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Peri-Menopause, Menopause and the Gut

By Anna Pettit


The menopause is a natural part of ageing and officially is said to occur when a woman has stopped periods for 12 consecutive months. In the UK, the average age for a woman to reach the menopause is around 51 years of age. 

Peri-menopause (the time leading up to the actual menopause) can last for many years. If you are in the stages of perimenopause, your body has begun its decline in oestrogen production. 

What does oestrogen do?

Oestrogen is a key female hormone as it controls reproduction and the menstrual cycle. 

Oestrogen receptors are in many tissues of our body and play a role not only in our reproductive cycle but also in the health of our bones, heart and blood vessels, breasts, brain and skin and hair. Oestrogen also helps regulate body fat. 

Fluctuating hormones lead to changes in the menstrual cycle and symptoms which can vary in severity. These symptoms can include:

  • hot flushes
  • night sweats
  • brain fog
  • lack of concentration
  • memory troubles
  • reduced libido
  • insomnia 
  • mood swings 

Gut-hormone axis

We used to think these changes and symptoms were all about the ovaries, but now we know that the gut microbiome plays a pivotal role via the gut-hormone axis. 

The “Oestrobolome” is a subset of microbes within the gut which can help to regulate and metabolise oestrogen and oestrogen-like metabolites. It does this via oestrogen-metabolising enzymes called beta-glucuronidases which convert oestrogens into their active forms so that they can enter the blood circulation and reach other tissues in the body by binding to oestrogen receptors and influencing oestrogen-dependent physiological processes.

In general, the more beta-glucuronidases are produced, the less oestrogen is excreted out of the body so that more remains within the body to be recirculated and bound to receptors to  influence various physiologic processes. 

In simple terms, this means our gut microbe diversity can really impact the balance of oestrogens circulating in the body. When our gut microbiome is healthy, we’re likely to be producing optimal levels of beta-glucuronidase. 

Peri-menopause affect on the gut microbiome

The relationship between the gut microbiome and oestrogen is bidirectional. Just as the gut affects oestrogen levels, the natural decline of oestrogen levels during peri- and menopause has a direct effect on the gut microbiome. There’s evidence that a compromised oestrobolome in postmenopausal women is associated with an increased risk of osteoporosis, obesity, cardiovascular disease and reduced immunity. 

Interestingly, some studies show that the gut bacteria species that usually coexist happily in the gut of a pre-menopausal woman start competing with each other for survival after the menopause, often leading to dysbiosis. A few theories have been proposed to explain why, but the exact reason for this is still unknown and more research is required to identify it.

What can you do?

As the gut microbiome can potentially influence the development of disease through the changes to the estrobolome, it’s beneficial to focus on dietary and lifestyle factors that may positively impact on oestrobolome to aid the transition between peri- and menopause and to reduce the risk of any oestrogen-related disease. 

Overzealous use of antibiotics, smoking and  excessive alcohol intake which are harmful to the gut microbiome should be avoided. Diets high in fat and refined carbohydrates can also lead to microbiome disruption.

The focus should be on diversifying the diet with plenty of fibre-rich plants through generous intake of fruit and vegetables, whole grains, pulses, nuts and seeds to  support the gut microbiome and therefore the oestrobolome. 

Interestingly diet is also one of the contributing factors that can influence the the age at which the natural menopause occurs.  In a large UK based prospective study of more than 35,000 women aged 35 to 69 years, they found that there was an association between higher intakes of oily fish and fresh legumes and delay of the natural menopause by a staggering 3.3 years. Higher intakes of high Glyacaemic index (GI) refined foods such as white pasta and rice on the other hand were associated with an earlier menopause. Another argument for a varied high fibre diet!


We know that diet and lifestyle plays an important role not only in determining the age at which the natural menopause can occur  (along with other factors such as genetics,  environment and others) but also can also contribute to diverity of the gut microbiome including oestrobolome which has a direct effect on estrogen levels and vise versa impacting the natural menopause.  

There’s so much to say around the topic of the menopause, so I’ll do another post discussing the evidence for supplements at this time in life. 

I have a specialist interest in women’s health, so if you’re interested in having a session to discuss optimising your diet get in touch today!

Anna has over 12 years of experience working with clients in the NHS and privately in the UK and the Middle East. She is a specialist in the use of the low FODMAP diet in managing IBS and other conditions often accompanied by troublesome symptoms such as reflux, bloating, abdominal pain, excessive flatulence, constipation, urgency to open bowels and diarrhoea.

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