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E208
October 06, 2026
How Menopause Changes Your Gut Health with a Leading Gastroenterologist
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In this episode of unPAUSED, recorded on location at the Aspen Ideas Festival, Dr. Mary Claire Haver sits down with Dr. Trisha Pasricha, a neurogastroenterologist at Beth Israel Deaconess Medical Center, assistant professor of medicine at Harvard Medical School, and author of the new book You've Been Pooping All Wrong. Women in perimenopause and menopause who describe bloating, new constipation, or digestion that suddenly feels unfamiliar are often told it is stress or age. This conversation explains the biology behind gut health in midlife, starting with the estrogen receptors inside the gut's nervous system.

Dr. Pasricha explains the gut brain connection and makes the case for treating the gut as a second brain rather than plumbing. She walks through why irritable bowel syndrome affects women about twice as often as men, and why women with gut pain are so often told it is all in their heads. In her words, it's not the stress causing the symptoms, it's the symptoms causing the stress.

They also cover the less obvious causes of bloating, including pelvic floor dysfunction, accidental bowel leakage and fecal incontinence after menopause and how they are treated, the link between smartphones in the bathroom and hemorrhoids, what to expect from GLP-1s, and why women treating iron deficiency can often take oral iron every other day to ease constipation.

The conversation then turns to the four colorectal cancer red flags women should stop normalizing, which stool colors need attention, why colonoscopy is the only colon cancer screening option that prevents colorectal cancer, and why new bloating after menopause should always be evaluated.

The practical takeaways include daily fiber targets, the case for psyllium and fermented foods to support a healthy gut microbiome, why ramping up fiber slowly prevents gas and bloating, and a realistic approach to cutting ultra processed foods. The episode closes with a habit Dr. Pasricha asks of her own patients: look at your stool every day, because knowing what is normal for you is how you notice when something changes.

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Chapters

00:00:00 – Why your gut is a second brain
00:02:54 – What a healthy gut really means
00:06:21 – How often should you poop
00:08:58 – Menopause, IBS and bowel changes
00:14:01 – What really causes bloating
00:18:11 – Estrogen and the gut microbiome
00:25:34 – Constipation, laxatives and pelvic floor clues
00:32:37 – Hemorrhoids, straining and toilet habits
00:35:59 – GLP-1 medications and GI side effects
00:39:05 – Four colorectal cancer red flags
00:45:58 – What stool color can tell you
00:52:27 – Early-onset colorectal cancer and screening
00:58:33 – Why IBS is not just stress
01:01:35 – The gut-brain connection and vagus nerve
01:05:30 – Fiber, fermented foods and gut health
01:09:12 – Psyllium versus probiotic supplements
01:12:03 – How to increase fiber without bloating
01:14:00 – Ultra-processed foods and gut health
01:21:03 – New bloating and cancer warning signs
01:22:04 – Three gut health mistakes to stop making

About the guest

Dr. Trisha Pasricha

Trisha Pasricha, MD, MPH is an Assistant Professor of Medicine at Harvard Medical School and author of the national bestseller "You've Been Pooping All Wrong." As a physician-scientist, Dr. Pasricha serves as Director of the Institute for Gut-Brain Research at Beth Israel Deaconess Medical Center, leading an NIH-funded research laboratory at the forefront of gut-brain science. She is also the “Ask A Doctor” columnist for The Washington Post where she translates complex medical topics into must-read insights—with a touch of humor—for millions each week.