How Women Can Optimize Gut Health for Hormonal Balance in Perimenopause + Beyond
How To Optimize Your Gut Health for Hormonal Balance in Perimenopause
“I’ve always been the rock of my family,” Janine said, almost stone-faced. “Now, I’m lucky if I make it to 3 pm without wanting to throw everyone out of my house, curl up in a ball and cry in peace.”
Janine sighs, and I can see tears rising. She continues, describing the belly weight she’s gained, the exhaustion and mood swings, the irregular periods and new return of heavy bleeding (“I remember heavy bleeding in high school, but not since”).
If you’re relating to Janine, you may feel more fatigued and unfocused, experience mood swings, or even see new and troubling fluctuations in your weight. These shifts are often linked to hormonal changes that occur during perimenopause, a time when your body is adjusting to rapidly shifting estrogen and progesterone levels.
What many women don’t realize is that your gut health—specifically a group of bacteria known as the estrobolome—is essential in regulating these hormones. A healthy gut makes perimenopause much easier to handle, while poor gut health only makes the ride rockier.
Why Gut Health Matters During Perimenopause
Understanding the connection between gut health and hormonal balance could be the key to managing perimenopausal symptoms and maintaining your energy and productivity.
Gut health directly influences hormone balance through the microbiome's ability to regulate hormone levels, such as estrogen and testosterone, by producing enzymes like β-glucuronidase that affect hormone metabolism. This interaction impacts immune responses, inflammation, and hormone-driven diseases, affecting everything from your energy and mood to your sex drive.
In this article, we’ll explore the estrobolome–the part of your gut microbiome that directly affects your estrogen levels–and what you can do to support gut health and hormonal balance during this pivotal stage of life.
Changes in the Gut Microbiome During Perimenopause
During perimenopause, a shift in hormone levels accompanies a decrease in the diversity of the microbiome. This favors an increase in Firmicutes and a decrease in Bacteroidetes, the two main bacterial groups present in your gut.
Firmicutes are more likely to produce β-glucuronidase, promoting estrogen reabsorption and driving hormone imbalance.
A rise in Firmicutes also means fewer beneficial bacteria that help maintain hormonal balance and regulate enzyme activity related to estrogen metabolism.
A decrease in microbial diversity also means an increase in a woman’s baseline inflammatory levels, which can further irritate her hormone function and also promote weight gain, especially belly fat that just won’t budge.
Decreased microbial diversity often seen in menopause has big meaning for the estrobolome, which is up next.
Gut Health and Hormonal Balance in Perimenopause: What Women Need to Know About the Estrobolome
The Estrobolome’s Role in Hormonal Health
The estrobolome is a group of gut bacteria specifically involved in estrogen metabolism. In your large intestine, these bacteria make specific enzymes that reactivate estrogen, allowing it to be reabsorbed into your circulation.
When it’s balanced, the estrobolome ensures that excess estrogen is metabolized and excreted through your digestive system, preventing it from re-entering your bloodstream.
However, when it’s out of balance, the estrobolome can become overactive and promote reabsorption of excess estrogen, worsening symptoms of perimenopause and increasing the risk of estrogen-dependent conditions like endometriosis, breast or ovarian cancer.
Why The Estrobolome Matters for Perimenopausal Women
During perimenopause, your hormone levels naturally fluctuate, particularly estrogen and progesterone.
An imbalance in the estrobolome only worsens these fluctuations: an imbalanced estrobolome disrupts how your body processes estrogen, leading to estrogen dominance—a condition where estrogen levels are disproportionately high compared to progesterone.
Symptoms like weight gain, fatigue, mood swings, and massive dips in energy and focus (and an increased risk of more serious health issues like breast cancer) can seem like a total mystery until you understand that hormone fluctuations can be behind them.
Understanding the gut-hormone connection is essential for maintaining hormonal balance during perimenopause, which is already a time of hormonal irregularity.
Hormone Balance: Pre-Menopause vs. Perimenopause
Before perimenopause, estrogen and progesterone work in a coordinated cycle to regulate the menstrual cycle and support reproductive health. Estrogen rises during the first half of the cycle to build the uterine lining, while progesterone peaks in the second half, balancing out estrogen and preparing the body for pregnancy.
This harmony between the two hormones keeps your body functioning smoothly, from fertility to mood regulation to metabolism. However, in perimenopause, progesterone levels tend to decline more rapidly, causing periods of functional estrogen dominance.
If your estrobolome is not functioning well, this hormone imbalance becomes more pronounced as more estrogen is reabsorbed from the large intestine and re-enters circulation, exacerbating perimenopausal symptoms like irregular periods, heavy bleeding, mood swings, weight gain, and more.
The Gut-Hormone Connection: How an Imbalanced Estrobolome Affects Your Health
Turns out, hormone harmony is intimately linked with gut health.
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The Gut-Hormone Link
The connection between your gut and hormones runs deep. The estrobolome helps regulate estrogen by breaking it down after it's been used by the body. If your gut is healthy, this excess estrogen is excreted, helping maintain hormonal balance.
However, when your gut is out of balance, estrogen that should be eliminated can be reabsorbed into the bloodstream, leading to estrogen dominance.
Consequences of an Imbalanced Estrobolome
An imbalanced estrobolome can have a massive impact on your hormone levels, resulting in symptoms such as:
Weight gain, particularly around the abdomen
Fatigue, low energy, and difficulty focusing
Mood swings and irritability
Irregular menstrual cycles and heavy bleeding
Bloating and digestive issues
These symptoms can make the transition through perimenopause even more challenging for high-achieving women who need to stay on top of their game.
The Effect of Stress on the Estrobolome
Chronic stress fuels the fire of estrobolome dysfunction and hormone imbalance.
When you're stressed, your body produces more cortisol, which has massive effects on other hormone levels including progesterone and estrogen. This further rocks the boat, making an already shaky ride through perimenopause feel even more difficult.
Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, which can dampen the hypothalamic-pituitary-gonadal (HPG) axis. When the HPG axis isn’t functioning properly, estrogen levels are thrown into chaos which can worsen a woman’s experience of hormone imbalance and may contribute to estrogen dominance.
Stress also shuts off digestion and promotes gut dysbiosis, further disrupting the estrobolome’s ability to regulate estrogen. Stress slows digestion, and a slower digestive system allows more unhealthy bacteria to build up, including those that increase estrogen reabsorption.
This creates a vicious cycle where stress worsens gut health, which in turn exacerbates hormonal imbalances.
A growing body of research shows how the gut microbiome is influenced by lifestyle factors such as stress and diet. Studies indicate that women who experience chronic stress are more likely to have an imbalanced gut microbiome, leading to disrupted hormone metabolism and may cause more severe perimenopausal symptoms.
How to Support a Healthy Estrobolome: The Best Foods and Lifestyle Choices for Hormonal Health
Healthy, happy hormones require the foundations:
Nutritional Recommendations for a Healthy Estrobolome
Fiber-Rich Foods: fiber-rich foods like leafy greens, beans, flax seeds and whole grains help feed beneficial bacteria and promote regular digestion, which is essential for proper estrogen metabolism.
Fermented Foods: incorporating foods like sauerkraut, kefir, kimchi, and miso into your diet provides your gut with the probiotics needed to support a healthy microbiome.
Lifestyle Choices That Support a Healthy Estrobolome
Prioritize Quality Sleep: Sleep is crucial for hormonal balance and gut health. Aim for 7-8 hours of restful sleep each night to support the estrobolome and the body's natural detoxification processes. Good sleep helps regulate cortisol, reducing the stress on your gut and hormones.
Practice Stress Reduction: stress negatively impacts gut bacteria and disrupts the estrobolome’s ability to metabolize estrogen. Incorporating stress-reduction techniques like yoga, meditation, and mindfulness practices can help reduce cortisol levels and maintain hormonal balance.
Engage in Regular Exercise: moderate exercise such as walking, swimming, or strength training supports a healthy gut microbiome and estrogen metabolism, helping to maintain hormone balance during unpredictable perimenopausal times.
Reduce Alcohol Consumption: alcohol can damage the gut lining and disrupt the balance of gut bacteria. It also affects hormone balance by altering hormone processing in the liver and allowing estrogen to stick around longer, worsening estrogen dominance. Limiting alcohol intake, especially in perimenopause, helps maintain proper estrogen metabolism and overall hormonal health.
Probiotics and Prebiotics for Gut Health and Hormonal Balance
Probiotics: Taking a high-quality probiotic supplement can help restore healthy gut bacteria, particularly if you’ve experienced gut dysbiosis. This should be done under the guidance of a functional medicine expert, as overconsuming probiotic supplements can worsen dysbiosis.
Prebiotics: Foods like garlic, onions, bananas, and asparagus provide prebiotic fibers that nourish the beneficial bacteria in your gut, which may support the estrobolome and hormone regulation.
How Probiotics and Prebiotics Work Together
When consumed together, probiotics and prebiotics work to create an optimal environment for gut bacteria to thrive. This supports the estrobolome in efficiently metabolizing estrogen and maintaining hormonal balance during perimenopause.
How Can I Find Out if My Estrobolome is Messing Up My Hormones in Perimenopause?
A good medical review will begin with a thorough medical assessment including your personal medical history, medications, current symptoms, as well as your lifestyle. Your doctor should ask about stress, sleep, exercise, diet, and alcohol intake to determine which lifestyle factors may be affecting your hormones.
In my gut health program, we undergo functional medicine testing that includes a thorough digestive health assessment. It looks at key factors including:
Your microbiome status: do you have hidden dysbiosis going on?
Beta-glucuronidase levels: do you have excessive amounts of the enzyme that promotes estrogen reprocessing? (This is best assessed alongside a urinary panel for estrogen levels to see if your body is shunting excess estrogen down a different elimination pathway)
Gut inflammation: gut inflammation means systemic inflammation, and hormones can’t come back into balance inside an inflamed body
Digestive function: is your digestive system doing a good job of breaking down food?
When I work one on one with women, we may decide to assess digestive function alongside hormone levels and other tests to discover the root cause of her problem and hopefully, for maybe the first time ever, to shed massive light on why she’s been feeling the way she has.
Insider Secrets to Optimal Health
Probiotics and Prebiotics for Gut Health
Probiotic-Rich Foods: Incorporate foods like yogurt, kefir, sauerkraut, and kimchi into your daily meals to supply your gut with beneficial bacteria that support hormonal balance.
Prebiotic Foods: Add prebiotic-rich foods like garlic, onions, bananas, and asparagus to nourish your gut bacteria and promote a healthy microbiome. Prebiotics fuel the beneficial bacteria that make up your microbiome, which benefits the estrobolome.
Eat Whole Foods
Whole, Unprocessed Foods: whole, nutrient-dense foods like leafy greens, lean proteins, and fiber-rich grains found in the Mediterranean diet support gut health and overall hormonal balance. Whole foods provide essential nutrients for optimal digestion and hormone regulation, as well as inflammation-calming antioxidants.
Avoid Highly Processed Foods
Limit Processed and Sugary Foods: highly processed foods and added sugars can disrupt your gut bacteria, cause massive inflammation and lead to hormonal imbalances. Reducing your intake of these foods helps keep your estrobolome functioning properly.
Stay Hydrated
Drink Plenty of Water: proper hydration is essential for digestion and detoxification, both of which are essential for maintaining hormonal balance. Plus, research indicates that drinking enough water may also have important implications for microbiome health. Aim for half your body weight in pounds, in ounces of water, to support healthy digestion and gut function.
Exercise Regularly
Physical Activity: Regular exercise—whether it's walking, swimming, or strength training—supports gut motility, reduces inflammation, and promotes hormonal balance. Aim for at least 30 minutes of moderate exercise most days of the week, although many women find that they benefit from personalized exercise recommendations.
Prioritize Quality Sleep
Get Enough Sleep: quality sleep is vital for regulating hormones and supporting gut health. Ensure you’re getting 7-8 hours of restful sleep each night to allow your body to heal and maintain balance. If you are hitting this number and still feel exhausted when the alarm goes off, you may need more sleep, or this may mean it’s time for a deeper dive into your health through functional lab testing.
Stress Reduction through Meditation
Practice Meditation and Mindfulness: stress negatively impacts gut health and hormone balance. Incorporating daily meditation or mindfulness practices can help reduce stress hormones like cortisol, which affect other hormone levels. Personally, I use the guided meditations of Dr. Joe Dispenza to stay on top of my meditation practice (I used to always say, “I can’t meditate!” until I found his work. Now I do it daily. Well, almost daily. Really).
Work with a Functional Medicine Health Expert
Personalized Health Strategy: If you continue to experience symptoms despite making lifestyle changes, consider working with a functional medicine expert, who can provide a comprehensive lab assessment to evaluate hormonal imbalances and gut health in greater depth, offering you a personalized strategy for healing and long-term wellness.
Reduce or Pause Alcohol Consumption
I love a glass of wine at the end of a long day, just like many of my patients. But if alcohol is disrupting your hormone health, it’s time to consider cutting back or taking a break, in honor of feeling better.
Going Deeper: The Benefits of Functional Medicine Lab Testing and Working with an Expert: What It Looks Like
Advanced Healing Solutions
For those experiencing persistent symptoms, functional medicine lab testing can uncover hidden gut or hormonal imbalances, especially when they have your full medical history and symptoms in mind.
A comprehensive level of testing that includes gut health, hormones, toxins, nutrients, cardiometabolic health ensures that no stone is left unturned in understanding what’s really going on below the surface of your health.
Working with a Professional
If you’re at your wit’s end with how you feel, working with a functional medicine expert can provide eye-opening answers and completely personalize your healing journey. Through testing, tailored lifestyle changes, and targeted supplements, you can address imbalances that are specific to your body.
Life-Changing Potential
By addressing your gut health and hormones with a professional, you can experience profound improvements in your energy, mood, and overall health during perimenopause. The right approach can help you regain control over your body, allowing you to thrive in both your personal and professional life.
Final Thoughts
Supporting your gut health, particularly the estrobolome, is key to navigating the hormonal shifts of perimenopause with greater ease and balance. By focusing on diet, reducing stress, and seeking personalized medical care when necessary, you can take control of your health and feel empowered through this stage of life.
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