Is Perimenopause affecting your gut health?

If you were my client and you told me that since you hit the perimenopause years (somewhere between the age of 35-45 is when we typically begin) that your digestive habits and symptoms have changed, I would tell you that the two things are absolutely linked. It’s not all in your head. It’s all in your hormones!

Many women experience more bloating, constipation or looser stools and indigestion when they start to experience hormonal changes due to perimenopause. It’s certainly no fun to go from having digestion that’s fine, that you don’t have to think about, to having a daily battle with symptoms.

Here’s what could be happening in your gut during perimenopause::

• Declining estrogen levels increases systemic inflammation in the body, including in your gastrointestinal tract. This can leave you vulnerable to developing leaky gut syndrome- where the lining of your GIT becomes inflamed and the once tight junctions of the membrane lining becomes damaged and loose allowing bacteria and toxins that should be moved through to waste (through your stool) to flow through your bloodstream, thus creating more inflammation.
• When your gut lining is inflamed, the balance of your microbiome- your “good" and “bad” bacteria can become chaotic and the opportunistic species or “bad bacteria” can start to run the show, creating a range of unpleasant and chronic symptoms. The changes to the abundance of good bacteria can influence cholesterol levels and our metabolic health. This means lower bacteria diversity can be a contributor to weight gain and cardiovascular disease risk.
• A strain of bacterial enzymes found in the GIT called Estrobolomes start to diminish during perimenopause. They have the important job of helping to bind free estrogen so that it can be carried out of the body. Diminished numbers means that estrogen can more readily be re-absorbed into the blood stream which can contribute to estrogen dominance. We don’t want this as it can lead to symptoms like heavier periods, PMS, acne, and a multitude of other hormonal related problems.

So what can we do to help this rollercoaster of digestive issues that have started to appear with perimenopause?

Here’s what I would do if you were my patient:

• Stool testing, specifically a complete microbiome map. This will tell us exactly what is going on in there, including what species of bacteria are lacking, and which ones are getting out of control so we can start to feed them, or weed them out, whichever needs to happen. (Sometimes both.) Stool testing can also tell us things like how well you are currently breaking down your food and therefore absorbing nutrients, as well as how well your liver is doing it’s job of detoxifying and what inflammation is present in the lining of your gut. All really useful information to have when tailoring your treatment plan.
  
• If warranted, I might also suggest a breath test to check for SIBO (small intestinal bacterial overgrowth) and SIFO (small bacterial fungal overgrowth). SIBO is one of the most common presentations I see in women who come to me with gut related issues. It can be tricky to treat, especially alone. I would always recommend seeking professional help if you have SIBO.
  
• Advise what supplements can be useful in your particular case of digestive issues. Generally speaking, there will be a need to incorporate pre-biotic fibre to help assist with the growth of good bacteria as well as nutrients to target inflammation and help repair the lining of the gut wall if it is damaged.
  
• Talk to you about specific foods to include in your diet to sooth repair the gastrointestinal tract, help rebuild good bacteria levels and reduce bloating. Sometimes there might also be a need to remove certain food types for a short period of time whilst we do the healing work, before reintroducing them back in. This could include high FODMAP foods, however this is never a long term solution. The low- FODMAP diet is often treated by doctors as a cure all for gut related problems, but it can be more damaging to our gut to stay on this type of diet long term, as we are essentially starving the gut of different types of fibre it actually needs to thrive.
  
• Talk to you about your stress. A practitioner once told me when I was at the beginning of my learning journey around gut health, that we can do all the treatment with supplements and diet we like to help improve digestive issues, but if the client is stressed (work, kids, money, home life as well as stress in the body due to underlying viruses or illnesses) we can only go so far before treatment stalls. Stress plays a direct role in the health of our gut microbiome because of the gut-brain connection through the vagus nerve. If we are chronically stressed out and doing nothing to bring our nervous system back into balance, we will never fully eradicate inflammation and therefore never fully get on top of bacteria imbalances.  

Let's get a little more specific about food choices when working on repairing our gut.

• Anti- inflammatory foods. Think cooking with turmeric, ginger, garlic (if tolerated) lots of green leafy veggies as well as carrots, pumpkin and zucchini. There’s plenty of other veggies considered anti-inflammatory you can google this easily.
  
• Slow cooked meats and bone broths contain glutamine, an important amino acid that plays a huge role in reducing inflammation and repairing the lining of the gut.
  
• Pre- biotic rich foods- such as onion garlic, asparagus, lentils and chickpeas are all rich in fibres that help to feed the gut microbiome. You just need to be cautious of what choices you make if you have been diagnosed with SIBO or IBS. This is another reason guidance from a professional can be really helpful.
• Pro-biotic rich foods- foods that contain live bacteria strain to help your gut rebalance the bacterial environment, and can also help to reduce bloating, diarrhoea and assist with immune system function. 

So if you are in the throes of Perimenopause and you are starting to notice some shifts in your digestion and you’re wondering if the two things are linked, I can safely say that they most likely are. 

You don’t have to “put up” with your symptoms. Peri-menopause related or not, there is a root cause to your problems. Once we unlock the root cause we can start a journey of treatment to help you feel great again.

Reach out to me by booking in to a free 10 minute chat with me so we can figure out the right treatment plan for you.