When we talk about menopause, the conversation turns to hormonal factors — oestrogen, progesterone, the sliding scale of a hot flush. According to Dr. Levidia Strauss, founder of Revita Health, the gut may be the single most overlooked factor in how women experience the menopause transition. Strauss told Gisèle Wertheim Aymes in a recent episode of Wednesday Wellness that,
“Menopause, or declining hormones, suddenly shines a spotlight on the gut,”
Explaining that women can often get away with a less-than-perfect diet, patchy sleep, and chronic stress for years without consequence. That is, until oestrogen begins to decline, at which point her body’s tolerance for those habits appears to vanish overnight. The reason being that our gut is doing extraordinary hormonal and neurological work behind the scenes.
Dr. Levidia Strauss
Anaesthesiology to Integrative Medicine: An Unexpected Journey
Strauss trained as a medical doctor at Stirling University and originally intended to become an anaesthesiologist. When her husband’s rugby career took the couple to France, her plans changed. A journey she initially planned to take two years became eight. There, she encountered integrative medicine. The discipline looks beyond prescriptions and examines the lifestyle around a patient’s health, diet, sleep, stress, and movement.
“I didn’t choose this path for myself. The Lord chose it for me. I’m very grateful because I get to meet so many new people, and I’ve found a way of implementing my passion for living a healthy lifestyle, cooking healthy food, and helping women along the way.“
She now describes her work as lifestyle medicine — full medical training paired with an approach that treats the gut, inflammation, and metabolism as central, not incidental, to women’s health.
Gut health: your second endocrine system
To understand why gut health matters so much during menopause, it helps to understand what one’s gut is doing all day. Strauss explains that the gut is home to millions of microorganisms that help to regulate the immune system, produce key hormones, and communicate constantly with the brain.
The gut hosts nearly 70% of the body’s immune cells, and produces around 90% of the body’s serotonin, our feel-good hormone. During menopause, as oestrogen declines and gut diversity changes alongside it, the system starts to wobble. This can show up as mood changes, inflammation, low energy, and disrupted sleep.
Meet the estrobolome
If there’s one concept from this discussion worth remembering, it is the estrobolome. The estrobolome is a collection of enteric bacterial genes and taxa within the gut microbiome that metabolize and regulate estrogen levels. It centers on specific microbial enzymes that control whether the body excretes or recycles estrogen.
Healthy gut bacteria help usher that packaged oestrogen out of the body. Less helpful bacteria produce an enzyme called beta-glucuronidase, which can reopen those packages and let the oestrogen back into circulation instead of letting it leave. Strauss notes that research suggests the gut recirculates as much as 40% of oestrogen through this process every day.
“The gut microbiome isn’t just helping us digest food, it’s actively participating in hormone regulation.”
The December phone call: a gut health mystery
Strauss called attention to a pattern she had begun to notice during her sixteen years of prescribing hormone therapy. Around November and December, patients of hers who had felt stable and well all year long suddenly called her again. They believed their hormones had “stopped working,” describing tender breasts, spotting, and bloating.
The first question she asks has nothing to do with dosage. Strauss inquires if they have been constipated as of late. It turns out that, more often than not, the answer is yes. During the social celebrations of the festive season, her patients will indulge in more alcohol, experience more stress, and consume less fibre. During these occasions, the hormones have not failed. The gut has lost its ability to excrete oestrogen effectively, allowing it to recirculate and cause symptoms that look identical to a dosage problem.
“Before adjusting the hormone dosage, I first go back and fix the gut. Many of them go back to feeling amazing again without us having adjusted anything.”
In Dr Strauss’s opinion, gut health is sometimes more important to how a woman experiences her hormones than the dose of those hormones.
Leaky gut, inflammation, and the mystery of the changing belly
The term “leaky gut” has become both a popular and controversial topic online. Some specialists once dismissed it, but Strauss says the medical community now recognizes it as increased intestinal permeability. Remarkably, the gut lining, only one cell wall thick, takes on the job of absorbing nutrients. A protein called zonulin regulates this barrier. Chronic stress, poor diet, and inflammation can cause those tight junctions to loosen, allowing bacteria and undigested particles to leak into places they shouldn’t be – explaining the rise in food sensitivities in many people as they age.
This chronic, low-grade inflammation closely connects to a shift in body composition that many women experience during menopause: the appearance of visceral fat. This fat sits around the organs rather than just under the skin. Strauss explains that oestrogen encourages fat storage around the hips and thighs; as it declines, fat distribution shifts towards the abdomen instead. Visceral fat is not passive; it actively produces inflammatory molecules. Compounding upon the cycle of inflammation, poor sleep and stubborn weight can cause serious emotional frustration for many women during menopause, describing that they are “doing everything right and still struggling.”
Mood, brain fog, and gut health
Strauss connects two of the most distressing menopause symptoms – low mood and brain fog, directly back to the gut. Serotonin production ties closely to gut health, so a disrupted microbiome can definitely affect one’s mood. The gut also communicates with the brain via the vagus nerve, meaning bacterial changes can show up as anxiety, low mood, or trouble sleeping, not just digestive symptoms.
“Oftentimes, when we fix a patient’s gut, they tell me, ‘Wow, my anxiety lifted,’“
The second driver of low mood, Strauss notes, is more directly hormonal. Without ovulation, the body stops producing progesterone. Many describe progesterone as the body’s natural “valium.” Leaving many women feeling less resilient and more anxious than before, regardless of what is happening in their gut.
Bones, hot flashes, and the heart: gut health’s reach
Strauss links several other menopause hallmarks back to gut health:
- Bone density: the gut absorbs calcium, magnesium and vitamin D, all essential for bone strength, and the microbiome’s role in oestrogen recirculation further ties gut health to bone health.
- Hot flashes and night sweats: these, she was clear, link directly to declining oestrogen rather than the gut, and hormone therapy can often resolve them in suitable candidates.
- Heart health: While the loss of oestrogen’s anti-inflammatory, blood-vessel-protecting effects mainly drives the sharp rise in cardiovascular risk after menopause, the gut compounds that risk by driving more visceral fat, insulin resistance and inflammation.
Food first
When people ask whether the answer to gut health is simply to take a probiotic, Strauss is clear that food comes first. She points to fibre as the foundational factor. Both insoluble fibre (which adds bulk to stool) and soluble fibre (which forms a gel-like matrix that slows glucose absorption and regulates blood sugar) are equally important in one’s diet.
Strauss advocates for resistant starch. You’ll find resistant starch in cooled cooked potatoes, cooled cooked rice, green bananas, oats, beans, and lentils. These foods feed butyrate-producing bacteria, the “hero” bacteria of the gut. One of her go-to supplements is partially hydrolysed guar gum, a flavourless fibre powder that feeds these same bacteria without causing excess bloating.
Strauss takes a nuanced stance on sugar. She’s not concerned about naturally occurring sugar in whole fruit, which comes packed with fibre and antioxidants the body knows how to process. Her main concern is added sugar. She describes the daily tolerance for added sugar for women as being between 24g and 36g for men. In processed and packaged form, sugar overwhelms the liver in a way that whole food rarely does.
On testing, supplements, and the danger of overkill
Despite working at the cutting edge of gut science, Strauss is cautious about jumping to microbiome testing for every patient. Much of the commercially available testing, she notes, benchmarks results against North American or European populations. These datasets do not reflect South African diets, environments, or genetics. Strauss is currently part of a group of experienced South African practitioners working towards building a population-specific microbiome database. The biggest concern with direct consumer testing is interpretation: isolated bacterial readings mean little without understanding how different bacterial groups interact.
“The gut works in groups together,”
She compares a healthy microbiome to a rainforest — not just ferns, not just moss, but abundance and diversity working together. She reserves testing for patients who aren’t responding to lifestyle changes, rather than using it as a first step.
Food is not the enemy
Ending on a personal note, Strauss reflected on what she called the “food jail” so many women feel trapped in from a young age. It involves a lifetime of eating less and hearing that smaller is better. Her message, which she says she has passed onto her teenage daughter, is that women should enjoy food, not fear it. Strauss recalled a recent two-week trip to France, in which she ate freely and walked often, gaining no weight in the process. In her view, this was proof that enjoyment and health are not opposites.
As a devoted rooibos tea drinker, Strauss credits her Carmién Tea gut blend as a travel companion during her tour through France. She also uses the brand’s Energize and Menopause blends daily. Strauss will be taking that same food-first philosophy on the road this Women’s Month, joining a food jam event in Cape Town on August 1.
