Gut-brain communication in menopause: insights into neuroendocrine and microbiome interactions

This review synthesizes current evidence linking alterations in the gut microbiome to menopausal transition. The gut microbiota plays a crucial role in numerous physiological processes, particularly due to its bidirectional communication with the brain via multiple neural, endocrine and immune pathways. Menopause-associated oestrogen decline disrupts this axis, influencing not only gastrointestinal function and microbial diversity but also mood, cognition and inflammation. The oestrobolome is a community of gut bacteria capable of modulating circulating oestrogen levels. Taken together, research suggests a complex dynamic interplay between the intestinal microbiota and sex hormones, potentially contributing to menopausal symptoms and related comorbidities. Understanding these interactions offers promising avenues for intervention, as dietary strategies (such as isoflavones), lifestyle modifications and targeted probiotic therapies may help restore balance within the gut-brain axis and support brain health during and after the menopausal transition. Here, we highlight the importance of an integrative, microbiome-informed approach to midlife women’s health, emphasizing innovative, non-pharmacological strategies to promote long-term well-being in women.