Menopause shows up differently for everyone. For many, it’s a hormonal rollercoaster, bringing shifts that feel sudden and unexpected.
One day, you might have hot flashes and brain fog, and the next, it’s night sweats and restlessness keeping you up at night. And while we often hear about the symptoms, what’s less talked about is why these changes happen and how deeply they affect your whole body—from your brain and bones to your gut and vaginal health.
Think of this as your guide to understanding menopause from the inside out. We’ll explore what’s happening hormonally, how it impacts different parts of your body, and how your gut and vaginal microbiomes play a role in the transition.
What is menopause?
You probably already know that menopause marks the end of your reproductive years—it’s official after 12 consecutive months without a menstrual period. But biologically, menopause is just one point in a longer hormonal transition that unfolds over several years [1].
Here’s how the full journey typically looks:
- Perimenopause: This is the transition phase leading up to menopause, often beginning in your 40s, where hormone levels start to fluctuate. Early perimenopause is marked by occasional missed periods or changes in cycle length. In contrast, later perimenopause involves longer gaps between periods—up to 60 days or more—and more pronounced symptoms as ovarian function declines. This stage can last anywhere from 5 to 10 years and varies widely between women.
- Menopause: This is the point when your periods stop for good.
- Postmenopause: The phase after menopause. While some symptoms may fade, others continue or change. And new health considerations—like bone or heart health—may come into focus.
Most women reach menopause around age 51, but the timing can vary depending on genetics, lifestyle, and health conditions.
The hormonal shift
At the heart of the menopause journey is a significant drop in two key hormones: estrogen and progesterone. These are produced by your ovaries and influence nearly every system in your body.
Estrogen in particular plays a major role in:
- Regulating your menstrual cycle
- Maintaining bone density
- Supporting brain function and mood
- Keeping your vaginal and urinary tissues healthy
- Influencing how your gut and immune system function [2]
When estrogen declines, your body has to adjust, and that’s when many symptoms appear.
What’s happening in your body?
Because estrogen affects so many tissues, the changes during the menopausal transition can feel like they’re happening everywhere. And in a way, they are.
Here’s how your body may be affected:
- Brain: Hormonal shifts during menopause affect areas of the brain involved in temperature regulation, mood, memory, and cognition, which can lead to changes in how you feel and think [3], [4].
- Bones: Lower estrogen levels accelerate bone loss, increasing your risk of osteoporosis [5].
- Heart and metabolism: Menopause is associated with changes in cholesterol levels, insulin sensitivity, and fat distribution, which can raise cardiovascular risk [6].
- Vaginal and urinary tract: Tissues can become thinner and drier, leading to discomfort, increased risk of infections, and changes in sexual health [7].
- Gut: You might notice changes in digestion or bowel habits—your gut is also influenced by hormonal changes [8].
Common symptoms of menopause
No two women experience menopause the same way, but here are some of the most common symptoms [9]-[11]:
- Hot flashes and night sweats
- Heart palpitations
- Sleep disturbances and insomnia
- Mood swings, anxiety, or depression
- Brain fog or difficulty concentrating
- Vaginal dryness and painful sex
- Increased urinary urgency or frequency, and more frequent urinary tract infections
- Changes in digestion or bloating
- Weight gain and slower metabolism
- Oral health issues
Your microbiome matters, here’s why
The gut microbiome and menopause
Your gut is home to trillions of bacteria that help regulate digestion, metabolism, immunity, and even hormone processing. Emerging research shows that the gut microbiome changes during menopause.
For example, studies have found that compared to premenopausal women, postmenopausal women often have:
- Lower levels of beneficial bacteria like Bifidobacterium, Faecalibacterium prausnitzii, and Roseburia.
- Higher levels of potentially inflammatory bacteria like Parabacteroides and Bilophila.
- Reduced microbial potential to produce beta-glucuronidase, an enzyme involved in estrogen metabolism [12]-[14].
These changes may contribute to digestive issues, weight gain, inflammation, and even mood changes. Supporting your gut health during this time can make a meaningful difference in how you feel.
The vaginal microbiome and menopause
Estrogen helps keep your vaginal microbiome healthy and dominated by Lactobacillus—bacteria that produce lactic acid and keep the vaginal environment acidic, which protects against disruptive bacteria.
When estrogen drops:
- Lactobacillus levels decrease, especially L. crispatus and L. iners.
- Other bacteria, including those associated with bacterial vaginosis or urinary tract infections, may increase [15], [16].
This shift can lead to vaginal dryness, discomfort during sex, and a higher risk of infections [9]-[11]. Thankfully, there are ways to support your vaginal health through targeted probiotics, moisturizers, and hormone therapy.
Managing menopause: what are your options?
There’s no one-size-fits-all approach to managing menopause. The best strategy is the one that fits your symptoms, preferences, and health history.
Here are some things to consider:
- Diet. What you eat can make a big difference. Diets rich in legumes, fish, fruits, and vegetables have been linked to fewer menopause symptoms. Cutting back on refined carbs (like white rice and pasta), sugary treats, and processed fats (like mayonnaise) may also help ease the transition [17]-[19].
- Lifestyle habits. Regular physical activity, stress management, and good sleep hygiene can help support your overall well-being during this transition.
- Menopause hormone therapy (also known as hormone replacement therapy, or HRT). Estrogen-based treatments are available as pills, patches, gels, or local vaginal applications. These can be highly effective for hot flashes, sleep issues, and vaginal symptoms [20].
- Non-hormonal prescription medications. Certain antidepressants or drugs like gabapentin may help with hot flashes, night sweats, and improve sleep [21]-[24]. Always consult your healthcare provider, as these medications can have side effects.
- Supplements. Some evidence-based options include black cohosh for hot flashes, cranberry and D-mannose for urinary tract health, and Lactobacillus probiotics to help restore the vaginal microbiome if needed [25]-[30].
- Vaginal support: Moisturizers and lubricants containing hyaluronic acid can ease dryness and discomfort during sex or daily activities [31], [32].
- Gut support: Targeted probiotics may help with common complaints like bloating, irregular bowel movements, and even support mood, especially when tailored to your gut microbiome profile.
- Other supportive therapies: Alternative approaches like acupuncture, cognitive behavioral therapy, and hypnosis show promise for managing symptoms like hot flashes, anxiety, or sleep issues [33]-[38].
You’re not alone—and you’re not powerless
Menopause is a natural part of life, but that doesn’t mean you have to “just live with it.” Understanding what’s happening in your body is the first step toward feeling better, and there are more tools than ever to help you thrive during and after the transition.
Whether you're just starting to notice changes or you're well into postmenopause, it's never too late to support your health. Testing your gut and vaginal microbiome can give you a clearer picture of what’s going on inside and help you find targeted ways to feel your best: from improving digestion and mood to supporting vaginal health and comfort.
