Gut Health and Perimenopause
The Hidden Link to Hormones, Mood, and Metabolism
I think we can all agree that having gastrointestinal symptoms, whether it is bloating, changes in stool, or constant discomfort, can be really debilitating. And sadly, during perimenopause, these gut issues often get worse. In fact, a recent UK study found that 94% of women aged 44–73 reported experiencing digestive symptoms like bloating, stomach pain, constipation, or acid reflux during the perimenopause/menopausal period. This shows that gastrointestinal problems are widespread, and yet they are often brushed aside. However, this is not just an annoyance. Poor gut health during perimenopause can have a major impact on quality of life, yet many of us do not get a clear diagnosis or feel properly supported.
Your gut can feel the impact too – women often experience more bloating and gas
The gut is the body’s hidden powerhouse
Your gut is not just responsible for digesting and absorbing nutrients from food. It also plays a key role in clearing out old hormones, producing certain vitamins, defending against harmful pathogens, and influencing mood and even weight. For this reason, the importance of beneficial gut bacteria and overall gut health should not be underestimated, particularly during perimenopause and menopause.
Often referred to as the body’s ‘second brain’, the gut supports both physical and mental health in many ways. During menopause, when hormonal fluctuations can affect energy levels, mood, digestion, and immune health, looking after your gut becomes even more important. A healthy gut supports nutrient absorption, immune function, and overall well-being, helping to ease symptoms and potentially soften the impact of hormonal changes on the body.
Imbalances in the gut microbiota, whether caused by alcohol consumption, antibiotic use, or hormonal shifts, can lead to inflammation and further hormonal disruption. The good news is that, although the gut is complex, it is highly responsive to what we eat and how we live. Even small, positive changes can have a significant impact on well-being during perimenopause.
Why gut matters more than ever in midlife
During midlife, especially in perimenopause, our bodies go through significant changes from hormonal shifts to a slower metabolism, which can affect digestion, energy, and overall well-being.
These changes can lead to a wide array of symptoms that significantly affect how we feel (see my post on common perimenopause symptoms – https://vitalityher.com/is-it-just-me-or-is-this-perimenopause-common-perimenopause-symptoms/).
Hormonal shifts during perimenopause do more than influence metabolism or energy, they also affect gut function. Changes in oestrogen and progesterone can alter gut motility, digestion, and the balance of gut bacteria, leading to bloating, constipation, or general discomfort. And it works both ways: slow or impaired gut function can influence hormone balance, because the gut plays a key role in metabolising oestrogen, regulating insulin, and absorbing nutrients needed for hormone production.
This creates a feedback loop: hormones affect the gut, and reduced gut function can, in turn, worsen symptoms and further disrupt hormone levels, amplifying the effects of perimenopause.
The estrobolome and hormone balance
One important player in this gut–hormone connection is the estrobolome, a group of gut bacteria that help metabolise and regulate oestrogen. Imbalances in these bacteria may affect circulating oestrogen levels, potentially contributing to hormone-related symptoms. Emerging research also suggests that the estrobolome may influence common perimenopause concerns such as weight changes, mood fluctuations, and libido.
A healthy gut can support the elimination of metabolised oestrogen through stool. Long-term digestive issues, such as constipation, may reduce this excretion, allowing oestrogen to be reabsorbed into the body and contributing to symptoms of oestrogen dominance. Maintaining a balanced gut microbiota may therefore help support hormone balance and overall well-being during perimenopause.
The gut’s effect on brain health
90% of our “happy” neurotransmitter, serotonin, is produced and stored in the gut. Although serotonin in the gut cannot cross into the brain, it has a strong influence elsewhere in the body, having a positive effect on our mood.
The gut and brain are closely connected through the gut–brain axis, a two-way communication system supported by the vagus nerve. This is why, during periods of stress, anxiety, or excitement, you may physically feel it in your gut. In perimenopause, when hormone levels begin to fluctuate, this gut–brain connection can become even more noticeable.
Hormonal changes during perimenopause can influence gut function and the balance of gut bacteria, which in turn may affect mood, stress resilience, sleep, and cognitive function. This helps explain why symptoms such as low mood, anxiety, brain fog, or changes in emotional well-being are commonly reported during this stage of life.
Research increasingly suggests that gut health plays a role in supporting brain health, particularly during times of hormonal transition. While this is a complex and evolving area of science, maintaining a healthy gut may help support emotional balance and mental well-being throughout perimenopause.
The gut’s effect on immune health
During perimenopause, changing hormone levels do not just affect mood, energy, and digestion, they also influence the immune system. Your gut plays a key role in keeping your immune system balanced and reducing inflammation. Research shows that women are more likely than men to develop autoimmune conditions, and the years around perimenopause are a time when these risks can increase. This may be partly due to oestrogen’s effect on both the immune system and the balance of gut bacteria. In other words, shifts in hormones and gut health together can affect how well your immune system responds, which may help explain why some women notice more allergies, inflammation, or autoimmune flare-ups during this stage of life.
The gut’s effect on weight
After reading about the gut so far, it may not come as a surprise that gut health is also closely linked to body weight, particularly during perimenopause. Research shows that lower gut bacterial diversity is associated with weight gain and changes in metabolism, which many women notice at this stage of life. Emerging evidence suggests that hormonal fluctuations during perimenopause may influence the composition and diversity of gut bacteria in some women, potentially making these metabolic changes more likely.
One reason for this is that certain beneficial gut bacteria produce compounds that help communicate with the brain and body, influencing appetite, blood sugar balance, and how we store and use energy. These gut-derived signals play a role in helping the brain recognise when we are hungry or full. When gut bacterial diversity is reduced, fewer of these signals may be produced, making appetite regulation more challenging. At the same time, fluctuating oestrogen levels during perimenopause can affect both gut bacteria composition and fat distribution, particularly around the abdomen.
This helps explain why weight changes during perimenopause are not simply a matter of willpower or calorie intake. Hormonal shifts, gut health, and metabolism are deeply interconnected.
Perimenopause is a time of change, but supporting your gut may help your body adapt more smoothly and feel more balanced
This is why looking after your gut is so important during perimenopause. A healthy gut supports the immune system, helps with nutrient absorption, and plays a key role in overall well-being, all of which can help ease symptoms and reduce the impact of hormonal changes on the body. While the gut is complex, small, consistent changes can make a meaningful difference. In my next article, I will be exploring how to support a healthy gut during perimenopause in a holistic and sustainable way, so keep an eye out.
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