Liver and Gut Health: The Missing Link in Hormonal Balance MyOva

Liver and Gut Health: The Missing Link in Hormonal Balance

By Rachel Zaw, Functional Nutritionist. Published by MyOva.

PMS, bloating, fatigue, acne, mood swings, irregular periods and weight gain are common, especially with conditions such as PMOS (PCOS). Hormone levels are only part of the picture. Looking at how the body processes and clears hormones may help explain why symptoms show up, and the liver and gut sit right at the centre of that process.

This guide covers how they work together, what the research does and doesn't support, and what is worth doing at the dinner table.

Top-down view of colourful whole plant foods on a marble counter, including broccoli, red cabbage, beetroot, chickpeas, seeds, walnuts, herbs, lemon, oats and avocado

In this guide:

The Liver's Role in Hormone Balance

The liver is one of the main places where oestrogen gets processed. It chemically modifies the hormone in two steps, first with enzymes that change its structure and then by attaching other molecules to it, so it can leave the body in bile, stool and urine [1, 2]. Oestrogen is the best-studied example.

You'll see claims online that stress, nutrient gaps or medications "clog" your liver and leave hormones hanging around. Treat those with caution. There's no good human evidence for them, and a review of "detox" diets found limited clinical evidence that they do anything useful [3]. The honest version is simpler: the liver does this job all day, and you can look after it.

The most evidence-backed way to look after it is not to overload it. Alcohol is broken down by the liver, and heavy drinking can lead to fat building up in it [4]. UK Chief Medical Officers advise that it's safest not to drink more than 14 units a week on a regular basis, spread over three or more days [5].

If you have PMOS, liver health deserves a place on your radar. Insulin resistance is a recognised factor in PMOS [6], and it is closely linked with fatty liver disease [7]. In a UK primary care study of more than 180,000 women, those with PMOS were more than twice as likely to be diagnosed with non-alcoholic fatty liver disease (hazard ratio 2.2), and signs of androgen excess were associated with higher risk too [8]. That is an association from health records, not proof of cause, but it's a good reason to mention it to your GP if you're worried. Our guide to PMOS (PCOS) and insulin resistance goes deeper.

Gut Health, Hormones and PMOS (PCOS)

After the liver has processed oestrogen, much of it travels in bile into the gut to be removed. Here's where it gets interesting. Some gut bacteria make an enzyme called beta-glucuronidase, which can unpick the packaging the liver added, so that some oestrogen may be reabsorbed. The collection of gut microbes involved is called the estrobolome [9]. In laboratory experiments, specific bacterial enzymes have been shown to turn inactive oestrogen conjugates back into active oestrogen [10]. How much this matters in real life is still unclear, and researchers are still working out whether a "poor" microbiome pushes oestrogen up or down.

So treat the estrobolome as a promising area of research, not a verdict on why you have PMS or heavy periods. Those symptoms have many possible causes, and the link between gut bacteria and them hasn't been proven.

The same caution applies to PMOS. Reviews of gut bacteria in PMOS don't agree: one 2023 meta-analysis of 28 studies found lower microbial diversity [11], while a later pooled analysis of 14 studies found no significant overall difference [12]. It also isn't known whether gut changes cause PMOS or follow from it.

You may also have heard that constipation causes oestrogen to be reabsorbed. There's no good human evidence for that. If anything, a small trial in 40 premenopausal women found that speeding up gut transit lowered circulating oestrogen [13]. Regular bowel movements still matter for how you feel, and persistent changes are worth raising with your GP.

What about fibre and plant variety?

The UK recommendation for adults is 30 g of fibre a day [14]. Vegetables, seeds, herbs, nuts, beans and wholegrains are the usual sources. In a large citizen-science study, people who ate more than 30 different plant foods a week had more diverse gut bacteria than those eating 10 or fewer, although that is observational and can't show that variety is the cause [15]. Aiming for 30 plants a week is a practical, low-pressure way to keep your fibre on track, and seeds, herbs and nuts all count. Our guide to anti-inflammatory eating has plenty of ideas.

One honest caveat. Fibre is not a hormone-clearing tool. In a US study of 250 healthy premenopausal women, higher fibre intake was associated with lower oestradiol and progesterone, and with more cycles where ovulation didn't happen [16]. That's an association in women without PMOS, so it's no reason to cut fibre, but it is a reason to follow the standard 30 g guidance rather than chase huge amounts, especially if you're trying to conceive. Our oestrogen dominance guide looks at what is and isn't known about oestrogen and ovulation.

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Blood Sugar Balance: A Key Piece of the Hormone Puzzle

Blood sugar is where the liver, the gut and your hormones overlap. Insulin resistance is a recognised factor in PMOS, and it links back to the liver, as above [6, 7]. Insulin also talks to your sex hormones: in a small 1991 study of six women with obesity and PMOS, lowering insulin with a drug raised sex hormone-binding globulin (SHBG) by about a third, which suggests that high insulin directly pushes SHBG down [17]. SHBG matters because it binds sex hormones in the blood.

Insulin resistance and fatty liver tend to travel together, and steadier eating habits are a sensible foundation for women with PMOS, though no single diet has been shown to be best [6]. Our guide to blood sugar balance covers practical steps, and our nervous system guide covers the stress side.

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Final Thoughts

Hormonal health, particularly with PMOS, is rarely about one hormone in isolation. Here is how the liver and gut handle hormones, in four steps.

Infographic titled How Your Body Handles Hormones, showing four steps: the liver processes hormones, bile carries them to the gut, fibre feeds your gut, and gut bacteria play a part

The practical takeaways are modest and doable: keep alcohol within UK guidance, aim for around 30 g of fibre and a wide mix of plants each week, and build meals that keep blood sugar steadier. Your body is trying to tell you something when bloating, heavy or irregular cycles or fatigue keep turning up, so it's worth getting them checked rather than guessing.

Related Reading

This article is for educational purposes only and does not constitute medical advice. MyOva products are food supplements, not medicines, and are not intended to diagnose, treat, cure or prevent any disease. Always consult your GP or pharmacist before starting a new supplement, particularly if you are pregnant, breastfeeding, on medication, or managing a diagnosed condition.

References

  1. Tsuchiya Y, Nakajima M, Yokoi T. Cytochrome P450-mediated metabolism of estrogens and its regulation in human. Cancer Lett. 2005;227(2):115-124. doi:10.1016/j.canlet.2004.10.007
  2. Raftogianis R, Creveling C, Weinshilboum R, Weisz J. Estrogen metabolism by conjugation. J Natl Cancer Inst Monogr. 2000;(27):113-124. doi:10.1093/oxfordjournals.jncimonographs.a024234
  3. Klein AV, Kiat H. Detox diets for toxin elimination and weight management: a critical review of the evidence. J Hum Nutr Diet. 2015;28(6):675-686. doi:10.1111/jhn.12286
  4. Drinkaware. Alcohol-related liver disease. Reviewed 5 May 2025. drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/diseases/alcohol-related-liver-disease
  5. Department of Health. UK Chief Medical Officers' low risk drinking guidelines. London: Department of Health; 2016.
  6. Teede HJ, Tay CT, Laven J, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2023;120(4):767-793. doi:10.1016/j.fertnstert.2023.07.025
  7. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. doi:10.1016/j.jhep.2024.04.031
  8. Kumarendran B, O'Reilly MW, Manolopoulos KN, Toulis KA, Gokhale KM, Sitch AJ, et al. Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: a longitudinal study based on a United Kingdom primary care database. PLoS Med. 2018;15(3):e1002542. doi:10.1371/journal.pmed.1002542
  9. Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: physiological and clinical implications. Maturitas. 2017;103:45-53. doi:10.1016/j.maturitas.2017.06.025
  10. Ervin SM, Li H, Lim LM, Roberts LR, Liang X, Mani S, et al. Gut microbial β-glucuronidases reactivate estrogens as components of the estrobolome that reactivate estrogens. J Biol Chem. 2019;294(49):18586-18599. doi:10.1074/jbc.RA119.010950
  11. Li P, Shuai P, Shen S, Zheng H, Sun P, Zhang R, et al. Perturbations in gut microbiota composition in patients with polycystic ovary syndrome: a systematic review and meta-analysis. BMC Med. 2023;21:302. doi:10.1186/s12916-023-02975-8
  12. Yang Y, Cheng J, Liu C, Zhang X, Ma N, Zhou Z, et al. Gut microbiota in women with polycystic ovary syndrome: an individual based analysis of publicly available data. eClinicalMedicine. 2024;77:102884. doi:10.1016/j.eclinm.2024.102884
  13. Lewis SJ, Heaton KW, Oakey RE, McGarrigle HH. Lower serum oestrogen concentrations associated with faster intestinal transit. Br J Cancer. 1997;76(3):395-400. doi:10.1038/bjc.1997.397
  14. Scientific Advisory Committee on Nutrition. Carbohydrates and health. London: TSO; 2015. See also NHS. How to get more fibre into your diet. nhs.uk/live-well/eat-well/digestive-health/how-to-get-more-fibre-into-your-diet
  15. McDonald D, Hyde E, Debelius JW, et al. American Gut: an open platform for citizen science microbiome research. mSystems. 2018;3(3):e00031-18. doi:10.1128/mSystems.00031-18
  16. Gaskins AJ, Mumford SL, Zhang C, Wactawski-Wende J, Hovey KM, Whitcomb BW, et al. Effect of daily fiber intake on reproductive function: the BioCycle Study. Am J Clin Nutr. 2009;90(4):1061-1069. doi:10.3945/ajcn.2009.27990
  17. Nestler JE, Powers LP, Matt DW, Steingold KA, Plymate SR, Rittmaster RS, et al. A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with the polycystic ovary syndrome. J Clin Endocrinol Metab. 1991;72(1):83-89. doi:10.1210/jcem-72-1-83
Rachel Zaw

Rachel Zaw

Rachel is a Functional Nutritionist specialising in hormone health, PMOS (PCOS), gut health and metabolic balance. She supports women to understand how liver function, digestive health and blood sugar regulation fit into the bigger hormonal picture, using evidence-based nutrition and lifestyle strategies.

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References