Sex hormones and functional gastrointestinal disorders in menopausal women

Functional gastrointestinal diseases (FGIDs)/disorders of gut-brain interaction (DGBI) that manifest during menopause are characterized by chronic recurrent gastrointestinal (GI) symptoms associated with fluctuations in sex hormones. Current research indicates that the regulatory influence of sex hormones on GI function is multifaceted, involving a complex endocrine regulatory network across multiple organs and systems. Various types of sex hormones exert both direct and indirect effects on GI function through their specific receptors located within the GI tract, the central nervous system, pancreatic islets, and thyroid tissue. This interplay contributes to the pathological and physiological mechanisms underlying the onset of menopausal FGIDs/DGBI. Simultaneously, these interactions create a complex pathological feedback loop with climacteric syndrome, depression/anxiety, and sleep disorders. In this study, we present a comprehensive narrative review detailing the molecular mechanisms by which sex hormones regulate GI function-both directly and indirectly-as well as examining the impact of clinical hormone replacement therapy on GI functionality. Our objective is to elucidate potential pathogenesis pathways for FGIDs/DGBI in menopausal women linked to changes in sex hormone levels, further clarify the relationship between hormonal fluctuations and GI function, and propose new therapeutic strategies for managing FGIDs/DGBI. Additionally, alterations in gut microbiota may play a significant role in mediating interactions between sex hormones and the gut-brain axis. This exploration also offers fresh insights and avenues for future clinical research into the relationship between sex hormones and FGIDs/DGBI.