Gut Health and Menopause: Why It Matters as Women Age

Gut health and menopause are intricately intertwined. During this phase of life, hormonal shifts can cause imbalances in the gut’s levels of “good” and “bad” bacteria. A two-way relationship exists between hormones and the environment of microorganisms in the intestines, known as the gut microbiome. Levels of sex steroid hormones can influence microbial balance and diversity, while gut health can also affect hormone levels. When gut homeostasis is disrupted, it can lead to uncomfortable digestive symptoms and other health issues.⁽¹⁾⁽²⁾ 

A healthy gastrointestinal tract is essential for overall health. The gut microbiome supports immunity, digestion, production of new blood vessels, and nutrient absorption.⁽³⁾ Understanding the compositional changes the gut microbiome undergoes as women age can help women effectively manage their gut health during menopause.

How Aging Affects Gut Health in Women

The composition of the human gut microbiome changes with age. While microbial diversity significantly increases during infancy, research suggests that sex differences begin to emerge during puberty.⁽⁴⁾ 

One study showed that the composition of the gut microbiome of adolescent girls shifted towards that of an adult as they progressed through puberty. However, this relationship was not observed in adolescent boys. Another study found that women in young adulthood have more gut microbiota diversity compared to men, but not women in older adulthood. These studies collectively suggest a role of sex steroid hormones in aging-related gut changes.⁽⁴⁾⁽⁵⁾ 

Nutrient absorption and gut motility also decrease as humans age. Increased medication use, dietary changes, weakened immunity, or the development of certain health conditions are all aging-related factors that may disrupt healthy gut function in older women.⁽⁶⁾

Many women between the ages of 40 and 65 experience gastrointestinal symptoms and changes in bowel habits that may worsen during menopause, including the following:⁽⁷⁾

• Abdominal pain

• Bloating

• Gas

• Diarrhea

• Constipation
  

The Science Behind Menopause and Gut Health

Women in their reproductive years have higher levels of estrogen. This hormone promotes the growth of “good” gut bacteria while hindering “bad” bacterial growth. As estrogen levels fluctuate and decline during menopause, the diversity of women’s gut microbiota decreases.⁽²⁾

These changes begin in perimenopause, when levels of healthy species like lactobacillus and bifidobacteria drop. Declining levels of estrogen and progesterone have also been linked with increased gut permeability, making it easier for potentially harmful pathogens to make their way through the gastrointestinal lining into the bloodstream. Increased gut permeability is also referred to as leaky gut.⁽²⁾⁽⁴⁾

One study showed an increase in gut permeability among postmenopausal women compared to premenopausal women. A connection was also observed between increased gut permeability and higher levels of high-sensitivity C-reactive protein (hs-CRP) in the body, a marker of inflammation. The research findings suggest that inflammation related to hormonal fluctuations may increase the risk of gastrointestinal issues during perimenopause. However, additional studies are needed.⁽⁷⁾

Menopausal Symptoms and the Gut Microbiome

Hormonal fluctuations may impact gut health, but the gut microbiome may also influence common menopausal symptoms, such as the following:

Mood Changes

A group of estrogen-regulating bacteria exists in the gut called the estrobolome. Disruptions in the gut microbiome (dysbiosis) can cause imbalances in the estrobolome and may increase the risk of menopausal mood changes. The gut-brain axis may also play a role in mental health by facilitating communication between the gastrointestinal tract and the central nervous system. Treatments focused on strengthening the gut microbiome may have positive effects on the gut-brain axis. Some experts believe these treatments hold promise for treating mood disorders in menopausal and postmenopausal women.⁽⁸⁾ 

Hot Flashes

Some research suggests a relationship between gut health and vasomotor symptoms. A study published in PLoS One found that women between the ages of 40 and 65 who experienced more severe hot flashes had higher blood levels of fatty acid binding protein 2 (FABP2), a marker of gut permeability. The researchers concluded that the intensity of hot flashes may be correlated with greater gut permeability among postmenopausal women.⁽⁹⁾

Sleep Disturbances

Many women experience sleep disturbances during menopause, which may be influenced by gut health. A healthy gut microbiome helps the body maintain its circadian rhythm by producing melatonin and other sleep-related metabolites. Compositional changes in the microbiome during menopause may cause dysbiosis, leading to disruptions in the sleep-wake cycle.⁽¹⁰⁾

Probiotics and Prebiotics for Gut Health During Menopause

Probiotics and prebiotics may support gut health in older adults. Probiotics consist of live microorganisms that may provide health benefits when ingested in effective amounts individualized to each person. Prebiotics are non-digestible compounds found in certain foods and supplements that promote the growth of one or more strains of natural gut bacteria. The combination of probiotics and prebiotics is termed synbiotics, which, together, may promote gut homeostasis. Prebiotics mainly consist of complex carbohydrates, while most probiotic products contain strains of “good” lactobacilli and bifidobacteria.⁽⁶⁾⁽⁸⁾ 

More research is needed on the benefits and risks of probiotics and prebiotics, particularly as it pertains to women’s health. Therefore, it’s important that women consult with their doctor before taking any medications or supplements. Probiotics and prebiotics may not be recommended for people with certain health conditions or those taking certain medications.

Dietary Sources of Probiotics and Prebiotics:

Probiotics and prebiotics can also be consumed through the following food sources:^(8)(11)

• Yogurt

• Soy sauce

• Sauerkraut

• Kimchi

• Kombucha
  

Lifestyle Tips for Maintaining Gut Health During Menopause

As the gut microbiome changes during menopause, the following are ways in which women can maintain their digestive health as they age:

Eating Fiber-Rich Foods

Eating sources of dietary fiber, such as oats, barley, or fruit, can boost the growth of healthy gut bacteria and maintain the function of the intestinal lining.^(11)(12)

Drinking Plenty of Fluids

A study published in The Journal of Nutrition found differences in the composition of the gut microbiome of people who drank less water compared to those who drank more water. Low water consumption was linked with higher amounts of campylobacter bacteria, which can cause diarrhea.⁽¹³⁾

Avoiding Processed Foods and Unhealthy Fats

Foods that are high in processed sugar, sodium, and trans fats hinder the growth of healthy microorganisms in the gastrointestinal tract. Minimizing intake of these foods can help preserve a healthy gut microbiome.⁽¹²⁾

Getting Regular Exercise

Physical activity improves gut motility, reducing the amount of time pathogens are in contact with the intestinal lining. Exercise may also reduce inflammation and has been associated with a lower risk of inflammatory bowel disease (IBD).⁽¹⁴⁾

Prioritizing Sleep

Maintaining a regular bedtime, avoiding eating late at night, and reducing artificial light exposure during the evening are healthy habits that can enhance sleep and support gut health. 

Reducing Stress Levels

Stress may boost inflammation, increase gut permeability, and alter the balance of gut bacteria.⁽¹⁵⁾ Keeping stress levels low through self-care practices can help strengthen gastrointestinal health.

Taking Control of Gut Health During Menopause

While the gut microbiome is influenced by aging and hormonal changes, menopausal women can still take control of their gut health with comprehensive knowledge and lifestyle modifications.

As the intestinal tract undergoes age-related changes in permeability and microbial diversity, maintaining a healthy diet, exercising regularly, and prioritizing mental well-being are all gut-friendly strategies women can implement on a daily basis to improve and maintain long-term gut health. If gastrointestinal symptoms worsen or do not improve, it’s important to consult with a healthcare provider for proper diagnosis and treatment. 

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.