THE BLOG

Your Gut, Your Hormones, Your Pelvic Floor with Dr. Betsy Greenleaf

drbetsygreenleaf gut healing gut health health journey menopause microbiome midlife health midlife sex midlifesexual health pelvic floor pelvic health Apr 20, 2026

Dr. Betsy Greenleaf is renowned as a premier expert in menopause and andropause, a bestselling author, entrepreneur, and innovative specialist in female pelvic medicine and reconstructive surgery with over two decades of experience. She was the first female in the United States to achieve board certification in urogynecology — which she had to explain to us because her own mom thought it sounded like "Euro Disney." We had a moment with that. She's also the founder of the International PAUSE Institute (perimenopause, menopause, and andropause support), CEO of the Pelvic Floor Store, and founder of Femversity, a women's empowerment platform focused on body, mind, and spirit. And she has a podcast called 40s Forward. Because of course she does.

Here's what we covered:

What even is urogynecology? It's not fancy European gynecology. it's the specialty that deals with everything inside the pelvis at a deeper level than a regular OB-GYN. The bladder, the vagina, the uterus, the rectum, all of it. And yes, Dr. Greenleaf really did say "my vagina has fallen and it can't get up." And I love her for it.

The pelvic floor matters more than you think. Like every muscle in the body, pelvic floor muscles weaken over time. We lose about 8% of our muscle mass every decade after age 30 and nobody ever thinks about exercising those muscles until there's a problem. Weakness can lead to leaking, difficulty controlling gas (she used the executive farting mid-presentation scenario and I was here for it), and reduced sexual function. The fix? Kegel exercises, adequate protein, and strength training. It all works together.

Andropause is real — and men don't escape it. While menopause is having its moment on social media, andropause is still flying under the radar. After 40, testosterone starts declining in both men and women. For men, that shows up as the dad bod creeping in, brain fog, lower motivation, mood changes, and reduced sex drive. Sound familiar? It's not just aging, it's hormonal, and there's a lot that can be done about it.

Alcohol and your hormones are not friends. This is where things got really specific in a way I hadn't heard before. Here's what Dr. Greenleaf broke down:

Hormones are metabolized in the liver. Alcohol messes with the liver. So even if you're on hormone replacement therapy, alcohol can prevent you from metabolizing those hormones properly.
Alcohol tanks testosterone and raises estrogen in both men and women. For men, heavy drinking can literally lead to the development of breast tissue. She said it, and I'm just repeating it.
The body's hormone pathway can go one of two directions: it can make testosterone and estrogen, or it can make cortisol in response to stress. Alcohol is a stressor. So when you drink to de-stress, your body actually makes more cortisol and less of the good hormones. It's doing the exact opposite of what you think it's doing.

The gut-brain-vagina connection. I had never heard this framing before and it stopped me in my tracks. Dr. Greenleaf explained that when the gut microbiome is off, it triggers a cascade that affects everything — including vaginal health and libido. Because of the anatomy (the anus, vagina, and urethra are very close together), bad bacteria from a disrupted gut can easily migrate and overpopulate the vaginal microbiome. This leads to recurrent UTIs, vaginal infections, and the body essentially deciding to shut down reproduction and libido because it senses inflammation. So when people say "I need a drink to get in the mood" — yeah, it's actually working against you long-term.

90% of serotonin is made in the gut. Read that again. Your happy hormone? Made in your gut. And alcohol kills off the bacteria responsible for producing it. Dr. Greenleaf also talked about GABA, another neurotransmitter made by gut bacteria that's critical for brain health, focus, and preventing brain fog. A lot of gray area drinkers drink specifically because they're chasing that GABA effect. But alcohol actually trains your body to make less of its own GABA over time. It's borrowing against your future.

The cortisol curve. This was one of those explanations that made me go "oh, THAT'S why." Normally, cortisol rises in the morning (helping you wake up) and decreases throughout the day. When you're chronically stressed, that curve flips — you can't get out of bed in the morning and you can't shut your brain off at night. Alcohol and caffeine both make this worse. If you're using coffee to get going and wine to wind down, you're in a loop that's actually reinforcing the problem.

Bladder health and yes, Botox. We have an epidemic of overactive bladder, and alcohol is a direct contributor. It dehydrates you, concentrates your urine, and is an irritant to the bladder lining. But here's the part that genuinely surprised me: there are more people walking around in their 70s with overactive bladder at any given time than have the common cold. Dr. Greenleaf does Botox injections into the bladder to calm spasming muscles — and she got into aesthetics because patients started asking her to use the leftovers on their faces. Her words. I love this woman.

Wearable tech changed her perspective. Dr. Greenleaf already knew intellectually that alcohol was bad for you — she's a doctor. But it wasn't until she started wearing a health tracker and actually saw what one glass of wine did to her sleep quality, heart rate variability, and oxygen levels that it really hit. She showed me her data during our conversation. The red dot was not subtle. She said one glass can throw off her microbiome for up to a week. After seeing that in real time? It's just not worth it anymore.

Non-alcoholic options she actually likes. Hop water, non-alcoholic beer, seltzer with bitters. She's a bitters fan because bitter foods have a GLP-1-like effect on appetite and gut health — something American diets are seriously lacking. And she made the point that nobody at a party is paying attention to what's in your glass. Nobody cares.

The PAUSE App. It's still in beta and she wants us to try it! Go to pauselabs.health and use code SOBERFIT for three months free. It tracks your hormones, symptoms, food, and stressors because hormone levels alone don't tell the whole story.

This is a must-listen. Go find her.