To understand weight gain associated with menopause, we need to start by understanding the gut microbiome. 

That’s why I’m excited to introduce you to Dr. Betty Murray, women’s health expert and researcher, as well as founder of a functional medicine clinic in Dallas, TX. She also runs a telemedicine clinic called Menrvawhere she helps women master menopause. She has a podcast, a TV show coming out, and a program specifically focused on helping women with menopause. 

I invited Dr. Murray to join me on How Humans Heal because I want you, the listeners, to have the most up-to-date information about menopause, hormone replacement, and metabolism so you can be making the informed decisions for your health care now, without having to wait for that info to be integrated into standard medical care.

Dr. Murray’s research is related to the microbiome and metabolism of women in menopause. In her research she was able to solve the mystery of why weight gain happens, and how to prevent it. 

When asked what got her started with this focus area, she shared that her passion about helping women with menopause started with experiencing it herself. As a clinical nutritionist, she become immersed in understanding the changes women experience and what can be done to address them without causing other issues. 

Dr. Murray believes women deserve so much more support during the menopause transition, and that is what drives her to be so outspoken about what is possible and what is not being offered in the standard of care. 

OK, so let’s get to the gut microbiome. 

The Microbiome-Gut Connection During Menopause

Who would have thought that our gut microbiome has anything to do with what we experience during menopause! 

The connection between gut health and hormones is actually quite fascinating and complex. 

Dr. Murray explained that we have a microbiome in every tissue of the body, not just in the gut. While we often think of the gut microbiome as primary – the three to four pounds of bacteria we carry – the fact is we have a symbiotic relationship with probiotic organisms throughout our body. 

They help us do many things, and most importantly, they act on our food before we can absorb any nutrients.

In 2011, groundbreaking research by Patel and Blazer revealed new insights about the microbiome through DNA research. We need DNA technology to properly identify the bacteria in the microbiome, and we’re still learning more about this identification process. 

You’re not going to get access to DNA testing at the regular doctor’s office. Traditional testing methods, like those used by gastroenterologists, involve culturing bacteria in a Petri dish. However, this approach misses about 80% of gut microbes because they can’t survive exposure to oxygen. 

To truly understand your microbiome, we need to use a DNA analysis, which both Betty and I use in our practices, for patients to understand what is happening in their microbiome, and for us to be able to make appropriate suggestions to improve the microbiome.

Understanding Beta-Glucuronidase and Hormones

Through research using DNA testing of the microbiome, several bacteria strains were identified that produce an enzyme called beta-glucuronidase. This enzyme exists naturally in the human body – our lymphatic system makes it, our bones make it – but these microbes also produce it. 

Beta-glucuronidase has a crucial function: it liberates estrogen and estrogen-like compounds, as well as toxins that are meant to be eliminated through stool.

These compounds typically get trapped in bile and wrapped into stool with fiber for elimination, but beta-glucuronidase allows them to be recirculated through hepatic recirculation, going back through the liver and into the bloodstream. 

This process, which initially seems counterintuitive, actually serves an important purpose in maintaining hormonal balance.

The Natural Balance of the Microbiome Shifts Over Time

Nature is usually symbiotic, even in ways we might not expect. Dr. Murray uses the example of sharks – while often viewed negatively, overfishing for sharks is actually disrupting ocean ecology. 

Similarly, everything in nature exists to create homeostasis or balance. When we look at beta-glucuronidase levels across age groups, we see fascinating patterns. Small children and infants who have been breastfed and had vaginal deliveries don’t naturally have many microbes that make beta-glucuronidase.

However, as we reach reproductive age and begin menstruating, these levels increase. Even more interestingly, the bacteria that produce beta-glucuronidase grow significantly during menopause. 

This shift appears to be the body’s attempt to maintain adequate estrogen levels as ovarian production decreases.

The Truth About Beta-Glucuronidase

While beta-glucuronidase has traditionally been perceived negatively in research – associated with colon cancer, drug-induced toxicity, chemotherapeutic drug complications, and breast and prostate cancer – its increased production during menopause suggests a more complex role. 

The question becomes: why would the body naturally increase production of something potentially harmful as we age? The research points to this shift in the microbiome being a protective mechanism, attempting to help recirculate what little estrogen remains as ovarian production decreases.

This relationship becomes even more complex when we consider environmental factors. In a purely organic environment without widespread toxins, this mechanism would be beneficial. 

However, in our current environment, filled with substances that mimic hormones (like pesticides and other chemical compounds), this same process can become problematic by recirculating these harmful compounds along with beneficial hormones.

Understanding Estrogen Detoxification

Dr. Murray explains the process of estrogen detoxification using a helpful analogy. 

Unlike breaking down a piece of furniture to fit it in a trash can, our bodies add things to toxins to prepare them for elimination. She describes it as wrapping a leaking pen in multiple layers before disposing of it. 

Each stage of liver detoxification adds different “wrappers” through processes like glucuronidation, methylation, and glutathione conjugation.

This process affects not just estrogen, but also testosterone, progesterone, and neurotransmitters like dopamine, serotonin, epinephrine, and norepinephrine. 

These compounds can influence gut function, affecting smooth muscle contraction and relaxation, which may explain why conditions like IBS often worsen for women during certain parts of their menstrual cycle.

When we talk about estrogen and other hormones and metabolites in our body, it’s important to understand that they eventually pass through the liver for detoxification. 

While some might question why we would want to eliminate estrogen, especially during menopause when levels are already low, it’s crucial to understand that this is part of a natural recycling process. We need estrogen to be present, go through the liver for detoxification, and then have new estrogen enter the system to maintain a stable state.

When our ovaries are active, they produce estrogen naturally. If we’re taking birth control pills or hormone replacement therapy, that becomes our source of estrogen. Either way, it goes through the liver and interacts with various detoxification pathways. 

The goal is healthy detoxification of estrogen and proper elimination from the body, but there are many other interactions and possibilities that can occur during this process.

Weight Gain and Metabolic Changes in Menopause

One of the most significant changes women experience during menopause is weight gain, particularly around the midsection. About 90% of women will gain up to 15% of their body weight during menopause. 

For example, if you weigh 150 pounds, you might gain about 22-23 pounds. This is actually a protective mechanism – as ovarian estrogen production decreases, the body attempts to compensate by storing more fat, since fat cells can produce estrogen.

However, the estrogen produced by fat cells is nowhere near the levels produced during regular menstrual cycles. During ovulation, estrogen levels can reach over 500, and in the second half of our cycle, they typically range from 250 to 400. During pregnancy, levels can reach 4,300. 

In contrast, the therapeutic range for postmenopausal women is typically between 50 and 160.

How Glucose Metabolism Changes in the Mitochondria

The mechanism behind menopausal weight gain is complex and involves cellular mitochondria – our body’s energy powerhouses. Inside our cells, there’s a transporter called GLUT4 that moves glucose to the mitochondria. 

While insulin gets glucose into the cell, it doesn’t drive it to the powerhouse – that’s GLUT4’s job. Dr. Murray describes this as being like a ladder with a gentle slope, creating a slow, passive transport system.

This transport system is estrogen-sensitive, which means when estrogen levels drop during menopause, glucose transport becomes significantly impaired. When cells have glucose inside but aren’t burning it efficiently, they become glucose toxic. 

The powerhouse slows down and becomes less efficient at burning fat as well. This explains why simply cutting carbs isn’t always an effective solution – if glucose is already present as a fuel source but can’t be properly utilized, the body struggles to switch to burning fat.

Additional Metabolic Changes of Menopause

Another fascinating aspect of menopause metabolism involves a mechanism similar to what allows animals to hibernate. Inside our cellular powerhouses, there’s a system driven by uric acid production that can switch metabolism down to about 30% efficiency. This is the same mechanism that enables bears to gain weight before winter and sleep through the cold months.

During menopause, women experience a steady rise in uric acid levels, effectively slowing their metabolism at the cellular level. Instead of being a high-performance Tesla, every cell becomes more like a 1984 Yugo. This metabolic slowdown is also estrogen-dependent, creating another layer of complexity in menopausal weight management.

The subcutaneous fat – what Dr. Murray calls the “jiggly bits” or “junk in the trunk” – has adrenal receptors with nerve connections that produce epinephrine and adiponectin. Adiponectin helps get fat out of fat cells, while epinephrine transports it to cells for use. However, these nerve receptors become less responsive when estrogen levels drop, making it particularly difficult to lose fat from certain areas of the body.

This complex system of metabolic changes raises an interesting evolutionary question: why would humans develop these mechanisms that seem to work against us? 

Dr. Murray suggests that these adaptations might have evolved to help women survive post-reproductively, as humans are one of very few mammals who live significant post-menopausal lives.

What would reverse these effects on the metabolism? Estrogen Replacement Therapy.

The Truth About Hormone Replacement Therapy (HRT)

The medical community’s approach to menopause treatment reveals a striking double standard. 

If a man loses testosterone, he receives replacement therapy. If someone’s thyroid stops working, we replace thyroid hormones. We readily replace growth hormone and insulin when needed. Yet when a woman goes through menopause, she’s often told to simply deal with it.

The Women’s Health Initiative study, despite its flaws, showed that women taking estrogen alone had a 23% reduced risk of breast cancer. It’s worth noting that the average age of breast cancer diagnosis is 63, when most women are post-menopausal and not on hormones. 

Furthermore, having more children, having them earlier, and having a longer menstrual history actually reduces breast cancer risk.

Dr. Murray points out the logical inconsistency in current medical thinking: how can it be completely safe to give high-dose birth control pills to young women, but somehow dangerous to provide lower-dose hormone replacement after age 50? 

The math simply doesn’t add up. In reality, bioidentical hormone replacement typically involves replacing only about 11-15% of what women naturally produced during their reproductive years.

Limited Coverage by Healthcare Systems for Women’s Health

One of the major challenges in women’s healthcare is the structure of our insurance and healthcare systems. CMS, the governing body over Medicare, sets standards that commercial payers like Blue Cross, United, and Aetna follow. 

According to CMS guidelines, they do not cover anything considered prevention of disease or improvement of health span. Hormone replacement falls into this category. Even more insidious is the fact that most healthcare costs hit Medicare because women typically don’t experience severe health complications until after age 65. 

Private insurance companies have little incentive to cover preventive care because they won’t bear the cost of later disease – that falls to government programs and taxpayers. 

Dr. Murray compares it to car ownership: you own your car and pay for insurance in case of accidents, but routine maintenance like oil changes and tire replacements is your responsibility.

The Cost of Prevention vs. Treatment

When we were young, managed care seemed wonderful – everything was covered with minimal cost. But that’s not today’s reality. 

Healthcare has become extremely expensive while covering less, and insurance companies are making record profits while people struggle with health issues without dying. This makes it crucial for women to take charge of their health and make conscious decisions about resource allocation.

Dr. Murray suggests that the cost of preventive care often isn’t as high as people think. The price of daily coffee drinks at Starbucks, for instance, could instead be invested in health maintenance. It’s about making choices and prioritizing long-term health over immediate conveniences.

It’s important to remember that not long ago, marriage was primarily a business arrangement between families. Dr. Murray’s grandmother, born in 1894, married as part of a family agreement – love had nothing to do with it. This historical context has led to generations of women being conditioned to put everyone else’s needs before their own.

Even basic behaviors reflect this conditioning – Dr. Murray recalls her grandmother refusing to sit down to eat until everyone else had started their meal, despite being the one who prepared the food. 

This generational pattern of self-sacrifice continues to influence how women approach their health today.

Breaking the Cycle of Self-Sacrifice

For women to be there for their families, they must first be healthy themselves. With the unseen hours and emotional labor that women provide, on top of often being breadwinners, it’s crucial to put themselves on the schedule and allocate resources to their health. This might mean having challenging conversations about money and priorities, especially if someone else is controlling the finances.

The choice is simple: pay for preventive care now or pay for managing illness later. Dr. Murray emphasizes that she would rather invest in prevention than spend everything trying to keep a failing body alive. This approach not only benefits women directly but also sets an example for future generations.

Our children learn not from what we say but from what we do. If we show our daughters that we don’t matter, that we run ourselves into the ground for everyone else, they won’t listen to our words – they’ll repeat our patterns. The only way to change future generations is to model the right behavior, which means taking care of ourselves first.

This isn’t easy, even for business owners and health professionals. Dr. Murray admits that she still has to force herself to meditate before checking email and to prioritize her health practices. It’s a constant learning process and one that requires conscious effort and support from other women.

Practical Resources and Support

For women seeking support with menopause and hormonal health, Dr. Murray offers several resources:

• The Menopause Mastery podcast, providing weekly science-driven content
• Her telemedicine company at gethormonesnow.com
• Living Well Dallas clinic at livingwelldallas.com
• Her personal website at bettymurray.com

You can also find her on Instagram @bettymurray_phd and Facebook @drbettymurray.

The key message is that women don’t have to resign themselves to menopausal symptoms, weight gain, or declining health. There are evidence-based approaches available to help women thrive through this transition. 

If you would like to learn more about how you can navigate through menopause you can save your spot for my upcoming Menopause Masterclass.

Sign Up Now

With proper support, testing, and treatment, women can maintain their health and vitality throughout menopause and beyond.

Remember, investing in your health is not selfish – it’s necessary. Just as we’re told on airplanes to put on our own oxygen mask before helping others, we must prioritize our own health to be able to care for those who depend on us. 

The time has come for women to take charge of their health and well-being, understanding that preventive care now leads to better outcomes in the future.

It is important to know that it is possible to recover from stress and trauma and truly heal, because you’re not likely to hear that from your standard doctor’s office. Keep in mind, they are not educated about diet, exercise, supplements, or stress recovery. 

I am living proof that it is possible to heal holistically and naturally. 

It’s possible to balance your hormones or to use hormone replacement safely and effectively, as well as toclear HPV and get a normal pap result, and to eliminate the effects of stress, trauma, anxiety and depression. I help patients with to do this in my practice every day – by phone and zoom, anywhere in the world. You can set up a one-on-one appointment here.

Once I meet with you one on one, we will create a strategic plan based on your health needs during menopause, including sessions with the health coach on my team to help guide you to implement my proprietary C.A.R.E. and Stress Mastery programs. 

If you’re dealing with persistent HPV I encourage you to check out my Say Goodbye to HPV Program. You can access it from anywhere in the world because it is online videos, with handouts, recipes, resources, as well as live group sessions and a private app, where I teach you to implement my protocol over 12 weeks.

You’ll also get access to order specialty testing I recommend to help us understand what your body needs in order to heal, as well as vaginal suppositories. I’d love to teach you how to heal and protect yourself from HPV. 

You can also go to clearhpvnow.com. There, you’ll find lots of resources and stories from women who’ve followed my protocol and cleared HPV to negative. 

Thank you all for joining me for this fascinating discussion with Dr. Betty Murray. If you found this information helpful, please make sure to subscribe so you don’t miss future episodes of How Humans Heal. 

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