How Menopause Changes Your Gut Health with a Leading Gastroenterologist

In this episode of unPAUSED, recorded on location at the Aspen Ideas Festival, Dr. Mary Claire Haver sits down with Dr. Trisha Pasricha, 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's stress or age — Dr. Pasricha explains the real biology, starting with the estrogen receptors inside the gut's own nervous system, and makes the case for treating the gut as a second brain rather than plumbing. She breaks down why IBS affects women about twice as often as men, and why women with gut pain are so often told it's all in their heads — in her words, it's not the stress causing the symptoms, it's the symptoms causing the stress.

They cover the less obvious causes of bloating — including pelvic floor dysfunction — accidental bowel leakage after menopause and how it's 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. Then it's the serious part: the four colorectal cancer red flags women should stop normalizing, which stool colors need attention, why colonoscopy is the only 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, why ramping up fiber slowly prevents gas and bloating, a realistic approach to cutting ultra-processed foods — and the habit Dr. Pasricha asks of her own patients: look at your stool every day, because knowing what's normal for you is how you notice when something changes.

Guest links:
Dr. Trisha Pasricha (Website) https://www.trishapasricha.com/
Dr. Trisha Pasricha (BIDMC Gut-Brain Institute) https://research.bidmc.org/gut-brain/people/team-member-1
Dr. Trisha Pasricha (Instagram) https://www.instagram.com/trishapasrichamd/
Dr. Trisha Pasricha (TikTok) https://www.tiktok.com/@drtrishapasricha
Gut Checker (Substack) https://gutchecker.substack.com/
Ask a Doctor (Washington Post) https://www.washingtonpost.com/people/trisha-pasricha/

Books:
"You've Been Pooping All Wrong: How to Make Your Bowel Movements a Joy," by Dr. Trisha Pasricha https://www.penguinrandomhouse.com/books/776380/youve-been-pooping-all-wrong-by-trisha-pasricha-md-mph/
"The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book
"The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z