Why the female gut functions differently

And very importantly: The intestine is also influenced by female sex hormones, whether in terms of transport speed or in terms of pain perception. Women more often show increased pain sensitivity in the abdominal area (visceral hypersensitivity), which can play a role not only in endometriosis but also in irritable bowel syndrome and can be influenced by hormone levels.

How do female hormones affect the intestine?

Female sex hormones can also act on the intestine via receptors - for example, we know that the hormone progesterone slows down the transport speed of food in the intestine, so the intestine becomes sluggish and prone to constipation. We observe this not only during pregnancies but often also in the second half of the menstrual cycle.

On the other hand, estrogen also affects our pain perception - and thus also how strongly we perceive signals from an irritated bowel. In addition, there is a close interaction with tissue hormones such as histamine and prostaglandin. Therefore, it is not surprising that some patients experience increased bowel problems depending on the cycle, or the bowel can become more irritable during phases of hormonal change (e.g., menopause).

What do conditions like PCOS and endometriosis have to do with the intestine?

On the one hand, we observe that about 20-30% of all patients with PCOS and endometriosis also have an "irritable bowel" at the same time - this naturally raises suspicion and suggests an influence of hormone balance and the microbiome on inflammatory processes. And indeed, science shows us that patients with PCOS often have a leaky gut; in patients with endometriosis, we often find a changed composition of the intestinal microbiome, which is probably also related to hormone levels and inflammatory processes.

What exactly is the gut-brain axis and what does it do?

The gut-brain axis is not a thick cable in our body. The term describes the complex and mutual communication between the nervous system of the gut and the central nervous system, that is, our brain. These two systems are in constant exchange via hormones, neurotransmitters, signaling substances, and also the autonomic nervous system.

A good connection is not only important for regulated digestion, but it also has far-reaching effects - for example, on our emotions, stimulus processing, immune system, or hormone balance. Interestingly, 90% of the communication goes from the gut to the brain, so what the gut and its microbiome have to say is indeed relevant for our headquarters in the head.

What does the perfect, healthy microbiome look like?

Science cannot clearly answer this question to this day, as this ecosystem and its effects on our health are too complex. However, we know that a high diversity of species in our gut is important and associated with health, and we also don't want disease-causing or inflammation-promoting bacteria in the gut. For example, we also know that some bacterial species are particularly important: for our immune system, the gut barrier, or the formation of anti-inflammatory fatty acids.

How does the gut microbiome change during menopause?

The gut microbiome develops into a largely stable ecosystem in the first three years of life, but with the onset of puberty, differences in composition appear between the male and female microbiomes under the influence of hormones.

And we know today that the microbiome changes again during menopause, for example, in species diversity, but also in the occurrence of different species. Interestingly, after menopause, the female microbiome becomes more similar to that of men again. Researchers suspect that these change processes and the resulting altered formation of metabolic products could also be related to the increased risk of cardiovascular diseases, obesity, and osteoporosis.

What does a reconstructive diet for the microbiome and gut barrier consist of?

A diet rich in fiber is crucial for a healthy and diverse microbiome. It means consuming at least 30 grams of vegetables, whole grains, and fruits per day. A plant-based, fiber-rich diet is a good foundation, just like an anti-inflammatory approach with high-quality omega-3 fatty acids and avoiding industrial ultra-processed foods. The latter can harm the gut barrier and microbiome due to their many additives and unhealthy fats.

Foods naturally containing valuable bacteria such as lactobacilli and bifidobacteria, i.e., those that are probiotic, are also helpful for the microbiome. Examples include kefir, natural yogurt, sauerkraut, beetroot, or fermented vegetables.