571: Why Women Gain Weight in Midlife (And What Actually Works) | Cynthia Thurlow, NP

The perimenopause-to-menopause transition fundamentally alters gut microbiome composition, driving systemic inflammation, insulin resistance, and weight gain. Cynthia Thurlow, author of *The Menopause Gut*, highlights that declining estrogen levels disrupt microbial diversity, necessitating a shift in lifestyle strategies to maintain metabolic health. Central to this approach is the protein leverage hypothesis, where insufficient protein intake drives compensatory consumption of ultra-processed foods. To counteract these changes, women should prioritize fiber-rich whole foods and consistent protein intake—ideally 100 grams daily—to preserve skeletal muscle and satiety. Furthermore, hormone replacement therapy serves as a critical, often misunderstood intervention that, when combined with lifestyle modifications, supports long-term health span and independence. Addressing these hormonal and nutritional factors proactively rather than reactively allows for better management of symptoms and improved body composition during middle age.