Menopause and the Microbiome. The Overlooked Connection.

By Chiza Westcarr

What if one of the most overlooked consequences of menopause isn’t hot flushes or mood swings, but the quiet changes in a woman’s microbiome that affect her immunity, metabolism, and skin health?

The Hormonal Shift That Changes Everything

Fatty Acid (SCFA) production. Polyphenols (from berries, green tea, or cocoa) support microbial diversity.

Menopause marks a profound biological transition. While hot flushes, night sweats, and cognitive changes often dominate discussion, the steady decline of circulating oestrogen has systemic consequences that extend far beyond the reproductive system.

Oestrogen is a pleiotropic hormone, influencing virtually every body system— from skin changes, weight regulation, sleep, and bone metabolism to vascular tone, cognition, vaginal and oral health, and even the body’s microbial ecology.

The female microbiome is not static. It responds dynamically to hormonal fluctuations throughout life. During reproductive years, oestrogen supports a healthy balance of microorganisms across the gut, skin, oral cavity, and vaginal tract. Its decline in perimenopause and menopause removes this support, setting the stage for changes in microbial composition and function.

Gut Microbiome: The Foundation of Systemic Health

The gut microbiome is central to immune, metabolic, endocrine, and brain function. One area of particular interest is the oestrobolome — the group of gut bacteria able to metabolise oestrogen.

When oestrogen is processed in the liver, it is “conjugated,” or packaged for removal via bile. Certain gut bacteria produce enzymes such as β-glucuronidase, which can “deconjugate” these metabolites, releasing them so that a fraction can be reabsorbed. In this way, the oestrobolome helps regulate levels of circulating oestrogen.

When oestrogen levels decline in menopause, this recycling loop weakens. Combined with age-related reductions in microbial diversity, women may experience:

• Loss of microbial richness, reducing resilience against pathogens.

• Increased gut permeability, fuelling systemic inflammation.

• Disrupted bile acid metabolism, influencing cholesterol and cardiometabolic risk.

• Reduced short-chain fatty acid (SCFA) production, weakening regulation of inflammation, appetite, and insulin sensitivity.

Clinically, these changes may contribute to weight gain, insulin resistance, glucose dysregulation, and increased systemic inflammation — risks already heightened in postmenopausal women.

Systemic Consequences

The downstream effects of menopause-related microbial change are farreaching:

• Immune function: Reduced microbial diversity contributes to chronic, lowgrade inflammation.

• Metabolic health: Gut dysbiosis (imbalance of gut microbial species) may worsen insulin resistance and dyslipidaemia.

• Bone health: Gut microbes influence calcium absorption and vitamin D metabolism, both critical in preventing osteoporosis.

• Mental health: Through the gut–brain axis, microbiome imbalances may contribute to mood disturbances and cognitive symptoms.

So, What Can Be Done?

Fortunately, gut microbiome health can be modified. Strategies supported by research and clinical practice include:

1. Dietary fibre and polyphenols: Vegetables, legumes, fruit, and whole grains fuel beneficial bacteria and enhance Short Chain

2. Fermented foods: Unsweetened yoghurt, kefir, sauerkraut, kimchi, miso, and kombucha provide live microbes that support microbial balance.

3. Probiotic and prebiotic supplementation: Selected Lactobacillus and Bifidobacterium strains, alongside prebiotic fibres like inulin, can support gut health.

4. Lifestyle interventions: Regular exercise, stress management, and adequate sleep help stabilise microbial balance and reduce inflammation.

5. Medication: Limiting unnecessary use of antibiotics and NSAIDs helps protect microbial diversity and gut integrity.

Clinical and Industry Implications

For skin specialists, understanding the microbiome’s role in menopause opens new avenues for client and patient care. Supporting gut health can improve systemic outcomes, enhance skin integrity, and optimise recovery from in-clinic treatments.

Across the industry, the link between menopause and the gut microbiome is becoming harder to ignore. Nutrition, supplementation, and clinical education now provide practical ways to support women’s health at this stage. Falling oestrogen and changes in the gut microbiome require serious attention, because they show up as inflammation, weight gain, and greater cardiometabolic risk.

For skin specialists, this opens the door to combining lifestyle and nutrition guidance with in-clinic treatments for more comprehensive results.

Menopause is a shared experience for all women, affecting every body system, yet its impact is too often reduced to hot flushes and night sweats. All symptoms matter, but the more significant changes are driven by declining oestrogen and its effects throughout the body.

Reduced microbial diversity, weakened oestrogen recycling, and changes in gut permeability result in inflammation, weight gain, insulin resistance, and cardiometabolic risk. These are serious issues that shape a woman’s health, energy, confidence and quality of life in midlife and beyond.

The good news is that the gut microbiome is not fixed. It can be supported and strengthened through diet, lifestyle, and integrated care. Fibre, fermented foods, targeted probiotics, movement, stress management, and adequate rest all influence microbial balance.

For skin specialists, recognising this means we can deliver care that goes beyond skin symptoms and supports long-term health. Menopause need not be a time of decline; it can be a new chapter of renewal and vitality, especially when the gut microbiome is brought into focus.

Chiza Westcarr is a university-qualified nutritionist, Dermal Clinician, Speaker, and Educator with over two decades of experience in the aesthetics and wellness industries. She is currently undertaking a menopause research PhD looking at the role of nutrition, exercise and health coaching in improving the cardiometabolic health of postmenopausal women. In 2025, she hosted the Australian Medical Aesthetic industry’s first-ever highly successful menopause symposium, Thriving Through Menopause by Chiza Westcarr, and thereafter founded the Menopause Skin Academy — a global online community for skin professionals with a special interest in menopause.

Please contact Chiza Westcarr for References. info@flora-biome.com | www.flora-biome.com