Gina Kaye (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. This episode is part of a miniseries focused on empowering and educating women about menopause and perimenopause. I'm your host, Gina Kay. And today, we are visiting with Dr. Ekta Gupta, gastroenterologist at the University of Maryland Medical System.

Our topic today is menopause and your gut, why digestion may change. Welcome, Dr. Gupta. It's great to have you.

Ekta Gupta, MD: It's a pleasure to be here. Thank you for the warm welcome, Gina.

Host: Digestive changes can sometimes accompany perimenopause and menopause, but they should not automatically be dismissed. Dr. Gupta explains possible connections between hormones and gut health, practical ways to feel better, and symptoms women should discuss with the doctor. To start, many women notice bloating, constipation, reflux, or changes in their bowel habits during perimenopause.

What do we currently know about the connection between menopause and digestive health?

Ekta Gupta, MD: That's a great question, Gina. And I think there are so many women who are going through this right now. So, it becomes all the more important that we talk about this important topic. So around perimenopause or menopause, there are expected hormonal changes, and one may expect to see a lot of gastrointestinal, you know, newer symptoms as well.

And these changes can be multifactorial. Part of it is related to the hormonal change or shift because, you know, there's change in the level of estrogen and progesterone in our body, which does help mediate a lot of the gut hormones to how the brain perceives a lot of it. So, you know, it can lead to you know, constipation, reflux, bloating, visceral hypersensitivity, which is increased sensitivity of the gut as well as change in the gut microbiome or the inflammatory pathway.

But if you ask me objectively based on available evidence or research, is it all truly 100% related to menopause or hormonal change? Possibly not. So based on evidence and signs, you know, these changes in symptoms can be multifactorial. Part of it could be hormones. There was a beautiful Nature Review from Gastroenterology and Hepatology in 2025 where it attributed part of it could be hormonal change, but part of it could also be some changes in metabolism, sleeping habits, eating habits, medications that we change, you know, around menopause time. So, you know, some of it could be attributed to that as well.

Host: I had a feeling this wasn't going to simple.

Ekta Gupta, MD: You're very right on that.

Host: How might changing levels of estrogen and progesterone affect digestion, gut movement, or the way women experience digestive discomfort?

Ekta Gupta, MD: It does have a role to play because, you know, estrogen and progesterone is present you know, in our body and also help mediate the bigger neural pathways which helps communicate the gut sensation and the brain. So, it can lead to, you know, increased sensation of bloating or what we call as visceral hypersensitivity.

So normally, if an individual's colon has some gas and has distension, you know, anybody with the hormonal change may perceive it way differently. The hormone progesterone can, you know, relax the lower esophageal sphincter, which may cause more reflux symptoms to happen as well, and sometimes can also slow down gut motility and can cause constipation.

So, you know, a lot of these hormonal pathways, you know, can also impact gut microbiome or can lead to change in the inflammatory pathways. And some of it, as we discussed, would be related to diet and lifestyle as well, which is common or expected during menopause.

Host: Great information. Can perimenopause or menopause make conditions such as acid reflux, irritable bowel syndrome, or inflammatory bowel disease feel different or become harder to manage?

Ekta Gupta, MD: So, that's a great question, and I'm sure a lot of our audience have this question as well. So, a lot of these diagnoses, you know, could be mediated by hormones. So, hormonal changes or menopause can be regulating a lot of these diagnoses, but should not, you know, change the diagnosis. So for example, as I just mentioned, that, you know, progesterone can cause reflux symptoms, or a lot of these hormonal changes can cause, you know, constipation, bloating, and these symptoms.

Especially irritable bowel syndrome, which means inherently if somebody has a sensitive gut, can cause, you know, increased constipation, diarrhea, bloating, and those symptoms can, you know, fluctuate during menopause or perimenopause. I would definitely be very cautious around patients with inflammatory bowel disease and, you know, patients with ulcerative colitis or Crohn's disease.

If they have changes in symptoms of diarrhea, constipation, blood in stool, you know, that is a, you know, manifestation of major inflammation. And, you know, that needs to be objectively evaluated if it is related to their inherent disease process of ulcerative colitis, Crohn's disease, and should less likely, you know, be attributed to hormonal changes.

Host: Let's talk about some things that we can do. What everyday changes may help women manage bloating, constipation, reflux, or irregular bowel movements during menopause?

Ekta Gupta, MD: Now, that is a great practical question, and a lot of our audience can benefit and take some practical tips from it. So, you know, increasing fiber intake, water intake, physical activity can really help with constipation because, you know, constipation and bloating truly relies on physical activity, movement, hydration, and our fiber intake.

One needs to be cautious about fiber intake to not, you know, just escalate fiber intake all of a sudden because that could worsen bloating as well. One needs to be cautious about, like, following different patterns. Maybe, you know, having a diary which monitors, like, your eating pattern or some trigger foods can be important.

So, those are the things one need to keep in mind, you know, when they are going through these hormonal changes, which can be really helpful in managing their reflux. Especially, you know, for reflux, if they're having a heavy meal, they should focus on, you know, lighter meals, early dinners, avoiding bedtime snacks, and avoiding a lot of spicy and acidic foods.

Host: Women are often marketed probiotics, detoxes, and supplements for menopause-related gut symptoms. Which claims should they approach cautiously?

Ekta Gupta, MD: So, that is where, you know, evidence should really come before marketing because, you know, like, if you go to any grocery store, there are aisles full of probiotic supplements and detox medications. Amazon, you know, tons of it. And one needs to be very judicious or mindful, like, what is the purpose or indication? Is menopause truly an indication to take a new probiotic or a new supplement? And if you look at American Gastroenterology Association guidelines, menopause is not one of the indications, and one needs to be mindful, what is the strain, what is the strength, what is the indication and purpose for taking those probiotics.

And, you know, probiotics basically, you know, a healthy gut microbiome can never be administered in a jar. It should more be with your diet. The foods which will promote the growth of good gut microbiome is the way to do it. Also, by increasing physical activity, sleeping well. You know, this is the way good gut microbiome gets populated in our gut and not in form of a supplement bought in a jar.

Some of it can even worsen diarrhea and bloating. So, you know, we need to be mindful of that. Our kidney and liver serve as major detoxificationsy stems in our body. So, we don't need an additional detox system in a form of, you know, some supplement or, you know, something that can be bought on Amazon. So, you know, here is a point where evidence, in fact, should come before marketing.

Host: That is great information to hear, and we are inundated with marketing on a daily basis for sure. Does every woman experiencing digestive changes need a probiotic?

Ekta Gupta, MD: So truly, you know, as I just mentioned, there could be certain indications when one needs to talk to their healthcare provider like, you know, if they have a true indication for taking a probiotic. But in form of diet, there are certain foods which promote growth of good microbiome is the way to go for probiosis. So, you know, taking sauerkraut, kimchi, yogurt increasing physical activity. You know, those are the ways where people who are in menopause or perimenopause should be able to inculcate growth of good gut microbiome in their gut.

Host: Which digestive symptoms should women not assume are simply part of menopause or getting older?

Ekta Gupta, MD: So, that is a million-dollar question. You know, in perimenopause where there are so many hormonal changes, there are newer symptoms for different reasons, one needs to be mindful if there are newer symptoms and they're persistent. They have what we call as red flag symptoms, which is blood in stool, unintentional loss in weight, unexplained anemia, fatigue, lack of energy.

You know, those are the symptoms which we call as red flag symptoms, which the patient should seek immediate medical attention and discuss with their primary care or their gynecologist and seek help. So if they have been having symptoms, they have been chronic and persistent and they have not been able to get some reasonable answer or an explanation to it, is definitely the time when, you know, they need to talk to their healthcare provider.

And this is a good point where preventative medicine also comes in picture where they need to focus on colon cancer screening, cervical cancer screening. You know, all the health maintenance and screening guidelines need to be met where, you know, they're at a juncture where their health truly need their attention.

Host: And I think you may have already touched on this, but let's ask this question anyway just in case. When should a woman talk with her primary care provider, gynecologist, or gastroenterologist about digestive changes?

Ekta Gupta, MD: So, I think we don't need to wait to see a specialist. You know, I think if they have symptoms, you know, which have been persistent, they need to talk to their healthcare provider. So, you know, a good start can be their primary care physician or gynecologist who can do an initial intake and workup and do an initial diagnostic test, you know, basic routine labs.

But if there are abnormalities or if these symptoms continue to be persistent with no explained reason, then definitely, you know, a gastroenterologist can be consulted. And What I always tell my patients is it's a collaborative approach. Patient care is truly a collaborative approach, you know, like between the primary care physicians and and the specialist and, you know, it has to be hand in hand with close communication, closed loop communication.

Host: To wrap up, what is one thing you wish every woman understood about protecting her gut health during midlife?

Ekta Gupta, MD: I truly want all women who are listening to this to understand that, you know, menopause can lead to part of their symptoms. But, you know, it is part of their story, but it is not the entire story. So if they have symptoms that does not fit into their story, you know, they need to seek medical attention and it is time to seek care. And, you know, the best care is when they are very open with their primary care or their gynecologist and discuss and get the care that they truly need and deserve.

Host: Dr. Gupta, thank you very much for sharing your knowledge and your time today.

Ekta Gupta, MD: Absolutely. It's a pleasure, and I'm hoping our listeners get some good tips for their gut health and also managing their menopause and perimenopause symptoms.

Host: Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. Please share this on your own social media channels. For more great health information, visit health.umms.org. Thanks for listening.