Estradiol loss, the “estrobolome,” and midlife symptoms: what the gut microbiome adds to menopause care

IMPORTANCE AND OBJECTIVE: Menopause is characterized by sustained estradiol decline affecting vasomotor, metabolic, skeletal, and neurobehavioral systems. Emerging evidence suggests that the gut microbiome may interact with endocrine pathways during this life stage. METHODS: Narrative review of literature examining relationships between menopause, estradiol signaling, gut microbiome composition, and symptom domains. Artificial intelligence (AI) disclosure: artificial intelligence tools were used for language editing and to assist in the preliminary creation of a conceptual illustration. All scientific content, literature interpretation, and final manuscript preparation were performed and reviewed by the authors. The authors take full responsibility for the accuracy, integrity, and originality of the work. DISCUSSION AND CONCLUSION: Current evidence indicates menopause is associated with shifts in gut microbial diversity and metabolic function. However, most human evidence remains observational and associative, and causal mechanisms remain to be established.