The Feminine Gut: How Your Microbiome Empowers Wellness

Another popular topic related to health and well-being is the gut microbiome. Much research has been conducted on the role of the gut microbiome in all aspects of health starting in 1880, when Russian scientist Élie Metchnikoff, known as the father of modern immunology, hypothesised that certain bacteria in the gut could promote health. He linked the consumption of fermented foods, like yoghurt, with longevity and good health (3).  Early microbiologists, such as Louis Pasteur and Robert Koch, were instrumental in identifying bacteria, which later laid the groundwork for understanding the gut microbiome (4). The gut microbiome refers to a community of microorganisms in your gut of 500-1000 species.  It almost acts like an organ and has many essential functions, such as;

• The digestion of complex carbohydrates (e.g. fibre) and conversion to Short Chain Fatty Acids (SCFA).
• The production of vitamins K and some B vitamins.
• Supporting the immune system
• Breaking down toxins
• Regulation of gut motility
• Maintaining the integrity of the gut barrier
• Controlling inflammation

Ultimately, your gut microbiome plays a role in your physical and mental well-being, and the health of your gut microbiome has been closely linked to the development and severity of many female health issues, such as Endometriosis, Polycystic Ovary Syndrome (PCOS), painful menstruation (dysmenorrhea), fertility issues, Fibromyalgia and more (1).

Hormones & the gut microbiome

Hormones are essential in male and female health, but this Blog looks at female health.  Oestrogen is a well-known female sex hormone that plays a critical role in the sexual development and reproductive health of females (5).  It also contributes to bone health, cardiovascular health, cognitive health, dermatological health, immune health and maintaining a healthy lining of the vaginal and urinary tract (5).  Keeping oestrogen levels balanced is extremely important, and having a balanced gut microbiome does just that!   The Estrobolome is a sub-set of gut microbes that produce enzymes that metabolise and regulate Oestrogen.  After the liver processes Oestrogen, these gut microbes make it water soluble and send it to the gut to be excreted.  If you have a healthy gut microbiome, it will help regulate how much Oestrogen is excreted and reabsorbed back into the bloodstream.  Gut dysbiosis (an imbalance in the gut microbiome) can lead to low or high levels of Oestrogen in the bloodstream, leading to unpleasant symptoms either way (6).

Low Oestrogen levels	High Oestrogen Levels
Irregularities in sexual development and function Female hypogonadism Weight gain Increased risk of cardiovascular disease Increased risk of Osteoporosis Increased UTI’s Period Irregularities Mood slingshot flushes Breast tenderness Depression Fatigue Difficulty concentrating	Breast tenderness Headaches Weight gain Very light or heavy periods Worsening PMS symptoms Fibroids on the uterus Fibrocystic lumps on the breast Fatigue Decreased libido Depression Anxiety

Then there is Progesterone, whose primary role in female health is to regulate the menstrual cycle, prepare the uterus for pregnancy, and support early pregnancy by maintaining the uterine lining.  Progesterone and the gut microbiome have a close bidirectional relationship.  Meanwhile, the gut microbiome (when balanced) helps metabolise and regulate progesterone.  Progesterone influences gut motility and immune function.  Progesterone slows down gut motility by relaxing the smooth muscles in the digestive tract.  This can lead to constipation, which is common during the luteal phase of the menstrual cycle and during pregnancy when Progesterone levels are high.  That’s why you should eat a high-fibre diet and drink enough water, especially during these periods.  Progesterone also has anti-inflammatory properties, which can impact gut health.  It helps create a less inflammatory environment for the developing fetus during pregnancy.  Chronic gut inflammation that is caused by gut microbiome dysbiosis can disrupt the effect or metabolisation of Progesterone, which leads to more inflammation; it’s a vicious cycle!  This increased inflammation can cause conditions such as PCOS and Endometriosis. 

Women have been made to feel that fluctuating hormones are just something they have to ‘deal with’ as females. However, much research seems to point towards gut health as a solution. The close bidirectional relationship between hormones and the gut microbiome indicates that as hormone levels change through puberty, menstruation, pregnancy, and menopause, so does the gut microbiome. 

Oestrogen and progesterone levels rise and fall during the menstrual cycle, influencing gut motility, inflammation, and the diversity of gut bacteria. For example, some women experience digestive issues like constipation or diarrhoea at different stages of their cycle.  Gut microbiome composition shifts during pregnancy to promote energy storage and nutrient absorption, which supports the growing foetus.  As for Menopause, reduced Oestrogen levels can lead to lower gut microbial diversity and may increase the risk of metabolic syndrome, osteoporosis, or cardiovascular disease. (6, 7).

Sex hormones can also affect the bacterial growth and virulence of microbes.  For example, two forms of Oestrogen, estriol and oestradiol, inhibit bacterial virulence by delaying the communication between gram-positive bacteria, preventing them from forming biofilms and making it more challenging to eliminate the infraction(1, 5).  Progesterone enhanced the growth of oral Bacteroides species and Prevotella intermedia. (1, 8)

The Gut Microbiome & Female Specific Conditions

As I mentioned before, females have specific health conditions, and the gut microbiome can play a role in the prevention or cause of these conditions and affect the severity of symptoms.  Because of the lack of studies done on female-specific conditions, it can be challenging even to get a diagnosis, and sadly, many women can go for years not being correctly treated and more or less ‘gaslit; into thinking it’s all in their head.  The gut microbiome could be a way of making diagnoses easier.  Multiple studies have shown that the presence/ratio of microbial species is altered in females suffering from Polycystic Ovary Syndrome (PCOS) and Menopause.(1)This could make it easier to diagnose these conditions and give more ways to treat them. 

 

Polycystic Ovary Syndrome (PCOS)

PCOS is a common hormonal disorder affecting8-13% of women worldwide in their productive age.  It is characterised by irregular, prolonged or absent menstrual cycles due to irregular or lack of ovulation.  Excess male hormones (androgens), which can cause acne, excess body hair or thinning of the hair on the head (androgenic alopecia) and polycystic ovaries where the ovaries enlarge and contain multiple small follicles that fail to release eggs regularly.  Other common symptoms include weight gain and difficulty losing weight, sleep issues, mental health, insulin resistance (type 2 Diabetes) and fertility issues.  PCOS patients have a less diverse gut microbiome, which correlates with hyperandrogenism.

Studies have shown that the administration of Lactobacillus acidophilus (L. acidophilus), Bifidobacterium bifidum (B. bifidum), Lactobacillus Reuters (L. Reuters), and Lactobacillus fermentum (L. fermentum) has been found to improve symptoms of PCOS (1)A change in diet and improving your gut microbiome health can also help alleviate symptoms of PCOS.

Endometriosis

Endometriosis is a chronic Gynaecological condition where tissue similar to the lining of the uterus grows outside the uterine cavity (9).  This leads to severe pain and potential infertility issues.  Endometriosis affects approximately 10% of females at reproductive age worldwide, equal to around 190 million females (9).  Symptoms include severe menstrual pain, pain during intercourse, chronic pelvic pain, abdominal bloating and nausea, fatigue, depression & anxiety and fertility issues.  Studies have shown a connection between endometriosis and alterations in the gut microbiome (6, 10).  This connection influences both the development and progression of the disease.  These include;

• Reduce microbiome diversity
• There was an Increased Firmicute to Bacteroides ratio, with higher Prevotella levels and lower Cryptococcus levels. This created an inflammatory environment.
• Gut dysbiosis can lead to immune dysregulation, thus promoting the implantation and growth of ectopic endometrial tissue.

The observed link between gut microbiota and endometriosis suggests potential avenues for diagnosis and treatment. For example, specific microbial signatures could serve as non-invasive biomarkers for early detection. Modifying the gut microbiome through diet, probiotics, or faecal microbiota transplantation may offer new therapeutic strategies to treat endometriosis symptoms. However, further research is necessary to understand these interactions and develop effective interventions fully.(10)

Fibromyalgia

Fibromyalgia can occur in both men and women, but women are seven times more likely to develop it.  It is a chronic condition characterised by widespread musculoskeletal pain and cognitive difficulties.  The general population has only about a 5% prevalence rate. However, 80-96% of these cases are women. (11).  Some research has shown that treating the gut microbiome can heal and ease pain from fibromyalgia and help diagnose it.  Not only is Fibromyalgia extremely difficult to diagnose due to there not being one set test to diagnose it, but the symptoms often mimic those of other conditions, so it is frequently misdiagnosed.  It was found that people with Fibromyalgia had altered gut microbiomes, which correlated with pain and fatigue, not medication, diet or other environmental factors.  A 2023 study showed that people with Fibromyalgia had lower serum α muricholic levels. (12), a bile acid produced by certain gut microbes.  Some of these bile acids bind to the neurons in the spinal cord and suppress pain so that pain can flare up without them. 

Nutrition & Lifestyle Tips for a Healthy Gut Microbiome

In a nutshell, our microbiome health significantly impacts our overall health.  Keeping it healthy and balanced will help keep our hormones and inflammatory markers in check and prevent the undesirable symptoms you can develop from being a female!  To do this, finding your microbiome health and working from there is a good idea.  Everyone is unique, so there’s no one-size-fits-all microbiome diet plan.  However, here are a few general tips that will push you in the right direction.

• Base your diet on plant-based foods. This doesn’t mean you must go vegan or vegetarian; try to include more growing foods. These foods are high in fibre and are food for gut microbes. Fruit, vegetables, nuts, seeds, beans, legumes, and whole grains should comprise the bulk of your diet.
• Drink water! Water is super important. Just plain water; nothing fancy is needed. If you want a detox, all you need to do is eat plenty of fibre and drink at least 2-3 litres of water daily, and your body will do the rest. 
• Include fermented foods like natural yoghurt, cheeses, kefir, sauerkraut, kombucha, and tofu in your diet.  These are excellent sources of beneficial gut bacteria.
• Try taking good-quality probiotics. Ask your local health food store to find one that is right for you. A microbiome test will also give you results that will tell you precisely the type of probiotic that would benefit you most.
• Getting enough sleep is also essential to your microbiome health.
• Stress can seriously harm your gut microbiome, so try to find a way to relieve stress. Whether doing some form of exercise, like yoga, walking, swimming, dancing, etc., or reading, playing an instrument, or meditating, find something that helps you relax.

Conclusion

Although studies into the human microbiome and its importance to health are extensive, more studies are needed to examine it and its effect on specific female health-related issues. This could lead to more diagnostic tools and treatments in the future. 

References

1.         Siddiqui R, Makhlouf Z, Alharbi AM, Alfahemi H, Khan NA. The Gut Microbiome and Female Health. Biology (Basel). 2022;11(11).

2.         Friedson-Ridenour S, Dutcher TV, Calderon C, Brown LD, Olsen CW. Gender analysis for one health: theoretical perspectives and recommendations for practice. Ecohealth. 2019;16:306-16.

3.         Vikhanski L. A Science Lecturer Accidentally Sparked a Global Craze for Yogurt. Smithsonian Magazine. 2016.

4.         Pierre JF. Introduction and Background to Microbiome Research. Metabolism of Nutrients by Gut Microbiota. 2022:1-17.

5.         Nichols H. MedicalNewsToday [Internet]2023 20/11/2023. [cited 2025]. Available from: https://www.medicalnewstoday.com/articles/277177#types.

6.         Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017;103:45-53.

7.         Peters Brandilyn A, Lin J, Qi Q, Usyk M, Isasi Carmen R, Mossavar-Rahmani Y, et al. Menopause Is Associated with an Altered Gut Microbiome and Estrobolome, with Implications for Adverse Cardiometabolic Risk in the Hispanic Community Health Study/Study of Latinos. mSystems. 2022;7(3):e00273-22.

8.         Rizzetto L, Fava F, Tuohy KM, Selmi C. Connecting the immune system, systemic chronic inflammation and the gut microbiome: the role of sex. Journal of autoimmunity. 2018;92:12-34.

9.         WHO. World Health Organization [Internet]2023. [cited 2025]. Available from: https://www.who.int/news-room/fact-sheets/detail/endometriosis.

10.       Pérez-Prieto I, Vargas E, Salas-Espejo E, Lüll K, Canha-Gouveia A, Pérez LA, et al. Gut microbiome in endometriosis: a cohort study on 1000 individuals. BMC Medicine. 2024;22(1):294.

11.       Ruschak I, Montesó-Curto P, Rosselló L, Aguilar Martín C, Sánchez-Montesó L, Toussaint L. Fibromyalgia Syndrome Pain in Men and Women: A Scoping Review. Healthcare (Basel). 2023;11(2).

12.       Minerbi A, Gonzalez E, Brereton N, Fitzcharles MA, Chevalier S, Shir Y. Altered serum bile acid profile in fibromyalgia is associated with specific gut microbiome changes and symptom severity. Pain. 2023;164(2):e66-e76.