Women often first meet autoimmunity during hormonal transitions like perimenopause and menopause. In this conversation, in this episode, Dr. Melissa Mondala and Dr. Jennifer Roelands (OB-GYN, integrative and functional medicine) unpack how shifting estrogen and progesterone interact with the immune system, why the gut–brain–hormone axis matters for mood and symptoms, and what to do first if you are seeing new labs, new aches, or a metabolism that no longer plays by your old rules. You will hear practical ways to lower inflammation, protect bone and muscle, choose labs that actually guide care, and build “low-hanging fruit” habits that stick.

Key takeaways

• Hormone transitions can “flip on” latent genes and unmask autoimmunity; gut health and hormone metabolism are tightly linked.
• Do not skip the gut: the estrobolome, serotonin production, barrier integrity, and antibodies formed in the gut influence thyroid and joint autoimmunity.
• Start small to beat overwhelm: stack easy “wins” such as step-ups, resistance bands, or brief “exercise snacks” while you build consistency.
• Protect bone and muscle: lift 2–3x weekly, add protein and fiber, and consider DEXA earlier than 65 to get a baseline.
• Labs that help: iron panel, vitamin D, CRP, fasting insulin, thyroid panel, and cycle-timed sex hormones; wearables or CGM can add useful data.
• Options exist: HRT is one path; omega-3s, fiber, magnesium (glycinate), curcumin, and targeted botanicals can also support symptoms and sleep.
• Perimenopause is more than hot flashes: watch for unusual signs like ear itching, body-odor changes, recurrent UTIs, libido shifts, or oral-health changes.

Suggested chapters

00:00 Intro and guest background

00:26 Why autoimmunity often appears in perimenopause

00:29 Gut–hormone metabolism, estrobolome, neurotransmitters

00:31 Stress load and “low-hanging fruit” habit building

00:34 Muscle and bone loss, strength training that fits pain levels

00:36 HRT, DEXA baselines, and fracture risk context

00:39 Supplement staples: omega-3s, fiber, magnesium, curcumin

00:42 Weight and metabolism changes, personalized nutrition

00:44 Unusual symptoms of perimenopause

00:46 Early or premature menopause and risk profile

00:49 Finding the right clinician; advocating for labs

00:51 What to test and how to time hormones

00:53 Where to find Dr. Roelands and her practice

Perimenopause is a whole-system transition. Pair smart medical care with gut support, resistance training, sleep, stress tools, and cycle-aware labs. Start with one easy win, get a baseline DEXA earlier, and build from there. The goal is not perfection. It is steady, sustainable progress that protects your brain, bones, and immune system.

Host Bio:

Dr. Melissa Mondala is a triple specialist in family medicine, lifestyle medicine, and integrative/primary care psychiatry. She is double board certified in family medicine and lifestyle medicine, completed her family medicine residency and Lifestyle Medicine Fellowship at Loma Linda University Health, and earned her MD from Chicago Medical School along with master’s degrees in Health Administration and Biomedical Science. Dr. Mondala is co-founder of Dr. Lifestyle in Newport Beach, where she provides direct primary care, integrative mental health, and lifestyle-based prevention for patients locally and via telehealth.

She has served as core faculty in Preventive/Lifestyle Medicine at Loma Linda University and has contributed to national education in lifestyle medicine. She also co-hosts the Autoimmune Alchemy podcast with Dr. Micah Yu and leads the Integrative Mental Health Summit, bringing root-cause strategies for anxiety, mood, and brain health to a wider audience. Her approach blends diagnostics and conventional care with nutrition, sleep, movement, stress tools, and community to help patients reduce inflammation and build long-term resilience.