If you’re in your late 30s or 40s, you’ll be aware that perimenopause is on the horizon. Alongside common symptoms such as brain fog, fatigue, mood changes and more, you may also notice that things have gone awry in your gut.

There are so many causes of digestive discomfort – travelling, stress and poor sleep among them – that it’s tricky to diagnose the cause, but with research showing a sex hormone-gut microbiome axis, if you’re in midlife and noticing changes to your gut symptoms, this could be a result of perimenopause.

So, we take a look at what perimenopause means for your gut health and how we can limit the impact of fluctuating hormones on our digestive systems. 

In a word, yes.

“As women transition into perimenopause, a range of gastrointestinal (GI) symptoms can develop or worsen due to fluctuating hormone levels,” says Dr Deepali Misra-Sharp, an NHS GP. “These symptoms can be distressing and often go hand-in-hand with other changes, such as hot flushes and mood swings.”

So, why is this?

According to Anna Mapson, a nutritional therapist and founder of Goodness Me Nutrition, this is down to the cell receptors for our sex hormones being housed in our gut. “There are cell receptors for our sex hormones in the gut, so fluctuations in oestrogen, progesterone and testosterone will affect processes like digestion, as well as mood, skin and energy,” she tells Strong Women.

And even if you’re not perimenopausal, you might still be susceptible to the hormone-gut relationship. “We know that almost twice as many women experience irritable bowel symptoms as men, possibly down to the effect of female sex hormones,” continues Mapson. “Unfortunately, women with IBS are twice as likely to experience premenstrual anxiety and painful periods as those who don’t have irritable bowel syndrome. This seems to be because microbes in your digestive tract can interact with female sex hormones, potentially increasing pre-menstrual symptoms.”

Oestrogen and gut bacteria play a key role

As is so often the case in peri- and menopausal symptoms, oestrogen is largely responsible for symptoms and, put simply, oestrogen and gut bacteria have a complicated relationship.

“Some gut microbes living in your large intestine produce an enzyme called beta-glucuronidase, which can reduce the amount of oestrogen that passes out of your body in your poo, meaning that oestrogen molecules are reabsorbed into the body,” explains Mapson. “If you have excess oestrogen, you might find you get more PMS symptoms, such as sore breasts, premenstrual acne, cramps, mood changes and sleeplessness.”

In any hormonal cycle, we can be prone to constipation before our periods and the opposite during our bleed. Throw perimenopause into the mix, and it’s quite common to feel like your symptoms are all over the place.

1. Bloating and gas

“Hormonal fluctuations, especially declines in oestrogen and progesterone, can slow down digestion, leading to increased gas and bloating,” notes Dr Misra-Sharp. “Many women find they become more sensitive to certain foods during this time.”     

2. Constipation

It’s well known that progesterone has a relaxing effect on the muscles, including those in the gut, which can slow down bowel movements and lead to constipation. This symptom can become more pronounced during the luteal phase of the menstrual cycle when progesterone is naturally higher, and it may persist into perimenopause.

3. Abdominal pain and cramping

“Many women report increased abdominal discomfort and cramping during perimenopause, which can mimic symptoms of irritable bowel syndrome (IBS),” says Dr Misra-Sharp. “These symptoms often correlate with the menstrual cycle or can occur more erratically during perimenopause.”

4. Indigestion and acid reflux

“Oestrogen helps regulate the production of stomach acid and the movement of food through the digestive tract,” Dr Misra-Sharp continues. “Lower levels of oestrogen during perimenopause can lead to acid reflux or indigestion.”

While all this can make for a cocktail of discomfort at certain times of the month and throughout the perimenopausal period, it’s not all bad news. There are steps we can take to limit the effect of fluctuating hormones on our gut health and function.

“Perimenopausal gut issues are common but manageable,” agrees Dr Misra-Sharp. “With a combination of dietary changes, physical activity, stress management and sometimes medical interventions, many women can find relief from these symptoms and improve their overall quality of life during this transition.”

While many perimenopausal gut symptoms can be managed with lifestyle changes, it’s important to seek medical advice if symptoms become severe or persistent.

“Significant changes in bowel habits, unexplained weight loss or severe pain should be evaluated by your GP to rule out other underlying conditions, such as irritable bowel syndrome (IBS), gastrointestinal disorders or malignancy,” advises Dr Misra-Sharp. 

Images: Getty