Have you noticed more bloating, constipation, food sensitivities, fatigue, joint pain, or mood changes since moving into your 40s?
You’re not imagining it, it’s common for gut health to shift significantly during perimenopause for many women, and understanding why can help you feel more empowered and supported through this phase of life.
In this blog post, we’ll explore how perimenopause impacts the gut and what you can do to start feeling better.
HOW PERIMENOPAUSE IMPACTS YOUR GUT
1. Changes to Your Gut Microbiome
Your gut is home to a diverse community of microbes (bacteria, fungi, viruses) called the gut microbiome. These tiny organisms are vital for digestion, immune function, hormone regulation, and even protecting the gut lining from damage.
During perimenopause, as oestrogen levels fluctuate and eventually decline, research shows that both the diversity and number of healthy bacteria in the gut can decrease. This leaves the gut more vulnerable to symptoms like:
- Bloating
- Gas
- Loose or urgent stools
- Changes in bowel movement regularity and quality
- Weakened gut lining
There’s also a specific subset of gut bacteria called the estrobolome, responsible for breaking down and clearing used oestrogens. When the estrobolome becomes less efficient (which often happens during perimenopause), it can lead to poor oestrogen clearance and symptoms of “oestrogen dominance”, such as heavy, painful periods, breast tenderness, mood swings, and even fibroids.
2. Increased Gut Permeability (“Leaky Gut”)
The term “leaky gut” refers to a weakening of the tight junctions between the cells of your gut lining. Normally, these cells form a protective barrier, allowing nutrients to pass into the bloodstream while keeping harmful substances out.
When the barrier becomes compromised, food particles, toxins, pathogenic bacteria, and other unwanted materials can “leak” into the bloodstream, triggering immune reactions and systemic inflammation.
Oestrogen and progesterone both help maintain a strong gut lining. As their levels decline, the risk of gut permeability rises. This can contribute to symptoms like:
- Fatigue
- Brain fog
- Achy joints and muscles
- Headaches
- Hormone imbalances
- Weight gain or stubborn belly fat
- Slow recovery after exercise
- Autoimmune conditions like Hashimoto’s or Rheumatoid Arthritis
Important note: Gluten sensitivity can also worsen gut permeability by increasing a protein called zonulin, which “loosens” the gut lining even more.
3. Rising Food Sensitivities and Intolerances
Declining oestrogen and progesterone also reduce immune regulation, meaning you might become more sensitive to foods you previously tolerated well.
Often, it’s not the foods themselves — it’s the underlying gut permeability.
When you repair the gut lining, many food intolerances (like to gluten, dairy, soy, etc.) can improve dramatically.
However, true allergies (like peanut anaphylaxis) or conditions like coeliac disease are different and require specific management.
4. Gut-Brain Connection and Mood Changes
Your gut is sometimes called your “second brain,” and for good reason.
Around 90% of your serotonin (your “feel-good” neurotransmitter) is produced in the gut.
When gut health declines — with dysbiosis (bacterial imbalance) or leaky gut — it becomes harder to produce enough serotonin.
This can contribute to:
- Low mood
- Anxiety
- Sleep disturbances
The gut-brain axis (connected by the vagus nerve) becomes especially important to nurture during perimenopause.
5. Constipation and Reflux
Gut motility (the movement of food through your digestive system) often slows down in perimenopause due to hormonal changes, leading to:
- Constipation
- Incomplete bowel movements
- IBS-type symptoms
In addition, lower oestrogen levels can weaken the lower oesophageal sphincter, the muscle that prevents stomach acid from flowing back into the oesophagus. This can cause reflux or heartburn — something that may feel new or suddenly worsened in your 40s.
Keep in mind: Stress also plays a major role in reflux and digestion, so it’s not always just about oestrogen.
6. Blood Sugar Imbalances and Gut Health
Fluctuating blood sugar during perimenopause doesn’t just affect energy and weight — it also impacts the gut.
High blood sugar can fuel the growth of pathogenic gut bacteria and yeast, worsening digestive symptoms like bloating, discomfort, and sluggishness.
How to Support Your Gut Health in Perimenopause
Now more than ever, it’s vital to look after your gut.
Here are my top nutrition and lifestyle tips to start supporting your digestion naturally:
Lifestyle Habits:
Chew food thoroughly and eat slowly
Avoid eating when stressed or rushing
Manage stress daily (e.g., 4:6 breathing, walks in nature, mindfulness)
Key Supplements (ideally under professional guidance):
High-quality probiotics
Digestive support (like stomach acid, digestive enzymes, bile acids if needed)
Gut-healing nutrients: L-glutamine, zinc carnosine, N-acetyl glucosamine (NAG), DGL, aloe vera, slippery elm, omega-3s
Reduce Inflammatory Foods:
- Gluten
- A1 cow’s milk
- Sugar and refined carbs
- Ultra-processed foods
- Alcohol and caffeine
Increase Gut-Supportive Foods:
- Chicken liver and other organ meats (for retinol, which is pre-formed vitamin A)
- Bone broth (rich in gut-healing amino acids)
- High-quality proteins (grass-fed meats, wild oily fish, organic eggs)
- Colourful vegetables and berries (antioxidants and fibre)
- Good fats (extra virgin olive oil, avocado, flaxseed, nuts, seeds)
- Fermented foods (like raw sauerkraut, kimchi, kefir if tolerated)
- Prebiotic fibres (onions, garlic, leeks, asparagus, Jerusalem artichoke)
- Resistant starches (like cooled potatoes, green bananas, buckwheat)
Final Thoughts
Your gut is truly at the centre of your health — and perimenopause is a critical time to give it extra care.
By supporting your digestion now, you can ease symptoms, balance your hormones, protect your immune system, and set yourself up for thriving well into menopause and beyond.
Ready for more personalised gut support? Book a free discovery call with me to explore how we can work together.
