Knowledge about how the gut-microbiome alters aspects of our immune, metabolic and nervous system health has increased 10-fold over the past decade. Fortunately for all of us, some of this knowledge has also been situated in midlife women’s health.
Whilst this increase in research 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 of gut health and the link to inflammatory diseases as we get older.
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 menopause symptoms may cause so much frustration. With my own gut health changing when I reached my early 50s, it made sense to me that these issues may well be related.
As it turns out they are, and with the huge number of women on my 12 week lifestyle programmes mentioning that they feel that their gut health has changed since arriving in menopause, I wanted, as part of the celebration of lifestyle science and menopause, to explain why.
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. Changes to your gut microbiome also change and I talk about this below.
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 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). This bought my attention to the possible link between our changing gut health and the frequency of severity of hot flushes, weight gain and other symptoms.
Another important realisation about our changing gut health, is the link between certain types of microbes that reside in our colon and how these impact health problems as we age.
For example, in women with menopause-related osteoporosis, scientists have discovered that the microbial organism called Prevotella may be protective against this life-changing bone disease. And when it comes to women’s heart disease, it seems that optimal numbers of Lactobacillus Casei may help to reduce vascular stiffness which is associated with women’s ageing blood vessels during and after menopause which can contribute to high blood pressure (hypertension). [Siddiqui et al, 2022].
Unnatural shifts in the gut microbiota composition, known as dysbiosis, can lead to several health disorders. Knowing that one of these disorders is to do with temperature regulation problems, is important for women transitioning into and through menopause.
That’s why, whether you are on menopause HRT or not, looking after your gut health is an important lifestyle strategy for you to consider as part of your symptom management too.
Numerous factors impact our gut function over our lifetime. This includes our diet, environmental changes (extreme heat and cold), antibiotic exposure, sleep disturbance, physical activity (too much or not enough), hormonal changes and pathological or disease stimuli – all of these factors cause a shift in the gut microbiota. Hormonal changes during menopause are included in this list too.
‘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)]
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’.
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). So, for women transitioning through menopause, from their mid-40s on, the decline in oestrogen levels impacts our gut health. This may result in a leaky gut and dysbiosis from a changing microbiome.
In turn, the subsequent inflammatory changes in our bowel can increase the frequency and severity of hot flushes. 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.
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 gut health too.
What all this means is that if you want to reduce your symptoms during menopause and manage your weight, then sorting out your gut health matters.
This is why I have a module about restoring Gut Health as part of my restoration series in the 12 week MyMT™ Transform ME programme which is ON SALE throughout the month of January.
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?
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, restrict your fats and increase Vitamin C intake. 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. This is a primary nutrient that is physiologically produced by the microbial fermentation of dietary fibres and therefore, plays a functional role in maintaining the integrity and function of your intestinal cells. (Leonel & Alvarez-Leite, 2015). Furthermore, studies also indicate that Vitamin C is needed to help prevent Intestinal bacterial overgrowth, which is a complication of the increased visceral fat that can arrive during menopause. (Traber, Buettner et al, 2019).
New research is also emerging about the role of the gut microbiome in certain women’s health problems, so having foods that increase certain healthy microbes in the gut and reduce harmful microbes is an interesting and emerging research purpose, so watch this space!
For example, new evidence on the connection between changing gut microbes and women’s health issues suggests that the microbes, Lactobaccillus casei and Lactococcus lactis help to alleviate vascular malfunction and arterial stiffness in overweight post-menopausal women [Siddiqui, Makhlouf et al., 2022]. Two foods that supply these bacteria, include Green Olives and hard Cheese. I talk about both of these foods in the MyMT™ Food Guide.
4. Your brain thermostat matters. All temperature changes are regulated in the brain, hence your circadian rhythm matters to your health as you age. Turning around your circadian rhythm is crucial for your gut health as your gut functions 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.
MyMT™ places menopause symptom and weight gain solutions in the women’s health and ageing lifestyle science … when nobody else is.
I hope you can join me sometime on my powerful 12 week programme and don’t forget that my January Visible Results SALE is on now. I tell you about this in the video below. All you do to take advantage of the incredible savings this month is to apply the promo code JANUARY2023 when you purchase. You can read more about how it all works HERE.
There is never a better time to start, but if you are hesitating, then I recommend you complete the MyMT™ Symptoms Quiz, watch the MyMT™ Masterclass on Menopause, go to the Testimonials and Success Stories on the MyMT™ website and find someone like you.
Dr Wendy Sweet (PhD)/ Member: Australasian Society of Lifestyle Medicine.
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, DOI: 10.1080/02656736.2019.1647356E.
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
Leonel, A. & Alvarez-Leite, J. (2012). Butyrate: implications for intestinal function. Review, Lippincott, Williams and Wilkin, 15 (5), 1-6.
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.
Siddiqui, R.; Makhlouf, Z.; Alharbi, A.M.; Alfahemi, H.; Khan, N.A. The Gut Microbiome and Female Health. Biology 2022, 11, 1683. https://doi.org/10.3390/biology11111683
Traber M., Buettner G., Bruno R. (2019). The relationship between vitamin C status, the gut-liver axis, and metabolic syndrome. Redox Biol. 21:101091.
Veira, A., Castelo, P. et al, (2017). Influence of oral and gut microbiota in the health of menopausal women. Front. Microbiol. 8: 1884.