Why the female gut works differently – and what that means for women

And very importantly: The intestine is also influenced by female sex hormones, whether in terms of transport speed or 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 estrogen and progesterone affect digestion

How do female hormones affect the intestines?

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

On the other hand, estrogen, for example, also influences our pain perception – and therefore also how strongly we perceive signals from an irritated intestine. There is also a close interplay with tissue hormones such as histamine and prostaglandin. It is therefore not surprising that some patients experience increased bowel problems depending on the cycle or that the intestine can become more irritable during phases of hormonal change (e.g. menopause).

Endometriosis, PCOS, and the Gut: What is the Connection?

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

On one hand, we observe that about 20-30% of all patients with PCOS and endometriosis also have "irritable bowel syndrome" – this naturally raises suspicion and suggests an influence of hormone balance and 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 an altered composition of the gut microbiome, which is likely also related to hormone levels and inflammatory processes.

The Gut-Brain Axis: What It Is and How It Works

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 reciprocal communication between the nervous system of the gut and the central nervous system, i.e., our brain. These two systems are in constant exchange via hormones, neurotransmitters, messenger substances, and also the autonomic nervous system.

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

Healthy Microbiome: What Science Knows

What does the perfect, healthy microbiome look like?

Science cannot clearly answer this question to this day, as this ecosystem and its impact on our health is too complex. However, we know that high biodiversity in our gut is important and associated with health, and we do not want disease-causing or pro-inflammatory bacteria in the gut. And we also know, for example, that some bacteria species are particularly important: for our immune system, the gut barrier, or the formation of anti-inflammatory fatty acids.

Microbiome during menopause: What changes

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 between male and female microbiomes emerge under the influence of hormones.

Today we know that the microbiome changes again during menopause, e.g., in biodiversity, but also in the occurrence of different species. Interestingly, the female microbiome becomes more similar to that of men after menopause. Scientists suspect that these processes of change and the altered production of metabolic products could also be related to the increased risk of cardiovascular disease, obesity, and osteoporosis.

Microbiome-friendly diet: What women should eat

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

Very important for a healthy and diverse microbiome are sufficient fibers, meaning at least 30 grams of vegetables, whole grains, and fruits per day. A plant-based, fiber-rich diet is a good basis, as is an anti-inflammatory approach with high-quality omega-3 fatty acids and avoiding industrially highly processed foods – the latter can harm the intestinal barrier and the microbiome due to their numerous additives and unhealthy fatty acids.

Foods that naturally contain valuable bacteria such as lactobacilli and bifidobacteria, and are therefore probiotic, are also helpful for the microbiome. Examples include kefir, natural yogurt, sauerkraut, beets, or fermented vegetables.