Cynthia Thurlow, NP: Perimenopause, Insulin Resistance and Midlife Metabolism

Feb 12

Perimenopause is not just about hormones, it’s a metabolic transition that affects insulin sensitivity, gut health, stress tolerance, and long-term disease risk.

In this episode, Cynthia Thurlow, board-certified nurse practitioner and functional medicine expert, explains how women’s metabolism changes in midlife and why insulin resistance, poor stress resilience, and gut dysfunction often appear years before menopause.

She breaks down how perimenopause can begin earlier than most women expect, why symptoms vary so widely, and how lifestyle factors like fasting, exercise intensity, sleep, alcohol, and chronic stress interact with hormones during this transition.

This conversation explores:

Why insulin resistance often emerges in perimenopause
How stress and trauma shape metabolic and hormonal health
The role of gut health in PMS, mood, and estrogen balance
When fasting helps women and when it makes things worse
Why “doing everything right” can still lead to symptoms
How to individualize nutrition, training, and recovery in midlife

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CHAPTERS

00:00:00 Trailer
00:01:25 Why Women’s Metabolic Health Is Finally Getting Attention
00:05:24 How Intermittent Fasting Brought Metabolism Into the Mainstream
00:07:18 Can Perimenopause Really Start in Your 30s?
00:09:02 PCOS, Low Progesterone, and Early Hormonal Warning Signs
00:15:09 What’s Actually Happening to Hormones in Perimenopause
00:19:40 Symptoms Women Don’t Realize Are Hormonal
00:20:54 Which Labs Matter in Perimenopause (And Which Don’t)
00:26:43 Why Stress Tolerance Drops in Midlife Women
00:28:21 Gut Health, Estrogen Recycling, and PMS
00:37:39 Vaginal Health, Painful Sex, and the Microbiome
00:43:42 Foundational Gut Health for Midlife Women
00:48:23 Childhood Trauma, ACE Scores, and Accelerated Aging
00:51:13 Healing, Resilience, and Long-Term Hormonal Health
00:57:24 Final Takeaways and Where to Find Cynthia

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Learn more about Cynthia Thurlow

Instagram: https://www.instagram.com/cynthia_thurlow_/
YouTube: https://www.youtube.com/cynthiathurlow
Website: https://www.cynthiathurlow.com/
Pre-order her upcoming book: The Menopause Gut (28th of April 2026):
https://www.penguinrandomhouse.com/books/777129/the-menopause-gut-by-cynthia-thurlow-np/?mcp…
ACE (Adverse Childhood Experiences) questionnaire:
https://www.acesaware.org/wp-content/uploads/2022/07/ACE-Questionnaire-for-Adults-Identified-English-rev.7.26.22.pdf