The Impact Of Menopause on The Gut

by | Nov 6, 2025 | Menopause, perimenopause, Physical health

A common issue that I hear from clients is bloating and changes in the gut, such as food sensitivities and not going to the toilet as regularly.

Although I know that declining hormones affect our digestive tract, I didn’t realise just how common issues of bloating and reflux were until i heard from women around me.

Common gastrointestinal symptoms

Digestive problems in menopause can significantly impact your quality of life, and gastrointestinal menopause symptoms include:

  • Constipation
  • Diarrhoea
  • Nausea
  • Vomiting
  • Bloating
  • Cramps
  • Wind or trapped wind
  • Heartburn
  • Indigestion
  • Acid reflux
  • Mild or severe IBS
  • Faecal incontinence

How the menopause can cause stomach issues

During menopause, fluctuations of the hormones oestrogen and progesterone that occur during menopause can influence:

  • Your perception of pain: During menopause, hormonal changes can make individuals more sensitive to pain, potentially amplifying the discomfort of gastrointestinal issues like bloating and cramps.
  • The movement of food through the gut: Menopause can slow down digestion, causing issues like constipation and bloating as food moves more slowly through the gut and more water is reabsorbed into the bloodstream.
  • Intestinal permeability: Fluctuating hormone may increase intestinal permeability (leaky gut), allowing toxins or bacteria to pass through the intestinal lining, potentially leading to inflammation and digestive discomfort.
  • Immune and inflammatory processes: Menopause can trigger changes in the immune system, increasing inflammatory responses in the gut, which may exacerbate symptoms like bloating, gas, and abdominal pain.

Why it happens: the gut microbiome and hormones

The estrobolome is a specialised collection of bacteria within the gut microbiome that directly interacts with oestrogen. These microbes produce enzymes, particularly beta-glucuronidases, which influence the reabsorption of oestrogen in the intestines. This interaction affects the amount of active estrogen circulating in the body, playing a crucial role in maintaining hormonal balance.

In simple terms, this means our gut microbe diversity can really impact the balance of oestrogens circulating in the body. When our gut microbiome is healthy, we’re likely to be producing optimal levels of beta-glucuronidase.

  • Irritable bowel syndrome (IBS)
  • Inflammatory bowel disease (IBD)
  • Gastroesophageal Reflux Disease (GERD)
  • Crohn’s disease
  • Coeliac disease

Research has found that for some women, going through menopause can exacerbate existing symptoms. For example, one study found that postmenopausal women had more severe IBS symptoms than premenopausal women while another found that 38% of postmenopausal women reported altered bowel function.

However, as some symptoms of menopause and digestive disorders are the same, it can be difficult to determine whether it is menopause or the condition itself that is responsible for any changes.

Things that can help with digestive problems in menopause

Exercise

Regular physical activity improves gut motility, helping to relieve constipation and bloating, common during menopause. Exercise also reduces stress, which can calm the digestive system by lowering cortisol levels, supporting overall gut health and reducing discomfort.

Diet changes

Adopting a nutrient-rich diet can not only help alleviate digestive discomfort, but it can also contribute to overall wellness and better management of other physical menopause symptoms. It can be beneficial to:

  • Learn your trigger foods
  • Increase your fibre
  • Reduce alcohol consumption
  • Limit caffeine and fizzy drinks
  • Include prebiotics and probiotics
  • Eat smaller, more frequent meals
  • Eat more slowly

Sleep

Quality sleep is essential for maintaining a healthy gut. Poor sleep disrupts the gut-brain connection, which can lead to slower digestion, increased inflammation, and heightened sensitivity to stomach pain. A regular sleep schedule supports better hormonal balance and gut function.

Stress reduction

Managing emotional stress is key during menopause, as the gut is sensitive to stress signals, which can exacerbate bloating, cramps, and other GI symptoms. Techniques such as mindfulness or deep breathing can help lower cortisol levels, reducing stress-related digestive issues.

Medication

Menopause Hormone Therapy (MHT) can help regulate symptoms by balancing hormone levels, thus improving gut motility. However, digestive issues can also be a side effect of treatment and research indicates there is a slightly higher risk of developing gastroparesis after taking MHT/HRT.

There is also a range of over-the-counter and prescribed medications that can help manage digestive symptoms including:

  • Antacids
  • Probiotics
  • Laxatives
  • Loperamide
  • Antispasmodics

If you want to learn more about this topic from a specialist, you can have a listen to this fascinating podcast with award-winning gut health scientist and registered dietitian, Dr Megan Rossi (PhD, RD) AKA The Gut Health Doctor. It’s about 40 mins long.