<b>Association of Gut Dysbiosis With Hormonal Imbalance in Perimenopausal Women</b>

Background: Perimenopause is a hormonally dynamic transitional stage often accompanied by menstrual irregularity, vasomotor symptoms, mood disturbance, sleep problems, and increasing metabolic vulnerability. Emerging evidence suggests that gut dysbiosis may influence estrogen metabolism, symptom burden, and cardiometabolic health through the estrobolome and related inflammatory-metabolic pathways. Objective: To determine the association of gut dysbiosis with hormonal imbalance, menopausal symptom severity, and metabolic health in perimenopausal women attending a tertiary care hospital in Multan, Pakistan. Methods: This cross-sectional analytical study included 180 perimenopausal women aged 40 to 55 years recruited through non-probability consecutive sampling. Data were collected using a structured proforma covering sociodemographic, menstrual, gastrointestinal, lifestyle, and medical variables. Menopausal symptoms were assessed using the Menopause Rating Scale, hormonal status was evaluated through serum estradiol, follicle-stimulating hormone, and luteinizing hormone, and metabolic assessment included body mass index, waist circumference, fasting blood sugar, HbA1c, lipid profile, and blood pressure. Participants were categorized into dysbiosis and non-dysbiosis groups according to protocol-defined clinical and laboratory criteria. Results: Gut dysbiosis was identified in 104 of 180 women (57.8%). Compared with women without dysbiosis, affected women had significantly higher mean total Menopause Rating Scale score (15.8 ± 5.9 vs 11.2 ± 4.8), lower serum estradiol (58.6 ± 21.4 pg/mL vs 74.9 ± 24.7 pg/mL), and higher FSH and LH levels. They also had higher BMI, waist circumference, fasting blood sugar, HbA1c, triglycerides, LDL cholesterol, and systolic blood pressure, with lower HDL cholesterol. On multivariable analysis, severe menopausal symptoms, low estradiol, high waist circumference, diabetes mellitus, and low physical activity remained independently associated with dysbiosis. Conclusion: Gut dysbiosis was significantly associated with hormonal imbalance, greater menopausal symptom burden, and adverse metabolic health in perimenopausal women. These findings support a more integrated clinical approach to perimenopausal care and justify further prospective studies to clarify temporality and mechanism.