Impact of a multi-strain probiotic in real-world women with perimenopause symptoms: a single-arm, virtual pilot study

Abstract

Perimenopause is characterised by fluctuating ovarian hormones and a heterogeneous, multisystem symptom profile that can substantially impair quality of life (QoL). Non-hormonal management options remain limited for those unable/unwilling to use hormone replacement therapy. Emerging evidence implicates gut microbiome alterations in menopause-related symptom burden, suggesting microbiome-targeted interventions may offer a novel approach. This study aimed to explore the impact of daily supplementation with Symprove, a water-based multi-strain live-bacteria supplement, on QoL and symptom burden in perimenopausal women. A 12-week, single-arm, virtual UK pilot study, recruiting a real-world population of women experiencing perimenopausal symptoms via a menopause-focused digital community to receive Symprove (70 mL/day). Outcomes were assessed at baseline and Weeks 4, 8, and 12 using validated patient-reported measures. Primary outcome: change in menopause-specific QoL measured by the Menopause-Specific Quality of Life (MENQOL) questionnaire. Secondary outcomes included: MENQOL domain scores, gastrointestinal symptoms (Midlife Women’s Symptom Index gastrointestinal subscale; MSI-GI), overall symptom burden (MSI), and sleep regularity (Sleep Regularity Questionnaire; SRQ). Analyses were based on available cases at each timepoint with no imputation of missing data. Of 237 participants completing baseline assessment, 197 met eligibility criteria; 140 provided paired baseline and Week 12 data. Mean MENQOL total score improved by 46%, from 4.52 (SD 1.11) at baseline to 2.44 (SD 0.94) at Week 12 (mean change − 2.07; p < 0.001). Overall, 98% of participants showed improvement from baseline and 84% achieved a clinically meaningful improvement (≥ 1 point reduction). Gastrointestinal symptom burden decreased by 63% (MSI-GI mean change − 4.36; p < 0.001), and overall symptom burden decreased by 52% (MSI mean change − 37.28; p < 0.001). Sleep regularity improved by 15% over the study period (SRQ mean change + 3.37; p < 0.001). Improvements were consistent in exploratory analyses of participants using and not using hormone replacement therapy. Adherence was high (89.3% compliant), and Symprove was generally well tolerated. In this pilot study, daily supplementation with Symprove over 12 weeks was associated with improvements across menopause-specific QoL, gastrointestinal symptoms, overall symptom burden, and sleep regularity in women experiencing perimenopause. Controlled studies are warranted to confirm these findings. IRAS, TRN: 352166 and ISRCTN, TRN: 56831337, Registration date: 12 August 2025.