What if your symptoms like fatigue and burnout aren’t just about stress or overwork, but your hormones waving a white flag? In this episode of Treated, Dr. Sara sits down with nurse practitioner and nutritionist expert Cynthia Thurlow to unpack the hidden drivers of midlife burnout, fatigue, and brain fog. Cynthia shares her own journey from practicing traditional cardiology medicine to navigating a full burnout in her early 40s – a turning point that reshaped not only her personal health but also her entire career. Together, they explore why so many women feel dismissed by conventional lab work, the role of hormones like progesterone and cortisol, and why biomarkers such as fasting insulin, HRV, and thyroid function can reveal what’s really going on beneath the surface.

Cynthia and Dr. Sara highlight the science of metabolic flexibility, cardiovascular risk markers like lipoprotein(a), and the connection between stress, trauma, and hormones. They also touch on the importance of alignment, meaning, and boundaries in preventing burnout – reminding us that midlife can be a time of initiation and transformation rather than decline. If you’ve ever wondered whether your fatigue is “just stress” or something deeper, this episode offers the tools and insights to measure what truly matters.

// REFERENCES // 

Dr. Sara’s Lab References Ranges in Healthy Adults

Cynthia Thurlow's TEDx Talk: On intermittent fasting.

Christina Maslach Burnout Inventory: Mentioned as a tool for assessing burnout.

World Health Organization (WHO): Mentioned for their classification of burnout in ICD-11.

The Women's Health Initiative (WHI) study: A 2002 study that led a generation of women to be taken off their hormone replacement therapy. – Rossouw, Jacques E.,et al. “Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results from the Women’s Health Initiative Randomized Controlled Trial.” JAMA 288, no. 3 (July 17, 2002): 321–33. doi:10.1001/jama.288.3.321. 

Oral vs. Transdermal Estradiol Study: A paper suggesting that oral estradiol is superior to transdermal estradiol for lowering Lp(a) levels.--- Hemelaar, Marjolein, et al. “Oral, More than Transdermal, Estrogen Therapy Improves Lipids and Lipoprotein(a) in Postmenopausal Women: A Randomized, Placebo-Controlled Study.” Menopause 10, no. 6 (November-December 2003): 550–58. doi:10.1097/01.GME.0000064866.58809.E5.

// LEARN MORE FROM CYNTHIA THURLOW // 

Visit Cynthia Thurlow’s website, cynthiathurlow.com 

Follow her on Instagram, @cynthia_thurlow_

Listen to her podcast, Everyday Medicine.  

 // KEEP IN TOUCH WITH DR. SARA //

If you have a question, leave a voicemail at speakpipe.com/treated 

Follow on IG: @saragottfriedmd @treatedwithdrsara

Watch Treated on YouTube

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