Gut health and the menopause: what the estrobolome does
What the estrobolome is, how the beta-glucuronidase enzyme affects oestrogen balance, and how gut health relates to menopausal symptoms. A general information page.
Hot flushes, weight gain and hormonal swings in the menopause are usually put down to falling oestrogen from the ovaries alone. In the functional medicine view, though, a community of bacteria in the gut microbiota called the estrobolome is an important mechanism determining how much oestrogen leaves the body and how much re-enters the circulation. What follows sets out what the estrobolome is, how an imbalance in the gut relates to hormonal balance, and the general approaches to supporting gut health.
What is the estrobolome?
The estrobolome is the whole collection of bacteria and microbial genes in the gut microbiota that can metabolise the body's oestrogens. Oestrogens produced by the ovaries, fat tissue and other organs travel through the bloodstream, are then processed — detoxified — in the liver and sent via the bile into the intestinal tract. There the estrobolome works as a kind of decision mechanism: whether those oestrogens are passed out in the stool, or become active again and rejoin the circulation.
Beta-glucuronidase and the reabsorption of oestrogen
During detoxification in the liver, surplus oestrogens are bound to glucuronic acid so that they can be excreted — a process called glucuronidation. Some bacterial species in the gut, however, release an enzyme called beta-glucuronidase. This enzyme can strip the glucuronic acid from the bound (inactivated) oestrogen arriving in the gut, making the oestrogen active again. The freed oestrogen is then reabsorbed through the gut wall back into the circulation, and the body's total oestrogen load can rise.
How does gut imbalance (dysbiosis) affect hormones?
An imbalance in the gut flora — dysbiosis — disturbs the diversity of bacteria in the estrobolome and can affect oestrogen balance in several ways:
- Oestrogen dominance: where diet, inactivity and similar factors increase the bacteria that release beta-glucuronidase, oestrogen is continuously reabsorbed from the gut, which can lead to oestrogen levels that are high relative to progesterone.
- Systemic inflammation: if the integrity of the gut wall is disturbed, bacterial components can leak into the circulation, which may trigger low-grade chronic inflammation throughout the body. Inflammation can in turn stimulate aromatase activity in fat tissue and affect hormonal balance further.
- The link with the vaginal microbiota: the fall in oestrogen with the menopause can also affect the amount of lactobacilli in the vaginal microbiota, and this is associated with genitourinary menopausal symptoms such as vaginal dryness.
The link with menopausal symptoms
The make-up of the gut microbiota is shaped less by the menopause itself than by a person's general eating habits and way of living. Research has observed that changes in diet affect the composition of the gut flora, and that these changes are associated with a reduction in the severity of hot flushes. These findings suggest that gut health may be one of the things worth taking into account when managing menopausal symptoms.
General approaches to supporting gut health
In the functional medicine approach, gut health is given priority as a way of supporting hormonal balance. The headings generally considered are these:
- A high-fibre diet: dietary fibre can bind free oestrogen in the gut and help it to be passed out in the stool.
- Prebiotic foods: Jerusalem artichoke, onion, garlic, leek, asparagus, banana and pulses can support the diversity of beneficial bacteria in the gut.
- Brassicas and flaxseed: cruciferous vegetables such as broccoli and Brussels sprouts, along with flaxseed, contain compounds that support the liver's oestrogen metabolism pathways.
- Probiotic foods and regular exercise: foods containing probiotics, such as yoghurt and kefir, together with regular physical activity, can have a favourable effect on the balance of the gut microbiota.
These approaches are general information. Individual nutrition and support programmes should be determined after assessment by a doctor.
Frequently asked questions
How is a disturbance of the estrobolome identified? The influence of the gut microbiota on hormonal balance is a complex field, and "a disturbed estrobolome" cannot be diagnosed from a single symptom. If you have complaints that may point to a hormonal imbalance, it is appropriate to see your doctor for a detailed assessment.
Why does gut health matter in the menopause? Because the gut microbiota plays a part in how oestrogen is metabolised and excreted, imbalances in gut health are considered one of the factors that can affect the hormonal swings of the menopause.
Does supporting gut health remove all menopausal symptoms? No. Gut health is only one of many factors affecting menopausal symptoms. Managing the menopause is an individual process and requires medical follow-up.
This page is for information. It does not replace an examination or individual medical advice.