US Edition
The key to a smoother menopause lies in your gut
Eighty per cent of women finding at least one menopause symptom "very difficult" to live with – the role of the gut is often overlooked
When Julia first consulted nutritional therapist Joanna Lyall, she was at a low ebb. Fifty-one, perimenopausal, anxious and struggling to sleep, the mother-of-two was often tearful and felt unable to cope with the pace of work in her senior position in HR. She had tried HRT and herbal supplements, but her continuing lack of sleep meant Julia felt increasingly too stressed to cope.
Lyall conducted a stool sample test to look at Julia’s gut biology and hormone levels. She then recommended that Julia follow lifestyle and dietary changes, like avoiding alcohol and processed foods and including more greens, nuts and oily fish, and sleep-enhancing tryptophan – an amino acid found in foods including chicken, turkey and bananas. She also recommended Julia should start taking a probiotic. “As a result, Julia’s mood improved and she now sleeps well for the first time in five years,” says Lyall, who is co-founder of The Better Menopause.
Menopause affects every woman, but only 15 per cent of women are taking HRT. It could be lack of access, or a fear of side effects or long-term consequences – but as a result, many females, whether on HRT or not, experience some sort of health problem in midlife, often relating to the menopause. According to Menopause Support, eight in 10 women of this age find at least one menopause symptom “very difficult” to live with, having problems ranging from brain fog to sleep issues and anxiety.
Research by the Fawcett Society and Channel Four found that one in 10 women have left work because of their symptoms. But the role of the gut is often overlooked – and it’s time for that to change.
There’s a growing science that looks at the link between our microbiome – the “friendly” bacteria that live inside our gut – and an improvement in mental health. A 2020 review of studies found a correlation between probiotic bacteria and sleep quality, as well as mood improvement in people who experienced anxiety and depression. For Julia this link proved to be key to resolving her menopause-related symptoms.
Now experts are focusing more on the menopause and an increasing number believe our gut health could be the non-medical solution to menopause symptoms.
This approach can also work in tandem with hormone replacement therapy. In some cases, HRT has been shown to positively affect gut health, as lower oestrogen levels during the menopause reduces the diversity of the microbiome, and topping those levels up reverses that effect.
Dr Shahzadi Harper, is a GP and menopause specialist. “As HRT directly affects the gut microbiome, it can help with other symptoms like fatigue and mood,” she says. Dr Jolene Brighten, a naturopathic endocrinologist who specialises in women’s health and hormone balance, agrees. “HRT has a crucial role in oestrogen metabolism.”
Why oestrogen matters
“The drop in oestrogen during both perimenopause and menopause, and the reduction in diversity in the gut microbiome affects the way the gut enzyme functions,” says Dr Harper. “This can exacerbate some of our menopause symptoms like low mood and anxiety, while increasing those tired, sluggish feelings.”
Sex hormones, particularly oestrogen, have a powerful influence on the way your gut and brain communicate – this is known as the gut-brain axis. “Because your gut health affects your brain health, metabolism and immunity, poor gut health can amplify the issues many women experience during the menopause,” says Dr Brighten.
“Brain fog and weight gain can accompany menopause, and these are directly impacted by poor gut health. In addition, the gut is a major conversion site for the thyroid hormone – where this hormone is activated – influencing your mood, digestion and energy.”
Rebalancing your gut
Understanding this process starts with understanding the role of the hormone estrobolome. “Estrobolome is made up of the microbes in the gut that interact with oestrogen,” says Brighten. “They are in part responsible for keeping your hormones at optimal levels and your vagina healthy.”
An unbalanced microbiome, however, can disturb levels of estrobolome, which can in turn impact your weight, libido, sleep and energy levels. “Poor sleep will in turn affect your cognition, concentration and focus, leading to a general loss of confidence,” says Dr Harper. “What’s more, as 90 per cent of our serotonin – the happy neurochemical – is made in our gut, when the microbiome is not working well it can cause anxiety and low mood.”
While there’s no silver bullet, there are ways to improve your gut health with a few lifestyle changes. “Increase your consumption of wholegrains and green vegetables, which contain beneficial fibre and promote the growth of healthy gut bacteria, especially broccoli, which is involved in the metabolism of oestrogen,” says Lyall.
“Minimise sugar, artificial sweeteners, fried foods, processed foods and alcohol. Meanwhile, reducing stress in your life is incredibly important, whether it’s through mindfulness, breathwork, yoga, Pilates or exercise.”
The link between the gut microbiome and your brain – linked through the multitude of nerve endings in your gut – is the subject of ongoing research. “These nerves connect to a larger one called the vagus nerve, which runs like a motorway from your intestines up to your brain,” says menopause nutritionist Penny Crowther. “Communication travels both ways, meaning that stressful thoughts and feelings can bring about changes in how your gut works as well as the other way around.”
Preventing digestive issues
Some women find the hormonal changes of menopause significantly affect their digestion, causing issues like bloating and excessive gas. “Oestrogen and progesterone affect our gut transit, so their decrease means our transit slows down,” says Dr Harper. “Our food remains within the guts and fermentation occurs, releasing gas and wind. Also, because oestrogen helps the body retain moisture, the drop in oestrogen often results in constipation.”
“Sticking to regular mealtimes and not missing meals will keep the muscles of your gut moving,” says nutritionist Emily Foster. “Meanwhile, acid reflux is a common problem for menopausal women and like most gut issues this can be heavily impacted by stress levels. Carrying excessive weight can also increase reflux symptoms.
Stress can have other negative impacts, says Crowther: “The stress that goes with the menopause may also affect the vital protective layer of cells in your gut known as your gut barrier. Keeping this barrier healthy is critical because it allows nutrients to be absorbed from the foods you eat, but also keeps harmful toxins out. If your gut barrier is not healthy, you are more likely to get irritable bowel syndrome (IBS).”
Prebiotics and probiotics
Foods that encourage the growth of healthy gut bacteria – prebiotics – include wholegrains and green leafy veg, bananas and almonds. Probiotics – the live bacteria and yeasts that are good for you – can also be taken as supplements and found in some foods, like live yoghurt.
Says Crowther: “Some prebiotics and probiotics produce chemical messengers called neurotransmitters, which help reduce anxiety and improve the way you deal with stress. These include GABA, which has a relaxing effect, as well as serotonin and the “feel-good” hormone dopamine.
These neurotransmitters are particularly helpful whilst navigating the ups and downs of menopausal hormonal mood swings. “What’s more, probiotics help reduce inflammation, which is known to play an important role in depression and many chronic diseases of midlife and beyond,” says Crowther.