Fibre and HRT: Is Fibre Necessary on HRT?

Is fibre necessary on HRT? Learn how fibre impacts hormone balance, digestion, and metabolic health for women using hormone therapy.

If you’re navigating menopause with hormone replacement therapy (HRT), you may wonder if fibre is essential—especially if you follow a low-carb or ketogenic diet. With the rising popularity of carnivore-style eating and zero-plant food approaches, many women are rethinking traditional dietary advice. The simple truth is, there’s no one-size-fits-all answer. But understanding the connection between fibre and HRT can help you make the best choice for your unique body.

Why Fibre Matters

Let’s start with what fibre is. Dietary fibre is the part of plant foods—like vegetables, seeds, and some fruits—that your body can’t digest. It helps move food through your gut and supports regular bowel movements. But fibre may also play a role in helping your body get rid of excess oestrogen.

How does that work?

When your body processes oestrogen, it sends the leftovers to your liver, then out through your bile and into your gut. If you don’t excrete them efficiently, some of those oestrogen fragments can get reabsorbed into your system. This is where fibre may help: it binds to those oestrogen leftovers and helps flush them out.

For women on HRT, that sounds like a good thing. After all, you want your hormone levels to be stable—not too high or too low. That’s why some practitioners recommend around 25g of fibre per day for menopausal women. But do you need that much? Maybe not.

What Happens During Menopause?

As oestrogen levels fall, many women notice changes in digestion. It’s common to experience:

Slower bowel movements
More bloating or gas
A shift in gut bacteria
Increased inflammation in the gut

These symptoms can affect how your body digests food and regulates hormones. But here's the good news: HRT itself can help restore gut health. Studies show that oestrogen therapy can reduce gut inflammation and support the lining of the intestines.

So, fibre may support your gut—but so can HRT.

What About Low-Carb and Carnivore Diets?

Low-carb, high-protein diets like keto or carnivore reduce or eliminate plant-based foods. That means fibre intake drops significantly. Yet many women report improvements in:

Bloating and gut discomfort
Constipation
Hormone-related symptoms like hot flushes
Insulin resistance

Enter Beta-Hydroxybutyrate (BHB)

When you're in nutritional ketosis (a state your body enters on a keto or carnivore diet), your liver produces BHB. This ketone acts like fuel for your gut cells—just like fibre does in traditional diets. So even without fibre, your gut can stay healthy if you’re producing enough BHB.

That’s one reason many women on keto or carnivore don’t struggle with digestion—even without fibre.

The Role of the Liver and Bile

Fibre also binds to bile acids in the gut, which helps reduce their reabsorption. Bile is made in your liver and stored in your gallbladder, and it helps break down fats. Some worry that too little fibre means more bile is reabsorbed—and that could reduce how much old oestrogen gets excreted.

But here’s the key: your liver can make more bile. If your liver is healthy, this isn’t usually a problem. What’s more, a high-protein, low-carb diet supports liver health and reduces insulin resistance—both essential for balanced hormones.

So, Is Fibre Necessary for Women on HRT?

Here’s what we know:

Fibre can help support oestrogen clearance, especially if your gut is sluggish or you're prone to constipation.
HRT can improve gut function on its own, reducing the need for added fibre in some women.
Ketogenic and carnivore diets often work well without fibre because ketones (like BHB) support gut cells and reduce inflammation.
Your fibre needs are individual. Some women thrive on 10g of fibre per day. Others do better with 30g. It depends on your digestion, liver health, hormone balance, and diet.

How to Personalise Your Fibre Intake

Here’s a simple plan to find your fibre sweet spot while on HRT:

✅ Step 1: Check Your Symptoms

Do you struggle with constipation, bloating, or hormone-related issues like breast tenderness or PMS-like symptoms? You may benefit from more fibre.

✅ Step 2: Try a Baseline

Start with 15–20g of fibre per day from non-starchy, low-sugar sources:

Spinach, kale, rocket
Flaxseed or chia (in small amounts)
Avocado
Artichoke or asparagus

✅ Step 3: Track Your Response

Use a journal or an app like Cronometer to track your digestion, energy, mood, and cycle symptoms for 2–4 weeks.

✅ Step 4: Adjust

Feeling great? Stay the course. Still sluggish or bloated? Reduce fibre and try carnivore for a few weeks to “reset” your gut. Then reintroduce gentle fibre sources as needed.

Key Takeaway

Fibre and HRT are connected, but not in a rigid way. Fibre can support hormone balance, gut health, and regularity—but it’s not essential for everyone. What matters most is how you feel. By tuning in to your symptoms and testing different fibre levels, you can find a balance that supports your gut, hormones, and overall wellbeing.

Real-Life Example

Claire, 52, had been on HRT for two years but still felt bloated and tired. She ate lots of lentils and brown rice to “get her fibre,” but it left her constipated and gassy. After switching to a ketogenic diet with just a handful of greens and some chia seeds, she felt lighter, her digestion improved, and her moods stabilised. Her fibre intake dropped from 35g to around 12g—but her body thanked her for it.

Final Word: Choose What Works for You

There’s no gold standard for fibre intake on HRT. Some women thrive with more, some with less. The best approach? Start with a clean, low-carb base. Introduce or remove fibre slowly. Listen to your body. And don’t be afraid to test different routines until you find your metabolic sweet spot.

💬 Ready to personalise your fibre and hormone strategy?

Start a two-week fibre trial today. Keep a simple daily journal: note how you feel, how your gut behaves, and what your energy is like. You’ll quickly discover what works best—for your body, on your terms.