Evaluating gut health and the microbiome (the organisms that inhabit your gastrointestinal tract) is crucial if you suffer from hormonal symptoms like fatigue, mood swings, headaches, hair loss, sensitivity to stress, cold intolerance, painful periods, or symptoms that suggest your hormone health is struggling.
In my clinical experience, hormone issues are often related to poor gut health because your gut:
- Is responsible for the absorption of essential nutrients and the building block for hormones.
- Has a direct relationship with estrogen metabolism and elimination with dysbiosis (imbalanced gut flora) being a contributor to estrogen dominance symptoms.
- Is a major site of thyroid hormone activation (converting T4 to T3), and compromised gut health can lead to the hormone imbalance known as hypothyroidism.
- Houses roughly 70-80% of your immune system, which can be a source of inflammation that leads to issues like hypothalamic pituitary adrenal dysfunction or HPA-D (some people call this adrenal fatigue), low progesterone, blood sugar dysregulation, and other issues of hormone imbalance.
- Facilitates the elimination of environmental toxins that can lead to symptoms of hormone imbalance.
- Communicates with the brain and helps maintain brain health. The master gland in orchestrating hormone production, the pituitary, is in the brain.
If you experience hormone imbalance symptoms like acne, painful periods, mood swings, or irregular periods, don't make the common mistake of overlooking your gut health. As a board certified naturopathic endocrinologist, evaluating gut health in conjunction with hormone symptoms can provide key insights into what may be at the root of the symptoms.
Keep reading as we dive into this fascinating and nuanced topic. I’ll provide a comprehensive overview of the gut hormone connection and cover specific topics of interest like the estrobolome and the role of gut health in female hormones.
Gut Health and Hormones: How Your Gut Microbiome Affects Your Hormones and Overall Well-Being
Gut health and microbiome balance can affect essential hormone production, hormone levels, and elimination of hormone metabolites from the body. The microbes that compose the body’s microbiome outnumber human body cells and contain at least 150 times more genetic information than the human genome. Gut health, specifically the microbiome, affects all body systems and overall health.
The reason why probiotics and prebiotics, like you find in the Women's Probiotic, can be an effective tool in restoring hormone health is because they encourage a balanced microbiome and healthy gut.
The gut microbiome helps regulate hormones and the gut itself is such a key player in hormone production that it’s considered an endocrine organ. The communication between bacteria and hormones affects immunity, behavior, metabolism, reproduction, and more.
These are the key areas where gut health can influence hormone regulation in the body.
Digestion and Absorption
Your body depends on the health of your gut to break down foods so they can be absorbed in the small intestine. When issues with gallbladder function, microbial dysbiosis (imbalance in intestinal bacteria and organisms), low stomach acid, or other issues affecting absorption occur, nutrient deficiencies can develop.
As I've said many times, you're not what you eat, you're what you absorb.
Poor absorption can lead to issues of hormone imbalance.
Estrogen Metabolism
The liver is responsible for processing estrogen the body no longer needs and packaging it up to be removed via the gut and kidneys. Within the gut, these estrogen metabolites will encounter beneficial gut bacteria and the enzymes they produce. Healthy bacteria balance in the gut is crucial for ensuring estrogen is efficiently eliminated from the gut.
But what is important to understand is that estrogen regulates the gut microbiome, and the gut microbiome affects estrogen levels.
Related: How menopause and perimenopause affect gut health.
What is the Estrobolome?
The estrobolome is the part of the gut microbiome (and its genetics) involved in estrogen metabolism. The estrobolome helps explain why women have a different microbiome composition compared to men.
Various bacteria produce an enzyme called beta-glucuronidase, which regulates estrogen levels. This enzyme changes the structure of estrogen, allowing it to be reabsorbed into the body.An impaired estrobolome can lead to low estrogen symptoms or high estrogen issues. Low beta-glucuronidase is associated with low levels of beneficial bacteria and dysbiosis and can lead to low estrogen levels. High beta-glucuronidase can be the root cause of elevated estrogen, which can lead to symptoms of irritability, breast tenderness, heavy periods and other symptoms. This is one factor that can influence the development of estrogen dominance symptoms.
Thyroid Hormone Health
The thyroid hormone known as thyroxine (T4) must convert into the active version T3 to bind to cells and influence the metabolic rate. This conversion occurs in two major sites: the liver and the gut, as well as other areas of the body. If gut health is suboptimal it may mean less active thyroid hormone in circulation. And low T3 could mean more, or more pronounced hypothyroid symptoms.
Hormone gut interactions are bidirectional; while gut health influences thyroid function, thyroid hormone levels affect gut health. Thyroid hormones drive the digestive process, including the production of stomach acid, digestive enzymes, and other digestive factors.
Related: The Thyroid-Gut Connection and How to Heal
Leaky Gut and Dysbiosis
Factors like medications, environmental toxins, alcohol, acute or chronic stress, and poor diet choices can lead to intestinal hyperpermeability or “leaky gut.” When this occurs, the barrier that allows digested food particles in and keeps potentially harmful organisms and larger molecules out, is compromised.
This gives way to immune system activation, which can result in food sensitivities, increased inflammation, and in some cases, autoimmune disease.
An imbalanced microbiome (dysbiosis) and “leaky gut” plays a central role in the development of autoimmune disease, including autoimmune thyroid diseases (Hashimoto’s thyroiditis and Graves’ disease). Autoimmune diseases are inherently inflammatory.
Elevated Cortisol and Gut Dysbiosis
The gut can be a hidden source of inflammation in the body with cortisol being one of the primary hormones charged with regulating inflammation. When there is dysbiosis, elevated cortisol levels and changes to the circadian rhythm that disrupt sleep can occur. Cortisol is a stress hormone that can also have a negative impact on gut health.
Healthy bacteria depend on fiber diversity in the diet. A diverse diet leads to a diverse microbiome. In addition to aiding in estrogen metabolism, as we discussed previously, microbial diversity also lends itself to a healthy body composition. Studies have shown that diets high in fiber and a variety of healthy gut bacteria is associated with lower belly fat.
Environmental Toxin Elimination
Endocrine disruptors are a group of environmental toxins that can disrupt your hormones in a variety of ways. For example, they are associated with blood sugar dysregulation, infertility, low libido, obesity, certain cancers, and may be implicated in contributing to the development of certain conditions like endometriosis.
Your gut is one of the primary ways we eliminate endocrine disruptors from our body. This is why a healthy diet that consists of at least 25 grams of fiber, staying hydrated, and regular movement, is all very important in ensuring daily elimination through the bowels.
Androgens, Testosterone and Gut Health
Gut health also influences androgenic hormones, including testosterone. Various gut microbes produce enzymes involved in androgen production, metabolism, and breakdown. In this way, the gut microbiome may be involved in regulating sex hormones in ways we are only beginning to uncover.
Research has shown there is a relationship between gut dysbiosis of PCOS patients and the development of insulin dysregulation, inflammation, metabolic disease, and elevated androgens.
Androgens may also directly influence the gut microbiome and play a significant role in gut function, as we'll discuss shortly.
The Gut-Brain Axis
The gut-brain axis is the biochemical and physical way that the gut and brain communicate with each other. Gut health is essential to brain health. And the brain, specifically the hypothalamus and pituitary, send the signals for hormone production.
You may be familiar with thyroid stimulating hormone (TSH), which signals the thyroid to produce hormones. Similarly, FSH and LH made in the pituitary signal the ovaries to produce hormones. There are several glands in the body that take their cues from the brain, making healthy brain function essential to hormone balance and production.
The health of the gut impacts the health of the brain and its ability to orchestrate hormone production.
Read more about the connection between brain health and hormone balance here.
What Causes Poor Gut Health
While some of these may seem obvious, other culprits that harm the trillions of bacteria and lead to an unhealthy gut can seem less obvious. These include:
- Antibiotic use
- Lack of exercise
- Chronic stress
- Drinking too much alcohol
- Not including enough diversity of food and plants
- Smoking
- Poor sleep
- NSAID and other medications
- Lack of dietary prebiotics
- Use of birth control pills
- A diet heavy in ultra processed foods
What Are Signs of an Unhealthy Gut
There are both digestive symptoms and symptoms outside of the gastrointestinal tract that suggest gut health is below optimal.
Common symptoms of an unhealthy gut include:
- Gas, bloating, belching
- Heartburn or Reflux
- Constipation
- Diarrhea
- Irritable bowel syndrome (IBS)
- Acne
- Chronic skin issues, like psoriasis and eczema
- Mood disorders, like anxiety or depression
- Poor cognitive function, brain fog, and inability to concentrate
- Headaches
- Fatigue
- Difficulty losing weight, weight gain
- Autoimmune disease like Hashimoto's, rheumatoid arthritis
- Hormone imbalances and exacerbation of issues like PCOS, hypothyroidism, fertility struggles, endometriosis, adenomyosis, PMS, and others
A good clinician can help you uncover the connections with a thorough intake and functional testing.
The Gut-Hormone Connection: Hormonal Influence on Gut Health
Your gut is the largest endocrine (hormone producing) organ, responsible for making more than 50 hormones. It produces hormones that regulate your hunger, sleep, stress, and mood. The health of your gut plays an essential role in your hormone health and some of these same hormones also influence the health of your gut.
As hormones change with your menstrual cycle, pregnancy, and perimenopause, they will affect the gut.
Conversely, imbalances in the microbiome could contribute to pregnancy complications, PCOS, endometriosis, cancer, and other conditions that affect more women. We can’t separate gut health from overall health; it’s intricately linked.
There are so many connections between the microbiome and hormones that scientists have likely only uncovered the tip of the iceberg! Microbes in the gut interact with estrogen, androgens (like testosterone), insulin, and various other hormones.
Here are how some hormones affect gut function, including those produced in the gut:
- Thyroid hormone affects gallbladder function, hydrochloric acid (stomach acid) production, motility (the reason you poop), and more.
- Estrogen regulates the gut to promote microbial diversity, which lends itself to hormone balance and better health. This is one reason why we can see gut issues arise post menopause when estrogen levels are lower.
- Testosterone aids in the regulation of inflammation, reduction of pain in the gastrointestinal tract, and may play a direct role in microbial health. Many of the studies we have to date focus on low testosterone in men, which shows a correlation with dysbiosis and an environment that lends itself to pathogenic organisms (“bad bacteria”) and gut dysfunction. Testosterone plays a crucial role in women's health and is much more than a hormone for our sex drive.
- Serotonin, which is produced in the gut, influences peristalsis, the contractions in the gut, and motility. Changes in the gut microbiome affect serotonin production and signaling.
* Read all about serotonin in the article How to Increase Serotonin Levels. - Growth hormone plays a crucial role in growth, metabolism, and repair on the cellular level, and the gut microbiome shares similar functions supporting system-wide homeostasis (balance). Imbalances in the gut microbiome (dysbiosis) may contribute to growth restriction and metabolic dysfunction, as the microbiome influences growth hormone via the gut-brain axis.
- Leptin is known as the satiety hormone because it helps regulate hunger. Fat cells primarily produce leptin which signals the brain that you are full and have had enough to eat. But your stomach is also a source of leptin production and releases this after you eat.
- Gastrin, secretin, and cholecystokinin (CCK) are 3 of the earliest hormones discovered that regulate digestion.
Improving Gut Health for Hormonal Balance
Caring for your gut health is one of the most influential ways to support hormonal balance. Daily nutrition and lifestyle habits shape the gut microbiome, which influences all aspects of health.
Aim for 25 Grams of Fiber Daily
Fiber is what feeds your microbiome, keeps your bowels regular, and aids in the removal of metabolic waste and environmental toxins. It is also crucial in helping your body eliminate the estrogen you no longer need.
Aim for at least 25 grams of fiber daily. If you're not eating much now, start with 5 grams daily for a week. The following week I aim for 10 grams daily. Continue this weekly increase until you reach the goal of 25 grams daily.
Take Pre and Probiotics for Hormone Imbalance
Probiotics are the beneficial bacteria that inhabit the gut. A combination of Lactobacillus species and spore-based organisms can help support the growth and diversity of beneficial organisms in both the gut and the vagina. These organisms can be part of the estrobolome, which is a key regulator in hormone health.The best probiotic for gut and hormone health should provide organisms specific to women's vaginal health, along with organisms that help regulate the microbiome. You'll find these organisms, plus prebiotics to support the growth of beneficial bacteria in Women’s Probiotic by Dr. Brighten.
Eat a Variety of Fiber and Nutrients
A variety of different fibers lends to a variety of organisms that grow in the gut and microbial diversity is a marker of health. Variety in the diet is also one way to prevent the development of food intolerances.
A diet rich in nutrient dense foods with lots of variety supports gut health and healthy hormones. One tip I tell patients is to try to consume 20-30 unique plants each month. These foods provide key micronutrients, a variety types of fiber, and bioactive compounds to support the microbiome diversity needed for happy hormones.
If you are transitioning from a more Western, processed food diet, add a few unique plant foods such as leafy greens, beans, and spices to your diet and then slowly ramp up.
We can influence microbiome balance and increase probiotic levels by eating fermented foods that contain live, beneficial bacteria.
Fermented foods include:
- Yogurt
- Kefir
- Sauerkraut
- Kimchi
- Kombucha
- Kvass
Prebiotics are non-digestible fibers that feed probiotics and help support healthy microbiome diversity and balance. Including prebiotics (oats, flax seed, asparagus), resistant starches (cooked and cooled rice or potatoes) and polyphenols (cacao, spices, ground flax, green tea etc.) is an important aspect of maintaining a healthy gut.
Prebiotic foods include:
- Artichokes
- Sunchokes
- Green bananas
- Asparagus
- Dandelion greens
- Berries
- Oats
- Chicory root
- Garlic
- Potatoes that have been cooked and cooled
Manage Stress and Anxiety
The parasympathetic nervous system is known as the “rest and digest” system. That's because for digestion to be optimal, you have to be relaxed. When we eat in a stressed state, our body diverts resources from digestion to run and fight.
Here's a few stress reduction techniques to promote healthy digestion:
- Eat in a relaxed environment
- Take a few deep breaths before your meal
- Avoid eating in the car or on the go when you can
- Take time to taste, smell, and feel your food
- Avoid eating at your desk
Stress can negatively affect the gut microbiome and hormonal pathways, including leading to adrenal and altering levels of sex hormones. In some cases, stress can be what is standing in the way of you achieving a balanced gut microbiome.
Consider Calcium D-Glucarate
Calcium D-glucarate supports both gut health and hormonal balance. It’s a natural substance made by the body and promotes the breakdown of environmental toxins and hormones in the liver. In the gut, calcium D-glucarate inhibits the beta-glucuronidase enzyme, which helps with estrogen clearance and maintains balanced estrogen levels.
Calcium D-glucarate is one of the key ingredients in Balance Women’s Hormone Support by Dr. Brighten in addition to nutrients that further support liver, gut, and hormone health.
Support Restorative Sleep
Bloating, food sensitivities, stomach pain, inflammation, and alteration to the gut microbiome can all be a result of poor sleep. And conversely, an imbalanced gut microbiome can lead to poor sleep as it is intimately connected to the brain-gut axis.
While sleep is essential to gut health and hormone balance, it can be sometimes difficult to achieve. I created this resource on how to get better sleep without relying on melatonin.
Importance of Regular Exercise
Exercise shifts the composition of the gut microbiome in a positive way and can improve digestive function and health. Exercise is also beneficial for hormonal health and easing hormone-related symptoms.
For more details about exercise and hormones, please read How to Exercise with Your Cycle and Why Eat Less Exercise More is Bad Advice for Women.
Signs You Should See a Medical Provider
It is always best to have a full workup to understand what the cause is of your symptoms and develop a targeted treatment strategy with your provider. While many of the tips discussed above can help with optimal digestion, you may require additional therapies or medications to address your issue.
You should see your medical provider if you experience:
Unexplained Weight Gain or Weight Loss
Always discuss unintentional changes in weight with your healthcare provider. If your weight increases or decreases without changing your diet, exercise, stress, or other lifestyle factors, hormones could play a role. Thyroid hormones, insulin, androgens, estrogen, leptin, and many other hormones can play a role in weight, and these imbalances are influenced by gut health.
For more on hormonal balances and weight, please read Why Hormonal Imbalance Can Make Weight Loss Difficult.
Significant Digestive Issues and Discomfort
Noticing blood, undigested food in your stool, greasy and foul smelling stools, or experiencing pain are a handful of reasons to visit your doctor. Changes in your bowel movements might be as benign as something you ate or as significant as ovarian cancer. When in doubt, see your provider to get it checked out.
Mood Changes and Sleep Disturbances
If you are noticing you're feeling anxious, depressed, unmotivated, sleeping all the time, or can't fall asleep, it's time to call your doctor. These can be signs of both gut imbalances and hormone issues. But they could also be due to something else.
Conclusion: The Symbiotic Relationship Between Gut Health and Hormones
This bidirectional influence between the gut and hormones influences all aspects of health. If you have hormonal symptoms, addressing the microbiome may be a critical factor in restoring balance.
By addressing the underlying causes of gut dysfunction, you optimize hormone balance and reduce symptoms of PMS, bloating, acne, and more.
References
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- Fenneman AC, Bruinstroop E, Nieuwdorp M, van der Spek AH, Boelen A. A Comprehensive Review of Thyroid Hormone Metabolism in the Gut and Its Clinical Implications. Thyroid. 2023.
- Siddiqui R, Makhlouf Z, Alharbi AM, Alfahemi H, Khan NA. The Gut Microbiome and Female Health. Biology (Basel). 2022.
- Mayer EA, Nance K, Chen S. The Gut-Brain Axis. Annu Rev Med. 2022.
- Stasi C, Sadalla S, Milani S. The Relationship Between the Serotonin Metabolism, Gut-Microbiota and the Gut-Brain Axis. Curr Drug Metab. 2019.
- Jensen EA, Young JA, Mathes SC, et al. Crosstalk between the growth hormone/insulin-like growth factor-1 axis and the gut microbiome: A new frontier for microbial endocrinology. Growth Horm IGF Res. 2020.
- Heiss CN, Mannerås-Holm L, Lee YS, et al. The gut microbiota regulates hypothalamic inflammation and leptin sensitivity in Western diet-fed mice via a GLP-1R-dependent mechanism. Cell Rep. 2021.
- Mailing LJ, Allen JM, Buford TW, Fields CJ, Woods JA. Exercise and the Gut Microbiome: A Review of the Evidence, Potential Mechanisms, and Implications for Human Health. Exerc Sport Sci Rev. 2019.
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