Part 1

Importance of Gut Health and Stool Tests During Hormone Therapy 

Have you heard the saying, “all disease begins in the gut?” When it comes to women’s health and hormone balance, gut health is a critical piece of the puzzle. 

This two-part series will discuss why I always recommend stool testing for patients working to balance their hormones and women taking hormone replacement therapy. Gut function is about more than just digestion; it affects everything in the body, from the gut-brain axis to our hormones. 

Keep reading to learn more about 

• The gut microbiome-hormone connection 
• The benefits of hormone replacement therapy
• And why stool testing needs to be a part of the treatment and monitoring strategy

Then, in Part 2, I’ll dive into stool test specifics and action steps for gut healing and microbiome support. 

‍Gut Health and the Gut Microbiome - Why Everything Starts in the Gut

These are some of the most common hormone-related symptoms I see in women of all ages, and particularly in women in their 40s and early 50s during the perimenopausal transition:

• Estrogen dominance symptoms
• Mood disorders and mood swings
• Premenstrual syndrome (PMS)
• Sore breasts
• Cravings
• Bloating
• Acne and other skin problems
• Insomnia 
• Fatigue

If these symptoms sound familiar, we want to take a detailed look at your hormone patterns and assess the imbalance. During perimenopause, women experience fluctuations in estrogen, particularly in estradiol, the primary estrogen in women who have periods. 

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During high estrogen (and low or no progesterone), women may feel more PMS symptoms, irritability, sore breasts, and heavy periods. During times of lower estrogen, they might notice hot flashes, night sweats, low mood, and vaginal dryness. 

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Interestingly, gut health is a crucial piece of estrogen balance that is often overlooked. Here’s why. 

...gut health is a crucial piece of estrogen balance that is often overlooked.

Estrogen is detoxified in the liver but excreted via the digestive system. We call the removal of estrogen metabolites from the body in the stool, Phase 3 estrogen detoxification. I outline it in detail in the article High Estrogen Symptoms and Estrogen Detox.

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The ability to effectively remove estrogen has to do with the health of the gut microbiome, specifically the estrobolome. The estrobolome consists of the microorganisms involved with estrogen metabolism. 

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When the liver detoxifies estrogen, it enters the GI tract via bile and interacts with the estrobolome. Some estrobolome bacteria produce an enzyme called beta-glucuronidase, which changes the estrogen, so it can be reabsorbed into the body instead of excreted in the stool. 

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Dysbiosis, an imbalance in the gut microbiome, affects beta-glucuronidase levels and therefore estrogen levels in the body, leading to hormone imbalance symptoms and estrogen-related disease. 

Dysbiosis, an imbalance in the gut microbiome, affects beta-glucuronidase levels and therefore estrogen levels in the body, leading to hormone imbalance symptoms and estrogen-related disease. 

Luckily, we can test beta-glucuronidase and other important microbiome and gut health markers in a stool test. As a clinician, this testing helps me uncover the root cause of hormonal issues for each woman. 

Benefits of Hormone Replacement Therapy

Hormone replacement therapy (HRT) or bioidentical hormone replacement therapy (bHRT) is a tool in my toolkit for helping women improve their quality of life. During hormonal transition, particularly perimenopause and menopause, exogenous hormones are an option for relieving hormone-related symptoms. 

Learn more about hormone therapy in these articles:

• History of Hormone Replacement Therapy
• Benefits of Bioidentical Hormone Therapy – Estrogen, Progesterone, and Testosterone

I use DUTCH hormone testing to help me understand my patient’s hormonal pattern before initiating hormone therapy. This test can also be used to monitor a woman while she is taking hormone replacement therapy and making adjustments as needed. 

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The DUTCH test is a dried urine hormone test that looks at sex and adrenal hormones, and their metabolites. It gives us a good picture of Phase 1 estrogen detoxification and Phase 2 estrogen methylation as well as patterns with progesterone, testosterone, cortisol, and more. We can look at aromatase, the enzyme conversion of testosterone to estrogen, potentially another clue. Read more about this hormone imbalance test here. 

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I recommend a stool test in conjunction with DUTCH testing to get a complete hormonal picture. If we are going to give hormone replacement, particularly estrogen, we must ensure that the body can effectively clear estrogen so it doesn’t build up. 

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Now that we see why stool testing is a critical piece of the hormonal picture, watch for Part 2 of this article in a few weeks where I’ll talk about how to improve gut health as a way to improve hormone balance.

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References

1. Baker, J. M., Al-Nakkash, L., & Herbst-Kralovetz, M. M. (2017). Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas, 103, 45–53. 
2. Ervin, S. M., Li, H., Lim, L., Roberts, L. R., Liang, X., Mani, S., & Redinbo, M. R. (2019). Gut microbial β-glucuronidases reactivate estrogens as components of the estrobolome that reactivate estrogens. The Journal of biological chemistry, 294(49), 18586–18599. 
3. Newman, M., & Curran, D. A. (2021). Reliability of a dried urine test for comprehensive assessment of urine hormones and metabolites. BMC chemistry, 15(1), 18. 

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