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Dear Readers, This blog article delves into advanced concepts related to microbiota. For a comprehensive understanding, we recommend starting with our previous blog on the Microbiome Magic: Unraveling the Secrets of Your Inner Ecosystem as an initial step, providing a foundation for the more intricate details discussed here.
Navigating Menopause: The Gut Microbiome's Impact and Hormonal Harmony Menopause is a transformative stage in a woman's life, signalling the end of her reproductive years. While the biological shifts during menopause are well-documented, emerging research is shedding light on another influential player in this journey: the gut microbiome. The unique characteristics of a woman's microbiome during menopause can affect her experience, and understanding this connection opens the door to potential interventions and support. In this article, we'll explore the fascinating relationship between the gut microbiome and menopause, highlighting the role of hormones and specific bacterial changes in women’s well-being during this chapter of life.
Age & Microbiome
Let’s talk about the microbiome’s evolution as we age.
Until the age of 3, the microbiota rapidly gains in diversity and is highly sensitive to destructive treatments for microorganisms, such as antibiotics.
During our childhood, teenage and young adult phases, our gut microbial composition continues to gain in variety and eventually stabilises. Moreover, adolescence is a stage of continuously increasing sexual dimorphism in the microbiota that is prolonged in adulthood. Women, for example, tend to host richer microbiotas that have lower proportions of the Prevotella species.
Then, as we age, it progressively loses in diversity; the microbiota of women resembles more to that of men due to the decrease in oestrogen and progesterone hormones. Concretely, at 40 the diversity begins to plateau, old age people have increasingly unique microbiomes. Furthermore, extremely long-lived individuals have specific common characteristics, different in comparison to the ones of young adults. Despite the lack of studies concerning microbiome modifications during the menopause phase, it has been found that, in contrast to the early adulthood phase, women generally have a lower microbial diversity as they age, in comparison to men, partly due to lower oestrogen and progesterone levels [1].
The Role of Oestrogen and Progesterone
Oestrogen and progesterone, two key hormones that decline during menopause, play a crucial role in maintaining gut health. Furthermore, during menopause, the predominant oestrogen shifts from estradiol, known to protect mucus-producing epithelial cells, more abundant pre-menopause, to estrone, being more common post-menopause [3].
Oestrogen protects mucus-producing cells and promotes gut barrier integrity, defending against oxidative stress.
Progesterone is known to reduce blood polysaccharide levels, contributing to a balanced gut environment.
Both oestrogen and progesterone are crucial in countering the microbial challenges of menopause. They prevent infections and microbial translocation (when bacteria enter the blood circulation through the intestinal barrier) by fortifying the gut barrier, averting inflammation and related gut issues [4].
Restorative Abilities of Gut Bacteria
Remarkably, the gut microbiome can help augment hormones in the blood by deconjugating them, allowing their reactivation in the bloodstream for hormone recycling. The estrobolome, consisting of specific bacteria such as Firmicutes and Bacteroidetes, is responsible for deconjugating estrogens in the gut. Progesterone and androgens also undergo recycling and reactivation within the gut microbiome.
This bidirectional relationship highlights the interplay between hormones and the microbiome. There is more to learn here but it appears the microbiome is an essential element to consider to boost the hormone production in the body and may help in reducing the symptoms of menopause.
Isoflavones: Nature's Oestrogen
Don't underestimate the power of plant foods. Isoflavones, found in soy, can be converted by gut bacteria into oestrogen-like compounds, as they are able to bind to oestrogen receptors. These compounds can bind to oestrogen receptors and help alleviate menopausal symptoms, providing a natural alternative to declining hormone levels. While soy has received the most attention for its estrogenic effects, it wouldn't be a surprise if we learn more about other plants with similar effects in the future!
Implications for Health and Future Research
Some bacterial changes associated with menopause, including the increased presence of Fusicatenibacter, Lachnoclostridium, and Megamonas, have been linked to osteopenia and compromised bone health [5].
Menopausal women often exhibit a distinctive gut microbiome with reduced Bacteroides dominance, indicating high uniqueness among individuals.
Menopause is associated with a higher likelihood of microbial translocation, where microbes breach the intestinal wall and enter the bloodstream. This process can trigger inflammation and potentially lead to conditions like the Irritable Bowel Syndrome (IBS).
During menopause, there is a decrease in Ruminococcus levels in the gut. Ruminococcus is a type of bacteria found in the gut microbiome that is responsible for fermenting dietary fibre and producing short-chain fatty acids (SCFAs). SCFAs have been associated with numerous health benefits, including improved immune function and metabolic regulation. Interestingly, Ruminococcus has been positively associated with total urinary estrogens. This suggests that the decrease in Ruminococcus during menopause may contribute to hormonal changes in the body.
Studies have shown that menopausal women tend to have higher levels of Dorea, Prevotella, and Sutterella bacteria in their gut microbiome. These bacteria have been linked to obesity in several research studies.
In addition, an increased Firmicutes-Bacteroidetes ratio, especially in post-menopausal women, implies increased calorie absorption and weight gain.
Post-menopause, the migration of certain skin and gut microbes to the vagina can lead to vaginal dysbiosis, potentially linked to urinary urgency, incontinence, and bladder pain.
Furthermore, Lactobacillus, typically beneficial for overall health, may become an indicator of vaginal dysbiosis during menopause. This shift can have adverse effects on urinary and vaginal health.
Then, certain bacteria may also start migrating to the vagina, such as strains from the Escherichia, Enterococcus, Staphylococcus, Corynebacterium phyla, thus inducing a disequilibrium.
Potential treatments
- Hormone Replacement Therapy (HRT): Hormone replacement therapy is a medical treatment that involves supplementing oestrogen and/or progesterone to alleviate menopausal symptoms and potentially counteract the associated gut microbiome changes. However, the decision to pursue HRT should be made in consultation with a healthcare provider, as it comes with risks and benefits.
- Lactobacillus and other probiotic Supplementation: Lactobacillus is a probiotic strain that can help maintain the balance of beneficial bacteria in the gut and the vaginal microbiome. It may be used alongside oestrogen supplementation to address genitourinary symptoms of menopause, such as GSM (genitourinary syndrome of menopause). Natural sources of probiotic, from fermented vegetables, kefir, yoghurt, for instance, can be very helpful too.
Fyi: for an optimal probiotic intake, it’s important to note that a probiotic should include the following:
List of the probiotic strains / species included.
CFU (Colony-forming unit - estimate of the number of viable bacterial cells) count for each strain.
Little to no binders and fillers like cornstarch: they might cause digestive issues.
Researchers continue to uncover new insights on the microbiome, its composition and the connection with health. The science is new and the direction and possibilities to benefit from it are growing.
In conclusion, the gut microbiome is a dynamic ecosystem that evolves with us throughout life. Its profound impact on menopausal experiences highlights the importance of nurturing a balanced gut microbiome through diet, probiotics, and lifestyle choices. As we continue to unlock the secrets of this intricate relationship, we may discover new avenues for supporting women during this transformative phase of life.