each of legumes, and nuts or seeds daily. Each plant food offers a unique package of fibres and phytochemicals, so mixing them up really matters. If you need inspiration, check out our recipe hub for tasty ideas.

3. Embrace fermented foods

Think yoghurt, kefir, sauerkraut and kimchi. These provide live microbes plus an array of bioactive compounds (for example, blood-pressure-lowering peptides in yoghurt and kefir). A Stanford University trial found that increasing fermented food intake boosted microbiome diversity and lowered inflammatory markers. At a time when diversity tends to fall and inflammation rises, that’s powerful. Start with one serving per day and, if tolerated, gradually increase (the study used up to 6 servings daily).

4. Add oily fish (or Omega-3s)

Long-chain omega-3 fats, found in oily fish like salmon, sardines, herring and mackerel, have been linked with bigger brain volume in memory-related regions (goodbye brain fog!) and are thought to support the estrobolome — those gut bacteria that help recycle oestrogen. In an observational study of over 900 women, those who ate ~90g of oily fish daily experienced a natural menopause around 3 years later than those who rarely ate fish. If fish isn’t for you, then this is one area where we would recommend omega-3 supplementation.

5. Try soy foods

Adding just half a cup of soybeans per day has been shown to reduce menopause symptoms, including hot flashes. In fact, studies have reported up to an 88% reduction in moderate to severe symptoms within 12 weeks alongside a plant-heavy diet. The secret? Phytoestrogens, which are plant compounds with gentle oestrogen-like effects. You’ll also find them in flaxseeds and legumes. Not sure where to start? Try a simple soy-based poke bowl.

6. Get smart with supplements

When symptoms hit, it’s tempting to look for a quick fix, and supplements (especially probiotics) are big business. In one survey, 20% of perimenopausal women reported spending between £351–£500 a year, yet most saw little benefit. The issue isn’t that probiotics don’t work; it’s that generic blends don’t match the symptom. Science shows that the right strain, at the right time, in the right way, is key. For example:

For vaginal health: Lactobacillus acidophilus La-14® + Lactobacillus rhamnosus HN001™ plus lactoferrin reduced thrush and BV recurrence by up to threefold compared to placebo.
For immune support: Lactobacillus rhamnosus LGG® + Bifidobacterium lactis BB-12® cut the length and severity of colds by over 30% vs placebo.

So before spending, get clear on what you need and match it to the evidence.

7. Look beyond your plate

Diet isn’t the only piece of the puzzle. Lifestyle factors make a huge difference:

Exercise: Regular movement, especially resistance or strength training, helps preserve muscle and support digestion.
Sleep: Poor sleep is common in menopause and can raise daily calorie intake by ~385 calories, according to research from colleagues at King’s College London. Build in routines that support sleep — avoid late meals, keep your bedroom cool, and aim for a consistent bedtime.
Stress: Chronic stress fuels bloating, gut sensitivity and low-grade inflammation. Gentle yoga, mindfulness, and breathing techniques have all been shown in clinical trials to help calm the gut:brain connection. Try them all, and stick to the one that works best for you..

8. Personalise your approach

When it comes to digestive symptoms that can flare in menopause, small tweaks to your diet and lifestyle shouldn’t be underestimated.

For reflux: Avoid eating late at night or lying down right after meals, as this can put pressure on the sphincter (think a little trap door) that normally keeps stomach contents from moving the wrong way, back up into your throat. Watch for common triggers too. Fatty foods (like pastries and fried foods), spicy dishes, caffeine and alcohol are the usual suspects. Keeping a food–symptom diary can help you identify what triggers your reflux.
For constipation: To keep things moving, prioritise hydration (2+L/day), regular movement (walking and yoga twists are great), and a mix of laxating fibres (like oats, chia, beans, psyllium husk) to soften stool, and roughage-type fibres (like wholegrains, nuts, skins of fruit and veg) to add bulk. And don’t underestimate the power of routine — giving yourself relaxed time in the morning can help train your bowels into a rhythm.
For bloating: There are 22 common triggers that can exacerbate hormone-related bloating. Check out this article dedicated to bloating for tips.

A photo of a patient speaking to a dietitian

When to seek medical advice

While many symptoms are part of menopause, always check in with your GP/ family physician if you experience:

Constant bloating that doesn’t fluctuate during the day
Unexplained weight loss (≥5% of body weight)
Blood in your stool (red or black)
Persistent changes in bowel habits
Ongoing fatigue unrelieved by rest

Takeaway

Menopause is a whole-body transition, and your gut is at the centre of it. While declining hormones can trigger uncomfortable symptoms, your gut microbes, particularly the estrobolome, can help recycle oestrogen and offer relief.

The most effective strategies are food- and lifestyle-first: more plants, more mixed fibre, more diversity, fermented foods, soy and omega-3s. Strain-specific probiotics may help with certain symptoms, but they need to be chosen with precision.

With the right gut support, menopause doesn’t have to feel like something you ‘get through’. It can be a stage to step into with confidence — thriving, not just surviving.