Gut health

Gut health here means how your digestion feels and works day to day: bloating, wind, how regular you are, how food sits with you.

No menopause guideline has a section on gut health. What follows is what women report, what one recent review has found, and what the guidance says about food and about bloating. Bloating has its own page, with more on what the guidance lists.

What women describe in perimenopause includes:

• A swollen, tight stomach, often worse as the day goes on.
• More wind, or more discomfort after meals.
• Bowels that have become less regular, either way.
• Foods that never caused trouble before suddenly doing so.

The Pakistan Menopause Society's recommendations list bloating among the symptoms of early perimenopause (Table 1). Beyond bloating, these are reports rather than recognised menopause symptoms, and each can have other causes.

Nobody can say for certain yet. One line of research looks at the bacteria living in the gut, known together as the gut microbiome.

A 2026 review in the journal Nutrients, led by Michelle Lim, pulls this work together. It reports that the menopause is associated with lower diversity in gut bacteria. It describes the estrobolome, a set of gut bacterial genes that, according to the review, help regulate how estrogen is processed and how much of it circulates in the body.

The same review is careful about how far this goes. It says that while the gut microbiome has been linked with perimenopause and its symptoms, studies showing cause and effect remain "few and nascent". Some of the work it draws on was done in animals. It also notes that the bacteria affected seem to differ between populations, with diet, lifestyle and ethnicity all playing a part.

In other words: an interesting idea, not yet a basis for treatment.

There is no menopause guidance on gut health as such. There is guidance on food.

The Pakistan Menopause Society's recommendations, in their section on healthy eating, encourage whole grains and dals, naming moong dal, channa, saag, methi and makkai ki roti. They name sweetened drinks and colas as feeding weight around the middle and metabolic risk (Table 5). Women's Health Concern says refined starches such as white rice and white bread can be part of a healthy diet and need not be avoided, though more wholegrain is the aim. See nutrition and gut-friendly foods.

The Nutrients review reports that diets higher in fibre were associated with a lower burden of menopause symptoms in the studies it looked at. That is an association, not proof that fibre treats symptoms.

On probiotics, the review discusses early studies of particular strains and says large clinical trials are still needed to confirm whether they work and whether they are safe. Roshara does not recommend any probiotic or gut supplement.

The NHS website says the most common reason for bloating is a lot of gas in the gut, and that constipation, food intolerance, coeliac disease and irritable bowel syndrome can also cause it, so it is worth ruling those out rather than putting everything down to hormones.

It says to see a GP if you feel bloated regularly, if you have changed your diet and still feel bloated, or if bloating comes with weight loss you cannot explain or blood in your poo.

It says to ask for an urgent appointment, or call 111 in England, if bloating comes with vomiting, diarrhoea or constipation, with stomach ache, with acid reflux, with a high temperature or feeling hot, cold or shivery, or with a swelling or lump in your tummy, or if you cannot pee, poo or pass wind. It says to call 999 or go to A&E if your stomach is swollen and the pain is severe and came on very suddenly, if you are vomiting blood or your vomit looks like ground coffee, or if you have severe difficulty breathing.

Ramadan changes how and when the gut is fed: a long fast, then iftar's pakoras and sweet sharbat, then a short night before sehri. Women often notice their digestion most in this month. Questions about fasting and health conditions belong with a qualified scholar, and questions about medicines with whoever prescribes them.

At home, a woman is often the one cooking for everyone and eating last. If certain foods disagree with you now, it is fair to say so and cook for yourself too.