June 4, 2025
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Unless you’re pregnant, it’s no fun to have a belly that expands like a balloon throughout the day. In the morning, your tummy profile looks flatter than when you went to bed. But as the day goes on, your bloated belly bulges more and more—like Winnie the Pooh’s expanding waistline after a pot of honey.
In a perfect world, digestion should be a non-issue in your life. It should occur in the background as an ongoing pattern: eat, digest, absorb, eliminate. As a normal bodily function, digesting food shouldn’t disrupt your life. You should be able to power through the day like the beautiful, sassy woman you are without worrying about gassiness.
But in perimenopause and menopause, many women fight a daily digestive battle against bloating and gas.
What causes bloating in perimenopause?
Bloating and gas may arise from hormonal fluctuations during perimenopause and menopause. While experts haven’t totally figured out all of the interactions between hormones and the gut, a couple of hormone-induced issues contribute to the bloat: slower digestion and imbalanced gut microbes.
Sluggish digestion
Since estrogen and progesterone help regulate gut motility, a decline in these hormones may lead to a lethargic gastrointestinal tract. Weaker muscle contractions in the intestines make the food travel more slowly through the digestive system. And the sloth-like movement leads to constipation.
When poop sits in your large intestine too long, bacteria break down the stool, creating extra gas. You end up with bloating, belly pain, and flatulence (a fancy word for farts).
Messed up microbes
The trillions of microorganisms—bacteria, viruses, and fungi—that live in your large intestine are collectively called the “gut microbiome.” For healthy digestion and immune function, you need many different types of beneficial microbes to be thriving inside you. These little critters support proper digestion, produce health-promoting compounds, and help keep the gut lining strong.
Estrogen and the gut microbes both affect each other throughout your reproductive years. Estrogen supports a healthy balance of gut bacteria—the right kinds and enough diversity. And some types of gut bacteria produce an enzyme that helps regulate circulating estrogen levels.
But then along comes perimenopause. The changes in hormone balance—including decreased estrogen and increased cortisol—alter the gut microbiome composition. Specifically, the microbial diversity lessens, so an imbalance of the microbe species develops. You may have heard this imbalance referred to as gut “dysbiosis.”
Dysbiosis in the intestinal microbiome leads to altered digestion, inflammation, and a weakened gut lining. As the intestinal lining weakens, tiny food particles can leak out into the bloodstream causing an immune response. The result? A condition called leaky gut syndrome with digestive distress in the form of—you guessed it—gas, bloating, and food sensitivities.
Hormone therapy may fight flatulence and bloating
If estrogen and progesterone imbalances in perimenopause wreak havoc on digestion, could replenishing the hormones make it better? While there isn’t a lot of research out there, a small study in postmenopausal women found that progesterone therapy did significantly speed up transit time through the colon, which could help alleviate constipation.
Another study compared the gut microbiomes of reproductive-age women with two groups of postmenopausal women—some on hormone replacement therapy (HRT) and some not. The women on HRT had more similar microbiomes to the reproductive-age women, while the women who were not on HRT had more gut dysbiosis.
Overall, these studies suggest that replenishing and balancing the hormones with hormone replacement therapy may help restore a healthier microbe population in the gut. If bloating and gas are making your life miserable, perhaps hormone therapy is worth a try.
At Belmar Pharma Solutions, our pharmacists create compounded bioidentical hormones based on two things: your prescribed dosages and whatever other unique needs you have. For example, if certain fillers in oral medications normally upset your digestion, we can work with you to find a different formulation in oral BHRT that you can tolerate.
Lifestyle changes to banish bloating and gas
There are strategies you can use in your daily routine to improve your digestion. A big one is making sure you don’t swallow air, which can cause bloating. It’s easy to gulp in air while eating and drinking, without even realizing it’s happening.
To prevent getting air into your digestive tract, shun these habits:
- Eating too fast
- Drinking soda and other fizzy beverages
- Using a straw
- Sucking on hard candies
- Chewing gum
Be especially wary of gum or mints that contains sugar alcohol sweeteners like xylitol or sorbitol. Not only will you swallow air while chewing or sucking them, but the sugar alcohols increase flatulence.
Another way to fend off flatulence is to steer clear of foods with high-fructose corn syrup, inulin, or chicory root fiber.
Eating lots of high-fiber foods like fruits, veggies, beans, legumes, and whole grains is great for your microbiome because the fibers in plant foods feed your intestinal microbes. But if you’re not used to a lot of fiber, add it slowly. If you ramp up the fiber too fast, your bloating and gas may temporarily increase until your body gets accustomed to it.
To soothe your gastrointestinal tract, try sipping herbal teas like peppermint, ginger, or chamomile. And an anti-inflammatory diet, including omega-3 fats, may help quell inflammation in the gut lining.
If you want to support your gut microbiome with probiotics, you can try yogurt, kefir, or probiotic supplements. Talk with your provider about what they recommend.
Here’s to banishing the gas and getting your sassy self back!
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