As a women’s health practitioner I have seen roughly 1000 different women sitting in front of me (or on the computer screen) telling me about their digestion. How they can start the day with a relatively flat stomach, and in the afternoon look as though they are 6 months pregnant. They will also comment on how they have started snapping at colleagues, their kids and husbands, like a monster has taken over their brain and they have no control over how they feel in acutely stressful situations. These are common scenarios which I look to help improve for these women.

Your digestive system is literally the engine powerhouse of your body. It is there to break down food into little pieces we use for energy, growth, and repair. It is also responsible for eliminating waste, and all the muck we don’t want clogging us up. When there is something wrong with the gut- you will know about it;

• bloating

• extra gas and burping

• indigestion and heartburn

• abdominal pain

• bowel and stomach noises

• bad breath

• funny taste in the mouth

• constipation

• runny or mushy poos

• undigested food in stools

• changes to skin

Something happens when we hit 40. What is it about our biology that intensifies these symptoms? Is our gut health linked with how our hormones work?

Absolutely! Can we do something about it? Absolutely!

The Gut–Hormone Connection: What’s Really Going On

Gut dysbiosis is when the balance of bacteria, predominantly in your small intestine is dysregulated. The groups of bacteria known to help promote good digestive function are affected by some of the potentially harmful groups like Streptococcous species, Staphylococcous species, or Klebsiella species (among possible other bacteria). These other bacteria are generally ok in small amounts, but given the right environment they can over-grow, create havoc and start to cause inflammation in the gut. Unfortunately, just taking a probiotic is not going to fix the issue.

Your gut microbiome does far more than help you digest food. It plays an active role in nutrient absorption, immune regulation, inflammation balance, and—crucially—hormone metabolism. One of the most important (and often overlooked) aspects of gut health is the estrobolome: a specialised group of gut bacteria involved in the breakdown and recycling of oestrogen. This estrobolome acts as a key link between digestive health and hormonal balance, helping determine how effectively oestrogen is cleared, reabsorbed, or recirculated in the body.

The Estrobolome: How is your body metabolising Oestrogen?

Your body uses oestrogen for multiple purposes every day;

1. Having a regular period and supporting ovulation to take place for a pregnancy to occur.

2. Breast development (growth and fat development), and mammary gland support during pregnancy.

3. Keeping bone density in check by inhibiting osteoclasts (cells which break down bone tissue), and promoting the activity of bone-building osteoblasts, thereby maintaining bone density and strength.

4. Helping to regulate HDL cholesterol levels to support heart health by boosting Apolipoprotein A-1 (Something I like to check with my patients when they have been told they have high cholesterol).

5. Stimulating collagen and elastin production to keep skin moist, elastic and stimulate hair growth.

6. Promoting serotonin production by stimulating the synthesis of tryptophan hydroxylase (which is essential to building serotonin). As well as increasing the number of receptors in the brain for serotonin to attach- for greater effectiveness. Helping mood, and cognitive function.

Once you body finishes using oestrogen for these cellular process the oestrogen molecules are then conjugated in the liver and excreted into the gut via bile. A particular enzyme of the estrobolome: β-glucuronidase deconjugates these oestrogens, allowing them to be reabsorbed through the intestinal wall and recirculated into the bloodstream, helping oestrogen to continue to work as needed.

When there is dysbiosis in the small intestine, the estrobolome is disrupted, recycling diminishes as systemic oestrogen levels drop further. These lower oestrogen levels can cause symptoms such as; hot flashes, night sweats, vaginal dryness, irregular periods, mood swings, sleep problems, and decreased libido.

So how do we manage our estrobolome?

We look to clean up the gut! This will often include identifying what’s there to clean up in the first place. Doing a Gut Microbiome test will give a thorough look at what is going on with some of the key players:

• how much Beta glucuronidase is present?

• are there any potentially harmful bacteria in high numbers which need managing?

• is the beneficial bacteria in a position to help or does it need nourishing?

• Are there any other pathogens like fungi, protozoa, or parasites contributing to the inflammation in the small intestine?

Once we have established the What, we can look at the how.

Some of the simple dietary tools can make the biggest difference.

1. Look at increasing dietary fibre from a variety of colourful fruits and vegetables, nuts, and seeds, legumes and pulses. Try for 50gm dietary fibre daily!

2. Keep the body well hydrated with two plus litres of filtered water daily, plus herbal teas like nettle leaf, calendula, dandelion root, chamomile, and fennel seed.

3. Use apple cider vinegar with olive oil as a salad dressing to help break down fibrous foods and support stomach acid production.

4. Limit inflammatory foods which can effect the beta-glucuronidase levels like coffee, red meat, processed foods, fried foods, simple carbohydrates (white rice and breads) and refined sugars.

5. Increase cruciferous vegetables in your diet: broccoli, asparagus, brussel sprouts, kale, cabbages, and broccolini. These contain a compound which favourably helps with oestrogen metabolism in the gut.

Lifestyle support is just as important as the actual food you eat.

1. Avoid eating with distraction. Sit down and take time out to eat your food slowly, chewing each mouthful, and away from stimulation like your phone, computer, or television.

2. Breathing is key! Find a breath work practice in your day which is easy to implement. It might be via an app like Nerva or Smiling mind. Or something you have learned in a yoga class. This automatically helps your vagus nerve with how inflamed or stimulated it is, and it can calm down.

3. Prepare a meal with mindfulness. Avoid buying takeaway foods on the go and write up a meal plan for the week with 5 meal ideas. Or bulk prepare enough for 2-3 days to give you a nourishing meal with the right amount of fibre and protein required for your body.

4. Try to finish your meal 3 hours before bed. Give your digestive system a chance to work through some of the complex proteins and fats you have eaten before laying down. Maybe an evening walk would also be a nice support for breath work and vagal nerve support.

5. Movement will allow for space in your gut to open up. If you sit at a desk all day, your stomach and intestines are literally compressed for hours at a time. Take breaks each hour to stand up, stretch, walk around a little. You will find this helps a lot for those prone to gas and constipation.

In my experience, after roughly three months of working on your gut, you will start to notice changes in your perimenopausal symptoms. Think of your gut as a portal to accepting messages from your hormones to your brain. When the gut is opening those messages and delivering them to the right places- the message is received more clearly.

Less fatigue, less irritability, and in many cases less bloating.

If you are experiencing changes to your gut or hormones and would like some support or guidance, you can find me online at:

https://www.naturopathywithclaire.com.au/ or instagram.com/naturopathywithclaire/

Key message: These symptoms aren’t random or “just ageing” — there’s biology behind them.

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Why can some couples fall pregnant strait away, and others cannot?

I have been working as a naturopath for almost twenty years, and fifteen of these years have been working with couples trying for a baby. Now before you ask, yes it is hard being part of this journey. As an emotional Scorpio, who for most of my career has been of child rearing age, I have found it incredibly rewarding when the outcome is a healthy beautiful baby. And yet incredibly upsetting when it just doesn’t happen. But why doesn’t it happen for some?

Is it the diet?

This is the largest part of what I work on with clients. We look to increase the volume of fresh, organic, fruit and vegetables to each meal. Increasing the antioxidants like; polyphenols, carotenoids, anthocyanins, vitamins, and minerals. Now making radical changes to someones diet can be tough, but the dedication to making it work for a couple trying to conceive is like no other motivation I have seen before.

For some increasing the antioxidant rich foods is easy, so we promptly move on to ensuring regular protein intake is coming from non-processed meats, organic eggs and tofu, nuts, seeds, lentils, pulses, and beans.

Honestly- that’s enough, if you can make the foundation of your diet a combination of these two categories you are going to provide your body with an entire list of vitamins, minerals, nutrients, and phytochemicals which really nourish your body and feed your hormones in all the right ways.

If you are doing all of this, but vaping, and consuming alcohol regularly, slamming a packet of chips, munching on take-away pad thai, hot chips, and burgers then there is going to be a lot of muck in your gut disrupting those endocrine receptors which are trying to get those hormones communicating at their best.

Is it the stress we put on ourselves and our partners?

There is no doubt that trying for a baby for months on end creates stress and tension in a relationship. It also creates stress in the body. When the body is under stress what do you think the first area of our biology is effected?

Our fertility is not a survival response, it is something which in most cases thrives in conditions amenable to a relaxed environment. Now in my experience, many couples I work with, they themselves work in the concrete jungle, often in high stress positions. They work long hours, in sedentary professions, in offices filled with artificial lighting, recycled air-conditioning, average cafes with toasted sandwiches, and a culture of coffee breaks. So to offset this go-go work life, 6am gym classes with 5:00am alarm clocks are set to get the exercise and mobility needed in for the day. Followed by a closing to the day of a ready-made meal at 8pm, a couple of glasses of wine, some streaming on phones/ipads before the lights go out and it starts all over again.

For many couples, I encourage them to look at what their week looks like, and how they can bring more down time, screen-free time, time spent in nature to create a more fertility friendly environment.

Is it the supplements or the lack thereof?

Patient X “My GP told me to take some elevit?”

Me “Ok, and what about your partner?”

Patient X“They didn’t say he needed to take anything”

Me “Ok… let’s talk about this…”

When trying to conceive, in Naturopathic territory, the type of prenatal multivitamin you take matters. Just like research has shown the importance of folate to prevent neural tube defects, adequate intake of nutrients like choline, iodine, active B12, and trace minerals are really part of our foundation for preparing the body for pregnancy.

Not only does it matter for the woman, but for the owner of the sperm cells too.

Not all prenatal multivitamins are created equal, so some products such as elevit are missing key nutrients essential for embryonic development, like choline. When you and your partner are looking to make a baby, you ideally want 12-6 months prior to conception to be nutrient loading. This means giving your bodies ALL the key nutrients required for healthy egg and sperm cell health.

There is no real way to know, but in many cases in my clinic we have switched over to good quality prenatals for both partners, and conception has occurred within 3 months of using the preferred supplements.

Is it the relationship?

I am not a counsellor, and by no means a relationship expert. But in some of my couples there is often one person driving the fertility train, and one person a passive passenger who hops on and off as they choose.

I always encourage both partners to come to appointments so everyone gets the same information and is given the advice appropriate to them. Yet as it goes for many couples, it is often the woman changing her diet, taking her vitamins, downloading the meditation apps. While the male partner (in heterosexual relationships) is eating the healthy dinners, sometimes taking his vitamins, and smashing the beers on the weekends.

Now of course this is not the cause of anyones infertility- but when the urge for some is so strong to have a baby, and just slightly there for others, I do believe there is a certain amount of cosmic energy at play perhaps stalling things for a reason.

Is it the timing?

We all know that falling pregnant requires insemination during the ovulatory window. But what we don’t all know is when we ovulate. This is a key piece of information for couples who have been trying for more than 6 months. There are only a certain number of days in a woman’s cycle in which ovulation can take place, so learning about your body for signs of ovulation is really helpful.

• One sided left lower abdominal pain (short and sharp, called “Mittelschmirz” translating to middle pain). It will alternate each month if you are ovulating from both ovaries. Not noticeable for all women.

• Cervical mucous is fluid which is made by the cervix at various times during the menstrual cycle. It typically becomes clear, stretchy, and thin during ovulation to allow for sperm to reach the egg easily.

• Basal body temperature increases by about 0.2-0.3 degrees celsius after you have ovulated. This is one of the most accurate ways to tell if you have ovulated. Tracking your temperature during your cycle is a great way to help support your conception if you are having difficulty.

These three signs are your best natural indicators for ovulation. There are more tests which can be done to gauge if you are ovulating regularly including blood hormone tests and ultrasound monitoring. The advice I give my clients is to have sex every 2 days from day 10 of your cycle until day 18.

My personal opinion

For me, as a person who studied naturopathy, as a woman who had PCOS with irregular cycles, as a person who eats a varied diet with as much organic produce as I can, as a person who took all the prenatal vitamins, and laid out the bottles for my husband to take each morning, and as a person who had a miscarriage for my first pregnancy, and fell pregnant first time at each attempt I believe it really is a combination of all the topics I mentioned above. Diet, stress, supplements, timing, and a supportive partner. I also believe that there are plenty of people just like me, for whom falling pregnant and having a baby hasn’t happened. For reasons we don’t yet know. I have my suspicions on environmental factors, genetic variants, and energetic blockages.

I believe that if you want a baby, you will try anything, and you will throw immense amounts of time, energy, and money at it, and for some it will work out, and others it wont. As an optimist I think it is always worth trying. I hope you all get to meet your baby some day and be filled with the fruits of your labour (including citrus).