The key to a smoother menopause may lie in your gut

Gut health is often overlooked when women are struggling with symptoms of menopause.

When Julia first consulted nutritional therapist Joanna Lyall, she was at a low ebb. Fifty-one, perimenopausal, anxious and struggling to sleep, the mother-of-two was often tearful and felt unable to cope with the pace of work in her senior position in HR. She had tried HRT and herbal supplements, but her continuing lack of sleep meant Julia felt increasingly too stressed to cope.

Lyall conducted a stool sample test to look at Julia’s gut biology and hormone levels. She then recommended that Julia follow lifestyle and dietary changes, like avoiding alcohol and processed foods, and including more greens, nuts, oily fish and sleep-enhancing tryptophan – an amino acid found in foods including chicken, turkey and bananas. She also recommended Julia start taking a probiotic. “As a result, Julia’s mood improved and she now sleeps well for the first time in five years,” says Lyall, who is co-founder of The Better Menopause.

Menopause affects every woman, but only 15 per cent of British women are on hormone replacement therapy (HRT) - perhaps because of lack of access, or a fear of side effects. Regardless, many women - whether on HRT or not - experience some sort of health problem in midlife.

According to Menopause Support, eight in 10 women of this age find at least one menopause symptom “very difficult” to live with, from brain fog to sleep issues and anxiety. Research by the Fawcett Society and Channel Four found that one in 10 women have left work because of their symptoms. But the role of the gut is often overlooked.

There’s a growing body of science that looks at the link between our microbiome – the “friendly” bacteria that live inside our gut – and an improvement in mental health. A 2020 review of studies found a correlation between probiotic bacteria and sleep quality, as well as mood improvement in people who experienced anxiety and depression. For Julia, this link proved to be key to resolving her menopause-related symptoms.

This approach can also work in tandem with hormone replacement therapy. In some cases, HRT has been shown to positively affect gut health, as lower oestrogen levels during menopause reduce the diversity of the microbiome and topping those levels up reverses the effect.

Dr Shahzadi Harper is a GP and menopause specialist. “As HRT directly affects the gut microbiome, it can help with other symptoms like fatigue and mood,” she says. 

Dr Jolene Brighten, a naturopathic endocrinologist who specialises in women’s health and hormone balance, agrees. “HRT has a crucial role in oestrogen metabolism.”

Why oestrogen matters

“The drop in oestrogen during both perimenopause and menopause, and the reduction in diversity in the gut microbiome, affects the way the gut enzyme functions,” says Dr Harper. “This can exacerbate some of our menopause symptoms like low mood and anxiety, while increasing those tired, sluggish feelings.”

Sex hormones, particularly oestrogen, have a powerful influence on the way your gut and brain communicate – this is known as the gut-brain axis. “Because your gut health affects your brain health, metabolism and immunity, poor gut health can amplify the issues many women experience during the menopause,” says Dr Brighten.

“Brain fog and weight gain can accompany menopause, and these are directly impacted by poor gut health. In addition, the gut is a major conversion site for the thyroid hormone – where this hormone is activated – influencing your mood, digestion and energy.”

Rebalancing your gut

Understanding this process starts with understanding the role of the hormone estrobolome. “Estrobolome is made up of the microbes in the gut that interact with oestrogen,” says Brighten. “They are in part responsible for keeping your hormones at optimal levels and your vagina healthy.”

An unbalanced microbiome, however, can disturb levels of estrobolome, which can in turn impact your weight, libido, sleep and energy levels. “Poor sleep will in turn affect your cognition, concentration and focus, leading to a general loss of confidence,” says Dr Harper. “What’s more, as 90 per cent of our serotonin – the happy neurochemical – is made in our gut, when the microbiome is not working well it can cause anxiety and low mood.”

The link between the gut microbiome and the brain is the subject of ongoing research. Photo / 123RF

While there’s no silver bullet, there are ways to improve your gut health with a few lifestyle changes. “Increase your consumption of wholegrains and green vegetables, which contain beneficial fibre and promote the growth of healthy gut bacteria, especially broccoli, which is involved in the metabolism of oestrogen,” says Lyall.

“Minimise sugar, artificial sweeteners, fried foods, processed foods and alcohol. Meanwhile, reducing stress in your life is incredibly important, whether it’s through mindfulness, breathwork, yoga, Pilates or exercise.”

The connection between the gut microbiome and your brain – linked through the multitude of nerve endings in your gut – is the subject of ongoing research. “These nerves connect to a larger one called the vagus nerve, which runs like a motorway from your intestines up to your brain,” says menopause nutritionist Penny Crowther. “Communication travels both ways, meaning that stressful thoughts and feelings can bring about changes in how your gut works as well as the other way around.”

Preventing digestive issues

Some women find the hormonal changes of menopause significantly affect their digestion, causing issues like bloating and excessive gas. “Oestrogen and progesterone affect our gut transit, so their decrease means our transit slows down,” says Dr Harper. “Our food remains within the gut and fermentation occurs, releasing gas and wind. Also, because oestrogen helps the body retain moisture, the drop in oestrogen often results in constipation.”

“Sticking to regular mealtimes and not missing meals will keep the muscles of your gut moving,” says nutritionist Emily Foster. “Meanwhile, acid reflux is a common problem for menopausal women and, like most gut issues, this can be heavily impacted by stress levels. Carrying excessive weight can also increase reflux symptoms.”

Stress can have other negative impacts, says Crowther: “The stress that goes with the menopause may also affect the vital protective layer of cells in your gut known as your gut barrier. Keeping this barrier healthy is critical because it allows nutrients to be absorbed from the foods you eat, but also keeps harmful toxins out. If your gut barrier is not healthy, you are more likely to get irritable bowel syndrome.”

Prebiotics and probiotics

Foods that encourage the growth of healthy gut bacteria – prebiotics – include wholegrains and green leafy veg, bananas and almonds. Probiotics – the live bacteria and yeasts that are good for you – can also be taken as supplements and found in some foods, like live yoghurt.

Says Crowther: “Some prebiotics and probiotics produce chemical messengers called neurotransmitters, which help reduce anxiety and improve the way you deal with stress. These include GABA, which has a relaxing effect, as well as serotonin and the “feel-good” hormone dopamine.

These neurotransmitters are particularly helpful whilst navigating the ups and downs of menopausal hormonal mood swings. “What’s more, probiotics help reduce inflammation, which is known to play an important role in depression and many chronic diseases of midlife and beyond,” says Crowther.

4 ways to improve your gut health

Find a good probiotic

Take a probiotic that’s designed for menopause to make sure you are getting the optimal amount without overloading the gut.

The right fibre

“Fibre provides food for good bacteria in your gut,” says Crowther. “However, the type of fibre you eat is important, particularly if you have IBS or bloating. Too much fibre from tough fruit or vegetable skins, whole seeds and wheat bran could make your symptoms worse, so stick to wholegrains, such as oats, brown rice or rye, quinoa, and ground seeds and nuts.”

Fermented foods

An excellent way to encourage good bacteria to grow in your gut is to eat fermented foods. Opt for sauerkraut and cultured vegetables, as well as kefir and kombucha. Look for “raw”, “live” or “active cultures” on the label.

Keep a food diary

“With the hormone fluctuations of the perimenopause making your gut more sensitive, keeping a food diary to pinpoint any trigger foods for gut problems will really help,” says Crowther.