In this episode, host JJ Virgin and clinician‑type guest (Speaker C) explore why many health‑conscious women still struggle with weight, digestion, energy and other symptoms during perimenopause and menopause. They argue that unresolved childhood trauma and chronic stress rewire the autonomic nervous system, creating a sympathetic‑dominant state with elevated cortisol that can become catabolic, impair immunity, and exacerbate gut permeability. The conversation moves to the "estrobolome"—the gut microbiome’s estrogen‑processing hub—explaining how a disrupted microbiome, poor diet, and exposure to estrogen‑mimicking chemicals can cause estrogen recirculation and trigger classic perimenopausal complaints (breast tenderness, weight‑loss resistance, brain fog, rashes, digestive issues). Practical, low‑cost interventions are offered: prioritising sleep, consistent stress‑management (nature walks, grounding, breathwork, box breathing), setting boundaries, and adopting longer periods of digestive rest (12‑13 h fasting windows). They also discuss biofeedback via HRV monitoring, praising the Pulsetto device for raising HRV. Testing options are outlined, including stool beta‑glucuronidase assays and blood/urine hormone panels to assess estrobolome function and estrogen metabolism. Finally, they urge women to become their own health advocates—question providers, switch doctors if needed, and treat their health like a CEO‑run organization. Sponsor messages are interspersed but do not affect the core content.
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Why do you think that there are so many high-performing, health-conscious women, I mean, women that are like watching all the shows, reading everything, doing all the right things, and they're still struggling? They're struggling with weight, struggling with digestion, energy. What's going on?
I think chronic or, you know, significant childhood events have a way of unwinding in perimenopause. You know, whatever adaptive patterns someone has created to be able to deal with what they experienced as a child or young adult becomes very maladaptive at some point. And I say this lovingly as someone who has an ACE score of 9. I have quite a high ACE score. And so in perimenopause, the wheels fell off the bus, and it has a lot to do with these changes in hormones. All of a sudden, you know, whatever adaptive strategies you had before, it's like— it's suddenly like the getting up early in the morning and forcing yourself through workout and not dealing with your stress, and all of a sudden these things start to come out, the autoimmune conditions really become problematic. So I think for a lot of people, underlying trauma and stress is at the basis for a lot of issues that I see in women in middle age that are doing all the other work and then not understanding that complex in a relationship. So think about how, how chronic stress and trauma rewires your autonomic nervous system. So suddenly you have someone who is, has a kind of sympathetic dominant state where they have elevated cortisol. Cortisol's not a bad hormone. It gets such a bad rap.
I'm so sick of the, the exercise cortisol situation online.
So thank you. It's like hormetic stress. But understanding that, you know, if stress is persistent and bothersome over time, what does cortisol do? It catabolic. So it breaks down muscle. It impacts your immune system. You're gonna be more susceptible to opportunistic infections. More likely to develop leaky guts. I mean, cortisol can be caustic over time. And so I think for a lot of people, they don't understand how that kind of rewires your nervous system and also impacts your health on such a significant level. So I think— this is my working hypothesis— there are a lot of women in perimenopause and menopause that suddenly that trauma that they suppressed, they pretended wasn't there, avails itself I think this contributes to a lot of midlife divorces. I think it also contributes to a lot of health problems that women experience. So I would say it is not just the gut health piece that's not being addressed. I would also say on the other side of that is this chronic trauma piece that is not being looked at. And I think, you know, even with all the experts that I know you and I have had on our podcasts, no one's really speaking to that. And yet I think it is something that is really pervasive and corrosive. And if you don't deal with your shit, it is going to come back to get you. It's stinky.
I'll link to Amy Apigean. We've had her on a couple of times, but it makes me think of this. I literally said this today on a podcast. I said, you know, if I could go back and tell my younger self, it would be, learn how to manage your stress before you get into perimenopause.
'Cause if you don't—
'Cause if you don't, guess what? And so that's just taking it to the next level. I had an ACE score of 6. And I have not met someone with a 9. And maybe tell someone what that means. Because they might go, "Oh." Yeah.
So I, I think when we talk about trauma, I think most of us acknowledge, and I trained in inner city Baltimore, so I saw murder, rape, suicide. I mean, horrible things that we— there's no one's going to question that that is traumatizing. But I'm really speaking to the little t trauma, the insidious stuff, the addiction, neglect, whether it's emotional or physical, you know, other types of, you know, stressors, loneliness or bullying. And it's, you know, this kind of cumulative long-term trauma long-term effect of these things that can really impact us. And so certainly for me in my childhood with, I had an alcoholic parent who was on the spectrum.
I think we all had alcoholic parents in our age range.
Yes. Um, alcoholic parent.
When Kim and I talk about this, it's like.
And a narcissistic mother. And so growing up in that environment, uh, the way that I adapted was to be like the good kid. So I got good grades and I was popular and you know, I never gave my problem, my parents a problem. But, you know, it gets to a point that's very heavy to hold for a long period of time. And so I think for those of us that have experienced those things, we adapt to our environments. Probably why I became a nurse and later a nurse practitioner, because I wanted to help take care of others. And so the service to others kind of mentality. But I think for so many people listening, whether you experienced overt neglect or other things, I think it imprints us and it becomes much harder to wear that mask as we get older. The mask comes down in the absence of hormones. Estrogen is a people-pleasing hormone. I can tell you as a reformed people pleaser, I don't know how I ever survived in the absence of, you know, that degree of estrogen that I had when I was still in traditional allopathic medicine. But I think for a lot of people, the mask comes off in perimenopause. People find their voice and suddenly they really start standing up for themselves in a way that I think can be very positive and uplifting. It doesn't have to be negative.
Yeah.
But you have to put the work in. And so I think this is that time where people have to put the work in.
If you're that busy, stressed midlife woman, mm-hmm, and now the mask is coming down, what would move the needle fastest to get you back into some kind of homeostasis?
Yeah, I would say first and foremost, you gotta sleep. So that's usually the first thing that we're addressing. You need to find some form of stress management that you can do consistently. And what might, might work for you and I may not work for someone else, whether that's, Putting your, your feet in the earth, whether it's getting the connection to nature in the morning, whether it's taking a walk. Dogs. Yes.
Dogs.
We both have, between us both, we have 6 dogs. Learning how to say no. Like, how hard is it as a people pleaser to know how to say no and not explain yourself?
You know, when estrogen comes down, you say no to everything. Like, it's, it's that beautiful switch that once these things come down, even with hormone replacement, they're not the same.
Nope.
And all of a sudden you're like, oh, you don't like me? Don't care. No, I'm not going to go there just because you asked me.
No, it doesn't, doesn't work that way.
Don't need to.
Yeah, but I mean, I think having boundaries is a way to preserve your sanity and your stress management. I think other things that I think about that are kind of like low-lying fruit, like learning how to eat less often. You know, we as a nation eat, you know, anywhere from 7 to 10 times a day. It's like, it doesn't— you don't have to intermittent fast, but even 12 or 13 hours of digestive rest, those are simple things that people can do up front. Well, simple in that I'm saying it is simple. Sometimes the sleep piece is elusive and takes a while to tease out. But I think for a lot of individuals, I'm not talking about buying a gadget or doing some complicated diet.
Although I've been using this Pulsetto.
I love Pulsetto. I'm obsessed with this thing. It's the only, you know, did it impact your HRV? It's the only thing I've ever used. It's dropped my, my HRV's gone up.
Yeah. It's the, I will tell you, I've tried all the gadgets. Mm-hmm.
Because they send me all the gadgets. Me too.
I'm like, this didn't do a thing. And I'm so hopeful. I'm like, oh, please do something. This one does something.
Yeah, my HRV has gone up, which is what I'm— I've been telling people. I'm like, I was almost hesitant to say anything because I didn't know about it when I wrote my book. That's number one. Number two, I was like, I'm cautiously optimistic. Like, oh my God. And I'm someone that I know when my HRV goes down because it impacts everything else. But I think for a lot of people, they want us to say a gadget.
And I'm like— You can do breathwork, whatever the thing. Like you said.
Box breathing. Like instead of doing CrossFit, 6 days a week with no— or Orangetheory Fitness 6 days a week with no recovery, like, learn how to take a slow flow yoga class or get outside and walk in nature. Like, I'm talking about simple things that we know on a very basic level are gonna improve your quality of life, but are also gonna have a positive net impact on the microbiome. This is before we even get to complicated stuff. I mean, I run the gamut in the book. I mean, that was, you know, I spent a concerted effort to make sure it ran from simple free stuff all the way up to, you know, interventions that involve other experts and hiring people to help you and stuff like that.
So let's deeper dive on estrobolome.
So this is your estrogen processing center of the microbiome. It is really important. It's important both in before menopause and after, but it's where your body, you know, the liver is this primary site to break down things that you're exposed to. I'm gonna oversimplify things, but to break it into water-soluble compounds where it goes to the gut., and it's supposed to get packaged up like a present and pooped out of your body. But what can happen is if you don't have the right microbiome constituency, you're eating a garbage diet, you're super stressed, it can get re— your estrogen can get recirculated. And these are the symptoms that make women really unhappy in perimenopause. This is when breast tenderness, weight loss resistance, brain fog, rashes, digestive concerns. I mean, it runs the gamut. For me, from my perspective, if you understand that the estrobolome is nurtured by the way we manage our lifestyle and the types of foods that we eat and the way we manage our stress. We've talked about stress, like this Goldilocks effect of stress, like beneficial stress, right amount, right time, versus chronic stress. And how the estrobolome is so important for managing and mitigating how we excrete our estrogen. And here's the thing, even in menopause, even if you're on HRT, if you're exposed to a lot of estrogen-mimicking chemicals in your environment, personal care products, or food that can throw off the estrobolome. So it does matter what we use in our personal lives. It is not irrelevant. It is not woo-woo. You know, we know that these estrogen-mimicking chemicals can be 100 or even up to 1,000 times more potent than the hormone itself. So if you think it's not important, I always remind people like, don't be paranoid, but just make conscientious efforts when you're purchasing deodorant or you are drinking your water. And I acknowledge like when I travel through airports, I don't stress about getting a bottle of water. It's like, yes, I'm exposed to some microplastics, but I need the hydration and I'm not going to stress about it. But I think for a lot of people, they assume it's just irrelevant.
Would you be looking at, say, a urine hormone test? Like, how would you know if this is working correctly?
Yeah, off of symptoms. But there's also— in stool testing, we look at things like beta-glucuronidase, which is this important enzyme that goes in and kind of helps break down the estrogen. And if it's elevated, it can be a sign that maybe things are not optimal. I think for a lot of people, it's really just getting a sense of Symptoms, and then we can look at blood work. Are they metabolizing things properly? But that stool testing piece I think can be very important. And then I would say that is where I think stool testing can be really helpful. And it doesn't necessarily mean that everyone has to run out and get a stool test, but I do think having a sense of whether or not the estrobolome— I'm laughing because someone the other day called it estrobolome, and I was like trying so hard not to laugh when I was talking to this person. I was like, I get it, it's kind of an awkward way of describing The estrogen processing center of the gut microbiome.
So they called it that the entire time.
It's sort of like, and I was like, you didn't tell 'em. I was like trying so hard. I was like, it makes me think of baloney. And then I was like trying to, I was trying very hard not to like correct them. I was like, afterwards I was like, it's estrobolomi. They're like, oh, I thought it was estrobolomi.
It actually is easier to pronounce as estrobolomi. Yeah. Anyway, if you could delete one piece of advice that women have been given about menopause, what would it be and what would you replace it with?
I think I would encourage women to be their own best advocates. So this kind of patriarchal environment where you go to your provider and they tell you what to do.
I love that women are being that way. It's like, come on, women.
Yeah. I mean, it goes and it, it can even be from female providers. Right. That's the thing. That's like, yeah. And they don't, their, their providers don't wanna be challenged. They don't wanna be questioned. I'm like, aren't those days behind us?
I thought they were.
So I think that if you are a middle-aged woman and you're seeking really good care and the person that you are seeing is not providing the care that you want, I give you permission to fire them. I've done it. I did it.
You know, the old days where you had an insurance plan and you had to go to this person on your— like, that is not— you are now hiring someone.
It's a free agency.
Yeah, it's like the COO of your, your health. You're the CEO. You better choose wisely.
