Gut Health and Menopause

By Christina Hanna, MPH, CHES • Published 7/14/2023

Medically Reviewed by Dr. Tara Scott, MD

a chalk illustration of the digestive system to depict gastrointestinal issues related to menopause

Did you know that menopause can affect your gut health? If you didn’t, you’re not alone. Many people know about hot flashes, but they don't realize that menopause can also cause symptoms like bloating, heartburn, upset stomach, constipation, and diarrhea. These symptoms can all be related to the decrease of estrogen during menopause.

What is gut health?

Our gut, or gastrointestinal (GI) tract, is a complex system inside our bodies. It includes the stomach, small intestine, large intestine, and colon. The GI tract helps us digest food, absorb nutrients, and plays a role in immune function. Inside our GI tract, there are about 100 trillion microorganisms. These microorganisms make up our GI microbiome and are mostly bacteria and most of them live in the large intestine. Many of the microorganisms are beneficial to our health, while others can be harmful, especially if they multiply. Gut health is all about having just the right amount and variety of these microorganisms. A good balance helps us digest food better, helps fight off infections, and even helps improve mood.

An imbalance in the gut microbiome can affect our health. It has been correlated with a wide range of conditions and diseases, including obesity, inflammatory bowel disease (IBD), colorectal cancer, depression, diabetes, and cardiovascular disease.

What’s the connection between gut health and menopause?

There’s more research needed on this topic, but studies so far suggest that menopause may be linked with a lower diversity of gut microbes. The relationship between our hormones and gut health is a complex relationship. Our hormones and gut health are connected, but we don't know everything about how they work together. When estrogen and progesterone levels decrease during menopause, it can change the types of bacteria in our gut. This can mean fewer beneficial bacteria and more harmful bacteria. If you're having gut health issues, you're not alone. About 2 out of 10 females between 40 and 65 experience gut health issues during the menopausal transition.*

The role of estrobolome

Okay, this is going to get a little science-y, but stay with us as there’s an interesting (and somewhat complicated) connection between estrogen, our gut, and menopause.

In your gut microbiome, there’s a special group of microbes called the estrobolome. They specialize in metabolizing (handling) and regulating estrogen circulating through the body. If you remember from our Hormones and Menopause – What's the Connection? article, estrogen is mostly made by the ovaries, but is also produced in other tissues including body fat, liver, adrenal, and breast tissues. When the estrogen is produced from those sources, it travels through the bloodstream and circulates through the body. When it reaches the liver, some of the estrogens are altered so they can be removed from the body.

As they move through the GI tract, they come into contact with microbes in the estrobolome. Those microbes make a chemical called an enzyme. This enzyme turns estrogen into an active form that can bind to estrogen receptors. When this happens, the estrogen can be taken back into the bloodstream.

microorganisms in the GI track to suggest the lower diversity of gut microbes in menopause

In general, when the estrobolome makes more of this enzyme (beta-glucuronidase), more estrogen stays in the body. It can be recirculated, bind to receptors, and influence the many physiologic roles estrogen plays in our bodies. Changes in the estrobolome can change how much estrogen is absorbed, which can affect hormone levels in the body.

When the estrobolome (and microbiome) is unbalanced (the balance is off between healthy and harmful bacteria), it’s called dysbiosis. Dysbiosis means there are fewer good bacteria and more bad bacteria. This can lower the number of different types of bacteria in the microbiome and may decrease the amount of estrogen circulating through the body. When dysbiosis occurs, enzyme activity and microbiome diversity may change. This may affect the balance of estrogens circulating in the body and this imbalance can lead to estrogen-related conditions and increase the risk of some chronic diseases.

And the relationship works in the other direction, as well. When our hormones change (like during perimenopause and menopause), the types of bacteria in our gut can also change. It’s interesting to know that after menopause, the female gut microbiome becomes more similar to the male gut microbiome. But before menopause there are clear differences in the amounts and kinds of certain bacteria.

Menopause can increase the risk for obesity, heart disease, osteoporosis, and depression. This is because estrogen and progesterone help control blood sugar, fat storage, bone formation, and inflammation. These risks may be even higher when the estrobolome is unbalanced.

The gut-brain axis

The gut-brain axis is another important aspect of gut health. This refers to the connection between the gut and the brain, which allows for communication between the two systems. The gut microbiome plays a crucial role in this connection. It's been suggested that changes in gut health may have an impact on brain health. For example, people going through perimenopause or menopause may experience depression or anxiety more often.

an illustration depicting the gut-brain axis, referring to the connection between the gut and brain

How can I improve my gut health during menopause?

Some parts of the gut microbiome are hereditary, but it can also be affected by many things like what we eat, how much we move, how stressed we are, what medicines we take, and if we smoke. By making some changes, you can improve the diversity and number of gut microbes.


A healthy, well-balanced eating plan is good for overall health and well-being, including gut health. There are certain elements of a healthy diet that are especially important for gut health:

  • Fiber. Fiber is related to better gut health and overall health. Eating a healthy number of high-fiber foods can help improve cardiovascular health, reduce the risk of developing type 2 diabetes, and help prevent or relieve constipation. It's found in foods like whole grains, vegetables, fruits, and legumes.
  • Prebiotic foods. Not all foods with fiber are prebiotic. Prebiotics are foods that contain a type of dietary fiber called oligosaccharides. This fiber can't be broken down in the small intestine. It goes all the way to the large intestine, where it helps feed the beneficial bacteria that live there. Prebiotic foods include asparagus, bananas, leeks, garlic, artichokes, onions, and whole grains.
  • Probiotic foods. Foods that contain beneficial bacteria that can help support gut health. Fermented foods, such as kefir, sauerkraut, miso, tempeh, kombucha, and kimchi are natural sources of probiotics.
  • Less sugar. Eat less sugar and artificial sweeteners. They have a negative effect on the balance of gut microbes.

If you’re unable to include prebiotic and probiotic foods in your diet, talk to your doctor about if prebiotic and probiotic supplements may be right for you.

Check out our options for Gut Health supplement products.

an array of probiotic-rich fermented foods that can help support gut health during menopause

Physical activity

Along with eating healthy foods, regular exercise can also help support gut health. Exercise has been shown to improve gut motility (the movement of food through the GI tract). This can help reduce the risk of constipation, colon cancer, diverticulosis, and IBD. Exercise also affects the variety and number of bacteria in the gut microbiome.

For adults, the Centers for Disease Control and Prevention (CDC) recommend 2 hours and 30 minutes of moderate-intensity exercise (or 1 hour and 15 minutes of vigorous-intensity exercise) each week. You can break that up into whatever small (or large) chunks of time that work best for you.

Stress management

Have you or someone you know ever experienced a “nervous stomach”? Maybe you get an upset stomach or run to the bathroom often during a stressful experience. Stress can have a significant impact on our gut health. And research has also shown that improved gut health can improve how our bodies react to stress.

Finding better ways to manage stress may help reduce the effect stress has on your GI tract and microbiome. Stress can come from psychological stress, environmental stress (extreme heat, cold, or noise), and sleep deprivation and disruption. Some ways to help manage stress include yoga, meditation, and deep breathing exercises.

To explore supplements that may also help, check out our supplement options. Talk to your doctor about whether they’re right for you.

Use antibiotics only as prescribed by your healthcare provider

Pay attention to the medications you’re taking. Certain medications, especially antibiotics, can affect the number of health bacteria in your gut microbiome. If you have an infection that needs to be treated, talk to your doctor about the antibiotics you need and how long you should take them.

Stop smoking

Smoking, and exposure to secondhand smoke, has been shown to reduce the number of beneficial bacteria in the gut. This can lead to some of the issues we talked about earlier in this article. If you or someone you know wants to stop smoking, talk to your doctor or visit They have helpful resources that make quitting easier.

*Data from Attitudes & Usage study conducted in August 2021 with 4,578 female participants ages 40-65. Funded by Kenvue.

Last Updated 5/6/2024



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