In western countries Irritable Bowel Syndrome [IBS] is 4 times more common in women as they reach mid-life – also a time of our lives, when hot flushes cause us so much frustration. As my own gut health changed when I reached my early 50s, it made sense to me that these issues may well be related – they are and in this article I explain why.
Knowledge about how the gut-microbiome alters aspects of our immune, metabolic and nervous system health as we age has increased 10-fold over the past decade.
Whilst this has been mainly due to improved genetic research, it’s also arrived from advances in microbial technology. Both have opened the door to better understanding gut health and the link to inflammatory diseases, as we get older.
One of the main effects oestrogen has in our body, is to support our digestive health. In our monthly cycle, oestrogen was cycling up and down, and this meant that the higher levels of oestrogen helped our gut enzymes to work more efficiently.
The role of enzymes in your body is important. They work hard every second of every day to produce chemical reactions in the body. For example, there are enzymes that help our digestive processes. When you eat that bit of bread, amylase is the enzyme that breaks down the starch in it. Amylase is present in your saliva. Then there is another enzyme called pancreatase. This is produced by our pancreas to help break down fats and proteins.
But here’s the thing; when we move from peri-menopause into menopause, when our oestrogen levels decline, the production of these enzymes is reduced. Only since 2015, have researchers begun to understand that oestrogen has a role in helping the gut epithelium or lining to turn over cells regularly. According to Dr Marek Glezerman, author of ‘Gender Medicine’ which explores the gender differences in health and disease,
“Functional Disorders of the digestive tract, such as Irritable Bowel Syndrome (IBS) is four times more common in women living in Western countries during and after menopause. In Japan, China, India and other parts of Asia, the ratio is the opposite.”
The added dimension that menopause symptoms, such as hot flushes (hot flashes) are less prevalent in these countries bought my attention to the possible link between our changing gut health and the frequency of severity of hot flushes. The nature of menopausal symptoms is common to all women, however, geographical location and ethnicity influence the prevalence of certain symptoms. (Hunter, Chedraui et al., 2012).
Another éureka-moment in untangling my own symptoms and considerating my changing gut health against my personal inner thermometer, which at the time, was going off the scale. At the time, I didn’t realise that this increase in personal internal heat was putting me at risk for sleep disorders, increased cardiovascular risk, and depression. (Monteleone et al., 2018).
Unnatural shifts in the gut microbiota composition, known as dysbiosis, can lead to several health disorders. Knowing that one of these disorders is problems with temperature regulation is important for women transitioning into and through menopause. Whether you are on HRT or not, your gut health is a target for you to consider in your symptom management too.
Understanding that specific factors including our diet, environmental changes (extreme heat and cold), antibiotic exposure, sleep disturbance, physical activity (too much or not enough) and pathological stimuli, also cause a shift in the gut microbiota. Hormonal changes during menopause is just one of these stimuli.
‘One of the factors that plays a pivotal role in microbiota modulation, although broadly understudied in current research, is the change in female sexual hormones throughout life, including menopause.’ [Veira, A., Castelo, P. et al, (2017)]
In other words, your gut microbiota changes as you move through menopause, hence, increasing the risk of inflammation.
When inflammatory changes are present in the body, your body’s natural defence mechanisms are to try to cool you down. Hence, as you already know from when you were sick or had a fever, you begin to sweat.
Hot flushes and night sweats are a sign that your body is trying to cool down. But why is this?
The role of oestrogen in our gut health is more important than we think. Throughout our life, and more so after puberty, oestrogen helps to keep inflammation in our intestines at bay. It does this by preventing us from developing what is known as ”leaky gut’. If you have a post-pubescent daughter who can eat anything and not get an upset tummy compared to you, then this is why. She has oestrogen and if you are in mid-life then your levels are declining. Unless of course, she has medical concerns with her bowel or is eating a diet that is typical of the Western diet and high in fats, sugars and processed foods, then she might also experience dysbiosis, which increases the number of harmful bacteria in the gut.
Researchers have discovered that dysregulation of oestrogen receptors in the intestinal mucosa of patients with Crohn’s Disease and Ulcerative Colitis indicates that oestrogen signaling plays a role in the local immune response in the intestine, helping to maintain the integrity of the gut lining, called the epithelium. The interesting thing is that this is known to occur in a gender- and age-dependent manner (Jacenik, et al. 2019). And for women transitioning through menopause, from their mid-40s on, the loss of oestrogen impacts our gut health leading to a leaky gut and dysbiosis from a changing microbiome. In turn, the subequent inflammatory changes in our bowel can increase the frequency and severity of hot flushes. It’s no surprise to me that many menopause supplements have ingredients that are known to improve the gut microbiota … but my challenge to you, is what are you doing about your diet and sleep? These factors impact your bowel health too.
If you want to decrease your hot flushes and night sweats, sorting out your gut health matters. It’s why I have a module about restoring Gut Health as part of my restoration series in the 12 week MyMT™ programmes.
So, how is your gut health? Do you suffer from Irritable Bowel Syndrome (IBS)? Or diverticulitis? Or do you swing between being constipated and having diarrhoea? Maybe your brain also feels foggy all the time and you find it difficult to concentrate? Maybe you feel sad and depressed? Maybe your hot flushes are driving you crazy?
If these health changes have arrived in mid-life, then I can assure you that your menopause symptoms and your gut health are connected. And you aren’t alone. Numerous women on my programmes tell me that they are experiencing gut health issues that have mainly arrived since they went into their menopause transition.
The gut microbiome is one of the largest organs in the body (along with our skin) but here’s what blew me away with the research. Gut health researcher, Professor Thomas Borody from Australia, reports that the gut is responsible for producing 70% of our energy. There is also a powerful connection between your gut and your brain (which is why our gut is now referred to as our ‘second brain’), therefore many symptoms that we experience in menopause, such as foggy brain, depression, anxiety and mood swings can also be linked to the health of your gut micro-biome. I might also add insomnia in there too.
Imagine what happens to your hot flushes, energy levels, sleep, brain and moods, when your gut isn’t performing to its best? It’s Ok, don’t answer that – I already know.
If this sounds familiar to you and you are confused and frustrated with your changing gut health (and your hot flushes), especially those of you in post-menopause, then here are 3 strategies to get you started on sorting out your gut health naturally.
- Menopause hormonal changes cause our gut motility (called peristalsis) to slow down. Understanding this means that you should also slow down the amount and frequency of your food intake. Portion control is important as is your overnight fasting for 12-14 hours. This allows time for the food already in your gut to be digested.
2. Try not to overheat or be in extreme cold. Very hard with climate change in many countries I know. Environmental temperature and heat stress are known to modify the gut microbiome. Changes in core temperature have been linked to altered microbiome composition and function. Those of you living in regions such as the Northern parts of Australia, need to keep this in mind. Your extreme summer heat causes worsening gut health. (Hylander & Repasky, 2019). The opposite is true for those of you living in countries that have extremes in cold, such as in Canada. As such, you have to tone down your exercise intensity in extreme heat or cold environments. That’s a double-whammy for worsening gut health during menopause.
3. Change your diet and restrict your fats. New research reports that high fat diets mimic the effects of a western diet (Lobionda, Sittipo et al, 2019) and this increases bowel inflammation. Hence, the type of fat you have matters as are the foods that supply your gut microbiota with good bacteria. Prebiotic foods are rich in dietary fibres. So what you’re looking for are fruit, vegetables, wholegrains, and pulses. Your body can’t digest these fibres, so they travel to your gut where they feed the good bacteria that make butyrate.
4. Your brain thermostat matters. All temperature changes are regulated in the brain, hence your circadian rhythm matters too. Turning this around is really important, not only to manage hot flushes and night sweats, but also your gut health. Your gut is on a 24 hr circadian cycle too.
Dysbiosis of the gut microbiota in menopausal women is mainly due to changes in oestrogen levels as we age. This increases hot flushes, night sweats, depression, sore joints and gut discomfort such as bloating. Put this up against our levels of stress, whether we are sleeping, our diet, whether we live in extreme climates, our history of medication use (including antibiotics) and of course, alcohol consumption, then understanding these influences is an integral part of your menopause symptom management.
As a note of caution too, all Gastro-intestinal symptoms should always be evaluated promptly and aggressively by your Doctor – bloating can be a sign of a much more serious problem like certain cancers, ovarian cancer, pancreatic cancer, liver disease, inflammatory bowel disease, bowel obstruction, diverticulitis, infectious causes, amongst many other conditions. But if all is OK and clear, then don’t forget that making some lifestyle changes matters much more than you think during menopause.
When you are ready, I hope you can join me on either of the 12 week coaching programmes, which also includes my gut health module too.
Glezerman, M. (2016). Gender Medicine. Duckworth & Co Publ.
Hunter, Myra & Chedraui, Peter & Blümel, JE & Tserotas, Konstantinos & Aguirre, W & Palacios, S & Sturdee, David. (2012). The International Menopause Study of Climate, Altitude, Temperature (IMS-CAT) and vasomotor symptoms. Climacteric : The Journal of the International Menopause Society. 16. 10.3109/13697137.2012.699563.
(2019) Temperature as a modulator of the gut microbiome: what are the implications and opportunities for thermal medicine?, International Journal of Hyperthermia, 36:sup1, 83-89,E.
Jacenik, D., Cygankiewicz, A. I., Mokrowiecka, A., Małecka-Panas, E., Fichna, J., & Krajewska, W. M. (2019). Sex- and Age-Related Estrogen Signaling Alteration in Inflammatory Bowel Diseases: Modulatory Role of Estrogen Receptors. International journal of molecular sciences, 20(13), 3175. https://doi.org/10.3390/ijms20133175
Monteleone, P., Mascagni, G., Giannini, A. et al. Symptoms of menopause — global prevalence, physiology and implications. Nat Rev Endocrinol 14, 199–215 (2018). https://doi.org/10.1038/nrendo.2017.180
Nie, X., Xie, R. & Tuo, B. (2018). Effects of Estrogen on the Gastrointestinal Tract. Dig Dis Sci 63, 583–596
Veira, A., Castelo, P. et al, (2017). Influence of oral and gut microbiota in the health of menopausal women. Front. Microbiol.