The Gut Microbiome and Women's Health

Hormonal Balance: PCOS, Endometriosis — and Estrogen Dominance

When most people think about gut health, they think digestion. Bloating, bowel movements, maybe probiotics. But the gut does much more — especially for women.

Your gut microbiome, a diverse ecosystem of bacteria living in your intestines, influences how you metabolize hormones, how your immune system functions, and how your body handles inflammation. These processes matter a lot — particularly when it comes to conditions like PCOS, endometriosis, and estrogen dominance.

This is the first post in a 3-part series where I’ll walk through the connection between your gut and different stages of women’s health:

1. Hormonal balance (today’s focus)

2. Pregnancy and postpartum

3. Menopause

Let’s start with the foundation — the gut-hormone connection that shapes so much more than we’ve been taught.

The Gut as a Hormone Regulator

There’s a specific set of gut bacteria — known as the estrobolome — that helps metabolize and regulate estrogen. When the microbiome is diverse and healthy, this process flows smoothly. But when there’s dysbiosis (an imbalance in gut bacteria), things shift.

Too much estrogen can be recirculated. Too little may be excreted too quickly. Either imbalance can lead to symptoms like mood swings, irregular cycles, fatigue — and in some cases, more complex hormonal patterns.

Let’s look at how this plays out in specific conditions.

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1. PCOS and the Gut Microbiome

PCOS (Polycystic Ovary Syndrome) is a complex, hormone-driven condition affecting up to 1 in 10 women. It’s characterized by:

• Irregular periods

• Elevated androgens (testosterone)

• Ovarian cysts

• Insulin resistance

What the research says:

A study in the Journal of Clinical Endocrinology & Metabolism found that women with PCOS had significantly lower gut microbial diversity and altered ratios of specific bacteria. These differences correlated with higher testosterone levels and more severe symptoms.

Researchers believe gut imbalances may:

• Worsen inflammation

• Disrupt insulin sensitivity

• Amplify androgen production

Gut support isn’t a cure-all — but it’s often a missing piece that helps the whole system recalibrate.

2. Endometriosis and the Gut

Endometriosis is deeply tied to both hormones and inflammation. Women with endometriosis often experience:

• Elevated gut permeability ("leaky gut").

  • Research indicates that women with endometriosis may have altered gut barrier function, leading to increased intestinal permeability. This "leaky gut" can allow harmful substances to enter the bloodstream, triggering systemic inflammation. Studies have found higher levels of zonulin, a marker of leaky gut, in women with endometriosis.

• Increased bacteria that promote systemic inflammation.

  • Studies have shown that women with endometriosis have altered gut microbiota, with increased levels of bacteria that promote inflammation. These inflammatory bacteria may contribute to the pelvic inflammation and pain associated with the condition.

• Impaired estrogen clearance.

  • The gut microbiome plays a role in estrogen metabolism through the production of enzymes like beta-glucuronidase. Changes in gut bacteria can affect how estrogen is processed and eliminated from the body. Impaired estrogen clearance can lead to estrogen dominance, a factor implicated in endometriosis.

The gut-immune-estrogen triangle is real. Supporting gut function may help lower the inflammatory burden and support more balanced hormone activity — especially estrogen metabolism. Research has demonstrated that the gut microbiome can modulate immune responses and influence estrogen levels, both of which are critical in the pathogenesis of endometriosis. Targeting the gut microbiome may offer a novel approach to managing this complex condition.

3. Estrogen Dominance: When the Balance Tips Too Far

Estrogen dominance isn’t just “too much estrogen.” It’s too much estrogen relative to progesterone — a ratio that often gets disrupted in the 30s and 40s.

Symptoms may include:

• Mood swings or anxiety

• Breast tenderness

• Heavy or irregular periods

• Bloating

• Fatigue

• Weight gain around hips, thighs, and midsection

One of the lesser-known drivers of this imbalance is the gut — specifically the estrobolome.

How it works:

Certain bacteria in the gut produce an enzyme called β-glucuronidase, which can reactivate estrogen in the gut and send it back into circulation. When β-glucuronidase activity is elevated (often due to dysbiosis), more estrogen stays in the system — increasing symptoms of dominance.

A 2021 review in Frontiers in Endocrinology connected elevated β-glucuronidase activity with increased estrogen reabsorption and higher risks of estrogen-driven conditions, including fibroids, breast tenderness, and hormone-sensitive cancers.

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How to Support Your Gut for Hormonal Balance

The goal isn’t to overhaul everything — it’s to create a gut environment that supports hormonal regulation gently and consistently.

Here are some foundational practices:

1. Prioritize Plant Fiber.

   1. Soluble fiber from oats, beans, apples, and carrots feeds beneficial gut bacteria and supports healthy bowel movements (key for estrogen elimination). Aim for 25–35g per day from food first.

2. Eat Fermented Foods Regularly. Start slowly and consistently — just 1–2 tablespoons a day can make a difference.

   1. Try small amounts of:

      1. Plain yogurt

      2. Kefir

      3. Sauerkraut

      4. Miso

      5. Kimchi

3. Support Detox Pathways.

   1. Cruciferous vegetables like broccoli, Brussels sprouts, and kale contain compounds that help your liver process estrogen more effectively.

4. Don’t Skimp on Healthy Fats.

   1. Omega-3s from salmon, flax, chia, and walnuts reduce inflammation and support the gut lining.

5. Limit Ultra-Processed Foods and Alcohol.

   1. These can impair gut diversity, raise inflammation, and increase β-glucuronidase activity.

Supporting Clients the Vango Wellness Way

When clients come to me with hormonal symptoms, they’re often frustrated and tired. They’ve tried restrictive diets, isolated supplements, and a lot of guesswork — with limited relief.

Here’s what we do differently:

• We look at gut function, nervous system patterns, and hormonal history together

• We personalize nutrition based on your body’s real signals

• We build routines that work in your life — even with work, caregiving, or a chaotic schedule

Gut health isn’t about fixing digestion — it’s about supporting the system that supports everything else.

If this is the season you're in, I’d love to support you.

If you have any friends who would find this info useful, share my work:

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