Understanding the connection between hormones and gut health

Menopause is a natural transition, but many women are surprised by how often gut symptoms appear alongside hormonal changes. Bloating, constipation, diarrhoea, and shifting digestion patterns can become more noticeable during perimenopause and beyond.

One of the key reasons for these changes is the close connection between oestrogen, progesterone, and gut health. Both hormones influence how your gut functions, affecting digestion, microbiome composition, and gut sensitivity. As levels of oestrogen and progesterone begin to change during perimenopause and menopause, shifts in these hormones can impact gut comfort and overall digestive wellbeing.

This blog explains how these hormones influence gut health, what happens during menopause, and how nutrition and lifestyle strategies can support a healthier gut [1].

How oestrogen and progesterone influence gut health

Oestrogen and progesterone interact with the gut in several ways, influencing motility, microbiome diversity, and hormone recycling.

Gut motility

Both oestrogen and progesterone help regulate muscle contractions in the digestive tract, which keep food moving smoothly. However, their effects differ depending on hormone levels:

• Higher oestrogen levels are linked with faster gut motility, which can sometimes contribute to looser stools, especially during certain phases of the menstrual cycle.
• Progesterone, on the other hand, can slow gut motility when levels are high, which is one reason constipation is common in the luteal phase before menstruation.
• In menopause, both oestrogen and progesterone levels drop, often leading to slower digestion, bloating, and constipation [2].

Gut microbiome diversity

Research suggests that oestrogen levels are linked with the diversity and balance of gut bacteria. During the reproductive years, higher oestrogen supports a more diverse and stable microbiome, which helps maintain gut health [3].

As oestrogen declines during menopause, studies show that bacterial diversity can shift, sometimes leading to dysbiosis(an imbalance between beneficial and less favourable bacteria). This can affect digestion, inflammation, and gut barrier function [4].

While progesterone’s direct effect on the microbiome is less studied, changes in both hormones together seem to influence gut bacterial composition, potentially altering digestion and immune responses.

Hormone recycling

Your gut and liver work closely to process and recycle oestrogen through what is known as the gut–liver axis. Certain gut bacteria produce enzymes that determine how oestrogen is metabolised and reabsorbed. When the gut microbiome is balanced, this recycling process works smoothly, supporting more stable hormone levels [1].

However, when oestrogen levels decline during menopause, shifts in gut bacteria can alter this process, further influencing overall hormone balance and gut function.

Changes in gut health during menopause

As oestrogen and progesterone levels decrease, you may notice changes in digestion and gut comfort. These vary between individuals but can include:

Slower digestion

Lower levels of oestrogen and progesterone are linked with slower gut motility, which can lead to bloating, constipation, and discomfort [2].

Shifts in microbiome composition

Research has linked menopause with reduced bacterial diversity in the gut. These shifts may contribute to gut discomfort, changes in bowel habits, and greater sensitivity to certain foods [3].

Increased gut sensitivity

Hormonal changes can also influence how sensitive the gut feels, making symptoms like cramping, bloating, and digestive discomfort more noticeable [4].

Why gut health matters in menopause

Your gut influences much more than digestion alone. A healthy gut environment supports hormone regulation, immune function, bone health, and metabolic balance [3][4].

Changes in gut health during menopause have been linked with:

• Differences in calcium absorption, which may affect bone density
• Variations in how oestrogen is processed and recycled
• Changes in inflammation and cardiometabolic health.

Taking steps to support your gut can improve digestive comfort and have positive effects on overall wellbeing during this transition.

Nutrition strategies to support gut health

Focusing on nutrition is one of the most effective ways to support both gut and overall health during menopause.

1. Prioritise plant diversity

Aim to include a wide range of fruits, vegetables, wholegrains, legumes, nuts, and seeds throughout the week. Research suggests that eating more than 30 different plant based foods weekly is linked with a more diverse and resilient gut microbiome [1][3].

2. Include prebiotic and probiotic foods

Prebiotics are fibres that feed beneficial gut bacteria, while probiotics provide live bacteria that may support a balanced microbiome [5][6].

Prebiotic rich foods: legumes, onions, garlic, wholegrains, pistachios, cashews
Probiotic rich foods: kefir, yoghurt, kimchi, miso, and sourdough

3. Support Gut Health with Omega-3s

Oily fish like salmon, sardines, and mackerel provide omega-3 fatty acids, which have anti-inflammatory benefits and may support gut balance. For those who do not eat fish regularly, an omega 3 supplement may be an option [7][8].

4. Maintain Vitamin D and calcium levels

Vitamin D plays an important role in both gut health and bone strength. Include foods like fatty fish, eggs, fortified products, and mushrooms exposed to sunlight. Where needed, supplementation may be helpful [9]. Calcium helps support bone health. Include foods such as milk, Greek yoghurt, Kefir, dark leafy greens, tahini, fish with bones and calcium set tofu.

5. Manage stress for gut and overall health

Chronic stress can influence gut function, affect the microbiome, and trigger digestive symptoms. Mindfulness, breathing exercises, journalling, gentle movement and getting professional help can all support both gut health and stress management [10][11][12][13].

Final Thoughts

Menopause brings natural changes to the body, and gut health is no exception. Oestrogen plays a key role in gut motility, microbial diversity, and hormone recycling, and lower levels can influence how the digestive system functions.

Supporting your gut through nutrition, stress management, and lifestyle strategies can help improve symptoms, microbiome diversity, and promote overall wellbeing during this stage of life.

If you are experiencing gut symptoms through perimenopause or menopause, working with a dietitian can help you create a personalised plan that supports your gut and overall health.

Book an in person dietitian consultation in Canmore today or option for Telehealth consult for clients based in Alberta: Canmore, Banff, Calgary, Edmonton, Cochrane.

References

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Bridgewater LC, Zhang C, Wu Y, Hu W, Zhang Q, Wang J, et al. Sex differences and hormonal effects on gut microbiota composition in mice. Gut Microbes. 2020;11(5):1246–1261. doi:10.1080/19490976.2020.1733922
Wang J, Chen WD, Wang YD. The gut microbiome is altered in postmenopausal women with osteoporosis and osteopenia. Front Cell Infect Microbiol. 2021;11:631583. doi:10.3389/fcimb.2021.631583
Santos-Marcos JA, Rangel-Zuñiga OA, Jimenez-Lucena R, Quintana-Navarro GM, Garcia-Rios A, Tena-Sempere M, et al. Spotlight on the gut microbiome in menopause: Current insights. Maturitas. 2023;171:1–11. doi:10.1016/j.maturitas.2023.02.006
Kim HJ, Camilleri M. Probiotics and prebiotics: Any role in menopause-related diseases? Climacteric.2021;24(4):343–350. doi:10.1080/13697137.2021.1910921
Bourrie BC, Willing BP, Cotter PD. Kefir and intestinal microbiota modulation: Implications in human health. Front Nutr. 2020;7:63. doi:10.3389/fnut.2020.00063
Lin PY, Huang SY, Su KP. A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression. Biol Psychiatry. 2021;89(3):222–231. doi:10.1016/j.biopsych.2020.10.021
Yang J, Ma Y, Wang L, Li Y, Wu Z, Tian H, et al. Effect of omega-3 supplements on vasomotor symptoms in menopausal women: A systematic review and meta-analysis. Menopause. 2020;27(4):412–420. doi:10.1097/GME.0000000000001480
Charoenngam N, Holick MF. Exploring the role of vitamin D and the gut microbiome: A cross-sectional study of individuals with IBS and healthy controls. Nutrients. 2021;13(7):2323. doi:10.3390/nu13072323
Foster JA, Rinaman L, Cryan JF. The effects of stress and diet on the “brain–gut” and “gut–brain” pathways in animal models of stress and depression. Nat Rev Gastroenterol Hepatol. 2017;14(9):488–505. doi:10.1038/nrgastro.2017.75
Bailey MT, Dowd SE, Galley JD, Hufnagle AR, Allen RG, Lyte M. Psychological stress and gut microbiota composition: A systematic review of human studies. Brain Behav Immun. 2019;82:55–65. doi:10.1016/j.bbi.2019.07.002
Sudo N. Stress and the gut-brain axis: Cognitive performance, mood state, and biomarkers of blood-brain barrier and intestinal permeability following severe physical and psychological stress. Brain Behav Immun. 2019;80:222–232. doi:10.1016/j.bbi.2019.05.006
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How Menopause Affects Your Gut and What You Can Do About It