The gut microbiota in menopause: Is there a role for prebiotic and probiotic solutions? Original paper

What was reviewed?

This review article explores the role of the gut microbiota in menopause and evaluates the potential of prebiotic and probiotic interventions as therapeutic strategies for managing menopausal symptoms. It summarizes current evidence on how the menopausal transition influences gut microbial diversity and composition, especially with sex hormone fluctuations, and how these microbial changes may contribute to common menopause-related conditions such as metabolic disorders, osteoporosis, inflammation, and cognitive decline.

Who was reviewed?

The review synthesizes data from a wide range of studies, including human observational cohorts, animal models, and clinical trials involving peri- and postmenopausal women. It covers studies investigating the gut microbiota composition across different menopausal stages and examines interventions with prebiotics and probiotics designed to modulate the microbiome in menopausal populations. Additionally, it includes mechanistic insights from rodent models and discusses potential translational applications for human health.

Most important findings

Menopause induces significant shifts in gut microbiota characterized by decreased diversity and a shift towards a composition resembling that of age-matched men, including reductions in beneficial bacteria like Roseburia and Lachnospira and increases in potentially detrimental taxa such as Bacteroidetes and Tolumonas. These microbial changes correlate with altered estrogen metabolism through the estrobolome, a collection of bacterial genes encoding β-glucuronidase and sulfatase enzymes that reactivate estrogens, impacting systemic estrogen levels and menopausal symptoms.

Emerging evidence indicates that gut dysbiosis during menopause may play a significant role in driving increased intestinal permeability, chronic systemic inflammation, and metabolic disturbances. Various prebiotic fibers, such as flaxseed and soybean fiber, and specific probiotic strains, including Lactobacillus acidophilus, L. gasseri, and L. rhamnosus, have demonstrated potential in alleviating menopausal symptoms. These interventions appear to work by enhancing gut microbial diversity, strengthening intestinal barrier function, modulating systemic inflammatory responses, and influencing estrogen metabolism. Collectively, these findings suggest that targeting the gut microbiota may offer a promising adjunct or alternative approach to managing menopause-associated health challenges.

Key implications

This review highlights the gut microbiota as an important and potentially modifiable factor influencing a wide range of menopause-associated health challenges. Accumulating evidence suggests that targeted modulation of the gut microbiome through prebiotic and probiotic interventions offers a promising non-hormonal therapeutic strategy to alleviate menopausal symptoms and manage related metabolic, inflammatory, and psychological conditions. However, to translate these findings into effective clinical practice, future research should prioritize elucidating the underlying causal mechanisms linking gut microbial alterations to menopausal health outcomes. In addition, there is a critical need to identify specific microbial strains, functional pathways, or metabolites that mediate these beneficial effects. Developing personalized, evidence-based microbiome-targeted therapies could ultimately enhance long-term health, reduce disease risk, and improve the overall quality of life for menopausal women.