Gut Health During Menopause: What You Need to Know - Stella
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Gut health and menopause – how to create a healthy gut biome

byDr. Lucy Wilkinson

While the word microbe may have you reaching for the cleaning wipes, these tiny organisms also have an important role to play in keeping you healthy.

Read Stella’s clinical advisor Dr Lucy Wilkinson’s guide to gut health, microbes and menopause.

What is the microbiome?

The microbiome is the ecosystem of microbes that live in, on and around your body. These include bacteria, fungi and viruses that live in harmony with your body and help to keep it in good health. 

While it may be hard to believe, there are at least as many microbes in your microbiome as there are cells in your body!

You may hear these microbes called flora. For example, the bugs that colonise the gut are commonly called gut flora.

Microbe is a general word for all microscopic organisms, including bacteria, viruses and fungi. You may also hear them called germs or micro-organisms. These terms are all used interchangeably.

Why is the microbiome important for gut health?

Some of the microbes that form the microbiome live harmlessly on our bodies and have little effect on our wellbeing. These are known as commensals. Others, given the right circumstances, can spread and cause illness.

However, some microbes actively work to keep us healthy! This is especially true for those microbes which live in the gut. Here, helpful bacteria can:

  • Keep other, potentially harmful microbes in check
  • Ferment fibre into easy-to-digest nutrients
  • Help process Vitamin K and folic acid
  • Regulate the immune system

Helpful bacteria can also boost the levels of oestrogen in circulation by ‘recycling’ them from the gut and releasing them back into the bloodstream. You may hear this group of bacteria called the estrobolome.

We are still learning about the microbiome, and it is likely that this list of functions will grow with our understanding of this complex ecosystem.

Needless to say, the microbiome is an important part of a healthy body.

Why is gut health important at menopause?

Menopause happens when your body experiences a dramatic change in the type and amount of hormones it produces. Most menopause symptoms come from the sudden decrease in oestrogen.

However, microbes may play a role too. Menopause is known to change your gut microbiome and scientists are still learning about the implications of this. 

Mental health and menopause

Although it may be difficult to believe, the microbes in your gut can have an impact on the way your brain works. This is known as the gut-brain axis.

Bacteria living in the gut produce chemicals known as neurotransmitters, which send signals to nerve cells. These signals can affect nerves in the gut, and even those within the brain. 

Neurotransmitters play an important role in regulating moods, thoughts and emotion. In fact, treatments for depression and anxiety work by boosting the amount of certain neurotransmitters available within the brain, chiefly serotonin.

This is why a healthy microbiome is thought to help maintain good mental health. Research is ongoing as to the extent and importance of this relationship, but boosting your microbiome might be a good way to care for your mental health too.

That isn’t the whole story though. The gut-brain axis works both ways! Just as microbes in the gut can affect the nervous system, the nervous system can affect the microbes in the gut. Stress and anxiety are known to change the composition of the microbiome.

While a healthy microbiome may contribute to good mental health, you should still speak to your doctor if you are struggling with any troubling symptoms including anxiety, depression and mood swings. Other treatment options may work well for you, including antidepressants or HRT.

Weight gain and menopause

Weight gain is very common at menopause and for most, is due to a combination of factors. Hormonal changes and inconsistent levels of exercise (because let’s face it, working out is often the last thing on your mind when you feel under the weather) can both contribute.

Scientists are now also studying the possible link between menopausal changes to the microbiome and weight gain. Lab studies have shown a link between menopausal changes to the microbiome and increased body fat, slowed metabolic rate and insulin resistance.

While this by no means proves the link, it is perhaps sensible to consider a few microbiome-friendly changes to your lifestyle. Many of these – including exercise and a diet rich in whole foods – can also help you to shed weight.

Genitourinary syndrome of menopause

Genitourinary syndrome of menopause (GSM) affects about half of postmenopausal women and includes symptoms like vaginal pain, dryness, tightness and recurrent urinary infections. 

Studies suggest that there may be some link between symptoms and the types of bacteria found in the vagina after menopause – a population of bacteria which are often positively affected by a healthy gut biome (known as a microbiome axis). However, there is not yet any conclusive evidence and research is ongoing.

While you may choose to include some microbiome-friendly foods in your diet, GSM can be treated effectively with low-risk topical HRT. Speak to your doctor for more advice.

Osteoporosis and osteopenia

Thinning of the bones is common after menopause, and happens due to the reduction in oestrogen levels. This is known as osteopenia or osteoporosis if more severe, and can make you more prone to fractures.

There is emerging evidence that your gut microbiome could contribute to healthy bones. Some studies have even suggested a link between changes to the microbiome and thinning of the bones, although this relationship is still being investigated.

If you have osteoporosis, your doctor may recommend treatment to preserve your bone density. Speak to them for further advice about your individual options. 

Explore the many benefits of good gut health during menopause with our expert partner

How can you build a healthy microbiome?


Probiotics are helpful bacteria found in certain foodstuffs. These commonly include yoghurts and yoghurt drinks, kombucha, sauerkraut and kimchi among others. 

Once consumed, these helpful bacteria contribute to your microbiome by colonising the gut. There is some evidence that probiotics can help with symptoms of IBS and certain types of constipation. Probiotics are also thought to be helpful in inflammatory bowel disease.

It is important to note that, while probiotics can be helpful for specific illnesses, they are just one part of the treatment plan. You should still see your doctor if you have any new or worrying symptoms including a change in bowel habit, bleeding, abdominal pain or weight loss.


Prebiotics are foodstuffs which nourish your microbiome. These usually include types of hard-to-digest fibre which feed and stimulate the growth of helpful bacteria in your gut. 

Some good sources of prebiotic fibre include:

  • Oats and barley
  • Wholegrain cereals 
  • Wholewheat flour
  • Bananas, apples and berries
  • Artichokes, asparagus, onion, leek and garlic

You may notice that these are all generally healthy choices! A healthy and balanced diet has plenty of benefits besides nourishing your microbiome. 

However, these choices are not always straightforward. Prebiotic foods can cause increased flatulence because of increased bacterial activity in the gut. If you have any pre-existing bowel conditions including IBS, introduce these foods slowly and with caution to minimise any discomfort.


Moderate exercise has also been found to contribute to a healthy gut microbiome. This is in addition to the other positive effects that exercise can have at the time of menopause.

Read more here on the best exercise for menopause.

Would HRT boost my gut microbiome?

We do not yet know whether HRT has an impact on your microbiome. Lab research has found that this does happen in rats, but human studies are needed to confirm this effect in people.

Like all medications, HRT comes with certain risks. It is therefore not used solely for the purposes of enhancing the gut biome as this is (so far) unproven.

However, HRT is an effective treatment for many symptoms of menopause including hot flushes, poor sleep and mood changes. While HRT is not suitable for everyone, it may be a useful part of your treatment plan. Speak to your own doctor to find out more.

Read more about the risks and benefits of HRT.

Do antibiotics affect the microbiome?

While antibiotics are literally life-saving in many cases, they can also alter the balance of bacteria in the gut. Antibiotics kill off good bacteria as well as those which cause nasty infections. For this reason, it is important to use antibiotics only when necessary and as advised by your doctor. While you should not avoid antibiotics if you need them, you should stick to your doctor’s recommendations.

When should I see a doctor?

Don’t assume that any medical issues will be cured by a change in your diet. While a microbiome-friendly diet can be helpful, your symptoms need assessing properly.

This is particularly important if you experience:

  • Abdominal pain
  • Any change to your bowel habits (diarrhoea or constipation)
  • Bloating or abdominal swelling
  • Nausea or vomiting
  • Blood in your stools
  • Urinary changes
  • Irregular bleeding
  • Weight loss
  • Any other changes or concerns

Final word

The microbiome is a rich ecosystem which we are just beginning to understand. It is likely that we will discover more relationships between the microbes in your gut and menopausal symptoms as more research is done.

Changes to your diet can help to boost your microbiome, but should not be relied on to treat your symptoms when used alone. Speak to your doctor for advice on the best treatment for your symptoms.

Find out more about menopause on our blog or in our symptoms library.

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