Many people ask me “what’s the best diet for perimenopause” and really it’s about including foods that nourish your body and support crucial processes that, for example, clear out your used oestrogen, which is what this blog (and part 1 of this blog) is all about.

Oestrogen clearance is also referred to as oestrogen detoxification (detox for short). There are 3 phases of oestrogen detox, the first two phases occur primarily in the liver and the third phase occurs in your gut.

When it comes to detoxification, phase three is actually number one!

This blog is about the third phase, refer back to part 1 of this blog to learn about the first two phases.
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For help during perimenopause and reduction of symptoms such as heavy periods, clotting, mood swings, breast pain, headaches, weight gain, fibroids, cysts and even breast cancer risk reduction, you MUST be clearing out used oestrogen all.the.time, every.single.day.

Let’s look at your body’s phase 3 of oestrogen clearance.

Although the gut is the third phase, it’s actually the FIRST place to start!

Why?⁠

⁠Because if someone has an unhealthy gut microbiome and or they’re not pooping daily, they are NOT detoxing their used oestrogen!⁠

After oestrogen circulates around your body – doing all the “jobs” it needs to do, from keeping your hair shiny, your mood good and your menstrual cycles healthy, to keeping your bones strong and supporting your metabolic health – it ends up in the liver, where it gets broken down into oestrogen “metabolites” (break-down products) and packaged-up for elimination (detox phases 1 and 2) and delivered to its final destination for just that – your intestines (detox phase 3).

The efficiency of Phase 3, relies on a healthy gut ‘microbiome’ and daily, healthy bowel movements. 

If you are constipated and / or your gut bacteria is out of balance, in favour of unfriendly bacteria strains, you risk reabsorbing the broken down oestrogen from phases 1 and 2 BACK into your body and into circulation, causing excess oestrogen levels in the body and all of the issues that go with that such as those already mentioned above and in part 1 of this blog.

You can actually think of your gut as phase 2.5 and then phase 3, because bowel movements are phase 3 (the permanent removal of used oestrogen from the body) but your gut microbiome plays a key role before that, hence phase 2.5.

PHASE 2.5

The relationship between the collection of bacteria in your gut and oestrogen regulation has been named the estrobolome. Think of the estrobolome as an entire collection of microbes (microbiome), within your overall gut microbiome, dedicated to the job of regulating your oestrogen levels. This special collection of bacteria influences how you metabolise and regulate oestrogen.

For example, certain strains of bacteria can produce more of an enzyme called beta-glucuronidase. Elevated levels of beta-glucuronidase, can increase reabsorption of oestrogen into your body because this enzyme pulls used oestrogen apart from the molecule it was previously attached to in the phase 2 for it to be removed from the body. Pulling apart this attachment means the oestrogen molecule is free to move back into your bloodstream and into circulation.

PHASE 3

This is where your used oestrogen is permanently removed from your body by way of a bowel movement. These need to be occurring at least once a day and your stool wants to be fully formed, smooth and easy to pass, like a sausage or snake.

If you aren’t doing this at least once daily, then your used (processed) oestrogen may be reabsorbed back into your body and into circulation.

Allowing used oestrogen to go back into your body increased your total load of oestrogen and creates oestrogen excess symptoms and situations such as heavy periods, clotting, mood swings, breast pain, headaches, weight gain, fibroids, cysts and even an increased risk of breast cancer.

So, ensuring you have regular, healthy bowel movements AND a healthy estrobolome (population of gut bacteria) are BOTH KEY for the health of your hormones and management of perimenopause symptoms.

Causes of elevated beta-glucuronidase enzyme

Low levels of beneficial/friendly bacteria in the gut is a big reason for high beta-glucuronidase activity. Low levels of friendly, protective strains of gut bacteria results in higher levels of pathogenic/unfriendly strains of bacteria plus an overgrowth of pathogenic yeasts in some people (dysbiosis). Certain pathogenic bacteria and yeasts, when overgrown, have the ability to increase levels of the beta-glucuronidase enzyme in the gut.

A comprehensive stool test such as GI Effects by Genova Diagnostics can provide you with a comprehensive assessment of your gut health, including telling you if you have elevated levels of beta-glucuronidase and assessing your gut microbial balance.

Causes of constipation (bowel movement less than once a day)

If you experience constipation, whether chronically or intermittently, then working on your gut health and digestion should be your first priority when it comes to oestrogen clearance.

Reasons for constipation include:

• Low intake of fibre in your daily meals
• Stress
• Gut bacterial imbalance (Dysbiosis)
• Lack of water / dehydrated colon
• An underactive thyroid
• Small Intestinal Bacterial Overgrowth (SIBO)
• Under-eating generally
• Certains medications

A healthy microbiome houses a very wide variety of organisms (bacteria), in the right amounts and located in the right places. It should be like the Amazon rainforest – lush and rich in different species that work TOGETHER to create a healthy, energetic and vibrant ecosystem. The opposite of this is called dysbiosis – a problem that arises when gut microbes come out of balance.

Dysbiosis can show up in a couple of ways but most commonly it’s a combination of both:

1) Bacterial Overgrowth
Bacterial overgrowth is when certain bacterial species that shouldn’t be present in high levels start to take a hold and dominate the environment. When this happens, levels of friendly/protective bacteria start to decline whilst pathogenic bacteria continue to thrive. Unfriendly bacterial overgrowth can cause bloating, gas, pain, constipation and loose stools – mostly due to fermentation of your food by the pathogenic bacteria. Not to mention the potential elevation of the beta-glucuronidase enzyme as discussed above.

2) Low Microbial Diversity
Lack of microbial diversity is also a common problem. This means not having a good variety of strains and types of microbes living in your gut (microbiome). Our health is closely linked to the diversity of microbes in our gut, including oestrogen regulation.

HERE ARE SOME STEPS YOU CAN TAKE TO RESTORE OR IMPROVE YOUR GUT HEALTH, DIGESTION AND BOWEL MOVEMENTS:

Eat all the colours
Eating a variety (diversity) of colours and types of plants including vegetables, herbs, spices, lentils, beans and particularly berries when it comes to fruit, can help to increase your microbial diversity! This is the best kind of fibre for friendly/protective bacteria to feed on and thus continue to grow and thrive.

Include ‘prebiotic’ fibres + resistant starches
Prebiotic fibre is what your friendly gut bacteria (probiotics) eat, again allowing them to grow and thrive. Prebiotic foods include onions, garlic, leeks, asparagus and Jerusalem artichoke. ‘Resistant starches’ are also a form of prebiotic fibre. There are four types and some may work better for you than others. These include:

• Resistant starch found in the coating of seeds, nuts, grains and legumes like lentils and beans.
• Fermentable fibres in green bananas and raw potatoes (or raw potato powder e.g., added to smoothies or yoghurt etc.)
• Resistant starch that is made when some of the naturally occurring starches in white potatoes and rice are cooked and then allowed to cool.
• Resistant starch powders such as inulin.

Include probiotic-containing foods
These are foods that contain live bacteria. Try to have 1 cup per day of any of:

• Raw, unpasteurised sauerkraut
• Kimchi
• Kefir (preferably made using water or coconut water rather than cow’s milk)
• Live natural yoghurt
• Unflavoured kombucha

Have 1-2 tablespoons of ground flaxseed daily
Flaxseeds (or linseeds) are a good source of both soluble and insoluble fibre which can help to encourage healthier, regular bowel movements. Additionally, flax contains lignans, which are a class of phyto (plant) oestrogens meaning they may ‘act’ like oestrogen in the body, binding very weakly to cell receptors and positively modulate oestrogen levels in the body.

Chew every mouthful REALLY well!
Once your mouthful goes down the hatch there are no teeth in your gut to continue chewing on it so make sure you chew well enough BEFORE you swallow. Your digestive system takes over from you once your food goes down and the more liquified it is the better your digestive system can do its work. Undigested food particles increase the growth of pathogenic bacteria because they feed off the fermentation of food in your gut, which is far more likely if you’re not chewing properly.

Keep your colon hydrated
This is so important for regular bowel movements as it’s difficult for your colon to effectively pass stool through if it’s not hydrated. Stay hydrated with plenty of clean water & herbal teas throughout the day. Check for very pale urine (like the colour of straw or hay) in order to know if you are properly hydrated, if it’s very dark yellow (e.g., first thing in the morning) or even just too yellow if you are dehydrated.

If you start with even just one of these steps you should notice benefits pretty quickly. Perhaps you already practise some of these steps and just need to add in some more to further improve things. I’ve had clients that come to me with digestive issues such as bloating, gas and alternating between constipation and loose stools and once they go away and start chewing their food properly, they cannot believe how much their symptoms reduce if not disappear completely!

Need More Help?
If you’ve read this and you feel you would like support in applying it to your personal situation/case or simply want help implementing changes, I am here for you. You can find out more about working with me here.