Perimenopause - What has the gut got to do with it?

bloating gut health menopause perimenopause womens health

Many women experience what could be described as a wild rollercoaster before reaching menopause, with symptoms like hot flushes, insomnia, weight gain, and irritability to name a few. This life stage is called perimenopause, and it’s a transitional time in a woman’s life where many changes occur. One of these changes appears to be a shift in the gut microbiome. Emerging research indicates that our gut may play an important role when it comes to symptoms and health outcomes during perimenopause and menopause – let’s take a look!

What happens during perimenopause?

During perimenopause, hormone levels fluctuate and eventually decline once menopause is reached. This fluctuation of hormone levels can lead to a range of signs and symptoms including hot flushes, insomnia, mood disorders, and gut symptoms such as bloating.

The Gut Microbiota

We are continuously learning more about just how interconnected the gut is with our overall health, and spoiler alert: the gut appears to play a central role! An imbalance of good and bad bacteria in the gut has been linked to a number of health conditions and diseases, including female reproductive diseases like endometriosis and polycystic ovarian syndrome [1]. The make-up of our gut bacteria is constantly changing throughout our lives as well, and can be influenced by our environment, stress, diet, as well as age.

How is the gut connected to perimenopause?

The gut microbiota plays a role in our metabolism, immune function, hormone secretion and even the regulation of oestrogen, as good gut microbes recycle old oestrogen back into the bloodstream [2]. This may have a flow on effect, dampening the symptoms associated with perimenopause and a drop in oestrogen. There is some research to suggest that lower oestrogen levels, among other hormonal changes, can affect the gut microbiota and lead to an imbalance of good and bad bacteria [2]. So, eating well to support a healthy gut population during this time, is arguably more important than ever! In fact, studies have shown that the gut microbes differ between premenopausal and postmenopausal women [3, 4]. Postmenopausal women appear to lose gut diversity, which can lead to a range of gut issues including food intolerances and gut symptoms like bloating.

The Mediterranean Diet

The good news is that age isn’t the only factor that can influence our gut – our diet can too! A well-researched healthy dietary pattern that has been shown to support the gut microbiota is the Mediterranean diet [5]. In fact, a study done in the UK found that a high intake of oily fish and legumes (which are key components of the Mediterranean diet) was associated with a delayed onset of menopause by nearly 3 years [6]. On the other hand, researchers found a diet high in refined nutrient-poor foods was associated with an earlier onset, roughly by a year and a half. Eating a Mediterranean style diet may help to support a healthy gut microbiota, and in return help to improve menopausal symptoms and delay the onset of menopause [7].

Key Components of the Mediterranean Diet

  • Have plenty of vegetables and herbs (5+ serves daily)
  • Include plenty of fresh fruit (2 serves daily)
  • Incorporate legumes or beans (3+ times per week)
  • Choose whole grains over refined grains
  • Snack on nuts and seeds most days
  • Include oily fish and seafood (2-3 times per week)
  • Choose red meat less often (about once per week)
  • Include chicken and eggs in moderation
  • Use extra virgin olive oil as your main source of added fat (2-3 tablespoons daily)
  • Include fermented dairy like yoghurt and cheese (daily)
  • If you drink alcohol, include wine in moderation with meals (~100ml)

Other components of a gut-healthy diet include aiming for 30 different types of plants a week and including prebiotic foods which selectively feed the good bacteria in your gut. Some examples of prebiotic foods include under-ripe bananas, extra virgin olive oil, legumes, asparagus, Jerusalem artichoke and leeks.

Practical Tips

  • Look over the key principles of the Mediterranean diet and consider what principles fit in with your individual needs such as your preferences, culture, lifestyle, and budget.
  • Find Mediterranean recipes online that you can try (we have several available!)
  • Start with implementing small changes such as choosing Mediterranean-style snacks (like a handful of unsalted nuts), swapping to extra virgin olive oil, or adding an extra veg to your dinner plate.
  • It can help to make small changes to give our taste buds time to adapt! If you’re new to using whole grains, you can mix them with one that is more familiar. For example, trying mixing brown rice with white rice.
  • Try doing Meatless Mondays so that you can experiment cooking with legumes or beans.
  • Shop online before going grocery shopping so that you know what foods are in season, and plan to include more variety.

The Bottom Line

Our gut bacteria naturally change with age, and we can experience a loss of gut bug diversity during perimenopause. Maintaining a gut-healthy diet, such as the Mediterranean Diet, can help to improve gut microbiota diversity, reduce menopause symptoms, and delay the onset of menopause. If you’re going through perimenopause, our gut health dietitians can help you navigate this life stage and help you with any gut symptoms you may be experiencing!


[1] Han Q, Wang J, Li W, Chen ZJ, Du Y. Androgen-induced gut dysbiosis disrupts glucolipid metabolism and endocrinal functions in polycystic ovary syndrome. Microbiome. 2021;9(1):101.

[2] Liu Y, Zhou Y, Mao T, Huang Y, Liang J, Zhu M, et al. The relationship between menopausal syndrome and gut microbes. BMC Womens Health 2022.

[3] Zhao H, Chen J, Li X, Sun Q, Qin P, Wang Q. Compositional and functional features of the female premenopausal and postmenopausal gut microbiota. FEBS Lett. 2019;593(18):2655–64.

[4] Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. Int J Womens Health 2022.

[5] Beam, A., Clinger, E., & Hao, L. (2021). Effect of Diet and Dietary Components on the Composition of the Gut Microbiota. Nutrients13(8), 2795.

[6] Dunneram, Y., Greenwood, D. C., Burley, V. J., & Cade, J. E. (2018). Dietary intake and age at natural menopause: results from the UK Women's Cohort Study. Journal of epidemiology and community health72(8), 733–740.

[7] Park S, Kim DS, Kang ES, Kim D Bin, Kang S. Low-dose brain estrogen prevents menopausal syndrome while maintaining the diversity of the gut microbiomes in estrogen-deficient rats. Am J Physiol - Endocrinol Metab 2018.

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