​Perimenopause and Gut Health: Your Guide to Digestive Relief

If you’ve noticed changes in your digestion during perimenopause such as bloating, constipation, or that uncomfortable heavy feeling after meals, you are not alone.
​
Research shows that more than 90% of women experience digestive changes during this stage, with bloating (77%), constipation (54%), and acid reflux (49%) among the most common. Many find these symptoms begin or intensify as they transition through menopause.

But why does this happen? And more importantly, what can you do about it?

Let’s explore how your gut and hormones are connected, and how improving your digestive health can help ease symptoms like fatigue, brain fog, and inflammation during perimenopause.

The Gut–Hormone Connection: How Your Digestion Affects Estrogen Balance

Your gut does far more than digest food, it actually helps regulate your hormones, especially estrogen.

When your liver processes estrogen, it “packages” it so your body can safely remove it through bile and stool. But certain gut bacteria can “unwrap” those packages, sending estrogen back into circulation.

​This recycling process is controlled by a group of gut bacteria known as the estrobolome.  When it’s in balance, your body maintains healthy estrogen levels. When it’s not, you may experience hormone-related issues like weight gain, mood swings, and bloating.

Q. What is the estrobolome?

A. The estrobolome is the collection of gut bacteria that regulate how estrogen is recycled and eliminated from the body.

Contact Us For the free 10 minute chat

Why Gut Diversity Matters

​A healthy, balanced microbiome supports hormone metabolism. But stress, antibiotics, or a low-fibre diet can reduce gut diversity, and that can throw your estrogen balance off.

Studies show that postmenopausal women have less bacterial diversity than premenopausal women, meaning their bodies process estrogen less efficiently.

The Stress–Gut–Hormone Triangle

Perimenopause already affects mood and sleep, but when you add stress, things can snowball quickly.

Your gut and brain are connected through what’s called the gut-brain-adrenal axis; feedback loop that links stress hormones like cortisol to gut function.

​When you’re under chronic stress, your digestion slows, your microbiome shifts, and your hormone balance becomes harder to maintain.
This is one reason why digestive issues often flare during stressful periods and why supporting your gut can also support your emotional wellbeing.

Q. Does stress make perimenopause gut symptoms worse?

A. Yes. Chronic stress alters gut bacteria and hormone balance, worsening bloating, constipation, and mood changes.

Inflammation, Leaky Gut, and Menopausal Health

​As estrogen declines, your body loses one of its natural anti-inflammatory defences. This can trigger widespread low-grade inflammation, especially in the gut.

Lower estrogen levels can increase intestinal permeability, allowing bacteria and toxins to pass into the bloodstream.​ This sets off inflammation throughout your body, contributing to joint pain, fatigue, and brain fog.

​Your gut bacteria normally produce compounds called short-chain fatty acids (SCFAs) that protect this barrier. But these beneficial bacteria often decrease during perimenopause, leaving the gut lining more vulnerable.

Our Peri/Menopause Clinic

Q. What is leaky gut in menopause?

A. “Leaky gut” happens when the intestinal barrier weakens, allowing inflammatory substances to enter the bloodstream — something that becomes more common as estrogen drops.

Why the Liver Matters So Much

Your liver and gut work as a team to manage hormones. The liver breaks down used estrogen and sends it to the intestines via bile for removal.

If bile flow slows down (which can happen when estrogen levels fall), toxins and hormones linger longer in your body. Constipation makes this worse, because when waste sits in the bowel too long, estrogen can be reabsorbed.

​That’s why regular bowel movements are more than just comfort, they’re essential for hormonal balance.

Q. Why is it important to poop daily during menopause?

A. Daily bowel movements help your body remove used estrogen. Constipation lets estrogen recirculate, worsening symptoms like bloating and mood swings.

Supporting Liver Detox Naturally

Your liver thrives when you feed it the right nutrients:

• Cruciferous vegetables like broccoli, kale, and Brussels sprouts support estrogen detoxification
• B vitamins and magnesium help enzyme activity
• Bitter greens (like dandelion and rocket) improve bile flow
• Hydration keeps bile thin and moving

​
Even gentle exercise and deep breathing can support liver circulation and hormone clearance.

Rebalancing Your Gut Through Food and Lifestyle

You can make a big difference to your gut and hormone health through everyday choices.

1. Feed the Good Bacteria
Aim for 30 grams of fibre a day from a wide variety of plant foods. Fibre feeds beneficial gut bacteria and helps eliminate excess estrogen.  A simple goal is to eat 30 different plant foods each week — fruits, vegetables, legumes, grains, nuts, and seeds.
Great sources include:

• Berries
• Lentils and chickpeas
• Oats, quinoa, and barley
• Garlic, onion, leeks, and asparagus (natural prebiotics)

2. Add Fermented and Probiotic Foods
Fermented foods give your gut new beneficial bacteria every day. Yogurt, kefir, sauerkraut, and kimchi can all help.
​
3. Support Liver and Bile Flow
​Add bitter greens like rocket, dandelion, and radicchio. Beets and turmeric also help the liver detoxify and improve bile flow.

4. Manage Stress and Sleep
Your gut won’t heal properly if you’re constantly stressed or sleep-deprived.  Simple practices like walking, yoga, meditation, or breathing exercises can make a noticeable difference.  Also try keeping a consistent bedtime, your hormones and gut bacteria thrive on routine.

The Naturopathic Approach: Working With Your Body’s Wisdom

A naturopath considers how digestion, hormone balance, liver function, and stress can influence each other, rather than focusing on each symptom in isolation. This whole-body perspective helps identify factors contributing to bloating, fatigue, or mood changes.​

Functional Testing for Clarity

Modern testing can identify where imbalances begin:

• DUTCH testing shows your estrogen and progesterone levels and how your body processes them 
• Microbiome mapping reveals gut diversity and digestive health markers

With these results, your naturopath can create a plan that matches your unique body chemistry.

Herbal and Nutrient Support

Common naturopathic tools include:

• Adaptogens (like ashwagandha) to reduce stress
• Phytoestrogenic herbs and foods (like flaxseed) for hormone balance
• Nutrients to support the gut wall - these are best in combinations of nutrients
• Liver support herbs (like milk thistle) for detoxification
• Targeted probiotics to rebuild the estrobolome

Q. Can a naturopath help with perimenopause bloating?

A. Yes. Naturopaths address the gut-hormone connection using diet, lifestyle, and herbal support to restore healthy digestion and hormone balance.

When to Check In with Your GP

Most digestive changes around perimenopause are linked to hormonal shifts and are well managed through diet and lifestyle support. However, if bloating or discomfort feels new, persistent, or different from your usual patterns, especially if it’s accompanied by spotting, pelvic pressure, or a constant feeling of fullness, then it’s worth checking in with your GP. Getting symptoms reviewed early helps rule out other causes and gives you confidence that your naturopathic plan is supporting you in the right way.

Conclusion: Heal the Gut, Balance the Hormones

Perimenopause isn’t just a hormonal shift , it’s a whole-body reset that also effects your gut.

Your digestion, mood, inflammation, and energy all depend on how well your gut microbiome and liver work together.

By supporting these systems naturally, through fibre-rich foods, fermented foods, good hydration, regular movement, and stress management, you help your body process hormones more effectively.

And working with a qualified naturopath can make this journey smoother. They can tailor advice to your unique microbiome, helping you feel balanced, energised, and comfortable again.
​
Because when your gut is happy, your hormones often follow.

Key Takeaways

Your gut bacteria regulate estrogen recycling through the estrobolome.

• Declining estrogen increases inflammation and “leaky gut.”
• Daily bowel movements help clear estrogen and reduce symptoms.
• Fibre and fermented foods restore healthy gut bacteria.
• Supporting the liver improves hormone detox and balance.
• If new or unusual digestive symptoms appear, get them checked by your GP before supporting gut and hormone balance with a naturopath.
  

Contact Us

​Vanessa Winter
​Naturopath & Medical Herbalist
BHSc (Deans Award for Academic Excellence), BED, Adv.Dip.Nat., Adv.Dip.Herb.Med., NMHNZ
​Registered with Naturopaths and Medical Herbalists of NZ (NMHNZ)

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC9379122/
https://jneuroinflammation.biomedcentral.com/articles/10.1186/s12974-020-01998-9
https://pmc.ncbi.nlm.nih.gov/articles/PMC7098720/
https://www.biocodexmicrobiotainstitute.com/en/pro/press-review-1-menopausal-microbiota
https://www.news-medical.net/news/20250806/Gut-microbiota-and-short-chain-fatty-acids-influence-bone-health-in-postmenopausal-osteoporosis.aspx
https://www.healthline.com/nutrition/probiotics-for-menopause
https://www.healthcert.com/blog/gut-health-perimenopause
https://www.health.harvard.edu/womens-health/beyond-hot-flashes