Show Notes HOST Melody Hartzler | | Book Appointment AROUND THE TABLE Kara Siedman | ResBiotic In Today's Episode In this episode of the Tables Talk Podcast, Dr. Melody Hartzler sits down with Kara Siedman, RD, CDCES, Director of Partnerships at ResBiotic, to examine how microbiome-driven physiology intersects with hormonal transitions during perimenopause and menopause. As estrogen and progesterone fluctuate and decline, women experience predictable shifts in metabolic regulation, immune signaling, and inflammatory burden. Increasing evidence suggests these changes are tightly linked to alterations in gut microbial diversity, intestinal barrier integrity, and microbial metabolite production. This conversation explores the gut–hormone axis through a mechanistic lens, highlighting how microbiome dysfunction may amplify symptoms such as blood sugar instability, weight gain, estrogen dominance, gastrointestinal distress, and genitourinary changes. Kara draws on clinical experience and emerging research to clarify why many hormonally driven symptoms occur in the absence of overt disease on conventional testing. The episode emphasizes perimenopause as a critical intervention window—one in which targeted dietary, lifestyle, and microbiome-supportive strategies may meaningfully influence long-term cardiometabolic and immune health. Key Takeaways Hormonal decline during perimenopause is closely linked to reduced microbiome diversity and resilience Estrogen loss impacts intestinal barrier function, inflammation, and metabolic regulation The estrobolome plays a central role in estrogen metabolism and symptom expression Microbiome-targeted interventions may reduce cardiometabolic risk during menopause Diet, fiber diversity, and precision biotics are foundational tools for supporting this transition Episode Highlights Hormonal Transitions & the Gut–Hormone Axis Estrogen and progesterone fluctuations in perimenopause Bidirectional signaling between endocrine function and the microbiome Declining microbial diversity and reduced short-chain fatty acid production Inflammation, Metabolism, and Insulin Resistance Metabolic endotoxemia and LPS-driven inflammation Microbiome contributions to blood sugar dysregulation and weight gain Links between dysbiosis, immune activation, and chronic disease risk The Estrobolome & Estrogen Metabolism Beta-glucuronidase activity and estrogen deconjugation Microbial reactivation of estrogen and clinical implications Estrogen dominance, elimination pathways, and gut health Vaginal Microbiome & Genitourinary Health Estrogen-dependent Lactobacillus depletion Increased risk of UTIs and yeast infections Gut–vaginal microbiome crosstalk and clinical considerations Clinical Interventions to Support Microbiome Resilience Mediterranean-style dietary patterns and plant diversity Fiber intake, resistant starch, prebiotics, probiotics, and postbiotics Stress, sleep disruption, medications, and microbiome vulnerability Precision supplementation during the menopausal transition
