The Surprising Truth About Menopause and Gut Health

3 min. read

Written by:

As women enter their perimenopausal and menopausal years, new (and often distressing) symptoms may start to pop up as their hormone levels change. The ovaries, the primary supplier of estrogen, begin to reduce their production and the circulating estrogen level in the body declines.

Then come the dreaded hot flashes and night sweats, among other annoying and uncomfortable menopausal symptoms. Here’s where it gets interesting. Did you know that the severity of these symptoms may be closely related to your gut health?

Estrogen is not only important for reproductive health, it’s also essential for our gut health—and vice versa.

The Connection Between Your Gut Health and Estrogen Levels

There is an important bidirectional relationship between the estrogen circulating in your body and your gut health.

We know estrogen is important for our reproductive health, but it may not be widely known that having healthy and balanced estrogen is also essential for our gut health.

Specifically, healthy estrogen levels:

  • Promote the growth of healthy and diverse beneficial bacteria
  • Maintain our gut barrier integrity
  • Decreases inflammation in the body

How Menopause Affects Your Gut Bacteria

Research suggests estrogen can positively influence the composition and increase the diversity of the bacteria in our gut. For example, one study shows that animals treated with estrogen displayed a significantly greater amount of microbial diversity in their gut versus the animals not treated with estrogen.

When estrogen levels decline during menopause, it impacts both the gut microbiome and the genitourinary system, which includes the organs of both the reproductive and urinary systems. In the absence of enough estrogen, the tissue lining the vagina and urethra can become dry, thin and inflamed. This combined with less beneficial lactobacillus bacteria in the gut microbiome and higher vaginal pH levels can lead to some common but very undesired and uncomfortable symptoms, including:

  • Yeast infections
  • Urinary tract infections
  • Bacterial vaginosis
  • Urinary frequency, urgency and incontinence
  • Vaginal dryness that can lead to painful intercourse

How to Improve Gut Health Naturally

To promote a healthy balance of beneficial gut bacteria, I recommend that my patients:

  • Prioritize dietary choices:
    • Increase fresh fruits and veggies.
    • Decrease refined carbohydrates and sugar.
    • Go organic for produce, meats and dairy to minimize pesticide residue exposure that can negatively impact hormonal health.
    • Opt for low glycemic food choices and balance each meal or snack with a healthy protein or fat to help keep your blood sugar stable.
    • Drink plenty of fresh, filtered, water.
  • Eat ground flax seeds. They not only provide beneficial fiber, they act as phytoestrogens that bind to estrogen receptors, creating an estrogen-like effect when estrogen is low. Eating ground flax seeds has been shown to help relieve menopausal symptoms and improve quality of life after 3 months. Additionally, flax seeds act as a prebiotic fiber that can beneficially alter the microbiome of the gut.
  • Minimize antibiotic use.
  • Be mindful of environmental toxinsMinimize xenobiotic plastic exposure, and avoid hormone-disrupting agents such as parabens in personal care products, makeup, and cleaning products. They can act on estrogen receptors and result in negative health consequences.
  • Take an oral probiotic that contains a variety of beneficial organisms. This includes lactobacillus, bifidobacteria, soil-based organisms and Saccharomyces boulardii.
  • Consider organic, non-GMO soy isoflavones, in moderation.

When someone is showing specific signs of dysbiosis (microbial imbalance) in their genitourinary system, I recommend:

  • A personal lubricant to help rehydrate and protect their dry, delicate tissue. Make sure it is pH balanced and doesn’t contain any irritating ingredients such as alcohol or parabens.
  • Vitamin E suppository to help moisten, rehydrate and heal the delicate vaginal tissue.
  • Vaginal probiotic suppositories to help bring beneficial bacteria directly to the urogenital area.
  • If symptoms are really severe and the above recommendations don’t provide enough support, we may consider a prescription of compounded bio-identical estriol (a gentle protective estrogen that promotes urogenital tissue health) applied directly to the vaginal tissue.


Dr. Briana Sinatra

Meet Dr. Briana Sinatra

Dr. Briana Sinatra is a board-certified naturopathic doctor with a vibrant practice in the Pacific Northwest. There she focuses on women’s and family health, taking a holistic approach to healthcare by empowering women with the knowledge and tools they need to live their best life now and protect their future wellness by looking at how all the systems in the body work together and how diet, lifestyle, and environment all influence health.

More About Dr. Briana Sinatra