As women transition through perimenopause and menopause, their internal landscape undergoes profound transformation. Fluctuating oestrogen and progesterone levels can alter mood, sleep, temperature regulation, and circulation. However, beyond the hormonal shifts, what I observe in clinic and what current research increasingly confirms, is that the gut plays a pivotal role in how women experience this transition.
This is something Chinese medicine has recognised for thousands of years.
The Gut–Hormone Connection Through Two Lenses
In Chinese medicine, the Spleen–Stomach system governs transformation and transportation. This system creates the body’s capacity to turn food into Qi, Blood, and Body Fluids. The Kidneys (Yin and Yang) oversee growth, reproduction, and the deep reserves of vitality known as Jing.
As we move through menopause, Kidney Yin and Jing naturally decline. Internal Heat rises, circulation changes, and the body’s ability to nourish itself shifts. When the Spleen becomes weakened through our current ‘busy’ lifestyles it creates chronic stress, irregular eating, or impaired digestion, and the gut’s efficiency falters. Clinically, this can appear as bloating, hot flushes, restless sleep, or mood instability.
Modern biomedical research echoes these classical ideas. Studies show that gut microbial diversity and function change during menopause. In fact, one large study of over 70,000 women found that the gut microbiome could predict the severity of physical and psychological menopausal symptoms. Another found that changes in microbial metabolites directly correlated with hormonal status.
When looking at this through a classical Chinese medicine lens, this reflects the Earth element (Spleen) losing steadiness. Hence, Qi and Blood become less abundant, Heat and Dampness arise, and the system loses its natural grounding.
Microbial Diversity, Oestrogen & Gut Integrity
Falling oestrogen impacts gut microbial diversity. The “estrobolome”—the collection of gut bacteria responsible for metabolising oestrogen—becomes less active, reducing the body’s ability to recycle and regulate hormones effectively.
From a Chinese medicine viewpoint, this mirrors the decline in Yin and Blood—our internal cooling, nourishing, and moistening fluids. The gut lining itself contains oestrogen receptors, and as they become less responsive, barrier integrity can weaken. The result may be new food sensitivities, digestive unpredictability, and systemic inflammation—what TCM recognises as Spleen Qi deficiency with Damp or Heat accumulation.
Immunity, Metabolism & the Gut–Hormone Axis
Around 70% of the immune system resides in the gut. As oestrogen declines, the gut–immune interface also shifts. Research shows that postmenopausal women often exhibit increased inflammatory markers and metabolic changes—particularly those with higher visceral fat.
In Chinese medicine, this reflects a weakened Spleen and stressed Kidneys. Dampness and stagnation may accumulate, circulation slows, and transformation processes become inefficient. The gut becomes a key site of hormonal, immune, and metabolic recalibration.
Practical Diet & Lifestyle Guidance from a Chinese Medicine perspective
1. Nourish the Earth, digestive pathways and Preserve Yin
- Favour warm, cooked foods such as soups, stews, broths and if so inclined, congee.
- Avoid iced drinks or raw salads during digestive sensitivity. Reach for warm drinks.
- Consider including Yin-tonic foods: black sesame, goji berries, seaweed, tofu, mushrooms, leafy greens.
- Support the Spleen with earthy staples: pumpkin, sweet potato, barley, oats, legumes.
- Aim for a diverse plant-based diet, which research links to a more stable gut microbiome and fewer menopausal symptoms.
2. Support Microbial Diversity & the Estrobolome
- Incorporate fermented foods (if tolerated): miso, kefir, kimchi, natural yoghurt.
- Focus on fibre diversity: fruits, vegetables, grains, beans, peas and lentils. Include various colours, textures, and plant types. Eat from the rainbow!
- Speak to your health care provider about the possible benefits of adding probiotics.
3. Regulate Lifestyle Rhythms
- Eat at consistent times to support digestive Qi.
- Sleep before 10 pm to nourish Liver and Kidney Yin.
- Engage in gentle movement such as walking, Qi Gong, Pilates, yoga—to promote flow without depletion.
- Manage stress with meditation, acupuncture, and breath work as these harmonise the Shen (spirit) and regulate the gut–brain axis.
4. Acupuncture & Chinese Medicine Modalities
Acupuncture helps regulate hormonal and nervous system feedback loops. By harmonising Qi and supporting Kidney Yin and Spleen function, it can reduce hot flushes, balance mood, improve sleep, and strengthen digestion. Cupping, gua sha, or herbal medicine may also be integrated for tailored support.
Menopause is a Transformation, Not a decline
Viewed through both Western and Chinese frameworks, menopause is not a loss, it’s a recalibration. The body is reorganising how it produces, circulates, and responds to hormones. The gut sits at the heart of this process, influencing metabolism, mood, and inflammatory balance.
In Chinese medicine, this phase marks a natural evolution of Yin and Jing, asking the body to adapt and redistribute its inner resources. Supporting the Spleen and Kidneys helps stabilise this transition. This can assist in anchoring mood, sleep, and digestion while cooling internal Heat and restoring vitality.
When you nourish your gut, honour your body’s rhythms, and integrate some simple Chinese medicine concepts into your care, you strengthen the systems that keep you grounded, resilient, and well.
Interesting research:
Kim C, Asnicar F, Marples L, Pounis G, Bermingham K, Hall W, Segata N, Spector T, Berry S. Associations between gut microbiota and menopause symptoms: novel insights from the ZOE PREDICT 3 cohort. Proceedings of the Nutrition Society. 2025;84(OCE3):E243. doi:10.1017/S0029665125101122.
Xie X, Song J, Wu Y, Li M, Guo W, Li S, Li Y. Study on gut microbiota and metabolomics in postmenopausal women. BMC Women’s Health. 2024;24:608. doi:10.1186/s12905-024-03448-7.
Peters BA, Santoro N, Kaplan RC, Qi Q, et al. Spotlight on the gut microbiome in menopause: current insights. International Journal of Women’s Health. 2022;14:1059–1072. doi:10.2147/IJWH.S340491.
Peters BA, Lin J, Qi Q, Usyk M, Isasi CR, Mossavar-Rahmani Y, Derby CA, Santoro N, Perreira KM, Daviglus ML, Kominiarek MA, Cai J, Knight R, Burk RD, Kaplan RC. 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):e0027322. doi:10.1128/msystems.00273-22.
Park MG, Cho S, Oh MM. Menopausal changes in the microbiome — a review focused on the genitourinary microbiome. Diagnostics (Basel). 2023;13(6):1193. doi:10.3390/diagnostics13061193.
Gaber M, Wilson AS, Millen AE, Hovey KM, LaMonte MJ, Wactawski-Wende J, Ochs-Balcom HM, Visceral KL. Visceral adiposity in postmenopausal women is associated with a pro-inflammatory gut microbiome and immunogenic metabolic endotoxemia. Microbiome. 2024;12:192. doi:10.1186/s40168-024-01901-1.
Wang H, Shi F, Zheng L, Zhou W, Mi B, Wu S, Feng X. Gut microbiota has the potential to improve health of menopausal women by regulating estrogen. Frontiers in Endocrinology. 2025;16:1562332. doi:10.3389/fendo.2025.1562332.
