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Author: Rese Carter MS CNS LDN
Why Perimenopause Requires Gut Optimization to Balance Hormones, Reduce Belly Fat & Restore Energy
A 42-year-old patient came to me in my virtual office, frustrated and in tears. She told me, “I don’t even recognize myself anymore.” She had been dealing with everything, mood swings, bloating, sluggishness, zero motivation to work out, intense back pain, a disappearing sex drive, and the constant feeling that she was losing control of her emotions.
Honestly, her story reflects almost every woman who sits in front of me, truth is I have been there too, and every time I hear this, it hits me in the chest because I know how isolating it feels. She was convinced her hormones were the issue and to be fair, she was partially right.
But what if the real problem isn’t your hormones at all? What if the gut is the silent switch that controls everything?
What we discovered on her GI-MAP stool test changed everything.
Is It Really Your Hormones — or Is It Actually Your Gut?
According to an article published in October 2024 in the Journal of Applied Sciences by Lara Pires and her research team, the gut microbiota plays a vital role in host health and functions like an endocrine organ, with effects that extend far beyond the digestive tract. In fact, the gut produces hormones and neurotransmitters that influence distant organs, including the brain such as GABA, dopamine, and serotonin.
This means that many women may be approaching perimenopause from the wrong starting point. What appears to be a hormonal imbalance may have actually begun years earlier in the gut and finally culminated in midlife. When the gut ecosystem is disrupted, hormone signaling becomes chaotic.
Many of my patients tell me it just hit them over night, the weight gain, the mood swings. This is the part no one tells us and it’s why so many women feel blindsided by their symptoms.
The Symptoms She Experienced
During her intake session, she described a long list of complaints, including:
She looked at me and said, “I used to be so driven. I don’t understand what’s happening to me.” “I am an overachiever, I don’t miss when it comes to my goals, but I can’t get this right’!
We ran standard labs and found results showing prediabetes and iron deficiency. I placed her on a carb-cycling protocol with macros designed to support fat loss and stabilize blood sugar.
One of her biggest challenges was constant sugar cravings.
I told her I suspected Candida overgrowth and I could see the hesitation in her eyes when I said it. I also told her I suspected her back pain might actually be gut related. I could tell she was a bit skeptical but I was unfazed as I had that response enough to know her curiosity would be sparked.
Have you ever had a moment where your body was screaming something, but you couldn’t interpret the signals?
She didn’t believe it at first. Most women don’t because we’re conditioned to think it’s just hormones, just stress, just aging.
Finally, she agreed to run the GI-MAP Stool Test not because she was convinced yet, but because she was exhausted and desperate for answers.
The GI-MAP Results Explained Everything
Here were the highlights — and this is where everything clicked:
| GI-MAP Finding | What It Means | Related Symptoms She Reported |
| Enterobacter spp (high) | Drives inflammation & raises blood sugar instability | Prediabetes, fatigue, belly fat |
| Klebsiella (high) | Linked to autoimmune activation & joint/back pain | Severe back pain, stiffness |
| Staphylococcus & Streptococcus (high) | Drive histamine, immune dysregulation & anxiety | Allergies, anxiety, emotional swings |
| Firmicutes elevated | Associated with weight resistance & abdominal fat | Stubborn midsection |
| Candida (high) | Causes cravings, brain fog & mood instability | Sugar cravings, brain fog |
| Elastase-1 (low) | Poor enzyme output → poor nutrient absorption | Bloating, low libido, poor recovery |
| Secretory IgA (low) | Immune depletion & chronic stress | Fatigue, illness sensitivity |
| Anti-gliadin antibodies (high) | Gluten-triggered inflammation | Gut pain & inflammation |
I remember looking at the labs and I felt relieved because now I could be more targeted and I could give her solid answers without guessing!
This was never just about hormones it was about their inability to function because the gut was inflamed, imbalanced, and overloaded.
No amount of hormone therapy, calorie restriction, fasting, over-exercising, or supplements could have fixed this until we addressed the gut.
How We Began Her Recovery
We approached it in phases:
Phase 1 — Remove
Clear pathogenic overgrowth (Enterobacter, Klebsiella, Candida, etc.)
Phase 2 — Replace
Support digestion and nutrient absorption with enzymes.
Phase 3 — Reinoculate
Rebuild healthy bacteria using probiotics (Bloombiome).
Phase 4 — Rebalance
Support metabolic pathways and blood sugar stability (Berberine Boost).
I always tell my patients, you cannot build balance on top of dysfunction, so clearing the debris first is cruicial.
The Shift
Within weeks she started texting me updates like,
“I woke up with energy today I haven’t felt like this in years.”
Her bloating decreased, her cravings were gone, her mood leveled, and she finally started losing belly fat she had been fighting for months.
Moments like that remind me why I do this work. This is one of many women I have liberated from the traditional approach to Perimenopause. When I wrote Perimenopause Unlocked this was my goal to help as many women as possible.
The Bottom Line
If the gut isn’t healthy, your hormones cannot be healthy.
Perimenopause isn’t a decline it’s a demand shift.
So the real question becomes: are you treating the symptom, or the source?
Gut dysfunction can mimic hormonal imbalance so perfectly that most women never know the difference until they test.
If You’re Wondering Whether It’s Your Hormones or Your Gut
You don’t have to guess.
Testing reveals the truth that guessing never will.
When we heal the gut, the hormones follow. Every time.
References
Pires, L., González-Paramás, A. M., Heleno, S. A., & Calhelha, R. C. (2024). Gut Microbiota as an Endocrine Organ: Unveiling Its Role in Human Physiology and Health. Applied Sciences, 14(20), 9383. https://doi.org/10.3390/app14209383