Hot flashes, bloating, mood swings, and sleep disturbances making life a daily struggle? Wondering where that extra layer around the middle has come from (seemingly overnight!), and why you just walked into your bedroom but can’t remember what you went in there for?
If you are in mid-life and this resonates with you, chances are you’re experiencing the signs and symptoms of perimenopause. As our bodies transition to the natural end of our menstruating time we get held up in a period of perimenopause.
Peri is Greek for ‘around’ and menopause is the point in time where you have not had a period for 12 months. The perimenopause period on average is 4-6 years but can be as long as 10 years for some.
This transition period can be unpredictable where you feel fabulous one day, and then in the depths of hormone hell the next. The previously predictable hormone fluctuations of our reproductive years and typical menstrual cycles are starting to shift. You might notice subtle changes in the duration of your cycle (slightly shorter or longer), an increase in premenstrual symptoms such as bloating and sore breasts, and changes in blood flow.
Other perimenopause symptoms include brain fog, fatigue, night sweats, weight gain and mood shifts. Almost 90% of women seek out their healthcare provider for advice on how to cope , so if you are experiencing symptoms you are not alone!
The good news is that there are pro-active steps you can take to cushion the transition to menopause. If you want to manage perimenopause symptoms effectively and improve your quality of life, the latest research supports that your gut health may hold the key.
Let’s take a look at the role of our microbiome in menopause, and how nurturing gut health can make for a smoother perimenopause.
What is the Gut Microbiome?
The gut microbiome refers to the complex community of microorganisms that reside in our gastrointestinal tract. These microorganisms, including bacteria, viruses, and fungi, play a crucial role in our health, including digestion, immune function, cardiovascular health, and mental health.
With lots of different microbes living in the gut there are lots of ‘workers’ to do different jobs. Our microbes produce compounds that help us digest food, control inflammation, support our metabolism and hormone levels. Greater diversity in our gut microbes is a positive predictor of general health.
Ever gone on a restrictive diet and then found that you are experiencing gut symptoms even worse than before when you reintroduce particular foods? You may have just stripped out some of the ‘workers’ in your gut that were producing certain enzymes to help you break down different foods!
When diversity of our microbiome is reduced, or there are a large number of microbes on board that are not so helpful, our gut can be in a state of imbalance, or dysbiosis.
This imbalance can result from a diet low in fibre and plant-based foods, taking antibiotics, missing out on sleep, missing key micronutrients, stress or even changes across our reproductive life.
Dysbiosis is associated with health impacts and disease, and can worsen menopause symptoms.
Keep in mind that disruption in your gut microbiome does not necessarily mean you experience gut symptoms. While bloating, frequent (or too infrequent) trips to the loo, cramping or stomach pain are signs that your gut is less than happy, it is possible to not experience gut symptoms and have an imbalance in your microbiome too.
The reduction in microbiome diversity or dysbiosis may present as weight gain, brain fog, fatigue, anxiety and depression, skin rashes, menstrual pain, joint pain, hormone imbalance or irregular periods.
The Gut Microbiome in Menopause
While gut microbiome diversity promotes health, a reduction in diversity can have an impact on our health. In menopause there is an increase in dysbiosis as the diversity of our microbiome is reduced .
There is a shift in the main bacteria groupings in the gut and changes in the populations that produce an enzyme to regulate oestrogen levels. This microbiome dysbiosis is related to an increase in systemic inflammation  and could just be the key player we can support during the perimenopause transition for improved quality of life.
Ever Heard of Meno-belly?
Have you noticed weight gain around your mid-section? This is one of the most common symptoms experienced in perimenopause.
Changes in the gut microbiome increase inflammatory pathways and this reduces how sensitive we are to the hormone insulin. As we are less responsive to insulin, our blood sugar levels rise and we put on weight, or more accurately we put on fat.
Inflammation also causes us to lose muscle. Even if our weight stays the same, we may notice less favourable changes in body composition as we reduce lean mass, and gain fat mass. After menopause females present with higher fasting blood glucose levels than pre-menopausal females , and it is not uncommon for those sugar cravings to rear their head!
It's a vicious circle of extra fat increasing insulin resistance, and insulin resistance increasing deposits of fat. The extra fat we accumulate is often deposited around our internal organs, and this is known as visceral fat.
Increased visceral fat increases inflammation and the risk of metabolic disease, fatty liver, certain cancers, muscle wasting and dementia. It also has impacts on heart health with the menopause transition recognised by The American Heart Association as a time of accelerated cardiovascular disease risk.
How do I Reduce or Prevent Perimenopause Weight Gain?
Increasing gut diversity and the amount of bacteria in your gut that produce health promoting compounds can benefit insulin resistance and prevent weight gain .
One beneficial compound your microbes produce is a short chain fatty acid called butyrate. If you nurture your microbes with proven prebiotic fibres they produce butyrate that:
- reduces inflammation
- helps curb appetite
- reduces insulin resistance
- increases antioxidant defences
- supports immune function
- is cardio-protective 
Our Microbiome Essentials and Cacao Latte deliver unique prebiotic fibres that have been shown to support microbiome diversity, enhance intestinal integrity, enhance insulin sensitivity, reduce fat absorption and bioavailability, and increase hormone balancing butyrate production.
The Gut, Weight, and Hot Flushes
As our gut microbiome diversity reduces into menopause and our weight changes, this is closely related to symptoms of hot flushes and night sweats.
In over 2,000 pre-menopause or perimenopause females monitored over 10 years, an increase in hot flushes and night sweats over time was associated with increased body weight and waist circumference, indicating abdominal weight gain .
Are you interested to know what strategy has been shown to reduce the vasomotor symptom of hot flushes by 95%?
Enhancing diet quality!
In 84 women experiencing 2 or more moderate to severe hot flushes a day, changing diet to include more plant-based foods, increasing fibre intake, soybeans and wholegrains (hello prebiotics!) and reducing animal proteins dramatically reduced hot flushes in only 12 weeks .
A reduction in severe day hot flushes was associated with a decrease in the abundance of inflammatory species Porphyromonas and Prevotella corporis in the gut microbiome.
Eating to Manage Perimenopause
Focusing on a gut nurturing diet to support your microbiome will reduce perimenopause symptoms and in turn, help attenuate the unfavourable changes in body composition such as belly fat gain and muscle deterioration.
Perimenopause is an incredibly opportune time for exercise and nutritional interventions .
As visceral abdominal fat accumulates, the risk of insulin resistance increases, impacting our blood sugar levels. Post-menopausal women show higher fasting blood glucose, sugar intakes and poorer sleep compared with pre-menopausal females , but you can manage this!
Prebiotic Fibre Fuelled
Aim for 30-35g fibre daily from a wide variety of foods to support the gut microbiome for optimal function and nutrient digestion. Not all fibre is prebiotic so be sure to include unique prebiotic fibres that promote the growth of beneficial species living in the gut to support blood sugar regulation, metabolism and cardiovascular health.
The micronutrient Chromium mitigates insulin resistance and improves blood sugar control. Fertile Gut Microbiome Essentials delivers over 65% of your daily chromium needs, naturally occurring in our unique plant-based prebiotic.
While carbohydrate is necessary to feed your gut bacteria, the type of carbohydrate you choose to nourish your microbiota will make all the difference.
Wholegrains, rather than refined grains, are the key carbohydrates you want to incorporate in your diet. Brown rice, multigrain bread, rye and quinoa are all examples of wholegrains.
Restricting carbohydrate in the diet reduces beneficial species in the microbiome of post-menopausal females  so ensure you are getting adequate carbohydrate to support your activity and lifestyle .
Along with higher fibre periodised carbohydrate intake, dietary protein needs to be increased to prevent the age-related loss of muscle, known as sarcopenia. With age our rate of muscle synthesis slows, reducing protein turnover and ultimately, we lose skeletal muscle .
In females, oestrogen is known for its role in maintaining muscle mass and energy production efficiency. As oestrogen declines in perimenopause the age related drop in muscle synthesis begins, long before menopause arrives.
During the period prior to menopause muscle mass can decline by 9% ! A higher protein diet (greater than 2.0g/kg/day) from quality protein sources containing all essential amino acids has been shown to help females hold onto muscle. If you pair a higher protein intake with strength training you can ensure muscle building is maximised . This supports you metabolism and mood, and so much more!
Good sources of lean protein include poultry, fish and small amounts of red meat. Plant-based sources of protein to add to your diet include edamame, tempeh, tofu, lentils and beans. Increases in fibre degrading bacteria that come with a diet high in plant-based foods produce beneficial compounds to strengthen the intestinal barrier, reduce inflammation, balance hormones and support your metabolism.
Healthy Fats & More Omega-3s
There are three broad categories of fats: unsaturated (microbiome loving), saturated, and trans fats (microbiome disrupting fats).
Fats you get in your diet are often a blend of these, with some foods containing more of the microbiome nurturing unsaturated fats (e.g. olive oil), and some containing more of the microbiome disrupting saturated fats (e.g. butter).
If your diet contains more healthy fats, there is an increase in bacteria that produce beneficial short chain fatty acids. There is also a more favourable ratio of bacteria that reduce obesity risk, lower levels of inflammation and this means better hormone control, better weight management, reduced joint pain, and more resilience both in your gut community and in your mental health.
Unsaturated fats include omega-3s that we can obtain from marine and plant-based sources. Supplementing with Omega-3s reduces the stress marker cortisol and lowers inflammation in mid-life women .
Combining omega-3s with prebiotics is even more effective at reducing inflammation than supplementation with just an omega .
Add more microbiome nurturing fats such as extra virgin olive oil, avocado, nuts, seeds and oily fish in your diet. Combining these with daily Microbiome Essentials will ensure you are amplifying the anti-inflammatory, gut nurturing benefits!
Eat the Rainbow
Phytonutrients are the compounds in plants that confer colour. Using the phrase “eat the rainbow” points to the benefits of including a large variety of different coloured plants which will bring with them many different phytonutrients, like polyphenols and Carotenoids.
A diet rich in phytonutrients found in colourful fruit and vegetables delivers antioxidants and anti-inflammatory compounds that help prevent bone, metabolic and cardiovascular disease that increases with menopause .
Eating 5 to 7 serves of fruits and vegetables daily has widespread health benefits, but choosing to ‘eat the rainbow’ adds a unique microbiome nurturing benefit of increased diversity when different coloured bioactive pigments in fruit and vegetables are consumed .
Time to Muscle Up!
Maintaining or even increasing muscle mass during perimenopause is a great way to smooth the transition, and even be protective again menopause symptoms.
Females with greater skeletal muscle have an increase in butyrate producers in their microbiome . Remember the beneficial short chain fatty acid butyrate that supports our metabolism, immune system, gut health and heart health (plus so much more!)?
Nurturing your gut microbiome to feed your beneficial butyrate producers will support your muscle gains with regular strength training. Strength training at least twice a week (total body strength sessions) to maintain higher skeletal muscle has also been shown to be protective against the development of vasomotor symptoms of hot flushes and night sweats .
By promoting a healthy gut microbiome through targeted diet, supplement and lifestyle changes, you will be on your way to managing those menopause symptoms!
If you are ready to:
- reduce the bloat
- trim your waist
- boost your energy
- regain your mental clarity
- enhance your mood
- lower your hot flushes,
Be sure to Follow @angeliqueclark_nutrition, Australia’s leading Perimenopause Dietitian, for more nutrition tips to navigate the journey to menopause, smoothly.
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If you would like to read more about menopause head to Jean Hailes https://www.jeanhailes.org.au/health-a-z/menopause