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The Gut and The Menopause

Finally we are starting to understand and appreciate that the menopause is more than just getting through the hot flushes! In fact, for many, it can be an awful time. The drop in hormones including Estrogen, Progesterone and Testosterone can have a profound effect on you both mentally and physically.

Women will say to me ‘I just don’t feel like me anymore’. Anxiety levels increase, the ability to be motivated and decisive often disappears, energy levels can crash and the body can feel heavy and stiff. In addition, your mood may seem more labile and your sleep hits a new low. Weight gain and a loss of libido slowly inch their way in and before you know it you really aren’t you anymore! Rest assured that these symptoms are incredibly common, and they can start years before you are menopausal.

The definition of menopause is 1 year without bleeding. However, from the age of 30 our hormone levels decline, albeit incrementally. That means that some women will feel the effects associated with menopause earlier than others and knowing this is important. Often individuals will go months or years not feeling quite right before they seek help. Hopefully, as our knowledge and understanding of peri-menopause and menopause increases, this will not have to be the case.

There is a misconception around the use of hormone replacement therapy (HRT), that it can only be used once your period has fully stopped or only for a certain number of years after the menopause. This is not the case and really an individual can be supported with bio-identical hormone therapy whilst they are still cycling, at any age, to help restore balance and thus wellbeing. Working with a practitioner to balance your hormones in the years before menopause and beyond it can prevent the burden of the mental and physical changes that many suffer with or experience. You do not have to hit rock bottom before we can help treat you and restore you back to vitality.

A particular point I wanted to highlight today, that is often overlooked when speaking about menopause, is the importance of and the influence of the gut microbiome on the effects that the menopause can have on a woman. Zoe’s PREDICT study, the world’s largest in-depth nutritional study of its kind, found that of the 1,002 participants of the trial, those who had gone through the menopause had, on average, higher blood sugar levels, higher blood pressure levels, were at increased risk of developing cardiovascular disease in the next 10 years, had more belly fat and worse sleep.

The good news however was that women with a more ‘favourable’ gut microbiome had much better health outcomes than those with a more ‘unfavourable’ array of microbe species. Good bacteria in your gut appears to positively affect how you respond to and digest your food, reducing blood sugar spikes and in turn inflammation. Actively working to optomise gut health can therefore help mitigate the negative effects on health caused by the menopause.

In controlling blood sugar, we help to control inflammation. Moreover, improving gut health, improves the integrity of the gut wall which overall helps to reduce Inflammation systemically. This is vital, as it is inflammation that is emerging as the number 1 root cause of chronic disease and can increase our chances of developing diseases such as:-

Type 2 Diabetes

Cardiovascular Disease


Heart Attacks


The menopause appears to reduce our gut microbial diversity due to the impact of declining estrogen levels. Therefore, it is important to actively test your microbiome, particularly as you enter into perimenopause and menopause so that you can adapt your diet to the changing environment of your gut and help support it. Women often say to me ‘I eat and exercise in the same way I always have but I am putting on weight’ and this is because of this changing microbial environment as well as the drop in reproductive hormones. It affects how we metabolise fats and other lipids, leads to a decrease in muscle mass which reduces our metabolic rate and in-turn can explain that stubborn accumulation of body fat around the tummy.

You may be wondering if starting Hormone replacement therapy can mitigate ALL of the negatives above? And the answer is in part yes. It can definitely play an important role to help slow this process and help you feel more yourself throughout despite the changes to your physiology.

Nevertheless, I encourage all women considering HRT to ensure they address the complete picture of their health to learn HOW their ‘new’ body is working for them. The graph below shows us how blood sugar levels following a meal change as we age.

As you can see blood sugar levels are increasing in response to our food. As discussed, this has a negative effect on inflammation in the body which in turn causes many unwanted downstream effects.

Therefore, it is important to approach menopause holistically, to learn the new you. For our patient’s that includes wearing a continuous glucose monitor to learn and understand how foods are affecting their blood sugar and thus work to reduce these blood sugar spikes. This has positive effects on long term health by helping to support the integrity of the gut, reducing inflammation and incidence of chronic disease and improving sleep, among other factors.

Therefore, HRT can be a useful addition when faced with perimenopause and the menopause however supporting gut health, learning to control your blood sugar, and uncovering some other potentially hidden causes that are affecting your overall wellbeing are vital counterparts to successfully navigating this time of change!

A typical Menopause consultation with a functional practitioner would include:

1. 1-1 hour long consultation to gain an in-depth understanding of your health through a comprehensive medical history.

2. Complete functional laboratory testing based on your needs and symptoms established in your history. This often includes, Hair mineral testing, Comprehensive stool analysis of the gut microbiome, blood analysis, and the use of a 2-week continuous glucose monitor.

3. Follow-up on results and a plan on how to proceed.

The menopause can affect our work life, our home life, and our relationships. Educating yourself on how to help yourself is luckily becoming easier and easier. Our ability to speak about what we are going through is also becoming more accepted, so you no longer need to dab your brow in silence and feel isolated. Reach out to us and get help!

Until next time, live well.

Best wishes,

Dr Lizzie


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