Is Perimenopause Affecting Your Gut Health?
By Sinéad Berry, Registered Nutritionist (MSC, mBANT, rCNHC)
The importance of gut health gets a lot of airtime these days. And rightly so; a happy gut is the cornerstone of good health, influencing everything from our mood to our metabolism and weight. While we’d be forgiven for thinking that the gut has the single job of digesting food, it actually acts as the body’s first line of defence, protecting from the outside world, while extracting essential nutrients from food (as well as making them) for energy and repair. It also works to eliminate harmful toxins and power the immune system.
Digestive issues such as constipation, bloating, acid reflux or diarrhoea may be symptoms of a wide range of things, but there is emerging evidence to suggest that there may be a link between menopause and changes in gut health. But if you’re in your 30s, this isn’t something you need to worry about just yet, right? In fact when it comes to women’s health, it’s never too early to get clued up. The stage leading up to menopause (diagnosed 12 months after your last period) is known as perimenopause; the age this begins varies massively but it can occur between 8 and 10 years before menopause (which has an average age of 51). So equipping yourself with knowledge and sensible food and lifestyle habits in your 30s has the potential to make your journey a little smoother. But how might your gut health impact your experience of perimenopause and vice versa?
What is the gut microbiome?
The gut lining is populated by trillions of microorganisms, including both beneficial (the ‘good’) and potentially harmful types (the ‘bad’); this is called the gut microbiome. Everything from diet and medication to genetics and the way you were delivered at birth can affect your microbiome — and each person’s is totally unique. Our community of beneficial gut microbiota does a lot for our overall health, including: breaking down dietary fibre; synthesising vitamins such as folate, riboflavin (B2), niacin (B3), B12 and vitamin K; protecting against opportunistic bacteria and stimulating the immune system to fight them off. It also produces short chain fatty acids (SCFAs) which help maintain the gut lining, as well as helping to regulate appetite, reduce inflammation and support metabolism. Poor digestion or imbalances in gut bacteria may result in symptoms ranging from diarrhoea, bloating and acid reflux to fatigue and low mood.
How does the gut microbiome change as you age?
A diverse microbiome with an abundance of beneficial bacteria is recognised as a contributory factor to longevity. From infancy through childhood, colonisation develops and diversity increases from diet and environmental exposure. During childhood, medications such as antibiotics may have lasting effects on the diversity of the microbiome. During adulthood, your microbiome stabilises somewhat but may continue to be impacted by changes in dietary habits, medication and lifestyle. Increasing evidence suggests that a decline in microbial diversity is common in older adults. These changes in the gut microbiome may be linked to age-related conditions such as inflammation, metabolic disorders and a weakened immune system.
Some research also suggests that a woman’s microbiome may be more diverse than a man’s, although for women, diversity appears to plateau at around age 40 with research linking these changes with menopause, suggesting that hormone fluctuations may be a key driver.
What have hormones got to do with gut health?
Receptors for the sex hormones oestrogen and progesterone are found throughout the gastrointestinal tract, so it’s unsurprising that fluctuations in these hormones may have an impact on our wellbeing. Oestrogen is essential for female reproductive function, regulating body fat, cardiovascular and bone health, and cognitive function. A collection of gut microbes called the estrobolome are capable of metabolising and regulating the amount of oestrogen circulating in the body. When oestrogen is (mostly) released from the ovaries, it travels around the body in an activated form. To clear it, it’s deactivated by the liver and eventually passes into our gut before being excreted. The microbes in the estrobolome secrete enzymes called beta-glucuronidases, which recycle oestrogens back into their active forms, meaning they can re-enter the blood circulation (other hormones including progesterone and testosterone are similarly recirculated by the microbiome). Oestrogen is effectively feeding these microbes and supporting gut bacteria diversity. With a healthy gut microbiome, just the right amount of beta-glucuronidase is produced to keep oestrogen in balance.
How does gut health impact perimenopause symptoms?
If the estrobolome is disrupted and there’s an excess or shortage of microbes producing beta-glucuronidase, there’s the potential for too much or too little oestrogen being excreted, leading to an imbalance between oestrogen and other hormones. This may negatively impact a wide range of oestrogen-related processes, resulting in the symptoms that many women report experiencing: bloating, weight gain, anxiety, brain fog, low energy, mood swings, loss of libido and poor sleep. Furthermore, the relationship between oestrogen and gut health is bi-directional — a natural decline in oestrogen during perimenopause may also have a reciprocal effect on the composition of the gut microbiome.
Why is gut barrier integrity so important?
Oestrogen has also been shown to protect the mucus-producing cells in the gut lining against damage. With the fluctuating oestrogen levels of perimenopause, there’s a risk of the gut lining becoming damaged, resulting in unwanted substances or microbes being absorbed into the bloodstream. This potentially compromises nutrient absorption and may trigger an inflammatory response, impacting wider processes throughout the body. Although there’s little robust evidence specifically linking menopause and gut barrier integrity, there is some research to show that gut permeability increases from pre- to post-menopause. As well as being linked with systemic inflammation, greater gut permeability has also been associated with lower bone mass density, increasing the risk of osteoporosis.
What’s the connection between oestrogen, stress and digestive symptoms?
Oestrogen also helps regulate the stress hormone cortisol. With decreasing oestrogen, cortisol may not be effectively regulated and our experience of stress can become heightened. Any form of stress (physical, emotional or psychological) triggers the body’s ‘fight or flight’ response, where energy is sent to muscles, heart rate increases and the body becomes primed for danger, even without a perceived threat. At the same time, functions that aren’t immediately needed for survival are reduced and compromised. That includes digestion. Secretion of stomach acid and digestive enzymes are impacted and the emptying of the stomach is delayed. This may lead to symptoms such as bloating, acid reflux, constipation and abdominal discomfort.
What can we do to support gut health as we age?
For women, being mindful of this gut–hormone connection, looking after your gut and adopting positive lifestyle habits may be key for helping us thrive as we approach perimenopause and beyond. By focusing on improving your gut health and supporting a diverse microbiome, many of the unwanted symptoms of perimenopause may potentially be alleviated. So what habits that we can embrace to create and maintain good gut health?
Eat probiotic and prebiotic foods: Probiotics are beneficial bacteria that support gut health, including fermented foods such as yoghurt, kefir, sauerkraut or tempeh. Prebiotics are non-digestible fibres that nourish these bacteria and prebiotic foods include onions, lentils, green bananas and apples (particularly stewed apples, containing quercetin and pectin, which may also improve gut barrier function), as well as green leafy vegetables, whole grains and flaxseeds.
Include variety: Make sure your diet includes a variety of fruits, vegetables, whole grains and lean proteins to provide a range of nutrients that support gut health.
Reduce processed foods: High consumption of certain processed foods, particularly ultra processed foods, has been shown to negatively affect the gut microbiome and lead to inflammation. Try to avoid any processed food that has long lists of ingredients that you don’t recognise, instead opt for whole foods and homemade alternatives instead.
Stay hydrated: Drinking plenty of water helps to maintain the mucosal lining of the intestines, supporting digestion and nutrient absorption.
Manage stress: Chronic stress can disrupt the structure and function of the microbiome and have a negative effect on digestion, as well as intensifying the impact of perimenopausal hormone fluctuations and vice versa. Taking time to breathe deeply before you eat may calm the nervous system and promote better digestion. Incorporating stress management techniques like meditation, yoga, or mindfulness into your routine may also be of benefit.
Get better sleep: Some research has shown better sleep (increased sleep efficiency and total sleep time) is linked to increased gut bacteria diversity. Restorative sleep is deep, uninterrupted and typically 7–9 hours long, so embrace ‘sleep hygiene’ by practising behaviours that facilitate sleep and avoiding those that interfere with it: get early morning daylight exposure; go to bed an hour earlier; limit devices at least 30 minutes before bed; develop a bedtime ritual; and stay hydrated throughout the day.
Move every day: Moderate exercise has also been found to contribute to a healthy microbiome — this is in addition to the other positive effects that exercise can have on physical and mental health.
ABOUT THE AUTHOR:
Sinéad Berry
Registered Nutritionist (MSc, mBANT, rCNHC)
Sinéad Berry is a registered nutritionist (MSc, mBANT, rCNHC) and health writer, with a Masters degree in Personalised Nutrition. Sinéad supports women struggling with perimenopause symptoms to feel empowered to achieve their health goals through a simple and joyful approach to food. Her research examining the role of vitamin D in female infertility as a symptom of polycystic ovary syndrome (PCOS) was published in the Journal of Reproductive Immunology. She has also trained in professional cooking skills at the prestigious Leiths School of Food & Wine. Sinéad works with clients on a one-to-one basis and is also a food & health editor providing copywriting, recipe editing and technical services to professionals and brands in the nutrition industry.
Instagram: @sineadberrynutrition
Website: www.sineadberry.com