Menopause & the hidden link between your gut, your hormones and recurrent UTIs

When we think of menopause, hot flashes and mood swings often come to mind. But there’s a whole lot more going on behind the scenes. 

But menopause reaches far beyond this. As oestrogen and progesterone levels shift, they affect bone and cardiovascular health (1,2), metabolism (3), sleep and cognition (4) too. However, there’s an exciting new area of menopause research that’s recently garnered attention, what happens to our microbiome during menopause, and could that help explain some of these changes? 

The gut–menopause link

Your gut microbiome is home to trillions of microorganisms – bacteria, fungi and other microbes that do far more than help digest food. They interact with the immune system, metabolism, the gut barrier, even the brain. And they have a relationship with our hormones as well, which is why understanding how the gut microbiome changes during menopause can help explain why this life stage affects so many aspects of female health.

As women move through menopause, the ovaries gradually produce less oestrogen and progesterone. These hormones help regulate gut function, so when they decline, digestion can be affected. But the impact goes far beyond digestion. The gut microbiome itself changes: diversity decreases and beneficial bacteria, such as Lactobacillus and Bifidobacterium, are reduced (5). Scientists sometimes refer to this shift as a “masculinisation” of the microbiome, as the microbial composition becomes more similar to what is typically seen in men (6).

These changes can also affect the production of short-chain fatty acids (SCFAs), such as butyrate, acetate, and propionate. SCFAs are beneficial compounds made when our gut bacteria break down dietary fibre. Butyrate is especially important because it helps keep the gut lining strong and supports a balanced immune response. When SCFA production decreases in menopause, the gut can become more permeable (“leaky”), inflammation levels may rise, and the risk of digestive, metabolic, cognitive, and immune-related issues can increase (7).

Another key player here is the oestrobolome, a collection of gut bacteria that help recycle oestrogen in the body (8). When this system is disrupted, hormone balance can be affected, which may worsen symptoms such as hot flashes, sleep disruption, and mood changes. New research is indicating that maintaining a healthy gut microbiome during menopause can help mitigate some of these effects and support overall health.

It's not just your gut that changes

The gut isn't the only microbiome affected by shifting hormones – your vaginal microbiome is closely linked to oestrogen as well.

A healthy vaginal microbiome is typically dominated by a protective bacteria known as Lactobacillus which helps to maintain a healthy microbial balance in both the gut and urinary tract (9) . As oestrogen declines during perimenopause and menopause, glycogen levels fall, vaginal pH tends to rise, and Lactobacillus abundance can drop resulting in a susceptibility to infections, including urinary tract infections.

"Oh no. Not another UTI."

If you've had recurrent cystitis, you know how disruptive it is: the constant need to pee, the burning discomfort, sometimes blood or an unpleasant smell – and just as you feel back to normal, another one turns up.

You're not imagining it. The risk of recurrent urinary tract infections increases during and after menopause, and changing hormone levels are thought to be one important reason why. As hormonal changes can thin the lining of the urethra, the tube that takes pee from the bladder and out of your body, making it more prone to infection (10). 

So, when we talk about menopause and the microbiome, we're not just talking about digestion. The gut and vaginal microbiomes are interconnected ecosystems, and hormonal changes can influence them both.

What can you actually do?

The good news is that supporting your microbiome doesn't mean overhauling your life. Many of the things that help your gut are also good for your wider health during menopause.

Eat a diverse, fibre-rich diet

Gut microbes thrive on dietary fibre, so aim for plenty of different plant foods across the week – vegetables, fruit, wholegrains, beans, lentils, nuts and seeds. Variety matters here: different fibres feed different microbes, so rather than chasing one "superfood," think about adding more diversity to your plate. This also supports bowel health, cholesterol and blood glucose regulation, all of which matter as your metabolic health changes.

Feed your microbes

Foods like onions, garlic, leeks, asparagus, and oats act as food for your gut microbes, encouraging the growth of bacteria like Bifidobacterium and Lactobacillus species that produce anti-inflammatory SCFAs. 

Don't skip fermented foods

Yogurt, kefir, sauerkraut, kimchi, and miso introduce beneficial bacteria into your gut, which can help maintain gut diversity and resilience against infections.

Move your body

Regular movement improves gut motility, encourages microbial diversity, and supports metabolic health and hormone regulation. You don't need to run marathons; walking, strength training, swimming, cycling or whatever movement you enjoy all make a difference.

Look after your vaginal microbiome

The vagina is a self-regulating ecosystem, so more cleaning isn't better. Avoid douching and heavily fragranced washes, wipes or products that can disrupt the natural environment. If you're experiencing vaginal dryness or discomfort, talk to your healthcare professional about your options. And if you're getting recurrent urinary symptoms, don't just write them off as "part of menopause" – get the cause properly assessed.

Look for the MTick

GenM discovered that despite there being 48 signs of menopause, most women are only able to name 3. Knowledge is power, whether you’re making sense of the changes you’re experiencing or learning how to support someone else through theirs.

And when it comes to finding menopause-friendly products, you deserve to search, source and shop with confidence. That’s where the MTick comes in: the universal shopping symbol and certification for menopause-friendly products. It’s a trust mark that helps you spot support for one or more of the 48 menopause signs. When you see the symbol on a product, in-store or online, you can shop for support with confidence. Know the sign: Look for the MTick.

Consider targeted live bacteria

This is where strain specificity matters. Live bacterial supplements aren't one-size-fits-all – different strains do different things, and evidence for one strain or combination doesn't automatically apply to another. 

As hormone levels change, the vaginal microbiome can become disrupted, increasing the risk of vaginal infections and general discomfort. That’s why SMART STRAINS for your vaginal microbiome is MTick-certified. Combining live bacterial strains La-14®️& HN001™️ , plus lactoferrin – this scientifically proven combination is shown to colonise the vagina in 7 days and help reduce candida growth, supporting a healthier vaginal microbiome.

The takeaway

Menopause brings a lot of change, but it's also a stage of life where understanding what's happening inside your body can help you make more informed choices. The gut and vaginal microbiome is one piece of that puzzle. 

If you're experiencing recurrent UTIs, vaginal dryness, pain, unusual discharge, burning or other new symptoms, speak to your GP or healthcare professional. There are evidence-based treatments and support available, and you deserve to understand your options.

But there are things you can influence day to day like eating a diverse, fibre-rich diet, moving your body and looking after your vaginal microbiome. Supporting your health through menopause isn't about finding one perfect solution – it's about understanding what your body needs and choosing support that's actually backed by evidence (and MTick-certified!).

References

1. El Khoudary SR, Aggarwal B, Beckie TM, et al.; American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020 Dec 22;142(25):e506-e532. doi: 10.1161/CIR.0000000000000912. Epub 2020 Nov 30. PMID: 33251828.

2. de Villiers TJ. Bone health and menopause: Osteoporosis prevention and treatment. Best Pract Res Clin Endocrinol Metab. 2024 Jan;38(1):101782. doi: 10.1016/j.beem.2023.101782. Epub 2023 May 9. PMID: 37230869.

3. Pu D, Tan R, Yu Q, Wu J. Metabolic syndrome in menopause and associated factors: a meta-analysis. Climacteric. 2017 Dec;20(6):583-591. doi: 10.1080/13697137.2017.1386649. Epub 2017 Oct 24. PMID: 29064321.

4. Reuben R, Karkaby L, McNamee C, Phillips NA, Einstein G. Menopause and cognitive complaints: are ovarian hormones linked with subjective cognitive decline? Climacteric. 2021 Aug;24(4):321-332. doi: 10.1080/13697137.2021.1892627. Epub 2021 Mar 15. PMID: 33719785.

5. Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. Int J Womens Health. 2022 Aug 10;14:1059-1072. doi: 10.2147/IJWH.S340491. PMID: 35983178; PMCID: PMC9379122.

6. Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. Int J Womens Health. 2022;14:1059-1072

7. Hays KE, Pfaffinger JM, Ryznar R. The interplay between gut microbiota, short-chain fatty acids, and implications for host health and disease. Gut Microbes. 2024 Jan-Dec;16(1):2393270. doi: 10.1080/19490976.2024.2393270. Epub 2024 Sep 16. PMID: 39284033; PMCID: PMC11407412.

8. Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103:45-53. doi: 10.1016/j.maturitas.2017.06.025. Epub 2017 Jun 23. PMID: 28778332.

9. Akgül T, Karakan T. The role of probiotics in women with recurrent urinary tract infections. Turk J Urol. 2018 Sep;44(5):377-383. doi: 10.5152/tud.2018.48742. Epub 2018 Sep 1. PMID: 30487041; PMCID: PMC6134985.

10. https://gen-m.com/signs/recurrent-utis/