How Perimenopausal Women Can Support Gut Health Before Starting HRT

Research shows that approximately 13 million women in the UK are currently going through perimenopause. However, Kirsten Jackson (aka The IBS Dietitian) warns that one of the most common medical treatments for the transition can make Irritable Bowel Syndrome (IBS) symptoms worse.

While menopause is defined as the point when a woman has had no period for 12 consecutive months, perimenopause is the symptomatic lead-up that often begins in a woman’s 40s – or even her 30s. During this time, fluctuating hormones don’t just cause hot flushes; they wreak havoc on the digestive system.

In her clinic, Kirsten has heard from multiple women whose GPs have prescribed Hormone Replacement Therapy (HRT) without considering their existing gut health issues. This highlights a significant awareness gap regarding the gut-hormone axis among many healthcare providers.

Hormone Replacement Therapy (HRT) is the gold-standard treatment for perimenopause, designed to replenish declining estrogen and progesterone levels, stabilising mood and eliminating vasomotor symptoms like night sweats. However, for the one in 10 women already living with IBS, HRT can be a double-edged sword. 

Kirsten Jackson, The IBS Dietitian explains: “Perimenopause can have multiple effects on the gut due to the change in hormone levels and the symptoms associated with this phase. For example, research has shown that gut microbiota diversity reduces and this is typically associated with a range of digestive symptoms such as bloating.

“Understandably, many people turn towards HRT to ease symptoms but trying to get the correct dose can take time and during this the estrogen and progesterone hormones used may worsen IBS symptoms

If you are among the one in 10 women who already live with IBS, the added perimenopausal symptoms – like poor sleep, night sweats, anxiety, and depression – will only exacerbate your digestive distress.

The good news is that you do not need to avoid HRT if you have IBS, it is simply a case of being prepared.

If you do decide to go on HRT but suffer from IBS, here are 3 ways to prepare your gut:

• Optimise sleep quality as much as possible using good sleep hygiene practices like black out curtains and ear plugs.
• Aim to consume 30 different sources of plants per week – this has been shown to be the optimal dietary pattern to optimise microbiota diversity.
• Take a 30 minute walk daily – this will help with a slower gut and improve your mood which in turn will target the gut-brain axis.

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