Gut Check: How Gut Health and Hormones Are Linked

Supporting Women’s Health Through the Gut Microbiome

If you’ve ever felt like something was out of balance in your body, it’s worth trusting your gut. More and more research points to the leading role our gut microbiome – the trillions of bacteria, parasites, and other microorganisms found in our digestive system – plays in our health. When it comes to women’s health and hormones, turning our attention to the gut may help us better understand and care for our bodies.

How the Gut Microbiome can Influence Hormones

The gut microbiome works a lot like other organs in the body and can influence things like metabolism, hormone production, and mood. In addition, it plays a significant role in the female reproductive system, interacting with estrogen, insulin, and other hormones that are important throughout a woman’s life. “We now have a deeper understanding of the gut-hormone-immune triad, thanks to microbiome sequencing and metabolomics,” Dr. Anna Askari, a One Medical provider and family physician with an interest in women’s health, explained.

• Estrogen: The gut microbiome is deeply connected to estrogen regulation. Levels can rise or fall based on how the gut processes and recycles it.
• Cortisol: Known as the stress hormone, its regulation is closely tied to gut-brain communication.
• Insulin: Sensitivity can be influenced by gut flora and can affect blood sugar balance.

Thyroid hormones: Thyroid hormones depend on gut health for proper conversion and absorption.

When Something is Off: More than “Just Hormones”

Women experiencing symptoms like chronic fatigue, mood swings, and weight gain may be told that what they’re noticing is “just hormones,” or have their symptoms dismissed entirely. It can also be easy to normalize symptoms as part of aging or a result of stress. “The complex overlap of symptoms between gut, hormone, and mental health issues can make it hard to know when or where to seek care,” Dr. Askari said. However, as she emphasizes, “Symptoms are valid — if your body feels off, it’s worth exploring.”

A growing body of research is shining a light on the link between gut microbiome imbalance, called dysbiosis, and female hormonal disorders. Dr. Askari has seen evidence on the role of gut bacteria in conditions like endometriosis and polycystic ovary syndrome (PCOS), the most common female reproductive endocrine disorder. Plus, recent research has established a link between the gut microbiome and autoimmune thyroid disorders, including thyroid nodules, Hashimoto’s thyroiditis, and Graves’ disease. “We're also seeing more focus on the impact of early life exposures – including birth method, antibiotic use, and diet – on long-term gut and hormone health,” Dr. Askari added.

Benefits of a Balanced Gut

Women who gain better gut balance and microbial diversity often report improved energy, mood, digestion, reduced bloating, and better menstrual regularity, Dr. Askari said. Pre and probiotics, which can support beneficial gut bacteria and microbial diversity, have been linked to lower cortisol levels in clinical trials. There’s evidence that they may help reduce anxiety and depression as well as promote healthy estrogen and testosterone levels.

“Clinically, I’ve seen improvements in insulin resistance; reduced symptoms of PCOS such as acne, hirsutism, and menstrual regularity; fewer thyroid symptom flares; and even better mental clarity,” Dr. said. “A balanced microbiome also supports a healthier immune system, which can decrease autoimmune reactivity and chronic inflammation.”

Dr. Askari recalls one patient with PCOS who had acne, hirsutism, and chronic bloating, and also struggled with irregular periods and fatigue. Within six months of focusing on gentle movement, targeted supplement support with magnesium and inositol, and a whole-food anti-inflammatory diet with higher protein and fiber, the patient’s periods became regulated, and her energy dramatically improved. “Such a case reminds me how interconnected systems truly are, and how empowering it can be when women can support their body’s natural rhythms,” Dr. Askari said.

5 Ways to Support a Healthy Gut Microbiome

Because gut health is unique to each person and influenced by long-term diet, lifestyle, medications, and stress, addressing some of these factors first can make a difference in hormonal balance. Dr. Askari suggests five strategies for supporting the gut-brain-hormone connection:

1. Start with a fiber-rich, plant-diverse diet. Aim for 30+ different plant foods per week, including legumes, vegetables, fruits, whole grains, nuts, and seeds.
2. Add fermented foods like yogurt, kefir, kimchi, and sauerkraut to your diet to support microbial diversity.
3. Limit ultra-processed foods and added sugars, which promote dysbiosis.
4. Incorporate regular physical activity like strength training, practice stress reduction through activities like mindfulness and yoga, and get sufficient sleep.
5. Targeted probiotics or prebiotics may also be helpful, Dr. Askari notes, but should be individualized, so work with your doctor to find the best fit.

Dr. Askari has seen firsthand how small, sustainable changes in lifestyle can have powerful effects. “You don’t need extreme detoxes or hormone ‘reboots.’ Gut and hormone health is about long-term consistency, not quick fixes.”

Better for Your Gut, Better for Your Body

As research continues to uncover new links between the gut microbiome and hormones, we’re more and more aware of the foundational role that gut health plays in women’s health. Supporting your gut microbiome through a healthy lifestyle is a great way to care for your hormonal health and your whole health. If you notice something is out of balance, working with doctors who understand this important connection can help you get back to feeling like your best self.

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