The Impact of Menopause on Gut Microbiome
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Once you’re in menopause, symptoms like hot flashes, poor sleep, and mood swings can likely occur. But researchers have started to notice that the gut microbiome starts to change too. And the changes are starting to raise eyebrows.
“We know the microbiome changes before and after menopause, but we’re still not sure what the implications are for our health,” says Rabia De Latour, MD, a GI specialist at NYU Langone Health in New York City. “It’s fascinating that there is a connection between gut bacteria and a woman’s changing hormones, but the research is in its infancy so we can’t say that gaining or losing a certain strain of bacteria is part of healthy aging.”
Dr. De Latour stresses that although menopause is associated with a change in which bacteria thrive in your intestines, it is still possible to maintain a healthy gut microbiome with a diet rich in fruits and vegetables, an active lifestyle, and by avoiding stress the best you can.
Why Aim for a Healthy Gut Microbiome?
The gut microbiome is integral to holistic health. After all, the trillions of bacteria, known as the gut flora, populating our intestines have the potential to preserve our health and improve our mood. Research suggests that our gut bugs play a vital role in a range of conditions, including obesity, diabetes, irritable bowel syndrome, inflammatory bowel disease, depression, and cardiovascular disease.
Scientists say a sign of a healthy gut flora is one that is teeming with a broad range of bacteria. A study published in February 2021 in Nature Metabolism looked at the gut flora of more than 9,000 people and found that healthy aging was associated with a diverse set of bacteria, while a lack of bacterial diversity was observable in several conditions, including unhealthy aging — characterized by rapid declines in cognition, strength and mobility, and cardiovascular health.
How the Microbiome Changes During Menopause
The microbes in the gut are integral to maintaining the estrobolome, a collection of bacteria in the gut which helps regulate the sex hormones released by the ovaries — estrogen and progesterone.
One study, published in mSystems in April 2022, looked at the gut microbes of nearly 1,000 Hispanic men, 1,000 post-menopausal Hispanic women, and close to 300 premenopausal Hispanic women. It found that the post-menopausal women had microbiomes more similar to the men than the premenopausal women.
“There are microbes that premenopausal women have that help with the retention of estrogen, which seem to decline in post-menopausal women,” says Brandilyn Peters-Samuelson, PhD, an epidemiologist at Albert Einstein College of Medicine in the Bronx, New York, who researches the dietary and environmental determinants of the human microbiome.
“It could be that as the hormone estrogen goes down, the bacteria just has less to work with,” she says. “But we do know that higher estrogen is associated with greater microbial diversity and that’s good for a woman’s general health. As the diversity decreases, we see increased risk of weight gain, as well as metabolic disease and cardiovascular disease.”
A review published in June 2021 in the Journal of Clinical Medicine looked at 15 different studies and found that the female gut microbiome is linked to estrogen levels, and as estrogen goes down, the microbiome loses its diversity, increasing the risk of obesity and endometrial cancer.
The Role of Healthy Eating Before and After Menopause
“We know that estrogen levels can help with how bacteria move around the intestines and organs,” says De Latour. “And we know that as hormones drop, it can impact the lining of the gut and as the gut barrier becomes more permeable, we are susceptible to inflammatory diseases. And yet, a diet rich in prebiotic fibers from a wide array of vegetables and plants and healthy fats can feed the bacteria that help fight inflammation.”
Feeding the bacteria that play a role in tamping down inflammation is essential. A review published in July 2022 in the journal Disease Markers looked at three studies and a trend where post-menopausal women tended to have a higher concentration of intestinal Bilophila, a genus of bacteria that leads to inflammation and mucosal damage in the lining of the gut, which then triggers inflammatory reactions in various tissues. The inflammatory reactions are linked to an increased risk of weight gain, weaker bones, and dementia.
On the other hand, having normal bowel habits is correlated with fewer menopause symptoms. A study published in November 2023 in the journal Menopause examined the menopause symptoms of nearly 700 women around age 50. It found that women who had normal digestion had fewer hot flashes than women who were frequently constipated.
Could Hormone Replacement Therapy Help?
Women who are suffering with symptoms of depression may find some relief in hormone therapy. It can help combat menopause-related depression, as well as cognitive decline, according to a review published in July 2022 in the journal Drugs and Aging that looked at a number of studies on hormones and depression in menopausal women.
And, it may help preserve the gut microbiome. A study published in September 2021 in Frontiers in Cellular and Infection Microbiology found that rats that had their ovaries removed and were then put on hormone replacement therapy saw improvements in the microbial diversity in their intestines. They also saw improvements in cognition, and they had less weight gain than the untreated rats.
“Hormone replacement therapy is often taken to deal with mood and physical symptoms. There’s not enough research yet to say that it has a role in maintaining healthy gut flora,” says De Latour.
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