Sex hormones naturally decline as we get older and this can affect your body in numerous ways, not least your digestion. Here’s what to know and how menopause affects digestion
Words: Katy Sunnassee | Images: Shutterstock
Perimenopause is often characterised by erratic menstrual cycles lasting 1-10 years. Periods may occur less or more often, last longer or be shorter, and bleeding may be heavier or lighter than usual. According to the NHS, 13 million women are peri- or menopausal in the UK, which represents a third of the female population.
Reproductive hormones such as oestrogen and progesterone fluctuate, and after your final period, oestrogen levels settle at a lower level, and the body stops producing progesterone altogether. Symptoms typically begin in your 40s, varying widely in timing, length, and intensity.
‘Combined with the effects of getting older, perimenopause can directly or indirectly contribute to an increased risk of several physical and mental health conditions, including osteoporosis, heart disease, depression, and obesity. However, some small lifestyle changes can help to reduce the risk of these conditions,’ says Dr Naomi Potter, an expert in women’s health and hormones (menopausecare.co.uk).
One of the ways perimenopause can affect your body is how it responds to food as you get older. While younger women tend to experience less severe spikes in blood-sugar levels after eating, compared to men, post-meal blood-sugar levels increase as we get older. These spikes in blood sugar, and the subsequent dips, can lead to fatigue and hunger soon after eating and, over the longer term, increase your risk of heart disease, type 2 diabetes and stroke. Blood fat levels increase as you get older, too, and some research suggests that women’s fat metabolism changes during perimenopause.
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‘There is still lots of research that needs to be done on the perimenopause, but we are now recognising that it is a phase that can lead to lots of different physical and mental health changes that many women need support with. Some women choose to take hormone replacement therapy (HRT) but changing lifestyle habits may also help to reduce symptom severity,’ says Dr Potter.
‘For example, women ought to try adopting a heart-healthy diet that includes a variety of fruit, vegetables and wholegrains, which also help increase fibre intake. Also aim to eat 2-3 portions of calcium-rich foods every day and increase your protein intake. These diet changes will also help with maintaining bone density and reducing your risk of heart disease, which increases in menopause. Reducing caffeine and alcohol intake can help reduce hot flushes,’ explains Dr Potter.
Fibre is important because it provides fuel for your gut bacteria, which turn it into many different beneficial compounds. However, results from the Women’s Gut Health survey, conducted by Yakult*, found that less than a third (29 per cent) of women aged 45-54 had prioritised eating more fibre to improve their gut. Sources include vegetables, fruit, legumes and wholegrains. Foods containing lots of fibre can make you feel fuller for longer, improve gut health and cholesterol levels, and lower your risk of heart disease.
Menopause and gut health
Menopause – a year after your last period – is a period of significant change to hormones which, in turn, can impact the gut microbiome. Oestrogen levels are lower, which influences gut function. Menopause is associated with lower gut microbiome diversity and a gut microbiome similar to that found in men. A less diverse gut microbiome can lead to microbial imbalance (aka gut dysbiosis), which can contribute to inflammation and a weakening of the immune system.
The Yakult research found that 71 per cent of women think that menopause can impact gut health, and more than 90 per cent of those aged 55 and above regarded gut health as important, yet only four per cent of those aged 55-64 had heard of the gut-hormone axis, highlighting the need for greater education in this area.
Almost half of those aged 55-64 said they now experience more bloating since having gone through menopause, while a third (34 per cent) have more gas and 29 per cent suffer from stomach ache and discomfort. Only a fifth had tried eating more fermented foods or probiotics to help improve their gut.
‘Postmenopausal women commonly exhibit a lower gut microbiome diversity and altered overall composition compared to premenopausal women. They also have fewer gut microbial beta-glucuronidase, the enzyme involved with the “oestrobolome”, which is a collection of gut microbes that can recycle oestrogen, allowing it to re-enter the bloodstream instead of being excreted. We understand that hormone levels impact the microbiome, which then impacts its reabsorption in a bi-directional way. This can subsequently impact a whole range of bodily functions beyond reproductive health that oestrogen plays a role in, including weight management, supporting libido, mood, bone and brain health, immunity and heart health,’ says Dr Potter.
‘During menopause, a diet focused on bone and heart health – for example one that includes calcium-rich foods and limiting saturated fat and refined salt intake – is beneficial as women are at an increased risk of osteoporosis and heart disease as oestrogen levels drop. Avoiding large meals near bedtime may also help to reduce some menopausal symptoms that can affect sleep such as hot flushes,’ says Dr Potter.
‘One of the most common symptoms of the menopause is weight gain. This can be attributed to various factors such as changes in muscle mass, metabolism and lifestyle factors, for example a fall in activity,’ she explains. ‘Also, a reduction in gut microbiota diversity can lead to lower production of short chain fatty acids, which play a role in appetite regulation through the gut-metabolism axis. This is another example of how our gut health can affect the symptoms of hormone changes during this phase,’ says Dr Potter.
The Women’s Gut Health survey, conducted in May 2024 by Mortar Research on behalf of probiotic brand Yakult surveyed just over 2,000 women, aged between 18-65+ years old. It found that while 91 per cent of respondents recognised the importance of gut health, there was a significant gap in knowledge as nine in 10 women had never heard of the gut-hormone axis: the two-way relationship between the gut microbiome and female sex hormones, namely oestrogen and progesterone, levels of which fluctuate across each life stage.
