Journal of South Asian Federation of Obstetrics and Gynaecology · Aug 11, 2026
The Estrobolome and Gut Microbiome in Perimenopause: Bidirectional Interactions, Clinical Consequences, and Therapeutic Opportunities
By Garg R
Objective: To synthesize current evidence on gut microbiome alterations during perimenopause, focusing on the estrobolome's role in estrogen metabolism and its implications for women's health.Materials and methods: Narrative review of peer-reviewed literature examining the estrogen-gut microbiome axis in perimenopause and early menopause.Results: The estrobolome comprises gut microbial genes encoding β-glucuronidase and related enzymes that facilitate enterohepatic estrogen recycling.Hormonal volatility in perimenopause likely destabilizes microbial diversity, reduces short-chain fatty acid (SCFA) producers (e.g., Roseburia, Faecalibacterium), and increases proinflammatory taxa.These shifts impair estrogen recirculation, intestinal barrier function, and metabolic homeostasis, contributing to insulin resistance, visceral adiposity, bone loss, mood disturbances, and genitourinary symptoms.Bidirectional crosstalk exists: estrogen modulates gut immunity and barrier integrity, while dysbiosis exacerbates hormonal fluctuations.Longitudinal data remain limited, but preclinical and cross-sectional studies support causality in metabolic and skeletal phenotypes.Conclusion: The gut microbiome, particularly the estrobolome, is a modifiable mediator of perimenopausal symptom burden and long-term cardiometabolic, skeletal, and neuropsychological risks.Dietary modulation and probiotics show promise, but rigorous interventional trials are needed.Integrating microbiome insights could refine preventive strategies and personalize care during the menopausal transition.