Menopause and gut health: Bad news for women

Menopause is a transitional period for women that can have major effects on gut health. There are quite a few reasons for this. First, estrogen protects against a great deal of problems including insulin resistance, obesity, osteoporosis, cardiovascular disease, and metabolic dysfunction cause by circadian disruption.

As a woman goes through menopause, her estrogen levels gradually decline and this protection lost. But a major driver of the problems isn’t low estrogen per se. Instead, it’s a lack of resilience due to a poor lifestyle subsidized by estrogen. At least until menopause.

In many ways, adequate estrogen during the fertile period protects against bad habits. Bad habits that, in a male or postmenopausal female, cause some serious damage to health. So if one accumulates these bad habits but never corrects them, menopause will be pure hell.

The connection between menopause and gut health is driven by 3 problems, all of which decrease resilience.

  • Insulin resistance
  • Autonomic imbalance
  • Circadian Disruption

The great news is that all 3 of these things are fixable. Another great thing is that factors that correct one correct them all. The bad news is that most people will have to completely change their lifestyle. And most people are terrible at that, particularly older people.

Menopause and gut health

Drivers of the damaging effects of menopause on gut health

Insulin resistance

There is a robust, almost comical, amount of evidence on the protective effects of estrogen on insulin resistance and Type 2 diabetes. Premenopausal women have better insulin sensitivity than postmenopausal women AND men. This is pretty incredible since men have more muscle mass which is the primary tissue that disposes of glucose.

Giving male and female mice without ovaries estrogen improves their insulin sensitivity. A recent review of human studies shows that estrogen protects against insulin resistance in many ways. And giving men and women with poor estrogen synthesis estrogen corrects insulin resistance.

The reason this is important is because insulin protects against hyperglycemia-induced leaky gut. I’ve covered that a million times, if you haven’t read about it, click here. The basic jist is if you’re insulin resistant, you have to fix it. Otherwise your gut will suffer.

As we all age, insulin resistance gets worse. This data shows that menopause independently decreases insulin resistance regardless of age. So women suffer a double whammy when they go through it.

Autonomic imbalance

The autonomic nervous system is essentially the control center for all automatic processes. This includes all aspects of gut health. We have 2 arms of our autonomic nervous system:

  • Sympathetic nervous system-Also known as fight or flight. It increases in response to stress, increasing heart rate, respiration, and blood pressure. However, it suppresses digestion.
  • Parasympathetic nervous system-Also known as rest and digest. It decreases in response to stress. But activating the parasympathetic nervous system has a relaxing effect. While it decreases heart rate, blood pressure, and respiration, it promotes digestion.

A review strongly establishes that estrogen protects against autonomic imbalance. It does this by inhibiting the sympathetic nervous system and activating the parasympathetic. Another study indicates that estrogen therapy corrects autonomic imbalance in menopausal women via these same mechanisms.

Researchers believe this is why pre-menopausal women have a much lower risk of heart attack than men. Conversely, postmenopausal women have the same risk as men.

Another interesting tidbit. The vagus nerve controls the parasympathetic nervous system. Decreased activity of the vagus nerve occurs in women during hot flashes. Decreased vagus nerve activity may explain the increased risk of heart attacks in peri- and postmenopausal women.

Circadian disruption

Circadian disruption is another cause of poor gut health in menopause. As we all get older, our circadian rhythms lose their robustness. And this is a huge problem because circadian rhythms regulate the autonomic nervous system.

Additionally, insulin resistance induces circadian disruption AND autonomic imbalance. Autonomic imbalance and circadian disruption also play a role in the development of insulin resistance. So when you have one of these problems, you normally have them all.

Time cues called zeitgebers help our body tell time. Your gut can’t see the clock, so it’s up to our behavior to give it the time of day. This helps the gut determine when to increase motility, synthesize and secrete enzymes and hormones, and when to protect against leaky gut.

When our behavior gives the gut erroneous time cues, gut function suffers. Important time cues include:

  • Light exposure
  • Meal timing, frequency, and composition
  • Physical activity
  • Exposure to stress
  • Social interaction

Just as important as when you do these things is that you get adequate amounts of each and how you layer them throughout the day. There is great variation between what is best for the individual, so it requires qutie a bit of tweaking.

You won’t just start wearing blue blockers and doing time-restricted eating tomorrow and everything will magically improve. I’ve been doing a vastly more comprehensive approach for 3 years and continue to see huge improvements.

But I measure and tweak to see what suits me best. And what suits me best may be overkill or too little for you.

Habits to prevent the negative effect of menopause on gut health

As we get older, we simply lose resilience. It’s an artifact of aging that we can’t prevent. But, we can mitigate the damage by observing good habits. Ideally, this starts before you enter menopause so that you enter it more resilient.

But just because you’re starting late doesn’t mean you won’t see tremendous benefit by changing your behavior. Our modern lifestyle is simply very bad for circadian rhythms and gut health as a whole. These 10 habits can move the needle pretty substantially on gut health.

  • If you are overweight or obese, lose weight
  • Start getting Sun exposure during the day
  • Block blue light at night
  • Prioritize sleep with good sleep hygiene
  • Eat all of your food within a 12 hour window
  • Get adequate physical activity during the day(Like walking)
  • Perform strength training 3-4x/week(doesn’t need to be strenuous)
  • Decrease the amount of time you spend sitting
  • Practice stress management with meditation, yoga, or others
  • Maintain a consistent schedule of all the above


The loss of estrogen during menopause is bad for gut health. Estrogen protects against insulin resistance, autonomic imbalance, and circadian disruption. Naturally, when women experience low levels of estrogen, these problems will creep up on them.

The biggest problem is that estrogen protects against the negative effects of a bad lifestyle. And this happens for decades before it’s lost. Reversing detrimental lifestyle habits that you’ve accumulated over decades is hard to reverse.

But reversing those habits leads to a tremendous uptick in quality of life and gut health. So for those willing to put in the work, the benefits are well worth it,

2 thoughts on “Menopause and gut health: Bad news for women

  1. Shauna says:

    Estrogen is sure weird, though. I have every symptom of estrogen dominance and lousy gut health, and I feel better during those times in my monthly cycle where estrogen is said to be lower. Is it possible that this is more complex than just estrogen levels? I seem to recall that maybe there multiple types of estrogen? I wonder if that accounts for my paradoxical experience. I can’t imagine an end to monthly cycles making my gut health worse, someday. If so, I’m in deep doodoo!

    • cincodm says:

      It’s definitely more complex than that, There are multiple types of estrogen and estrogen can be derived by many tissues. In fertile women, most of it comes from the ovaries and that is generally protective. But when it is derived from other tissues, primarily fat, it lowers androgen levels.

      One of the big factors that can drive estrogen dominance is insulin resistance, which increases androgen production and is a driving factor in PCOS. In a fertile woman I would suspect this to cause problems that get better during menopause, but will lead to bigger problems down the road because insulin resistance has many negative effects on human health. It’s one of the reasons I push correcting it as a requirement for gut health.

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