If you've ever felt that burning sensation creeping up your chest after a meal, you're not alone. Reflux, also known as heartburn or gastro-oesophageal reflux disease (GORD), affects over 2 million Australians—many of them women navigating the hormonal transitions of perimenopause and menopause.
While reflux might seem like a simple issue of too much stomach acid, emerging science is revealing a deeper connection: one that involves your gut microbiome. And if you’re in your 40s or 50s, this relationship becomes even more relevant.
In this blog, we unpack how reflux is influenced by hormones, lifestyle and your gut health—and what you can do to find relief naturally.
What Is Reflux and Why Does It Happen?
Reflux occurs when acid from the stomach flows backward into the oesophagus, causing symptoms like:
- A burning sensation in the chest
- Indigestion or burping
- Regurgitation (acid backing up into the throat or mouth)
It’s not just uncomfortable. Over time, it can damage the delicate tissues of your upper digestive tract.
And it’s especially common in women over 45, with menopause and perimenopause playing a surprising role.
The Hormone–Reflux Connection: Why Menopause Matters
As women move through perimenopause and into menopause, levels of oestrogen and progesterone begin to decline. These hormones aren’t just key to reproduction, they also play an important role in gut motility and digestive muscle tone.
Less oestrogen can mean a weaker lower oesophageal sphincter (the muscle that keeps acid in the stomach), making it easier for acid to travel upwards.
At the same time, the gut microbiome shifts dramatically, often becoming less diverse.
Research shows that individuals with reflux have different microbial communities in both their upper digestive tract and their gut. There’s often an increase in pro-inflammatory and pathogenic bacteria, which contributes to both systemic inflammation and digestive discomfort - including reflux (Guan et al., 2025).
Can HRT Make Reflux Worse?
Hormone Replacement Therapy (HRT) can be a game-changer for managing menopausal symptoms—but it may also impact reflux.
Recent studies have found that women using HRT have a 19–44% increased risk of developing GORD compared to those not using HRT (Aldhaleei et al., 2023; Saleh et al., 2023). This is likely due to:
- Oestrogen’s effect on weakening the oesophageal sphincter
- Slower gastric emptying, which increases stomach pressure
- The route of administration—oral HRT (taken by mouth) appears to have a greater impact on reflux symptoms than transdermal HRT (through the skin)
It’s a delicate balance—one that may require adjusting your HRT delivery method, and supporting your gut microbiome along the way.
The Midlife Lifestyle Layer: Stress, Meals, and Movement
Hormones aren’t the only trigger. Midlife lifestyle habits can turn up the volume on reflux.
Many women in their 40s and 50s face a unique combination of:
- Caring for children (and often parents)
- Heightened work demands
- Poor sleep
- Skipped meals or rushed eating
- Stress and increased alcohol use
All of these factors can contribute to reflux. In fact, studies show that:
- Skipping breakfast, eating quickly, or past fullness can increase reflux risk by 2–4 times
- Eating high-fat meals or dinner within 3 hours of bedtime can raise risk 7-fold
- Regular physical activity can reduce reflux risk by up to 30% (Zhang et al., 2021)
So Where Does the Gut Microbiome Come In?
The gut microbiome, the trillions of bacteria in your digestive tract, does more than support digestion. It also helps:
- Regulate hormone metabolism
- Maintain gut motility
- Modulate inflammation
- Protect the integrity of the oesophageal and gut lining
A balanced, diverse microbiome can act like a buffer against reflux. But during menopause, diversity declines and pro-inflammatory species rise, setting the stage for increased symptoms.
Natural Strategies to Soothe Reflux and Support the Microbiome
If reflux is cramping your style - and your sleep - there’s good news. Simple changes can go a long way. Here’s where to start:
1. Prioritise Prebiotic Foods
Prebiotics feed the good bacteria in your gut and help restore diversity. Include a diverse range of vegetables, wholegrains, legumes, fruits, nuts & seeds in your diet each day.
2. Eat Earlier and Eat Mindfully
Give yourself at least 3 hours between dinner and bedtime. Eat slowly, chew thoroughly, and stop before fullness.
3. Move Your Body
Even a 20-minute walk after meals can improve digestion and lower reflux risk.
4. Reduce Alcohol and Stress
Alcohol weakens the sphincter muscle and irritates the oesophagus. And chronic stress? It affects gut motility and microbiome balance.
5. Supplement Smartly
A daily prebiotic supplement, like Fertile Gut’s Microbiome Essentials, has been clinically shown to reduce both heartburn and regurgitation symptoms (Beckett et al., 2020).
A Gut-First Approach to Midlife Reflux
Reflux during perimenopause and menopause isn’t “just part of getting older” - it’s a signal that your gut, hormones, and lifestyle might need some support.
By nurturing your microbiome, adjusting meal timing, and embracing gentle movement, you can ease symptoms and reclaim digestive comfort.
It’s time to make midlife feel good, from the inside out.
Written by Dr Cecilia Kitic, PhD and Angelique Clark, APD
References
Aldhaleei WA, Bhagavathula AS, Wallace MB, DeVault KR, Faubion SS. The association between menopausal hormone therapy and gastroesophageal reflux disease: a systematic review and meta-analysis. Menopause. 2023
Beckett JM, Singh NK, Phillips J, Kalpurath K, Taylor K, Stanley RA, Eri RD. Anti-Heartburn Effects of Sugar Cane Flour: A Double-Blind, Randomized, Placebo-Controlled Study. Nutrients. 2020
Guan Y, Cheng H, Zhang N, Cai Y, Zhang Q, Jiang X, Wang A, Zeng H, Jia B. The role of the esophageal and intestinal microbiome in gastroesophageal reflux disease: past, present, and future. Front Immunol. 2025
Saleh S, Trujillo S, Ghoneim S, Thomas C, Fass R. Effect of Hormonal Replacement Therapy on Gastroesophageal Reflux Disease and its Complications in Postmenopausal Women. Clin Gastroenterol Hepatol. 2023
Zhang M, Hou ZK, Huang ZB, Chen XL, Liu FB. Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review. Ther Clin Risk Manag. 2021
