Could probiotics help with menopause symptoms?
The symptoms and severity of symptoms that a woman suffers during the menopause are very unique to each individual, however the kinds of unwanted symptoms that us ladies might have waiting for us (or, have already experienced) include: vaginal dryness, hot flashes or sweats, vulvo-vaginal atrophy (VVA), loss in bone density, headaches, loss of libido and low mood. It doesn’t really sound like a whole lot of fun, does it?! So, any advances in treatment/management approaches would be exceptionally well received by the 'fairer' sex, especially if that answer might lie in something as simple as the micro-organisms that we have living in our intestines and on other mucosal surfaces in the body.
Let’s first look at what causes this myriad of different symptoms. Menopause occurs due to a complex series of hormonal changes. As a woman’s egg reserves begin to run low, they become more resistant to FSH (follicle Stimulating Hormone), this causes a rise in FSH, at the same time there is a big drop in oestrogen production from the ovaries. Testosterone and progesterone levels also decline. Oestrogen affects many parts of the body, including the: breasts, uterus, skin, bones and brain. For this reason, loss of oestrogen is thought to be the main culprit behind most menopausal symptoms.
How might probiotics help?
Bone density preservation:
In a recent study, published in the Journal of Clinical Investigation 1, researchers at Georgia State University used mice that had had their ovaries removed to mimic the oestrogen loss in menopause. The mice were divided in to two groups, and either given probiotics (see Probiotics Learning Lab) on a daily basis, or not. A month after ovary removal, the mice that were not treated with the probiotics had lost half of their bone density, whereas those receiving the probiotic mix (an eight strain blend, including Lactobacillus rhamnosus GG) maintained their pre-operative bone density levels.
Researchers found that the protective effect that the probiotics had on bone density was caused by preventing gut permeability. A loss of oestrogen after the menopause, or in this case after the removal of ovaries, increases gut permeability, which allows bacterial products to activate immune cells. These immune cells release signals that break down bone. So, by preventing the gut permeability that is associated with oestrogen loss, probiotics were able to safeguard bone density in these mice. Senior study author, Doctor Roberto Pacifici commented that he feels that ‘there are direct implications for the treatment of osteoporosis that should be tested clinically’.
The type of bacteria used was important, as we all know that different strains of bacteria do different things. When laboratory mice were treated with E.coli bacteria for example, the intervention did not help to minimise bone density losses. More research is needed in to which other strains of probiotic may also exert a beneficial effect, and research using a human model is also necessary.
Reducing vaginal symptoms:
The health of vaginal tissues is directly linked to oestrogen levels, and as these levels drop during peri-menopause and then menopause, so the tissues of the vagina become less protected and less well ‘nourished’. The result is often vaginal dryness and vulvo-vaginal atrophy. But is it really the drop in oestrogen levels that causes this, or is there another link in the chain? Research suggests that rather than lowered oestrogen directly causing vaginal changes, it may be that lowered oestrogen is simply causing a reduction in probiotic bacteria in the vagina, which then in turn leads to vaginal dryness, atrophy and the potential for vaginal infections. It is thought that probiotic bacteria modulate the immune system and interfere with the inflammatory cascade. Less inflammation means less tissue damage. Studies 2 show that oral probiotic therapy can support the vaginal ‘ecosystem’, and prevent reductions to the protective vaginal flora that may cause dryness and irritation. To read more about the correct strains of bacteria for our 'intimate' flora, you may find the following FAQ in the Probiotics Learning Lab helpful:
Lifting a low mood:
Certain strains of probiotic bacteria, such as Lactobacillus acidophilus Rosell -52 and Bifidobacterium longum Rosell-71 have been shown to improve a low mood. Professors at Harvard Medical School 3 suggest that certain strains of bacteria are able to improve our mood in this way, by directly increasing the levels of certain key ‘feel good’ neurotransmitters such as GABA and serotonin in the body. The Harvard research team also suggest that these bacteria are able to activate neural pathways between the gut and the brain. To read more about the mood-elevating properties of probiotics, you may like to read my earlier blog post, also over in the Probiotics Learning Lab: Psychobiotics, just a fad or here to stay?
Early evidence suggests that probiotics may have their part to play in managing the symptoms of menopause and peri-menopause. It is my personal belief, that with good nutrition and lifestyle management, women do not necessarily need to suffer any discomfort during this transitional time. In fact women from more traditional cultures generally sail through the menopause unaffected, which leads me to believe that it is not necessarily the drop in hormone levels that is directly causing unwanted symptoms, rather it is the impact of this drop in hormones on our gut and vaginal flora that could be responsible. according to Dr. Lindsey Berkson's estimates in "Hormone Deception" only 7% of Japanese women suffer from hot flushes as opposed to 55% of women in the U.S. This lack of symptoms in Japanese women has often been put down to a diet that is rich in soy products, as soya is a good source of plant-based oestrogens. However, it could also be down to the amount of fermented foods that they eat, which provides them with a good daily dose of probiotics from traditional foods such as natto and tempeh.
Whilst more research certainly needs to be done, I can see no harm in increasing the amounts of fermented foods that we consume, and using a good, high-quality probiotic (or two) to improve microbial diversity in both the GI tract and also the vaginal tract, in an attempt to curb menopausal symptoms.
- Jau-Yi Li et al, Sex steroid deficiency–associated bone loss is microbiota dependent and prevented by probiotics, Journal of Clinical Investigation (2016)
- Hummelen, R., Macklaim, J. M., Bisanz, J. E., Hammond, J. A., McMillan, A., Vongsa, R., ... & Reid, G. (2011). Vaginal microbiome and epithelial gene array in post-menopausal women with moderate to severe dryness
- 'Fermented foods, microbiota, and mental health: ancient pratcice meets nutritional psychiatry' Eva M. Selhub. Journal of Physiological Anthropology, 2014.