Kim Vopni (00:01.459)
Welcome Cynthia. I am excited to have you on the show. I have listened to you and been a guest on your show, but I have listened to you for many, many years and have had the privilege of meeting you in person. I am a huge fan of your work and this new book of yours, The Menopause Gut is something that is well-timed, would say. Gut health is something I talk about a lot with my community. But now because I'm on the other side, I'm post-menopause, many people in my community are,
gut health is now just, it's never, it's not a one and done thing. It's something that kind of, it's like pelvic health that travels with us through our life stages. So welcome, congratulations on your new book. Can you please let the listeners know who you are and what brought you to writing this new book?
Cynthia Thurlow, NP (00:48.034)
Thank you for that. I think that the gut is really like peeling an onion. You peel a layer back and you realize you've got a lot more work to do. So I'm a traditional allopathic trained nurse practitioner. spent 20 years in ER medicine and cardiology and 10 years ago, I got tired of writing prescriptions. And so I literally walked away from.
an amazing job, but I felt compelled to really focus in on women and perimenopause and menopause. So I've really been in that space for 10 years now. My first Ted talk was on perimenopause in 2018 when no one was talking about perimenopause and menopause. And so I'm so glad that, you eight years later, there's so much more awareness, you know, experts like yourself and others that are really helping women better understand their bodies. But through the course of the past 10 years, you know, there's been a lot of integrated and functional medicine training that really is
the basis of what I do, but I always say I have the best of both worlds. I'm able to kind of view things from two different lenses. But I've always been really fascinated with the gut. I've been working with diagnostic testing there for 10 years. And what really started to avail itself were these common patterns that I was seeing with my patients that I hadn't ever learned anything about because there's so little medical training. Like I even pulled up, like I still have some of my textbooks. I pulled them up and I was like, how much discussion were we given?
in our training, either in undergrad or graduate school, about menopause. was literally nothing, little to nothing. And so for so many of us, it's trying to understand how is the physiology changing in the setting of declining hormones, changes in neurotransmitters.
And so there's so much more that I understand. And I think for a lot of women, this is going to resonate when I say this. If you think perimenopause and menopause is just about slapping on an estrogen patch, it is so much more than that. And if your practitioner is not focusing in on gut health, they are missing opportunities to support you because I will make the argument that most of the symptoms that we experience in that transitional time in our lives are a byproduct of the health or the lack thereof of the microbiome itself.
Cynthia Thurlow, NP (02:51.842)
It's a very dynamic living biome in our bodies. And so it's really been the last five or 10 years that we've learned so much about it. But it's like I kind of humbly sit back and I'm like, it's amazing that we don't all feel worse given what I have learned is changing so dynamically. But I think for a lot of women, certainly in your community and mine, I think that once we have a real sense of what's going on, we can appropriately add the correct interventions. It's not a blanket statement for all. It's really personalizing.
this bio-individual approach that every woman listening deserves to have.
Kim Vopni (03:26.407)
Yeah. When I think of the gut and I think when many people in my community think of gut health, we think of bloating, digestion, and poop. Those are sort of the main things that we think about when it comes to gut health. Yeah. So how would you, would you agree those are parts of, is there more, what, when you say gut health, what is the bigger picture of, of our gut? What's happening and why do we need to focus on it?
Cynthia Thurlow, NP (03:56.514)
Yeah, I mean, first of all, let's back up and just define what the gut microbiome is, because I think most people understand where your pelvic floor is. If they're listeners to your podcast, they understand where your heart is, your brain. The gut microbiome seems very nebulous because it's contained in large intestines. It's 40 trillion bacteria, viruses, fungi, and protozoa that inhabit a very dynamic ecosystem that interfaces every single organ system in the body. So there's a gut bone access, a gut brain access. There's a gut ovarian access that actually does impact when we go into menopause, which I found fascinating.
Fascinating and the reason why it's it's a bigger picture than just a couple symptoms that we experience It's understand that digestion starts in our brains So how many women listening live very harried stress lifestyles where they're eating on the go they're eating off their kids plates You know, they're constantly on the go and they don't even understand that if you are not literally not in the right frame of mind And by that I mean the parasympathetic nervous system the rest and repose side. You can't properly digest assimilate absorb
or detoxifying your digestive system. So everyone, if I were to ask them, most people will say, oh, digestion starts in your mouth. And I'm like, well, that's close. That is important. I mean, mastication, the actual chewing piece, is important. But there's so much more to it. it doesn't just, it starts in the brain and ends up in the toilet. And everything in between is kind of fair game, if you will. And the things that I think are interesting and relevant for women to understand is that as we get older, things just don't work as efficiently, not surprisingly.
Kim Vopni (05:26.045)
you
Cynthia Thurlow, NP (05:26.287)
produce as much hydrochloric acid, which means sometimes that bloating is a byproduct of protein that's just not broken down as readily. We don't produce as much digestive enzymes. So all of our food can be a little bit more challenging to break down. As estrogen declines, our bile is impacted. And bile is designed to break down and emulsify fats. And why do so many women say to me, all of a sudden when I eat a fatty piece of meat, or if I eat even a plant-based fat, why do I not feel good?
may have something to do with your gallbladder, but bigger picture is as estrogen declines, so does our ability to break down and emulsify fats. And so at a very basic level, those hormonal changes impact motility. They impact inflammation. They impact whether or not we have leaky gut. And so I think for a lot of women, their first symptoms may be, to your point, they may be bloating. They may be alterations in bowel habits. Like, do you suddenly get constipated? Or are you dealing with loose stools? Or did you just get a new diagnosis of IBS? And you're told,
You just have some underlying food sensitivities or where you just diagnosed with Hashimoto's or lupus or rheumatoid or Celiac, any of these 100 autoimmune conditions that we have now. And so I think it's really part of a bigger picture, but there just hasn't been a lot of awareness.
There hasn't been a lot of conversations around it. And quite transparently, I'm so glad that there is this kind of movement to help educate women about their bodies. But as I always say, if you think it's just about replacing hormones, it's a larger conversation than that. And the women that I think are doing best in that perimenopause to menopause transition or in postmenopause for those that are already there, is helping them understand the more you can do up front, the easier that transition's going to be and the less symptoms you'll experience.
Kim Vopni (07:10.097)
Yeah, 1000%. You said as you're talking to me, you're talking about the digestion of protein. And my immediate thought is, you know, I saw a meme on Instagram that said, I've been having more peer pressure to eat protein than I did to take drugs when I was a teenager. And I thought that was so right because it's just, and I'm one of those people that is preaching that as well. And so it made me think that especially if the gut is not working well, and we're now telling women,
Cynthia Thurlow, NP (07:24.013)
Yeah.
Kim Vopni (07:40.244)
to eat more protein and they're potentially not even digesting that properly, that could even, maybe they're not absorbing it as well, right? So all the things that, why the gut microbiome, the absorption, the digestion, all the processes is so important. It was just a kind of a thought there. what, is there a difference between perimenopause, postmenopause? For those that aren't familiar with the definition, so.
the six to 10 years leading up to perimenopause, people say in menopause or post menopause for the years beyond for the rest of your life. But is there a difference between what's happening in our gut in the perimenopause phase of life versus the post menopause phase of life?
Cynthia Thurlow, NP (08:27.341)
I mean, as we have these alterations in hormones, at first it starts with less progesterone. So many women in perimenopause may feel like they have more timing around their cycle. So they more anxiety, more depression. They may have mood disorders. They may have trouble sleeping around when their menstrual cycle will start.
We know that estradiol, is our predominant form of estrogen, tends to be 20 to 30 percent higher in perimenopause. suddenly these women, if they don't have a healthy estrobalome, so I'll explain what that is, it's the estrogen processing center of the microbiome. I didn't name it. It is very, very awkward. Someone called it estrobalome the other day, and I was like, from now on, I'm going to have to catch myself from saying that because it's so funny, estrobalome. But this is the estrogen processing center. So if your estrogen
levels in your body either due to a loop cycle or some little hiccup, they're much higher. You're gonna have more of those estrogen dominant symptoms which may show up as brain fog and breast tenderness and weight loss resistance, all the things we love having, But it's really interesting to understand that that is when I think we really get this peak in symptomatology around these particular cycles where the estrogen levels are higher. So estrogen becomes important because we need to be able to properly
poop it out of our bodies. So I know you talk about poop a lot, and I've been told that saying the word defecate is just too clinical, so I'm going to say poop. The estrogen processing center of our microbiome is very important. our liver helps break down many things in the body, but estrogen in particular, into water soluble compounds that the body can then take in the next phase of detoxification, package it up like a present, and poop it out. But for a lot of women that don't have healthy microbiomes as a baseline,
Kim Vopni (09:53.778)
Ha ha ha.
Cynthia Thurlow, NP (10:15.903)
they are more likely through enterohepatic circulation, that's the kind of professional way of explaining it, it recirculates. And then all of a sudden these women are feeling way worse. That's why for many women perimenopause, they feel worse. It's almost like the storm before the calm of menopause. So I would say if you can get through perimenopause, menopause is gonna be a whole lot easier. But I think for a lot of women they are much more symptomatic because they have this wild fluctuation in estrogen in particular, which we know has a lot of downstream effects on the microchip.
biome, like as estrogen declines, I always use the analogy of if we think about the small intestinal lining. So a small intestine is where we get most of the absorption of nutrients. It's a very important part of the digestive system. It's one cell layer thick. So it gets damaged really easily. Chronic stress, antibiotics, even if they're appropriately dosed, other toxins were exposed to alcohol. That one cell layer thick, it's interesting. Think of estrogen as the mortar between bricks. So as estrogen is declining, and that does happen in latter stages of
menopause, you're more likely to develop autoimmune conditions. The things I mentioned earlier, you're four to five times more likely. So to answer your question, I do think women tend to be more symptomatic when the hormones are going up and down than when they typically get into menopause. I think most hormones have started to quiet down, hopefully. But I think for many, many women, they kind of suffer in silence. Because we go to our GYN, and I'm not picking on GYNs, I'm just saying most of us, we
condition that you know yearly we see our GYN. Our GYN is the person who handles all our period problems and the period problems are usually handled in perimenopause with oral contraceptives, an IUD, an ablation or even a hysterectomy. And let me be clear if anyone listening has had any of those interventions that is totally okay. But it's not addressing the root reason why we are having so many estrogen dominant symptoms. It's this lack of progesterone. They're designed to be a symphony and when the symphony is off you know it's almost like you have a really loud trumpet and
it's totally off kilter with the rest of the orchestra. So I think for a lot of women, perimenopause is a bit more chaotic and much more bothersome with symptoms. And it can run the gamut depending on where your hormones are week to week or even month to month. Sometimes women feel great in one cycle and terrible in the next. And perimenopause is also as unique as each one of us. So your perimenopause journey was probably different than mine, which is different than my neighbors and even my sister-in-law's and all of your friends. And so I think it's providing women with this
Cynthia Thurlow, NP (12:45.423)
assurance that there are some consistencies. Yes, you will eventually have this lack of hormones, but whether or not we're particularly symptomatic can be largely driven by gut health and also lifestyle choices that we make because just about any lifestyle intervention we can talk about. I can relate it back to the microbiome and how it impacts the health of the microbiome, including things like poor quality sleep, not managing your stress, the types of foods we eat here in the United States. It's probably worse than it is in most other countries, but
70 % of our population consumes ultra-processed foods, which in and of themselves damage the microbiome. So there's a lot that's there, but usually helping women understand perimenopause is the storm before the calm. The calm is postmenopause.
Kim Vopni (13:30.674)
Yep. And that's me. I had this shit storm and now I'm sort of smooth sailing. At the time, I didn't even know the term perimenopause. It was the classic, know, everything's fine according to your labs, but not feeling fine. And that really was kind of my, my start of, I was already in pelvic health, but I, but just learning about a lot more hormone and gut and...
just to try to find my own answers is really how that started. And I wish I had had the information ahead of time because I feel like it would not have been quite as tumultuous a ride in the perimenopause zone that, yeah.
Cynthia Thurlow, NP (14:05.421)
I think so many of us probably feel that way. I think that was one of many reasons why I left traditional allopathic medicine, because I hit the wall hard. I was doing all the wrong things. I I think it's reassuring for people to know that most of us were not taught what to expect. Therefore, didn't, you know, wasn't until we crash landed into perimenopause that we were like, oh, I really have to change everything I do. And that becomes, for some of us, maybe more challenging than others. But I think most of us get to a point where we're like, yeah, I'm going to be
that person who goes to bed early and I'm not going to drink the alcohol and I'm going to make sure I exercise and leave the toxic people in the rear view mirror so I don't have to interact with them as much.
Kim Vopni (14:38.76)
Right.
Kim Vopni (14:45.779)
Yeah, yeah. Have you noticed a difference, and it may, we may need more years of research and even just working with people, but people who start hormone therapy earlier, so starting either within perimenopause or sort of around the start of their menopause, versus people who are.
like finding out about it now and now it's accepted again and now the black box labels removed and now they're thinking, well, I've missed the boat, but some of them are now starting. Do you notice any difference in the response of the gut, I guess I'll say, for people who've maybe started earlier in that transition versus went through and maybe even stayed on a bit of a tumultuous path and then started hormone therapy?
Cynthia Thurlow, NP (15:33.836)
Yeah, such a good question. I mean, the research is out there. If you compare what a microbiome looks like in a pre-menopause, so before we even get to perimenopause, versus perimenopause versus post-menopause, and you're looking at alterations of hormones,
A woman on HRT that's on a healthy amount of HRT, not a whiff, not like the lowest dose estrogen patch and maybe you're lucky if you get a whiff of some progesterone, but you're at an optimal amount of HRT, their microbiomes can start to resemble a younger woman's. And I think that is significant.
Kim Vopni (15:55.603)
Yeah.
Cynthia Thurlow, NP (16:09.919)
I think that when I was going through perimenopause, the mindset was you have this five-year magic window of which it is optimal to start hormones. And if you don't do that, then you're in trouble. But we now acknowledge it's really on a case-by-case basis. I think this younger generation from our generation is definitely having the conversation earlier. And people are aware that they have options. They don't have to suffer until they're not sleeping at all and have terrible, terrible symptoms.
But when I'm talking to patients, the patients that are on HRT, they sleep better, they manage their stress better, they make better food choices, their body composition is better. When we look at stool testing, it generally always looks better. So I think in many, many ways, my experience as a clinician has been that that supports the research that is out there. I think that we do not yet have a clinical indication, meaning here in the United States, we know that estrogen is primary prevention for osteoporosis, which is great, right?
We don't yet have that indication for the gut but I think the research is certainly trending in that direction and certainly, you know I always say like the end of one is really powerful and I start the book off the menopause got talking about this trip to Morocco where I got deathly sick and it set me up for a long Hospitalization my husband and I ate the same food, but I had no idea like no one had ever said hey Cynthia SOS your immune system takes a massive hit and with a decline in hormones and so I think that
That was my like aha moment, like what in the world is different that my husband literally ate the same food and didn't get sick and I got really, really sick. And so I think for many women, it's reassuring to know that it's not just about bones, it's not just about brain, it's not just about heart health. We're really speaking to like multi-system support. And yes, there are people out there in the health and wellness space that like to poo anything unless there's a double, know, randomized controlled trial. And I'm like, listen, where do you think a gastro
or a hypothesis comes from. It's from clinical research or clinical experience that then lends itself to, okay, let's fund some research to look at this a little more deeply. And so, you it's been my clinical experience as well as personal experience that HRT definitely supports women in just about every area that you can think of. And there's no longer this doom and gloom of, you missed your five-year window, therefore you're expected to suffer in perpetuity.
Cynthia Thurlow, NP (18:35.951)
We know that you can start vaginal estrogen like my mom just turned 80 and if she wanted to start vaginal estrogen tomorrow she could do that. It's not a big deal. Now when you're more than 10 years out
and you have an at estrogen, then there's a bigger conversation that has to be had about risk stratification, informed consent, all those things. But I certainly think that the patients that started earlier feel better, like not just physically, but emotionally, spiritually. I would imagine there'd be a lot less divorces in middle age if women were given back some power to feel like, I have agency, I can decide to start hormone replacement therapy. I may not feel like my head is spinning
off, I had a woman last night describe it as her foray into perimenopause was feeling like every single thing that her significant other did drove her crazy, including chewing. And so that irritability is definitely a little bit of estrogen, but certainly one of those things where I think this younger generation is going to benefit from us speaking about these topics and certainly doing so so openly.
Kim Vopni (19:28.273)
Yeah.
Kim Vopni (19:41.992)
Yeah. One thing in like a topic that you cover in the book and I hear you talk about a lot is the relationship of stress, stress management and our gut and the process of going through, especially if you're not informed, the process of going through this perimenopause into menopause transition is in and of itself a stressor. So knowledge is and like taking the knowledge, learning it and then implementing that knowledge is going to be
one step of potentially reducing some stress elements, but how else would you recommend women, like what do we need to know from a stress management perspective? And I guess maybe preface that with how is stress interfering with our gut health?
Cynthia Thurlow, NP (20:25.185)
Yeah, so let's back it up. So there's a lot of solid research around adverse childhood events. So for anyone that's unfamiliar with a joint venture between the CDC and Kaiser, anyone can go online and look at this very short quiz. And if you have a high number, it means that you have, at some point in your childhood or young adulthood, you were either exposed to big T trauma, which back in my inner city Baltimore days, we're talking about rape and suicide and murder. mean, just things that no one would question are big deal and imprint us significantly.
more insidious, I think it is incredibly insidious, little t-trauma, neglect, abuse, addiction, things you're exposed to, things you have no control over as a child. If that has imprinted you, we know that it kind of...
it kind of reroutes our nervous system. So instead of the normal nervous system where we have this sympathetic, which is the rest, sorry, excuse me, sympathetic, which is fight, flight, flee, or fawn, that's a lot of alliteration, or parasympathetic, which is rest and repose, it's helping people understand that balance is supposed to be there. We're not meant to be in the sympathetic dominant state all the time, but a lot of our modern day lifestyle is kind of conditioned that way. But children that grow up,
that are imprinted early with that amount of stress, cortisol is not a bad hormone. I have to preface this. But cortisol, when it's elevated over time, chronically and habitually, is caustic to the body. It makes it harder for us to build muscle. It lowers our immune system. It raises our blood sugar. raises our cortisol. So if cortisol goes up, glucose goes up, insulin goes up.
it also impacts the microbiome quite dynamically because not only does it lead to more propensity for autoimmune conditions and leaky gut, but it is caustic. When I use the term caustic, it's really irritating. And so over time, those people are more likely to have poor metabolic health. They're more likely to have distorted relationships with food. They're more likely to have autoimmune conditions, et cetera, et cetera. So when I talk about stress, there's that kind of conversation. And then there's the, we all have stress in our daily life. Some of us deal with it better than others.
Cynthia Thurlow, NP (22:31.785)
I'm the duck on the pond. So on the surface, I look super calm. People always say like you're so relaxed. Yes, but I'm an internal like internally I'm a very intense kind of person. So the duck is paddling furiously across the lake. That is me, but that is a lot of other people. But what starts to happen is with these changes in hormones, so progesterone marries well to a neurotransmitter called GABA. It is our main inhibitory neurotransmitter. So as GABA is declining because progesterone is declining,
Kim Vopni (22:43.891)
you
Cynthia Thurlow, NP (23:01.695)
more anxiety, more depression, more trouble sleeping. know, it's interesting, estrogen or estradiol is also integrally interwoven with serotonin. So serotonin is this happy hormone. As it is declining, you get more irritable. So we become less stress resilient. That does not mean we are incapable of managing stress, but we have to work harder. So maybe what I did in my 20s and 30s as lip service for stress management does not work anywhere. It doesn't work as well as we get older. So suddenly,
Thank
This may be having healthier boundaries. This may be getting out and grounding work, getting out in nature, finding something that you don't mind doing and doing it regularly, breath work, meditation. I don't care if you put legs up a wall. I don't care if you hum. We know things that stimulate the vagus nerve, humming, gargling, singing can all stimulate the vagus nerve. This is an important nerve that goes between the brain and the gut. It's like a superhighway, but it can be very calming.
And when the vagus nerve is stimulated, it will stimulate that parasympathetic nervous system, the rest and repose. So I oftentimes will say to patients, find something that you like and do it often. For me personally, the things that are easy for me to do may not be easy for someone else to do. And we do this before we ever add gadgets. We are in a health and wellness community where we love gadgets. We love the hot new bright shiny object. That's not necessarily what we need to be doing. We have to do the foundational work.
before we ever get to the latest vagal stimulator, vagal tone device, which are fun, let me be very clear, but you have to have the foundational work in place so that you can manage your stress because what starts to happen is 70 % of divorces are initiated by women. I think that a lot of women who want out of their partnerships, their marriages, maybe even happening with their occupation, they just decide I can't do it anymore. I think back to how I felt 10 years ago.
Cynthia Thurlow, NP (25:02.699)
I think for a lot of people they have to make kind of a drastic leap of faith or they have to change something drastically. It doesn't have to happen that way. But you do have to implement ways to manage your stress because...
The gut microbiome takes such a big hit with these decline in hormones that adding caustic cortisol, cortisol elevation, cortisol activation, I usually encourage my patients to wear a continuous glucose monitor because I think that can be very insightful. And what I find interesting is sometimes patients will say, well, it isn't even that the food was surprising. It's the stress I feel like when I argue with my spouse or I'm running through an airport, which is where my blood sugar always goes up because I'm always running in an airport, because inevitably I'm like,
missing a connection. But I think for a lot of individuals, it's figuring out, number one, you do have to have a stress management system. Number two, once you figure out what makes you feel good and you can do consistently, you have to commit yourself to doing it regularly, like every day. And then number four is, if you don't manage your stress, and I think for a lot of women, I have a lot of very type A women in my practice, and they'll tell me they're managing their stress. But I'm like, intrinsically, when I look at your lab work, it is evident that you are
just disconnected from your body. And so I think there are a lot of women.
whether for variety of reasons and I can provide some conjecture on why I think that happens. A lot of women are just disconnected from their bodies in general and so they're like, I'm not stressed. And I'm like, well, your lab suggests otherwise. like objectively, I know that you're subjectively telling me you're not stressed, but objectively, based on your vital signs and all these other parameters, it's evident that you're experiencing quite a bit of stress. So stress really has to be part of that foundational element. And the other thing, Kim, that I would say
Cynthia Thurlow, NP (26:49.422)
show me a woman who doesn't manage her stress and show me a woman who doesn't sleep. Like they are so intertwined with one another.
whether it's episodic trouble sleeping, but the people that really don't sleep well, there's a lot going on. It is more often than not underlying stress, and that's where that trauma piece sometimes comes on board. I always say perimenopause is the litmus test for how well you've taken care of yourself. And for all these adaptive patterns that we create in our teens, 20s, and 30s, sometimes they're no longer adaptive. They become maladaptive. They become problematic. And so it's very hard when I say to someone,
OK, well, like all the things that made you an incredibly successful person, now we have to change a lot of them. Otherwise, you are not going to fare well for the next half of your life. And so it's just an invitation to take better care of ourselves. There's no other way to put it. I think for many of us, we weren't sleeping, we weren't managing our stress, we were over-exercising or under-eating or whatever it is that we were doing. Suddenly, in middle age, the wheels fall off the bus.
Kim Vopni (27:36.381)
Mm-hmm.
Kim Vopni (27:52.776)
Yeah. Yeah. Yeah. And I, it's funny, I remember reading in sort of the intro blurb for your book too. was when you feel like you're doing everything right. And I was also one of those people that, you know, I've worked, I've been obsessed with health and wellness. I've worked in health and wellness. I work out, I drink water, I eat healthy foods. Like you feel like you're doing all the right things. And without anything that we have changed per se, well, we ourselves internally are changing. We just didn't have the knowledge of that happening. So,
Cynthia Thurlow, NP (28:11.594)
Yeah. Yeah.
Kim Vopni (28:22.749)
But I didn't change anything in my day day life. So why all of a sudden am I not sleeping? Why all of a sudden am I not pooping? Why all of a sudden all these things? And, and as you say, it's, it's, it's a time for some internal reflection and some change, but having the knowledge ahead of time would have changed the whole game for me. I know for a lot of people as well. And, so for somebody in that, let's say somebody starting
this perimenopause and it's not an exact start date, it's roughly and there's usually a transition, but somebody who has identified that they are in this now six, 10, 12 year window, however long it is, what would you recommend people do even if they aren't yet maybe even noticing any changes, but what could we do to prepare ourselves for the change in ways that would help improve the response of our gut and therefore response of everything else?
Cynthia Thurlow, NP (29:19.436)
Yeah, I mean, would say the first thing, it's like, think about the, I would say major and the majors, because I think that distinction is important. So if you're in your mid to late 30s, you could already be there. A lot of us were, I just chalked it up to having kids at 34 and 36, and I was like, oh, I'm tired. Why am I so moody? Why am I suddenly having all these symptoms? I think the first thing to consider is that we don't wait until you're suffering a lot to ask for help. So number one,
you
seek help from a perimenopause, menopause savvy licensed medical provider. I have to emphasize that because you at some point may need some hormone options and you want to be with someone that can actually offer that to you. That would be number one. Just you don't have to wait until you're suffering a lot. I think when you start noticing changes in mood or your sleep, you can't really get a good grasp on why your sleep is so poor. That's the time to start seeking help. But the other thing to consider
is that having a stress management system something. I didn't have anything. I thought I was like, I don't need to manage my stress. I do a great job managing my stress. No, I didn't. The other thing is really thinking about nutrition. I say that it all starts with food, but it really does. And this is when an elimination diet can be helpful. Before we even start doing testing, is thinking about what are the most inflammatory foods in general? And for my patients, it's gluten and dairy by far.
And people have an easier time getting rid of gluten than they do getting rid of dairy. Dairy is hard for a lot of people. They're like, I'm addicted to it. I love it. I don't want to give it up. And I'm like, well, we need to at least try because it is inflammatory. Thinking about an elimination diet, not forever, but just that N of 1. Thinking about eating more nutrient-dense foods. And as much as I agree about the protein, protein is very important. And as we get older, as we're losing muscle mass, and this acceleration of muscle loss can happen.
Cynthia Thurlow, NP (31:19.678)
Protein's important, but so is fiber. And I affectionately now refer to it as the new F word because it is very controversial, depending on who I'm talking to. But fiber becomes very important. And we're not talking about Gram is metamucil. We're talking about getting it from food-based sources and just tracking. Like, figure out how much protein you're eating. Figure out how much fiber you're eating. Now, if you look at the research, Kim, it'll say 25 to 30 grams. Not every person can get there. Some people, like standard American diets, 5 to 10 grams.
Kim Vopni (31:27.676)
Yeah.
Cynthia Thurlow, NP (31:49.617)
if you're lucky. So I always say, figure out what you're eating and just eat more. And I'm not going to say take the supplement. I'm going to suggest add a tablespoon of fresh ground flax and chia seeds to a smoothie. It isn't about eating more salads. don't know why it's like salads. Automatic people are like, I just need to more salads. You could have a couple tablespoons of beans or lentils on a salad. Or you could add it to your meals. There's so many easy ways to do it. But fiber is important, and I just want
Kim Vopni (32:06.653)
Yep. I know.
Cynthia Thurlow, NP (32:19.47)
want to make sure I mention why fiber is important. So when we eat fiber, it goes through our digestive system. When it gets to the large intestine or the colon, which is where the microbiome is, the cells there will ferment it, and then they create something called short-chain fatty acids. And I promise I won't get too in the weeds about this. But short-chain fatty acids are important because they help lower inflammation. One in particular can cross the blood-brain barrier. It's called butyrate. People have probably heard of it. It's really important for insulin sensitivity. It's important for the immune system.
So as our hormones are declining, we need more fiber. So I know everyone gets, depending on who I'm talking to, I have to be careful because sometimes people get very upset about fiber.
I would say the other thing is getting really clear and intentional about hydration because as our hormones are declining, we lose some degree of hydration sensing in the body. By the time we're thirsty, we're actually dehydrated. We're really dehydrated. Hydration becomes important. Movement becomes important. Notice I'm not saying go out and do strength training two to three days a week. That's important, but just moving your body daily is going to move things through your digestive system. It's going to get you moving your body.
are like the very basic things that we start with before we start doing more target intervention. But when it comes to younger perimenopause, do not wait until you are suffering to ask for help. Starting like oral micronized progesterone the week or two before your menstrual cycle might be life changing. Like that may improve your symptoms for a long time. I wish I had known that I deserve to ask for that. And I didn't even as an NP. In fact, I remember the time that I was
having a conversation with my GYN and she gave me those four options which I was like no no no no I was like my god
Cynthia Thurlow, NP (34:05.58)
I suffered like this with heavy, I used to call them crime scene periods, without anyone offering any options other than say, well, maybe you need some progesterone. Maybe that would have given me a couple years where I wouldn't have been praying I didn't start my period when I was rounding on patients in the hospital because there was never enough tampons or pads together that would have ever allowed me to get through a shift. It was just impossible. So I think you start with the basics. And I would say the other thing to layer in there is
Kim Vopni (34:10.013)
same.
Cynthia Thurlow, NP (34:36.104)
If you are someone that experienced quite a bit of childhood trauma and you know who you are, like you know who you are, even though if you're in denial about it, get the help that you deserve to have. I would say that's the other piece of that because when your hormones shift and your neurotransmitters change, you are going to really start to struggle with those feelings, those experiences because they're so somaticized in the body. And I'm sure for you as a pelvic floor expert, you see a lot of women that have either had some
type of sexual trauma or sexual abuse. And it's like, why is their pelvic floor so tight? Why is it not responding appropriately? And it's because, as they say, the body keeps a score. I think the more that I do this work, and even through my own personal experiences as someone who has a high ACE score from my childhood, I'm like, this makes sense. Why do I have four autoimmune conditions? Why do I have tight fascia? All the things that suddenly start making sense. So giving yourself the opportunity to explore and unpack
things that you experienced when you were younger. And there's so many options now for patients that it's not just a one size fits all. There's a lot of options available.
Kim Vopni (35:44.542)
Yeah. I want to just wrap it up with a couple final things. One is kind of tying in when you were mentioning leaky gut. This is a term that a lot of people have probably heard if they've, I gut health has been almost like a trendy thing for a while and leaky gut is, is an element. what, is happening with leaky gut and from an HRT hormone replacement or menopause hormone therapy perspective,
when we think of healing the gut lining, is that something that can play a role?
Cynthia Thurlow, NP (36:20.428)
Yeah, absolutely. So number one, when we talk about lehiga, we're speaking to small intestinal hyperpermeability. Remember I mentioned that small intestine is one cell layer thick. So imagine you appropriately are prescribed a round of antibiotics, and I'm not demonizing antibiotics, I'm just saying you get a round of antibiotics or you drink a bunch of alcohol or you have a lot of stress. It weakens that one cell layer thick. And so what happens is you eat a meal, and this is why food becomes so important in perimaxa.
and menopause, let's say you eat ice cream with your family and you've got leaky gut, you just got a round of antibiotics to treat a urinary tract infection, now you've got leaky gut. Those food particles leak into your bloodstream. Your immune system is triggered. Your immune system is now driving this inflammatory response, or worse yet, you go to a romantic location like I did, I got a whopping dose of LPS, which is an inflammatory endotoxin,
that you can get from food poisoning, it me very sick. But the point of why I'm sharing this is that small intestinal lining is one cell layer thick. It is very easy to damage it. And once those little gates are open, you can continue leaking food particles into your bloodstream. You continue provoking this immune response. What's interesting is the decline in estrogen. Estrogen is like the glue, the mortar between bricks. As estrogen is declining, we're more likely to have leaky gut. We know those autoimmune conditions are
four to five times more likely in perimenopause and menopause, which is astounding. 80 % of autoimmune conditions are diagnosed in women. So it's part of changes in the immune system that are ongoing.
setting of less hormones. So let's say a woman has leaky gut, which is something you can fix. Let me be very clear, it's not doom and gloom. And most of us have had episodic bouts with leaky gut over the course of our lifetime. But over time, what can happen is if we are taking HRT, we know that that can help with replenishing that little mortar between the bricks. There's other things that we can do, and it goes along with that stress management piece and anti-inflammatory nutrition and sleep and all those things.
Cynthia Thurlow, NP (38:32.686)
that it absolutely can improve it. And I think that, as I mentioned earlier, that certainly sounds like the research that's ongoing right now is suggesting that it has a positive net effect. In particular, estrogen, because estrogen in the immune system are, this is a terrible analogy, but I'm gonna make it, peanut butter and jelly, they kinda go together.
And so they literally they stick together. So when estrogen is optimized, the immune system quiets down and then we're able to fight off opportunistic infections where that we're able to have a less provoked immune system. And so really that's as simple as it is. But it's interesting allopathic medicine doesn't necessarily believe it exists, but yet, you know, integrative medicine, functional medicine talks about it quite a bit. The number one thing is that it's fixable. And number two thing is why are why do we develop lehiga? Those are the things we have to be
conscientious about.
Kim Vopni (39:23.367)
Yeah. Amazing. Where can people find your book and also where can people learn more about you and follow along with your amazing podcast as well?
Cynthia Thurlow, NP (39:33.012)
Yeah, thank you. So it's www.syntheathurlow.com at the top of my website is a banner that will take you to any of your favorite retailers. Probably by the time this podcast is out, the book will be on sale officially, not just in pre sale. I'm active across social media. I'm probably most active on Instagram. I'm just starting up on Substack and I do have a wonderful podcast that you've been a guest on called Everyday Wellness. It's probably my very favorite thing I do within my business. But the menopause gut is really
the missing link for so many women that are trying to better understand their bodies who are already sleeping well and managing their stress and they're on HRT and they eat an anti-inflammatory diet and they exercise and they're still trying to figure out why are things not optimal. It's probably from the gut.
Kim Vopni (40:19.325)
Yeah. Excited to share with everybody. Thank you so much for your wisdom. Thank you for writing this book and for all you do to help support us through this magical journey of menopause.
Cynthia Thurlow, NP (40:30.209)
Thanks so much, Kim.
