Can Probiotics Support Women Through Menopause?

Women go through hormonal changes during menopause that can have a significant effect on the gut microbiome. Emerging research shows that the gut plays a crucial role in modulating hormone balance, inflammation, and overall health during this life stage. Read on to learn about how menopause impacts the gut microbiome and to discover the best probiotics for menopause that can support women’s well-being through this transition.

Menopause and the gut microbiome: an emerging connection

Oestrogen is a key hormone for maintaining gut integrity and microbial diversity. It helps to regulate the structure of the intestinal barrier by promoting the expression of tight junction proteins and supporting a healthy balance of beneficial bacteria in the gut¹. During menopause, there is a sharp decline in oestrogen production by the ovaries. This has been linked to decreased gut microbial diversity and impaired intestinal barrier function, which may increase the risk of imbalanced gut microbiota (dysbiosis) and related health issues¹.

The estrobolome: a bidirectional relationship

The gut-oestrogen relationship isn’t linear, it’s bidirectional¹. Within the gut microbiota are several enzymes that regulate oestrogen metabolism. These enzymes form a group known as the estrobolome, and their main roles include:

• Reactivation of oestrogens – The gut microbiota secretes β-glucuronidase enzymes that convert inactive oestrogens back to their active forms, allowing them to be reabsorbed into the bloodstream.
• Regulation of systemic oestrogen levels – A healthy estrobolome supports optimal oestrogen bioavailability, while an imbalanced estrobolome reduces circulating oestrogen and contributes to oestrogen-related disorders.

By regulating the body’s internal ‘recycling’ process in these ways, the estrobolome influences circulating oestrogen levels. Although research is ongoing to better understand this interaction, oestrogen is thought to perform a number of beneficial functions for the gut, including maintenance of the gut barrier and supporting microbial diversity¹.

Common gut-related symptoms during menopause

During menopause, many women experience gut-related symptoms, including bloating, constipation, food sensitivities, and changes in digestion¹. These menopause gut symptoms are often experienced alongside mood changes, sleep disturbances, and increased inflammation, which can all be influenced by shifts in gut health. Due to the hormonal changes in this stage of life, some women are also at increased risk of developing chronic conditions like osteoporosis, cardiovascular disease, and insulin resistance².

Gut health as a therapeutic target

The gut microbiota plays a key role in immune regulation, helping to reduce low-grade inflammation that is often seen during menopause. An imbalance in the gut microbiome can impair oestrogen recycling, potentially intensifying hormone-related symptoms and risks of chronic conditions^1,2. Emerging research highlights gut health as a promising therapeutic target for modulating systemic inflammation and oestrogen metabolism. Supporting the gut through diet, lifestyle choices, and probiotics may offer an effective and natural approach to supporting women's health during menopausal transition.

Probiotics for menopause: what the research says

Probiotics are live organisms that have the potential to support gut health and symptoms of menopause. Clinical studies have explored the role of probiotics in managing menopause-related symptoms, focusing on hormone modulation, vaginal health, bone density, metabolic health, and mood.

Hormone modulation

Probiotics, including strains of Lactobacillus and Bifidobacterium, may influence oestrogen metabolism and support the gut estrobolome. One trial found that a combination of isoflavones and lactic acid-producing probiotics improved oestrogen metabolism in postmenopausal women^3,4. Another clinical trial found that a probiotic formula containing Levilactobacillus brevis KABP052 increased serum oestrogen levels in peri- and postmenopausal women when compared to the placebo group⁵.

Vaginal health

Many postmenopausal women experience a decline in the beneficial vaginal Lactobacillus species, which increases the risk of developing vaginal infections. A clinical study reported that a combination of oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 improved vaginal flora in postmenopausal women compared to those treated with placebo⁶. In another study, they found that vaginal L. rhamnosus GR-1 and L. reuteri RC-14 increased the abundance of Lactobacillus, decreased Atopobium (anaerobic bacteria associated with bacterial vaginitis), and had immune-modulatory effects when compared to placebo⁷.

Bone density and osteoporosis

Multiple clinical trials of postmenopausal women have found that probiotic supplementation may have benefits for bone mineral density⁸. One clinical study found Bacillus subtilis C-3102 improved bone mineral density compared to placebo⁹, while a different study found that Lactobacillus reuteri 6475 reduced bone loss in older women¹⁰. Another trial found that Lactobacillus acidophilus UALa-01 did not improve bone mineral density but did help stabilise bone turnover compared with placebo¹¹.

Mood and quality of life

A clinical trial of postmenopausal women found that probiotics improved depression, anxiety, stress, and physical, psychological, and urogenital symptoms compared to the placebo group¹².

Plant-based strategies for gut health during menopause

Gut health can also be supported by plant-based nutrition through a diet rich in prebiotic and probiotic foods. This can help maintain microbial balance, reduce inflammation, and support hormone regulation, which are especially important when oestrogen levels decline.

Prebiotic-rich foods

Foods rich in prebiotics include garlic, onions, leeks, asparagus, oats, and legumes. The fibres within these foods are fermented in the colon and produce short-chain fatty acids like butyrate, which help support intestinal barrier function and modulate systemic inflammation.

Probiotic-rich foods

Foods rich in probiotics include probiotic yoghurts, kefir, fermented soy, sauerkraut, and kimchi. These foods contain live beneficial microbes which support gut health and microbial diversity. In one clinical study, postmenopausal women who received probiotic yoghurt saw improvements in anxiety, stress, and quality of life compared to those who received yoghurt without probiotics¹³.

Clinical applications for healthcare professionals

As healthcare professionals, you can integrate gut health discussions into menopause plans by assessing diet, digestive symptoms, and lifestyle factors. It’s essential to recommend evidence-based probiotic strains that may help support menopause gut symptoms, hormone balance, vaginal health, bone density, and mood. Monitoring symptoms and conducting regular check-ins is crucial for evaluating the effectiveness of these natural interventions and assessing their ongoing benefits. Referral to a specialist, including a gastroenterologist or menopause clinic, may be necessary for persistent gastrointestinal symptoms, complex hormonal issues, or a lack of response to interventions.

When you understand the connection between menopause, gut health, and probiotics, you start to realise the potential for opportunities for personalised care. Supporting gut health with targeted probiotics and nutrition can be a powerful, evidence-based strategy to help women navigate menopause with fewer symptoms and a better quality of life.

References

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