Menopause is a major hormonal transition, and while most people associate it with hot flashes and mood changes, the digestive system is often affected as well. Many women notice new or worsening symptoms around this time—bloating, constipation, indigestion, or unpredictable bowel habits.
These changes are real, common, and medically understood. As gastroenterologists, we now recognise that menopause and gut health are strongly interconnected through the microbiome, digestion, and hormonal balance.
How Hormone Changes Influence Digestion
1. Declining oestrogen alters the gut microbiome
Oestrogen plays a role in maintaining the diversity and stability of the gut bacteria.
During perimenopause and menopause:
- Microbial diversity may decrease
- “Beneficial” bacteria populations may drop
- Inflammation-associated bacteria may increase
These shifts can contribute to bloating, irregularity, and increased gut sensitivity.
2. Changes in gut motility
Lower oestrogen and progesterone levels can slow the movement of food through the intestines, leading to:
- Constipation
- Gas and bloating
- Heavier or uncomfortable digestion after meals
For others, the opposite may occur—episodes of loose stools or urgency during hormonal fluctuations.
3. Increased gut sensitivity
The gut–brain axis becomes more reactive during hormonal transitions.
This may heighten the perception of normal gas or motility, amplifying:
- Pain
- Cramping
- Bloating
- IBS-like symptoms
4. Impact on metabolism and abdominal weight
Changes in the microbiome and slower motility can contribute to metabolic shifts, increasing abdominal fat storage and insulin resistance, even without major dietary changes.
Common Digestive Symptoms During Menopause
Women may experience:
- Bloating or abdominal distension
- Constipation or irregular bowel habits
- Increased gas
- Reflux or indigestion
- Sensitivity to certain foods
- IBS symptoms worsening or newly developing
- Changes in appetite
The Microbiome–Oestrogen Connection
There is a group of gut bacteria involved in metabolising oestrogen.
When the microbiome changes during menopause, this group of bacteria can shift as well, affecting:
- Circulating oestrogen levels
- Vaginal and bladder health
- Weight regulation
- Inflammation
This is one reason why gut health is increasingly recognised as an important part of menopause care.
When IBS and Menopause Overlap
Many women with IBS report fluctuations in symptoms around perimenopause.
The reasons include:
- Hormonal instability
- Changes in serotonin activity in the gut
- Increased stress sensitivity
- Altered motility
Women who have never had IBS may also develop IBS-like symptoms during this time.
A gastroenterological assessment can help distinguish functional symptoms from other conditions that become more common with age, such as bile acid diarrhoea, coeliac disease, diverticular disease, or microscopic colitis.
Supporting Gut Health During Menopause
Evidence-based strategies include:
1. Dietary fibre
Aim for 25–30 g/day from vegetables, fruits, legumes, whole grains, flaxseed, and chia seeds. Fibre supports motility, feeds beneficial bacteria, and reduces bloating over time.
2. Fermented foods
Daily intake of yogurt, kefir, sauerkraut, kimchi, or miso may enhance microbial diversity.
3. Hydration
Essential for bowel regularity and optimal digestion.
4. Regular physical activity
Movement improves gut motility and reduces bloating.
5. Stress management
Meditation, yoga, and paced breathing can calm the gut–brain axis and reduce symptom flares.
6. Targeted therapies
Depending on symptoms, a gastroenterologist may recommend:
- Probiotics
- Antispasmodics
- Pro-motility medications
- Low-FODMAP diet (short-term, dietitian-guided)
- Management of reflux or constipation
- Evaluation for overlapping conditions
7. Discussing HRT
Hormone replacement therapy may indirectly support gut health by stabilising hormone fluctuations. Your doctor can advise whether it is suitable.
When to Seek Gastroenterology Review
You should see a gastroenterologist if:
- Symptoms significantly affect your daily life
- Bowel habits have changed suddenly or unexpectedly
- You have persistent bloating, abdominal pain, or reflux
- Symptoms are not responding to dietary changes
- You notice red-flag signs such as weight loss, bleeding, or night-time symptoms
Final Thoughts
Menopause is a natural life stage, but the digestive changes that accompany it can be disruptive.
Understanding the connection between hormones and gut function empowers women to take control of their digestive health, improve comfort, and maintain quality of life.
If you’re experiencing new or worsening gut symptoms around menopause, a gastroenterology assessment can help identify the underlying cause and guide effective treatment.
We offer a personalised assessment can help identify the cause of your symptoms and provide a management plan tailored to menopause-related digestive changes.