I attended a continuing education event this weekend along with my colleagues, and we had the pleasure of listening to an interesting session by Dr. Kelly Ruef, ND, all about the connection between menopause and gut health. I’m going to try and condense the information here so you can learn about it too.
Gastrointestinal Complaints in Perimenopause & Menopause
Treating a lot of women in perimenopause and menopause, I do see a significant number of gastrointestinal complaints. A newer study out of the UK looked at nearly 600 participants and found that 94% reported symptoms such as bloating, constipation, stomach pain, and acid reflux. Even more striking, 82% said these symptoms either began or worsened during perimenopause and menopause. It’s validating to see research catching up to what many women have been experiencing and reporting for years.
It turns out that during menopause, much like during pregnancy, our bodies go through substantial shifts. One of the less obvious but important changes happens in the gut. The gut microbiome, our internal ecosystem of bacteria and other microorganisms, begins to shift as hormone levels decline.
Women generally have greater microbial diversity than men, which is associated with better resilience and overall gut health. However, as estrogen levels drop during menopause, that diversity tends to decrease, and the microbiome begins to resemble a more “male-pattern” profile. With less diversity, we often see an increase in the very symptoms many women report during this stage of life.
These changes are not just about digestion.
We also see an increase in gastrointestinal inflammation, and it appears that estrogen and progesterone play protective roles in maintaining gut integrity. Emerging research suggests that as ovarian function declines, there may be increased release of inflammatory signaling particles that can affect not only the gut but also the brain.
This may help explain why symptoms such as mood changes, hot flashes, sleep disturbances, low libido, and even issues with concentration and memory can all cluster together during menopause. While this area of research is still developing, it reinforces the idea that the gut and brain are deeply interconnected, especially during times of hormonal transition.
So the natural question becomes: does hormone therapy help support gut health?
At this point, we don’t have a definitive answer. Some early research is promising. For example, in animal studies, giving estradiol to mice that had their ovaries removed helped restore aspects of their gut microbiome. However, animal studies don’t always translate directly to humans.
In clinical practice, I’ve observed that many patients who choose to pursue hormone therapy do report improvements in a wide range of symptoms, including digestive concerns. That being said, I haven’t formally tracked microbiome changes before and after treatment, so this remains more of a clinical observation than a measured outcome.
The good news is that regardless of whether or not someone chooses hormone therapy, there are several practical steps that can support gut health during this transition.
Fiber is one of the most impactful.
Most people are not getting enough fiber in their daily diets. I often recommend tracking intake for a day or two just to get a baseline. Ideally, women should aim for about 32 to 35 grams of fiber per day. High-fiber foods include beans, fruits, vegetables, whole grains like quinoa, and seeds such as chia and flax. Increasing fiber gradually and ensuring adequate hydration can help minimize discomfort as intake improves.
Incorporating fermented foods can also be beneficial. Foods like sauerkraut, kimchi, and kombucha introduce beneficial bacteria and can help support a more diverse microbiome. Even small, regular amounts can make a difference over time.
Simple habits matter too.
Taking a short walk after meals can aid digestion and help regulate blood sugar, both of which support overall gut function.
Finally, it’s worth considering that the gut microbiome can be disrupted by events such as gastrointestinal infections, travel-related illness, or antibiotic use. In those cases, working with a naturopathic doctor to choose an appropriate probiotic may be helpful. Not all probiotics are the same, and a targeted approach can be more effective in restoring balance.
Menopause is a complex and highly individualized transition, but understanding the role of the gut opens up additional avenues for support. As research continues to evolve, it’s encouraging to see more attention being paid to this connection and more tools becoming available to help women feel better during this stage of life.
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Dr. Jennifer Potter, ND
Naturopathic Doctor San Jose
408-356-1364
Dr. Jennifer Potter, ND provides natural healthcare solutions for families and individuals, focusing on perimenopause/menopause, autoimmune conditions, fatigue, and immune support. She is deeply committed to her patient’s well being, prioritizes patient education and combines natural and conventional therapies to deliver personalized care. Outside of her practice, she enjoys time with her two kids, reading fiction, and crocheting.
References:
The Menopause Society. Press release. Denby N. Presented at: The Menopause Society’s 2025 Annual Meeting. October 2025. Orlando, FL.
The Peri-Menopause in a Woman’s Life: A Systemic Inflammatory Phase That Enables Later Neurodegenerative Disease. Journal of Neuroinflammation. 2020. McCarthy M, Raval AP.
Sexual Dimorphism in Inflammasome-Containing Extracellular Vesicles and the Regulation of Innate Immunity in the Brain of Reproductive Senescent Females. Neurochemistry International. 2019. Raval AP, Martinez CC, Mejias NH, de Rivero Vaccari JP.
Kaliannan K, et al. Microbiome. 2018 Nov 13;6(1):205.
Peters BA, et al. Int J Womens Health. 2022 Aug 10;14:1059-1072
