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Why gut health is a non-negotiable in perimenopause and beyond

Updated: Nov 8

#perimenopause #menopause #estrobolome #microbiomehealthinperimenopause #microbiomehealthinmenopause #vaginalmicrobiome #menopausesymptoms #womenshealth #functionalnutritionist #leakygutinperimenopause #hormonesimpactonmicrobiome #hormonesimpactonmetabolichealth


The impact of low hormone levels on your gut microbiome and metabolic health


The gut microbiome, which consists of the microbes in the intestinal tract and their metabolites, plays an important role in overall health. The drop in estrogen levels in perimenopause and menopause can cause changes to the gut microbiota. Yes, your hormone levels actually can impact the bacteria or ecosystem in your gut. And you guessed it - it’s unfortunately not a positive change: you’ll be more prone to weight gain (higher fat storage, lower fat consumption aka decreased metabolic rate, and insulin resistance) SIGH.


A healthy and diverse microbiome hosts primarily 4 phyla: Bacteroidetes, Firmicutes, Actinobacteria and Proteobacteria, with over 90% of species falling within the Bacteroidetes & Firmicutes phyla. When this balance is off, your ecosystem is out of balance and more pathogenic bacteria (the bad guys) are able to settle in.

Studies found that reduced circulating estrogen results in a significantly higher Firmicutes to Bacteroidetes ratio. This means that in perimenopause or menopause (or just when you’re lacking estrogen) you’re likely to suffer from dysbiosis in your gut, which is leading to a higher inflammation levels and has a negative effect on your metabolism and weight gain.


But not only declining levels of estrogen are negatively impacting your microbiome: also low progesterone has a negative effect. Actually, low levels of both hormones have been found to cause the downregulation of epithelial junction proteins, gut barrier dysfunction, and an increase in gut permeability. This will lead to food sensitivities and will cause inflammation that drives insulin resistance and weight gain. Source


Progesterone has actually been proven to decrease the inflammation and gut permeability. Source.


There’s a wealth of estrogen receptors in your intestine, brain, bones and adipose tissue. As much as low hormone levels impact your microbiome and gut barrier health, your gut microbiome then also impacts your hormone levels (go back to my previous article on the impact of your microbiome on hormones).


You know I always say: this is the time in our lives when we need to take care of ourselves and of our body and this is just another proof that there is an even greater need at this life stage to focus on removing lifestyle, environmental and dietary factors which are known to contribute further to dysbiosis and inflammation.


Low levels of hormones will also impact your vaginal microbiome and bladder


The vaginal microbiome is a dynamic ecosystem that varies a lot throughout a woman’s lifespan. The vaginal microenvironment is acidic, which prevents bacterial, viral, fungal and protozoan pathogens from settling in.


In healthy premenopausal women, estrogen stimulates glycogen accumulation in the vaginal lining, which supports specific Lactobacillus species that will ferment the glycogen to produce lactic acid.


When estrogen levels decline, the Lactobacillus abundance declines as well. This then leads to a less acidic environment which is more fragile and can easily be colonized by pathogenic bacteria. It also causes the vaginal lining to thin and get dry (frequent UTI’s, painful intercourse, vaginal infections…).


The gut microbiota can also impact your vaginal microbiome via the estrobolome:

The estrobolome is a collection of bacteria in the gut which is capable of metabolizing and modulating the body’s circulating estrogen. It is the bacteria in the gut, and the estrobolome, that affects estrogen levels, which in turn can impact weight, libido and mood.



Some of the bacteria in your gut can produce enzymes, such as β-glucuronidase and sulfatase. When these enzymes are elevated, they will “unpack” the estrogens that your liver had previously “packaged up” to excrete and therefore these estrogens can be reactivated and reabsorbed into circulation. If these “active” de-conjugated and unbound estrogens re-enter your bloodstream they can cause estrogen excess and lead to toxic estrogen metabolites that can cause estrogen-related cancers, endometriosis, PCOS, etc.



Phytoestrogens from foods we consume (soy isoflavones -SIF-, stilbene, coumestan, and lignans) are metabolized in the same way by the estrobolome they just have weaker binding capacity. So both, estrogens and phytoestrogens can impact your hormone balance by binding to estrogen receptors.

At the same time, if you have low diversity in your gut microbiota, it will lead to a decrease in estrogen metabolism - due to a lack of estrogen-metabolizing bacteria which can lead to symptoms of estrogen excess.

Not only estrogen is “packaged up” by your liver, but also your other hormones like progesterone and androgens (testosterone, DHT, …) are decomposed in a similar way and recirculated by the gut microbiome. You can see that it’s a complete ecosystem of recycling where your used up hormones end up in your gut to be excreted and depending on the microbes present in your gut can be recirculated and wreak havoc on your hormone balance.


Emerging research in mice shows that supplementation with various strains of Lactobacillus plantarum and Bifidobacterium longum in combination with soy isoflavones positively impacts the circulating estrogen level, the expression of an estrogen receptor linked to abdominal adipose tissue and improves the production of Short Chain Fatty Acids (SCFA’s) - definitely a combination to consider in the transition to menopause!


Impact of your gut on your mental health

Postmenopausal women show a decline in cognition, mostly memory, as a result of declining estrogen levels, as well as increased depression and anxiety.

I’ve told you many times about the gut-brain-axis and how your gut bacteria communicate with your brain. Some metabolites produced by your gut microbiota – Short-chain fatty acids (SCFAs), such as butyric acid, propionic acid and acetic acid, are able to stimulate your sympathetic nervous system, release mucosal serotonin and influence your memory and learning process.

Stress or anxiety on the other hand also have a negative impact on your gut lining integrity and gut microbiota composition through the release of cortisol, so again, it’s a bi-directional relationship...



What are the solutions?


Taking care of yourself isn’t a luxury, it’s a necessity!
  • Eliminate stressors and incorporate daily stress management techniques

  • Eat a whole food diet with plenty of veggies and fiber, flavonoids (all purple fruit & veg, citrus fruit, plus green tea and raw chocolate), quality protein and healthy fats => consider my Blood sugar & hormone balancing cookbook to get more guidance

  • Avoid inflammatory foods like: gluten, sugars & processed carbs, refined vegetable oils, alcohol, conventional dairy & meat, farm-raised fish, food additives & preservatives, artificial sweeteners

  • Get a food sensitivity and stool panel done

  • Naturally boost your hormone levels - go back to my previous articles on boosting estrogen and progesterone levels naturally

  • Consider bio-identical hormone therapy - contact me to discuss this option or talk to your doctor

  • Support your vaginal microbiome with specific Lactobacili - Invivo have great products for this, contact me to get a recommendation

  • Avoid xenoestrogens, synthetic hormones and drugs - read more on source of toxins in my previous article here










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