Overview
Menopause may affect your gut health. Fluctuating and declining oestrogen and progesterone can influence gut motility, the intestinal environment and the gut microbiome. This may contribute to bloating, constipation and changes in bowel habits, although sleep, stress, diet, medication and ageing can also play a part.
At a glance
- Common digestive changes include bloating, gas, constipation, diarrhoea, abdominal discomfort and altered bowel urgency.
- Hormones may be part of the explanation, but they are rarely the whole explanation.
- Fibre-rich foods, plant variety, fluids, gentle movement, sleep and stress support are practical foundations.
- New or persistent bowel symptoms should not automatically be attributed to menopause.
Have bloating, constipation, bowel urgency or a change in digestion arrived during your menopause transition? If so, you may be wondering whether your changing hormones have anything to do with it.
How Hormonal Changes May Affect the Gut
When I entered perimenopause, I wasn’t prepared for the sleepless nights, the incredible weight gain I experienced – or the discomfort from my continual bloating.
When around 60% of women completing the MyMT™ Symptoms Quiz, mentioned a similar experience, my research journey began to better understand why.
The more research I did, the more I realised that much of the information we hear about gut health takes a “one-size-fits-all” approach. But women’s digestive health can also be influenced by our changing hormonal environment during and after menopause and normal changes due to our ageing.
The female gut contains oestrogen receptors, and declining oestrogen during the menopause transition may affect gut motility—the movement of food through your digestive system—and the gut microbiome.
Studies have also identified differences in the gut microbiome after menopause, although researchers are still working to understand what these changes mean for women’s symptoms and long-term health.
Oestrogen also plays a role in maintaining the intestinal barrier and regulating inflammatory processes within the gut.
Digestive enzymes are important too. They help break down the food you eat so that nutrients can be absorbed and used by your body. For example, pancreatic enzymes include lipase, which helps digest fats, and proteases, which help digest proteins.
As we move from perimenopause into menopause, changes in digestion and nutrient absorption may affect how we feel and function. For some women, these changes may occur alongside challenges with digestive comfort, weight management and healthy ageing.
Stage | What may be happening | Possible gut-health experience |
|---|---|---|
Perimenopause | Hormone levels fluctuate considerably | Symptoms may appear intermittently or vary with the cycle |
Menopause | Oestrogen and progesterone are declining | Bloating, constipation or changed bowel habits may become more noticeable |
Post-menopause | Hormones remain at lower levels; ageing and lifestyle factors continue to influence the gut | Microbiome differences have been observed, but their clinical meaning remains uncertain |
Common gut-health changes during menopause
Digestive symptoms do not look the same for every woman. Some of the concerns women discuss with me during the menopause transition include:
- Bloating, increased gas or abdominal discomfort
- Constipation or a change in bowel frequency
- Diarrhoea or movement between constipation and diarrhoea
- A greater sense of bowel urgency
- IBS-like symptoms or a change in existing irritable bowel syndrome
- Digestive symptoms occurring alongside poor sleep, stress, low mood or brain fog
These symptoms can have many causes. Menopause may be part of the context, but it is important not to assume that every new digestive symptom is hormonal.
When should you seek medical advice?
Important: Speak with a healthcare provider if digestive symptoms are new, persistent, worsening or affecting your everyday life. Seek prompt medical advice for blood in your bowel motion, unexplained weight loss, iron-deficiency anaemia, a lump or swelling in your abdomen, severe or persistent abdominal pain, or a lasting change in your usual bowel habits.
If you’re experiencing bloating, I encourage you to read my blog “A spotlight on your changing gut health” for four factors to forget bloating.
Learn more about the changes that impact our gut health, including irritable bowel syndrome, as we move through menopause and into post-menopause.
What 20,000 Women Have Taught Me About Gut Health and Menopause
Over the past decade, more than 20,000 women have joined me through the MyMT™ programmes. Their experiences have taught me that many women feel unheard and that symptoms appearing during menopause and then returning after menopause are often considered separately rather than as part of a connected picture.
Gut-health concerns are part of this conversation. In our MyMT™ community, 58% of women have reported experiencing gut-health challenges after entering menopause. This valuable feedback reinforces my conviction that gut health must be included in the menopause conversation. It’s also why I developed a specialised programme called Masterclass on Menopause.
But before we explore the connections between gut health and menopause, it’s important to understand the gut microbiome, and the role it plays in digestive health.
What is the gut microbiome?
The gut microbiome is the community of bacteria, viruses, fungi and other microorganisms living in the gastrointestinal tract.
There is no single ‘perfect’ microbiome. Your gut microbiome is unique to you.
Some gut bacteria help the body process oestrogen. This part of the gut microbiome is known as the oestrobolome.
What is the Oestrobolome?
The estrobolome refers to the collection of genes in the gut microbiome that are capable of influencing how oestrogens are processed.
After oestrogens are processed in the liver, they are excreted into the gut. Some gut bacteria produce an enzyme called beta-glucuronidase, which can reactivate certain oestrogens and allow them to be reabsorbed into the bloodstream.
This suggests there may be a two-way relationship between oestrogen and the gut microbiome: changing hormones may influence the gut environment, while microorganisms in the gut may influence how oestrogen is processed.
However, research into the oestrobolome and menopause is still developing. We don’t yet fully understand what these microbial changes mean for an individual woman’s menopause symptoms or long-term health.
What else can impact gut health?
While research suggests gut health and menopause may be connected, hormones are only one part of the picture. Your gut health is also influenced by your circadian rhythm, the quality of your sleep, stress, diet, physical activity, medications, illness and ageing. These factors often overlap during the menopause transition, which may help explain why digestive changes can appear or become more noticeable at this stage of life.
This is why I don’t believe we should look at gut symptoms—or hormones—in isolation. As I often remind women in my MyMT™ community, your symptoms are connected. Understanding those connections is an important first step towards supporting your gut health during menopause.
The gut-brain connection in menopause
The gut-brain axis is the two-way communication pathway between your gut and your brain. This pathway involves nerves and hormones, including communication through the vagus nerve.
Research by Alsegiani and Shah explores gut microbiota alterations, age-related neuroinflammation and cognitive decline, while Shreiner and colleagues provide an overview of the gut microbiome in health and disease. This research is relevant to the menopause conversation because brain fog, mood, anxiety, sleep and the inflammatory changes associated with ageing do not occur in isolation from the rest of the body.
‘The gut microbiota has both positive and negative effects on the body and the brain. The scientific literature suggests that the gut microbiome now influences the brain ageing process and the initiation and progression of neuro-degenerative disorders.’ [Alsegiani & Shah, 2022, p. 2407].
To learn more about the connection between gut health and brain health, be sure to read my article “Gut Feelings: Is there a link between increased fruit intake, gut health, and your menopause brain fog?“
Turning the science into practical support
The gut-brain connection is another reminder that gut health during menopause is not only about digestion. Sleep, stress, mood, food and movement can all influence how your digestive system feels and functions—and each of these areas may also be affected by your changing hormonal environment.
While researchers continue to explore these connections, you don’t need to wait for every answer before supporting your health.
There are practical, evidence-informed habits that can help support bowel regularity, microbial diversity and digestive comfort as part of a wider approach to menopause and healthy ageing.
Gut health, serotonin and menopause mood
Gut health and menopause are interconnected through serotonin production. Because around 90 – 95% of serotonin is produced in the gut, hormonal changes, stress, sleep disruption, and dietary factors during menopause may influence mood, anxiety, and cognitive clarity. Supporting gut balance, circadian rhythm, and tryptophan intake may help regulate menopause-related mood changes. To learn more about the connection between gut health and mood, check out my article “Gut Feelings: Boost your menopause mood with food, sunlight and a gut health reset too.“
Watch: Gut Health in Your Menopause Transition
In this short video, I discuss why gut health deserves attention from perimenopause through post-menopause and how it fits within a whole-body approach to healthy ageing.
Source: Watch the MyMT™ video on YouTube
In summary, menopause may affect gut health. Changing oestrogen and progesterone levels may influence the digestive system and the gut microbiome—the community of microorganisms living within the gut.
Because the gut microbiome interacts with immune, metabolic and nervous-system pathways, researchers are exploring whether menopause-related changes in the microbiome may be associated with symptoms such as low mood, disrupted sleep, brain fog and changes in body composition.
However, most menopause-specific evidence is currently observational or based on biological mechanisms. This means we can describe possible connections, but we cannot claim that “healing the gut” will prevent hot flushes, anxiety, weight gain or other menopause symptoms.
What I can say is that many women in my MyMT™ community report changes in their gut health during menopause, including bloating, constipation and symptoms associated with irritable bowel syndrome (IBS). Their experiences do not prove that menopause is the direct cause, but they reinforce why gut health deserves a place in the menopause conversation. This is why, in all of the MyMT™ programmes, there is a specific Gut Health module for you. If you would like to learn more, then the MyMT™ Masterclass on Menopause and Beyond teaches you why you may be experiencing worsening symptoms, no matter if you are on HRT either.”
A connected approach to Menopause Gut Health
My approach is to connect the dots. Gut health is one part of a wider menopause and healthy-ageing picture that also includes sleep, stress, movement, nutrition, muscle, metabolic health and appropriate medical care.
Begin with the foundations, notice what changes, and avoid chasing the idea of a perfect microbiome. Most importantly, do not allow a new or persistent symptom to be dismissed simply because you are in midlife.
If you would like structured support, you can learn more about Restore Your Grateful Gut in Menopause and the wider MyMT™ approach.
Other Gut Health and Menopause Resources
Frequently asked questions - Gut Health & Menopause
Bloating and discomfort may sit alongside changing gut motility, microbiome changes, declining hormones, stress and insomnia. The first steps I discuss include improving sleep, increasing food quality and vegetable diversity, allowing an overnight break from eating where appropriate, and using gentle movement and stretching.
Probiotics introduce beneficial bacteria, while prebiotic plant fibres nourish bacteria already living in your large bowel. I encourage you to pay attention to this prebiotic foundation rather than focusing only on probiotic products.
The gut-brain axis may be relevant to brain fog, mood, anxiety and sleep during menopause. This is why I bring together gut health, changing hormones, stress, circadian rhythm and food rather than viewing any one of these in isolation.
My approach is to ‘connect the dots’. As I wrote in ‘10 Years, 10 Lessons’, your symptoms are connected, and scientific knowledge needs to be translated into practical lifestyle change. Gut health is one part of a wider healthy-ageing approach to menopause.
Changes in bowel habits are reported during the menopause transition, and hormones may influence digestive motility. Constipation or diarrhoea can also result from medicines, infection, IBS, dietary changes and other conditions, so persistent changes should be assessed.
Some women report new or worsening IBS-like symptoms during perimenopause or menopause. Hormone changes, stress, sleep and gut sensitivity may all contribute. Do not assume a new symptom is IBS without medical assessment, particularly if warning signs are present.
References:
- Nie X, Xie R, Tuo B. Effects of Estrogen on the Gastrointestinal Tract. Digestive Diseases and Sciences. 2018;63:583-596.
- Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. International Journal of Women’s Health. 2022;14:1059-1072.
- Traber MG, Buettner GR, Bruno RS. The relationship between vitamin C status, the gut-liver axis, and metabolic syndrome. Redox Biology. 2019;21:101091.
- Vieira AT et al. Influence of oral and gut microbiota in the health of menopausal women. Frontiers in Microbiology. 2017;8:1884.
- Shreiner AB, Kao JY, Young VB. The gut microbiome in health and in disease. Current Opinion in Gastroenterology. 2015;31(1):69-75.
- Alsegiani AS, Shah ZA. The influence of gut microbiota alteration on age-related neuroinflammation and cognitive decline. Neural Regeneration Research. 2022;17(11):2407-2412.
- Lyu C et al. Flavonoid-Rich Fruit Intake in Midlife and Late-Life and Associations with Risk of Dementia: The Framingham Heart Study. Journal of Prevention of Alzheimer’s Disease. 2024.
- Millman J et al. Extra-virgin olive oil and the gut-brain axis. Nutrition Reviews. 2021;79(12):1362-1374.
- Jenkins TA et al. Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients. 2016;8(1):56.
