Menopause linked to changes in gut health

New research suggests the menopause transition is accompanied by changes in markers linked to the intestinal barrier, while diet and lifestyle can help support gut health

By Dina Gavarieva

When we think about menopause, we tend to think about hot flushes, night sweats, insomnia and moods swings – but the gut can also go through ‘the change’. Common signs of this include bloating, constipation and suddenly discovering certain foods no longer agree with you.

New research published this summer in the Journal of Clinical Investigation, has found evidence that the menopause transition is accompanied by changes in the health of the gut barrier – the protective lining that separates the contents of the digestive system from the rest of the body.

The study followed 964 women through the menopause transition, taking blood samples at different stages. The researchers measured two markers linked to the health of the intestinal barrier and to the movement of substances from the gut into the bloodstream.

They found that the markers began to change around two-and-a-half years before the final menstrual period and continued to rise for several years afterwards, reaching their highest levels around six years after menopause.

What the research found

So, why is this important? Because your intestinal lining is actually a very sophisticated security system.

Your gut needs to allow useful things, such as nutrients, to pass into the body while helping to keep unwanted substances and products from bacteria inside the digestive tract where they belong.

When that barrier becomes less effective, substances from the gut can cross into the circulation. This is often referred to as ‘leaky gut.’ While the study does not prove or suggest that menopause causes leaky gut, researchers did find a change in blood markers associated with the health of the gut barrier.

Exactly what these changes mean for women’s health – and whether they contribute to disease or symptoms – still needs to be established.

However, what is clear is that there appears to be a genuine biological change taking place around menopause.

One of the reasons scientists are so interested in this connection is that oestrogen and progesterone play a role in maintaining healthy barriers in the body.

We already know that falling levels of these hormones during menopause can affect tissues throughout the body.

But there is also a fascinating relationship between our hormones and the trillions of microorganisms living in our digestive system – collectively known as the gut microbiome.

The microbiome helps with digestion and interacts with our immune system and metabolism. Researchers are now investigating how changes in the microbiome and falling oestrogen levels might interact during menopause.

This could eventually help explain why digestive symptoms become more common for some women around this time of life.

Supporting gut health through midlife

The good news is that supporting your gut does not require an expensive collection of supplements or a complicated diet. Fibre is your friend. Vegetables, fruit, beans, lentils, chickpeas, wholegrains, nuts and seeds provide the different types of fibre that our gut bacteria need, so try to eat a wide variety rather than relying on the same few foods every day.

If you currently eat very little fibre, increase it gradually. A sudden jump can actually make bloating worse. And remember to drink enough water.

This is one reason the Mediterranean-style diet is such a good fit for midlife health. It naturally provides plenty of vegetables, legumes, wholegrains, nuts, seeds and olive oil, while placing less emphasis on highly processed foods.

Fermented foods can also be useful so try live yoghurt, kefir, sauerkraut and fermented vegetables to introduce beneficial bacteria or support the existing microbial community.

As ever, exercise is another important part of the picture.

Regular movement supports cardiovascular health, bones, muscles, blood sugar regulation and mental wellbeing – all areas that become particularly important during and after menopause.

You do not need to become a marathon runner – walking, swimming, cycling, dancing, gardening and resistance exercise all count.

And then there are the basics we sometimes overlook, like getting enough sleep, managing stress, not smoking, keeping alcohol within sensible limits and avoiding a diet dominated by ultra-processed foods.

None of these things will magically restore oestrogen levels, but they can help create the healthiest possible environment for your gut and your body while your hormones are changing.

Perhaps the most useful message from this new research is that we should stop thinking of menopause as something that affects only the reproductive system.

The years around menopause can bring changes throughout the body – from bones and muscles to the cardiovascular system, brain, metabolism and, it now appears, the gut.

That does not mean every digestive problem in a woman in her fifties is a menopause symptom. And persistent bloating, changes in bowel habits, unexplained weight loss, bleeding or ongoing abdominal pain should always be discussed with your doctor.

But if your digestion seems different as you move through midlife, it is worth paying attention.

Dina Gavarieva is a qualified naturopath practising at Neomed Institute and Medical Centre, Limassol