The Gut Microbiome's Quiet Role in the Menopause Transition

This review pulls together what's currently known about oestrogen, progesterone and the gut microbiome across the menopause transition. The consistent thread across smaller studies is a drop in microbial diversity after menopause, alongside a composition that edges closer to the male gut microbiome — plausibly because both groups share a low-oestrogen environment. Beyond diversity, the authors highlight the "estrobolome": gut bacteria capable of reactivating oestrogen for recirculation in the body, a system that may modulate hot flushes, bone density, weight and cognitive changes during the transition. Refreshingly honest about the state of the science, the authors note that individual studies disagree on precisely which bacterial species shift, sample sizes are often small, and it remains unclear whether hormone therapy can restore menopause-related microbiome changes. Rather than offering a tidy prescription, this is a useful map of an emerging field — a reminder that the gut is an active participant in the hormonal choreography of midlife, even if the fine detail is still being worked out.