The gut microbiota in menopause: Is there a role for prebiotic and probiotic solutions?

Abstract

The gut microbiota, comprising a diverse array of microorganisms in the gastrointestinal tract, has emerged as a key player in human health. Emerging research indicates that this gut microbial composition is influenced by sex. These sex differences are not necessarily static and likely alter across the life course in response to several factors including changing hormone profile. As such, the menopause transition-a pivotal phase in female ageing in which the hormone profile changes dramatically is receiving increasing attention. Declining estrogen which occurs during menopause appears to influence the microbiota, which may in turn contribute to menopause-related conditions such as weight gain, bone health, cancer risk and cognitive health. The modulation of estrogen through the gut's 'estrobolome', a collection of bacterial genes involved in estrogen metabolism, may offer explanation for some of the interindividual differences observed during menopause (e.g. length, symptoms and disease risk). Therapeutic modulation of the gut microbiota therefore represents a potential approach towards managing menopausal symptoms. Indeed, prebiotics and probiotics such as Lactobacillus have been shown to increase bacterial diversity and improve metabolic and overall health in menopausal women. However, evidence remains limited regarding the specific underlying mechanisms, highlighting an urgent need for a research focus in the area. This review summarizes the current understanding of the gut microbiota's role in menopausal health and the potential of prebiotics and probiotics as therapeutic interventions. Further research into gut microbiota modulation may enable more effective, personalised treatments for menopause-associated health challenges, and supporting women's health into older ages.

Keywords: Menopause; diet; estrogen; fibre; microbiome.

Figure 1.

Estrogens are produced by the ovaries, adrenal gland and adipose tissue, and released in the blood stream, and metabolised (in the liver) into biologically inactive conjugated forms which are released via biliary excretion into the small intestine. A specific set of gut bacteria, possessing β-glucuronidase enzymes (referred to as ‘Estrobolome’) deconjugate estrogens into biologically active free-forms. These may be reabsorbed into the blood circulation, used by peripheral tissues, and returned to the liver through enterohepatic recycling for re-conjugation. Some of the conjugated and deconjugated estrogens are excreted via urine and stool.

Figure 2.

Representation of physiological symptoms associated with menopausal transition.