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The Role of Gut Microbiota in Postmenopausal Women: Implications for Lipid Metabolism and Targeted Nutritional Interventions

28 March 2026

Reytor-González Claudia, Verde Ludovica, Annunziata Giuseppe, Román-Galeano Náthaly Mercedes, Horowitz Raquel, Galasso Martina, Muscogiuri Giovanna, Frias-Toral Evelyn, Simancas-Racines Daniel, Barrea Luigi

Summary

  1. Plain-language summary of what the study found: Menopause-related hormonal changes can negatively impact heart health by altering lipid metabolism. This review highlights how shifts in the gut microbiome contribute to these changes, influencing cholesterol levels and inflammation. Optimizing gut health through specific nutritional strategies shows promise in improving cardiometabolic outcomes for postmenopausal women.

  2. Key findings:

    • Menopause and aging are linked to imbalances in the gut microbiome (dysbiosis), which can worsen lipid profiles and increase cardiovascular risk.
    • This dysbiosis contributes to adverse lipid levels by affecting bile acid metabolism, short-chain fatty acid production, and promoting low-grade systemic inflammation.
    • Specific dietary patterns (e.g., Mediterranean, plant-based, DASH) and nutrient interventions (e.g., increased fiber, prebiotics, probiotics, omega-3s, polyphenols, phytoestrogens) have shown potential to improve lipid profiles by modulating the gut microbiota.
    • While associations between certain gut microbes and lipid patterns exist, establishing direct causal relationships is challenging due to confounding factors.

  3. Practical takeaways for someone interested in nutrition and longevity:

    • Prioritize plant-rich, fiber-dense diets: Embrace dietary patterns like Mediterranean or plant-based, which provide ample fiber, polyphenols, and phytoestrogens to nurture a diverse gut microbiome.
    • Support gut health actively: Increase intake of whole grains, fruits, vegetables, and legumes. Discuss with a healthcare professional whether prebiotics, probiotics, or omega-3 supplements might be beneficial for you.
    • Manage inflammation: A healthy gut contributes to reduced systemic inflammation, which is crucial for overall cardiovascular health, especially during and after menopause.

  4. Study limitations: While promising, the review emphasizes that more rigorous, long-term intervention studies are needed to clearly establish cause-and-effect relationships and identify specific microbial "signatures" that can be consistently targeted in clinical practice.

Abstract

Purpose of Review This review explores the complex interplay between menopause, estrogen decline, lipid metabolism, and gut microbiota alterations. It highlights the physiological and metabolic changes that predispose postmenopausal women to dyslipidemia and increased cardiovascular disease risk, with particular emphasis on the emerging role of the gut microbiota in modulating lipid homeostasis and inflammatory pathways. In addition, it examines the therapeutic potential of microbiota-targeted nutritional strategies to restore metabolic balance and improve cardiometabolic outcomes in postmenopausal women. Recent Findings Recent clinical and experimental evidence indicates that menopause-related hormonal changes and aging are associated with gut microbiota dysbiosis, which may contribute to adverse lipid profiles through mechanisms involving bile acid metabolism, short-chain fatty acid production, and low-grade systemic inflammation. Associations between specific microbial taxa and lipid metabolic patterns have been reported; however, findings remain heterogeneous and causal relationships are difficult to establish due to confounding factors such as diet, lifestyle, and medication use. Nutritional interventions aimed at modulating the gut microbiota—including Mediterranean, plant-based, and DASH dietary patterns, increased dietary fiber intake, and supplementation with prebiotics, probiotics, polyphenols, phytoestrogens, and omega-3 fatty acids—have shown potential to improve lipid profiles and cardiometabolic risk markers. Summary The gut microbiota emerges as a relevant contributor to menopause-associated dyslipidemia and cardiovascular risk. While microbiota-targeted nutritional strategies are promising, further longitudinal and interventional studies are needed to clarify causal pathways and identify clinically actionable microbial signatures. Integrating microbiome-informed nutritional approaches into clinical practice may represent a future strategy to improve cardiometabolic health in postmenopausal women.
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