How Gut Bacteria May Shape Menopause Symptoms

For many women, the shift into menopause comes with changes that are hard to predict. One woman may sail through with few symptoms, while another with similar hormone levels struggles for years. Researchers are increasingly looking at an unexpected place for part of the explanation: the trillions of bacteria living in the gut.

Alicia Eve Ballok, Ph.D., translational science lead at Viome, is a microbiologist and immunologist who studies how gut microbes interact with the body, with a focus on inflammation. She explained what scientists know so far about the gut’s role in menopause and where questions remain.

The gut bacteria that help manage estrogen

The estrobolome is a collection of gut bacteria involved in how the body handles estrogen. Ballok said scientists once thought hormones were controlled only by hormone-producing organs such as the ovaries and thyroid. Researchers now understand that some gut bacteria also affect how much estrogen ends up in the blood.

According to Ballok, some of these bacteria recycle estrogen that would otherwise leave the body, which changes how much stays in circulation. “When your gut is healthy, these bacteria help keep estrogen at the right level,” she said. When the gut is out of balance, estrogen levels may run too high or too low, and that can contribute to health problems.

She added that scientists are still working out how this relationship affects hormonal health, especially during menopause.

Similar hormone levels, different experiences

Ballok said blood hormone levels don’t tell the whole story. Because gut bacteria affect how much estrogen is actually active in the body, two women whose hormone levels look alike may have very different symptoms. Each person’s mix of gut bacteria is also unique.

She said Viome’s research has found that people who eat similar foods can respond to them very differently. Genetics, stress and sleep also play a role, and Ballok said it is not yet possible to say exactly how much of the difference comes from the gut. Still, she noted, “unlike your genes, it’s something you can change.”

Encouraging real-world data, with clear limits

Viome’s data showed that among members who reported menopause symptoms, 38% no longer reported them when they retested after six months of following personalized nutrition recommendations based on their test results.

“For something as common and disruptive as menopause, that’s a meaningful result,” Ballok said.

She acknowledged the data’s limits. The symptoms were self-reported, there was no comparison group, and the participants were customers who had already chosen to take the test and follow their plans. Symptoms can also change over time on their own, and people who change their diet often make other healthy changes too. Ballok said the next step is a controlled study to confirm whether the effect holds.

Everyday habits that support a healthy gut

Ballok said a personalized approach is most effective because every woman’s gut is different. She also shared general habits that can help support the microbiome during perimenopause, whether or not a woman ever takes a microbiome test:

• Eat a variety of plants. A wide range of fruits, vegetables, nuts, seeds and whole grains supports a more diverse community of gut bacteria.
• Get more fiber. Fiber helps gut bacteria thrive and produce compounds that support the gut lining.
• Add fermented foods. Fermented dairy such as yogurt may help balance gut bacteria and ease bloating.
• Stay hydrated. Water supports digestion and the gut lining.
• Move daily. Ballok recommends at least 30 minutes on most days.
• Manage stress. The gut and brain communicate constantly, and chronic stress can disrupt gut bacteria.
• Sleep seven to nine hours. Too little sleep may upset gut bacteria and increase inflammation.
• Care for your teeth and gums. Bacteria from the mouth can reach the gut, so brushing, flossing and regular dental visits matter.

Women with bothersome menopause symptoms should talk with their health care provider about treatment options, including whether diet and lifestyle changes could be part of their plan.