Better! with Dr. Stephanie

Episode: She Said, She Said: Perimenopause with Kids, Facts on Fasting, Testosterone, Cold Plunges, Peptides & Callouses

Host: Dr. Stephanie Estima
Guest: Cynthia Thurlow
Date: October 27, 2025

Episode Overview

This lively AMA-style episode features Dr. Stephanie Estima and her colleague and friend Cynthia Thurlow as they field audience questions on women’s health—especially as it relates to perimenopause and midlife challenges. Key topics include navigating menopause while parenting young children, views on fasting and muscle preservation, hormone replacement therapy, the role of dairy and gut health, safe approaches to cold plunges, testosterone for women, responsible use of peptides and GLP-1 medications, exercise recommendations for busy women, and practical self-care strategies. The tone is candor meets camaraderie: everything from nuanced insights to honest personal anecdotes and actionable strategies for women over 40.

Main Discussion Points & Insights

1. Navigating Perimenopause with Young Children

[04:36–13:08]

• Unique Challenges:
  • More women are having children later, leading to unique overlaps between perimenopause and early motherhood.
  • Both hosts acknowledge the sleep deprivation, emotional labor, and physical exhaustion that come from parenting young children in midlife.
• Practical Strategies:
  • Make movement part of mother-child interactions (e.g., “kitty bell swings”: playful, kid-inclusive physical activity).
  • Even small bursts of bodyweight exercises can support mental clarity and energy.
• Hormone Therapy Considerations:
  • At 45, adding hormone replacement, especially oral progesterone, can buffer symptoms of low progesterone: “Even if it is for one week out of the month, buffering the effects of that drop in progesterone…can help with the really heavy cycles. A lot of the estrogen dominance type symptoms that we experience.” — Cynthia [10:20]
  • Alcohol should be minimized to support sleep, mental health, and hormonal balance.

Notable Quote:

“The other thing I would say is just be really gentle with yourself. We’re so hard…at every stage of the parenting game…just giving yourself a break.” — Dr. Stephanie [09:34]

2. Rethinking Fasting and Muscle Building in Midlife

[16:52–37:54]

• Personal Evolutions:
  • Cynthia shares how losing her father to “frailty” and muscle loss prompted her to prioritize muscle gain over intermittent fasting.

    “It was nearly impossible for me to build muscle eating two meals a day… I needed that third bolus of protein.” — Cynthia [20:56]

  • Both women now use shorter overnight fasts and more frequent protein feedings to support hypertrophy and aging gracefully.
• Critique of OMAD (One Meal a Day):
  • OMAD can be a mask for latent eating disorders or chronic under-eating.
  • It’s especially risky for middle-aged women, leading to under-fueling, loss of lean mass, and increased frailty risk.

    “There are people who hide their latent eating disorders in OMAD… they’re not hungry for more food. And it’s because they have chronically under-fueled their body.” — Cynthia [31:07]

  • Long-term caloric restriction disrupts hunger/thirst cues and leads to “skinny fat” and later-life health complications.
• Reverse Dieting:
  • Slowly increasing calorie/protein intake can reset metabolism and health for habitual under-eaters.
  • Weight fluctuations and scale anxiety are common; body composition and measurements are superior to the scale for tracking progress.

Memorable Dialogues:

“You are barreling toward a cliff… if you are not putting in the work to strength train and eat enough food, there’s an exponential decline that people don’t see coming.” — Dr. Stephanie [35:46]

3. Dairy, Gut Health, and Protein Sources

[44:07–52:47]

• Bioindividuality Rules:
  • Dairy tolerance is personal: goat/sheep’s milk products are less inflammatory than cow’s milk for many.
  • Gut microbiome composition, changes in estrogen, and leaky gut in perimenopause impact new sensitivities.
  • For some, dairy elimination leads to weight loss and reduced inflammation.
  • Use N=1 experiments: try removing and adding back dairy to gauge response.
  • If tolerated, dairy can be a useful way to boost protein—especially Greek yogurt, cottage cheese, and baked goods made with dairy.

Fun Exchange:

“There is something about the appearance of cottage cheese. I can't do it... it’s like a visceral response.” — Cynthia [50:14]
“I love it. I don’t love the chunks, but I definitely love it blended.” — Dr. Stephanie [50:22]

4. Cold Plunges & Hormetic Stress in Women

[52:47–58:04]

• When Cold Exposure Is (and Isn’t) Safe:
  • Avoid cold plunges within 4 hours after strength training, as it blunts the muscle’s adaptive response.

    “If your goal is hypertrophy…I would definitely stay away four hours, like you said, is the number at least four hours… Because you want that adaptive response.” — Dr. Stephanie [53:06]

  • Cold plunges may be temporarily helpful for rapid recovery during competitions, not for muscle gain.
  • Women are more sensitive to cold and don’t need as extreme exposures as men; be aware of overall stress burden.
• Practical Advice:
  • Use 15–30 seconds of cold at shower’s end or try cryotherapy for less system stress.
  • Don’t add cold plunges if already sleep-deprived or stressed.
  • Heat (sauna) is often preferable for recovery and resilience.

5. Testosterone Therapy for Women

[58:37–63:37]

• About 25% of menopausal women do NOT need testosterone; always get tested first.
• Preferred Forms:
  • Transdermal creams/compounded options are safest; allow fine-tuning and avoid unpredictable peaks/troughs.
  • Avoid pellets and intramuscular injections due to risk, irreversibility, and unpredictable levels.
• Individualization:
  • Dosage often requires “tinkering” due to bioindividual absorption.
  • Consider supports for related hormones like DHEA and pregnenolone.
• Other Considerations:
  • Test for methylation issues (e.g., MTHFR mutation) before starting HRT; use diagnostics (e.g., DUTCH test) to personalize support for hormone detox and avoid estrogen dominance.

6. Exercise Plans for Women with Limited Time; Caring for Callouses

[68:51–80:44]

• Minimal Effective Dose:
  • Two 75-minute full-body sessions per week with focus on strength training can produce remarkable results if progressive overload is applied.
  • Alternate upper/lower body pushes and pulls.
  • Everyday “zone 2” walking and occasional HIIT for heart health and body composition.
• Callous Care:
  • “Badges of honor”: Don’t remove lifting callouses; keep hands moisturized.
  • Personal and humorous stories about hand callouses from weight training and walking big dogs.

Lighthearted Quote:

“I like to always say, glamour on this side and gangster on this side.” — Dr. Stephanie, showing her hands [78:37]

7. Peptides and Microdosing GLP-1 for Health & Longevity

[81:04–89:02]

• Peptides as an “Icing on the Cake”:
  • Used wisely, peptides (including GLP-1 agonists like Ozempic and Tirzepatide) can assist with metabolic, neurological, and autoimmune concerns.
  • Microdosing may yield benefits beyond weight loss (ex: bone, endothelium, brain health) at lower risk of side effects.
• Cautions:
  • Not for women with active or latent eating disorders.
  • Always pair with adequate protein and strength training to prevent muscle loss.
  • Beware of DIY/black market products.
• Promise & Peril:
  • Medications can be bridges for motivation and dietary change but should NOT be used for endlessly pursuing leanness or keeping up with unrealistic body ideals.

Memorable Moment:

“We have a culture that glorifies thinness over strength... if you’re chronically undereating, you need to be thinking of long-term health risks.” — Cynthia [84:28]

Notable Quotes & Timestamps

• “It’s not about being perfect. It’s about being better.” — Dr. Stephanie [pre-episode]
• “Frailty is not a question of if, but when. If you are not actively working against it.” — Cynthia [32:08]
• “I want to be a jacked grandmother. That’s what I want to be.” — Dr. Stephanie [23:48]
• “Calluses…are my little badges of honor.” — Dr. Stephanie [79:28]
• “Test, not guess. Let’s figure out what you specifically need.” — Cynthia, on HRT and detox [65:30]

Key Takeaways & Action Steps

• Integrate Movement: Use creative moments with your children for exercise—every bit counts in perimenopause.
• Prioritize Protein/Strength: For healthy aging, build muscle with adequate protein spread across multiple meals; don’t fast at the expense of muscle.
• Customize Nutrition: Experiment with dairy and pay attention to your own gut reactions.
• Use Recovery Tools Wisely: Don’t blunt training adaptations with cold plunges post-lifting; use sauna and rest for overall benefits.
• Personalize Hormone Support: Always get hormone levels tested and favor the least invasive intervention first.
• Be Cautious with Trends: Use peptides or fasting tools thoughtfully—not as shortcuts or covers for disordered eating.
• Measure What Matters: Focus on strength, how you feel, and body composition—not the scale.

Closing Vibe

This episode offers a reassuring, evidence-informed perspective on midlife womanhood: acknowledge complexity, prioritize muscle and mind, personalize everything, and most of all, be merciful to yourself.

“Keep the great questions coming… I love the camaraderie between our communities and so many shared interests.” — Cynthia [89:23]

End of summary. This guide provides an actionable, real-world roadmap for listeners navigating midlife health—a blend of science, experience, and compassion.