Harnessing Gut Health for Hormonal Balance During Perimenopause


During perimenopause, fluctuating levels of oestrogen, progesterone, and other hormones can lead to a myriad of symptoms such as hot flushes, mood swings, weight gain, and disrupted sleep. Taking care of your gut health can play a vital role in managing these symptoms and achieving hormonal balance during perimenopause. In this article, we will explore the intricate connection between gut health and hormonal balance.

1. The gut-hormone connection

The gut and the endocrine system, responsible for hormone production, are closely interconnected [1]. The gut microbiota, a vast community of microorganisms residing in our digestive tract, has a profound influence on hormone regulation. Research has revealed that the gut microbiota plays a critical role in metabolising oestrogen, modulating the stress response through cortisol regulation, and producing neurotransmitters that impact mood and sleep patterns [2] [3].

2. Oestrogen metabolism and gut health

Oestrogen dominance is a common hormonal imbalance during perimenopause as we experience a roller-coaster of highs and lows, with oestrogen levels peaking at up to 30% those experienced prior to perimenopause. Imbalances in oestrogen metabolism, particularly an excessive production of an estrogen metabolite called 16α-hydroxyestrone (16α-OHE1), can contribute to symptoms like breast tenderness, heavy periods, and increased risk of breast cancer. A healthy gut microbiota promotes the production of beneficial bacterial enzymes that help convert 16α-OHE1 into a less potent and safer form, 2-hydroxyestrone (2-OHE1). Studies have shown that an imbalanced gut microbiota can lead to increased levels of 16α-OHE1, while a diverse and balanced gut microbiota can enhance the conversion to 2-OHE1, promoting hormonal balance [1] [4].

3. The gut-brain-hormone axis

The gut communicates with the brain through the gut-brain axis, a bidirectional communication system. This axis involves various pathways, including the vagus nerve and the production of neurotransmitters in the gut. Serotonin, a neurotransmitter known as the “happy hormone,” is primarily produced in the gut. It not only regulates mood but also influences sleep, appetite, and pain perception. Studies have suggested that disruptions in gut health can impact serotonin production, leading to mood swings, depression, and sleep disturbances often experienced during perimenopause [3] [5].

If mental health in perimenopause is of particular interest to you, take a look at my instant access masterclass “Getting back to YOU: Supporting your mental health in perimenopause”

4. Gut health and cortisol regulation

Chronic stress is a prevalent issue during perimenopause, and it can have a profound impact on hormonal balance. The gut microbiota is involved in the regulation of the hypothalamic-pituitary-adrenal (HPA) axis, which controls the body’s stress response and cortisol production. Imbalances in the gut microbiota can lead to dysregulation of the HPA axis, resulting in elevated cortisol levels and increased stress. Chronic high cortisol levels can disrupt the balance of other hormones, exacerbating perimenopausal symptoms [6].

5. Supporting gut health for hormonal balance

To optimize gut health and promote hormonal balance during perimenopause, certain strategies can be adopted:

  • Consume a wide range of different coloured plant foods which are rich in fibre and promote the growth of beneficial gut bacteria.
  • Incorporate fermented foods like yogurt, kefir, sauerkraut and kimchi, which contain probiotics that support a health gut microbiota
  • Avoiding or reducing your intake of processed foods
  • Reduce stress, which can alter the make-up of the gut microbiome.

Learn more & get support putting it in to practice

Join my online programme ‘Nutrition foundations for perimenopause’ starting 21st September 2023. This small online group programme includes 6 live sessions on a Thursday evening at 7.30pm.

“Beth is fantastic: so knowledgeable, and I thought the information shared on the programme was pitched at exactly the right level. I’ve taken such a lot from it and Beth’s advice on making changes to your diet is very realistic, so any changes have a better chance of sticking.” K.T. Recent attendee


  1. Fu, Q., et al. (2021). Gut microbiota association with estrogen metabolism in postmenopausal women: A cross-sectional study. PeerJ, 9, e10710.
  2. Vich Vila, A., et al. (2018). Gut microbiota composition and functional changes in inflammatory bowel disease and irritable bowel syndrome. Scientific Reports, 8(1), 1-13.
  3. Foster, J. A., & Neufeld, K. A. M. (2013). Gut-brain axis: How the microbiome influences anxiety and depression. Trends in Neurosciences, 36(5), 305-312.
  4. Plottel, C. S., & Blaser, M. J. (2011). Microbiome and malignancy. Cell Host & Microbe, 10(4), 324-335.
  5. Bailey, M. T., et al. (2011). Stressor exposure disrupts commensal microbial populations in the intestines and leads to increased colonization by Citrobacter rodentium. Infection and Immunity, 79(4), 1509-1519.
  6. Kelly, J. R., et al. (2015). Breaking down the barriers: The gut microbiome, intestinal permeability and stress-related psychiatric disorders. Frontiers in Cellular Neuroscience, 9, 392.

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