As women navigate the hormonal fluctuations associated with perimenopause and menopause, maintaining a healthy gut microbiome could offer significant benefits for health and wellbeing.

The gut microbiome – home to trillions of microorganisms such as bacteria, viruses, fungi, and other microbes residing in the digestive tract – is often described as a “second brain”. It influences multiple systems throughout the body and plays a central role in digestion, immune system regulation, mood regulation, cognitive function, and hormonal balance [1].

A well-balanced microbiome supports these functions, whereas dysbiosis (microbial imbalance) can contribute to a range of health issues, including metabolic disorders, inflammatory conditions, and even anxiety or depression [1].

This article explores the significance of the gut microbiome in the health of women aged 45 and over, and offers simple strategies to support the gut microbiome during this life stage. 

How Menopause Affects the Gut Microbiome

While maintaining a healthy microbiome is beneficial for women of all ages, it becomes especially crucial during midlife. Research has shown a decrease in gut microbial diversity in post-menopausal women [2], largely due to falling estrogen levels. This has important implications for health, as research has found that a diverse microbiome is one of the strongest predictors of healthy ageing and longevity [3].

Estrogen is known to influence the gut microbiome by promoting the growth of beneficial bacteria that are involved in the production of short-chain fatty acids (SCFAs), which help regulate hormone levels, reduce inflammation, and support gut barrier integrity [4]. When estrogen levels drop during menopause, the diversity of gut bacteria decrease, leading to an overgrowth of harmful bacteria and a weakened gut lining. 

Hormone Regulation 

Gut bacteria play a key role in estrogen metabolism through a group of microbes known as the estrobolome. These microbes help break down estrogen for reabsorption, helping to keep hormone levels balanced. When the estrobolome becomes disrupted, estrogen regulation can be impaired, potentially worsening menopause symptoms such as hot flashes, weight gain, mood swings, vaginal dryness, and bone density loss [2].

Digestive Health 

Gastrointestinal (GI) symptoms including bloating, constipation or diarrhoea, flatulence, and indigestion or acid reflux, commonly increase during menopause. 

Hormone receptors for progesterone, estradiol, and testosterone are found throughout the gastrointestinal system and fluctuations in these hormones during perimenopause and menopause can impact digestion [5]. 

Balanced gut bacteria support smoother digestion by breaking down food efficiently, maintaining a healthy gut lining, reducing inflammation, and supporting nutrient absorption.

Weight Regulation

The reduction in estrogen levels during menopause affects metabolism and gut microbiome diversity, shifting the ratio between Firmicutes and Bacteroidetes bacteria, which may promote greater energy extraction from food and contribute to weight gain. 

Changes in the production of short-chain fatty acids, insulin sensitivity, and fat storage can further increase the likelihood of visceral fat accumulation and metabolic changes during menopause [6].

A healthy gut microbiome can help stabilise blood sugar, regulate appetite-related hormones, reduce inflammation, and support healthy weight management.

Inflammation and Immunity 

Estrogen has anti-inflammatory properties, and its decline during menopause can lead to an increase in systemic inflammation, which may manifest as joint pain, hot flashes, weight gain and fatigue. Chronic low-grade inflammation has also been linked to conditions such as insulin resistance, cardiovascular disease, and osteoporosis – all of which become more common as women age [7].

Because 70% of the immune system resides in the gut, a stable microbiome is essential for immune health [8]. A healthy microbiome not only helps fight infection, but it also strengthens the gut barrier and reduces the likelihood of “leaky gut”, whereby harmful bacteria and toxins can leak into the bloodstream, triggering an inflammatory response. 

Mental Wellness and Cognition 

Emerging research shows that gut microbes influence the brain through the gut-brain axis – a bidirectional communication network involving nerves, hormones, and immune signals – that plays a critical role in regulating mood and emotional health [9,10].

During menopause, hormonal fluctuations (declining estrogen levels) affect the microbiome’s ability to produce neurotransmitters like serotonin and GABA, which are vital for mood regulation. Research has shown that an imbalanced microbiome can contribute to mood disturbances, increased psychological distress, anxiety, depression, irritability, mood swings, brain fog and even cognitive decline [11,12].

Cultivating a well-balanced microbiome can help maintain emotional well-being by promoting the production of these key chemicals. 

How to Support Your Microbiome During Menopause

The good news is that the microbiome responds quickly – often within days – to changes in diet and lifestyle. Here are some key strategies for promoting a healthier microbiome:

1. Prioritise Fibre – Your Microbiome’s Favourite Food 

Fibre feeds beneficial bacteria and is the number one predictor of microbial diversity. Fibre also supports short-chain fatty acid (SCFA) production, stabilises blood sugar and helps manage cholesterol. 

Aim for 25 grams of fibre per day by including a wide variety of fibre-rich foods, such as beans and lentils, nuts and seeds, wholegrain breads, brown rice, leafy greens, and berries.  Increase your fibre intake gradually and drink plenty of water to avoid gastrointestinal discomfort.

2.  Add Prebiotic-Rich Foods  

Prebiotics are non-digestible fibres that feed beneficial gut bacteria and may help support estrogen metabolism. 

Incorporate foods rich in prebiotics – such as garlic, onions, leeks, artichokes, asparagus, bananas, and whole grains – regularly. 

3.  Include Probiotics 

Fermented foods – kefir, kimchi, kombucha, miso, natto, sauerkraut, tempeh, belacan and probiotic yoghurts – introduce beneficial bacteria into the gut. They may help alleviate digestive issues, reduce inflammation, and even improve mood [13, 14]. Include varieties that are lower in sodium and added sugars. 

Probiotic supplements may also be helpful. For maximum efficacy, choose supplements that contain live organisms in sufficient numbers for health benefits (10-30 billion colony-forming units or CFUs). Consult a healthcare professional before starting supplements if you’re immunosuppressed or have any chronic health conditions [15]. 

4. Embrace Superfoods

Polyphenol-rich foods and beverages including berries, green tea, dark chocolate, certain herbs and spices, and red wine may promote the growth of beneficial bacteria and reduce inflammation [17]. 

Omega-3 fatty acids, found in fatty fish such as salmon, mackerel and sardines, as well as in walnuts and flaxseeds, have anti-inflammatory properties and may help increase beneficial bacteria in the gut [16].

5.  Minimise Processed Foods and Sugar

Ultra-processed foods can disrupt the gut microbiome by decreasing microbial diversity, leading to persistent inflammation and chronic disease [18].  Aim to limit your intake of packaged snacks, processed meats, fried foods, and those foods containing artificial sweeteners. 

Reading food labels can help you stay within recommended sugar limits. The World Health Organisation recommends a reduction in sugar intake to 5 teaspoons or 25g per day for health benefits such as maintaining a healthy weight [19]. 

6. Stay Hydrated

Water keeps the digestive system running smoothly and nourishes the mucosal lining of the gut. Aim for at least eight cups of water a day – increasing your intake if you’re very active or in a warm, humid climate. 

Limiting caffeine and alcohol intake can also help maintain hydration and support gut health.

7.  Mind Your Stress Levels

During menopause, many women experience heightened stress due to hormonal changes, lifestyle adjustments, and other factors. Chronic stress can negatively impact the gut microbiome by slowing digestion, and increasing intestinal permeability. 

Practices such as yoga, tai chi, meditation, deep breathing, journaling, or short walking breaks can help reduce stress and promote gut balance. 

8. Move Your Body Regularly

Regular physical activity is one of the best ways to promote a diverse and balanced gut microbiome [20].

You don’t need intense workouts – just being consistent helps. Aim for a mix of aerobic exercise (such as brisk walking, cycling or swimming), strength training, and flexibility exercises to keep your gut and body in balance.

9. Support Good Sleep Habits 

Sleep disturbances are common during menopause, yet poor sleep reduces microbial diversity and increases inflammation [21]. Support healthy sleep by having a consistent sleep/wake time, avoiding heavy meals close to bedtime, reducing alcohol intake, limiting screens 1-2 hours before bed, and keeping the bedroom cool, dark and as free from disruptive noise as possible. 

Final Thoughts

Gut health is a crucial but often overlooked aspect of perimenopause and menopause. As estrogen levels decline, the microbiome plays an increasingly important role in hormone metabolism, immune defence, mood regulation, and weight management. 

By focusing on a nutrient-rich diet, managing stress, exercising regularly, and prioritising sleep, women can support a healthy microbiome and ease many of the common challenges of perimenopause and menopause. Whether you’re experiencing digestive discomfort, mood swings, or weight gain, taking care of your gut may provide a natural and effective way to improve wellbeing during midlife.

_{Disclaimer Notice The information provided on this website, www.veveva-nutrition.com, is for general informational purposes only and is not intended as medical advice, diagnosis, or treatment. It should not replace consultation with a qualified healthcare professional. VeVeva Nutrition Pte Ltd (“VeVeva”), its directors, employees, affiliates, and partners make no representations or warranties regarding the accuracy, completeness, or reliability of the information provided. If you have any health concerns, are taking long-term medication, or are under medical supervision, please consult a doctor or qualified healthcare professional before making any changes to your diet, lifestyle, or treatment. Never disregard professional medical advice or delay seeking it because of something you have read on this website.}

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