Everyday Wellness: Midlife Hormones, Menopause, and Science for Women 35+

I’m honored to reconnect with Dr. Felice Gersh today! She is a multi-award-winning physician with dual board certification in OB-GYN and Integrative Medicine. We connected once before in Episode 221, where we spoke about PCOS and metabolic health.

Today, Dr. Gersh joins me to dive into perimenopause and menopause. We discuss various issues surrounding the Women’s Health Initiative and talk about estrogen as a family of hormones, estrogen-mimicking chemicals, synthetic hormones, and oral contraceptives. We cover the importance of thyroid function, the pro-inflammatory state associated with estrogen loss in perimenopause and menopause, and the role of nutrition and exercise in metabolism. We also discuss lesser-known changes that occur in menopause, including changes in body odor, constipation, sarcopenia, osteoporosis, and vocal changes.

I plan to invite Dr. Gersh back to discuss women and mitochondrial health, and then again to talk about her latest book, Menopause: The Fifty Things You Need to Know.

Stay tuned to find out what menopause really is, and what it does to a woman’s metabolic system.

IN THIS EPISODE YOU WILL LEARN:

Dr. Gersh discusses the Women’s Health Initiative study and its devastating effects.

The difference between synthetic and bioidentical hormones.

How chronic diseases of aging can be delayed when hormones are incorporated along with other lifestyle refinements.

What do hormones do?

Why every immune cell in the body has receptors for vital hormones.

Menopause may not be defined by a specific moment in time.

Physiological changes that occur during the perimenopause years

How hormones can change the perimenopause paradigm entirely.

Perimenopause and sleep issues

Phytoestrogens - nature’s gift to women

Connect with Cynthia Thurlow

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Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

Connect with Dr. Felice Gersh

Website:⁠ Integrative Medical Group of Irvine⁠

Instagram⁠

Dr. Gersh’s books are available on ⁠Amazon⁠

Previous Episode Mentioned

⁠Episode 221 on PCOS with Dr. Felice Gersh⁠

Today, I’m honored to reconnect with fan favorite, Dr. Tom Dayspring. Dr. Dayspring is a fellow of both the American College of Physicians and the National Lipid Association, and is certified in internal medicine and clinical lipidology with extensive experience in perimenopause and menopause management. He has been a frequent contributor and educator at Everyday Wellness.

In this episode, we discuss labs that help to monitor changes in insulin resistance (specifically the LPIR score), the clinical practice limitations Dr. Dayspring believes stem from a lack of humility, and aspects of women’s medical histories that may indicate greater heart disease risk. We examine statin therapy and other treatment modalities, premature menopause and cardiovascular disease risks, Lp(a) as the primary inherited risk factor for heart disease, and current guidelines, treatment goals, and recommendations. Dr. Dayspring also shares his thoughts on estrogen patch shortages and oral estradiol therapy challenges with elevated triglycerides.

As always, this is an invaluable conversation with Dr. Tom Dayspring. Stay tuned for an upcoming podcast with Dr. Dayspring, where we'll focus on lipids and brain health.

IN THIS EPISODE, YOU WILL LEARN:

Lipoprotein changes and how they can reveal insulin resistance before fasting insulin or glucose begin to rise

Why someone can be insulin resistant while showing normal triglyceride levels

The importance of looking at a woman’s broader medical history to find potential cardiovascular risk signals

Why premature menopause and premature ovarian failure should be taken seriously as cardiovascular and long-term health risk factors

How Lp(a) is the most inherited risk factor for atherosclerotic heart disease across the population

Why women may benefit from repeat Lp(a) testing around the menopausal transition

What clinicians may address when Lp(a) is elevated, including other modifiable cardiovascular risk factors

Oral estrogen may have a beneficial effect on Lp(a).

How epidemiological evidence has linked endometriosis with heart disease

Why Dr. Dayspring recommends checking ApoB when triglycerides are elevated

Connect with Cynthia Thurlow

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Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

Connect with Dr. Tom Dayspring

On X (@DrLipid)

LinkedIn

Welcome to the latest Midlife Minute.

This episode unpacks ongoing research on Lp(a), explores how women’s lipids change during the perimenopause-to-menopause transition, and clarifies what we can do about it.

Stay tuned for more!

IN THIS EPISODE, YOU WILL LEARN:

How total cholesterol, LDL, and ApoB tend to rise most steeply around the final menstrual period, rather than increasing gradually with chronological aging

Why women should have their Lp(a) checked both before and after menopause

How oral and transdermal estradiol can affect LDL, HDL, triglycerides, and Lp(a) differently

Why I recommend including ApoB when checking your lipids during the perimenopause window

How your lifestyle can reduce your cardiovascular risk, even when your Lp(a) is elevated

Why omega-3 fatty acids and commonly used lipid medications do not lower Lp(a)

Why supplements are not replacements for statins in genuinely high-risk patients

I review the various PCSK9 inhibitors currently available, how they are administered, and their effects

How a CAC, a CT angiogram, and an AI-assisted CT angiogram can help women and their providers determine how aggressive their approach should be when Lp(a) is elevated

Connect with Cynthia Thurlow

Follow on X, Instagram & LinkedIn

Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

References:

1. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.Circulation. 2020. El Khoudary SR, Aggarwal B, Beckie TM, et al.Guideline

2. Menopause: A Cardiometabolic Transition. The Lancet. Diabetes & Endocrinology. 2022. Nappi RE, Chedraui P, Lambrinoudaki I, Simoncini T.Review

3. Dyslipidemia Across the Menopause Transition: Mechanisms, Trajectories, and Opportunities for Cardiovascular Prevention. Maturitas. 2026. Castaneda R, Tatit CP, Hurtado Andrade MD, Faubion SS, Shufelt CL.RecentReview

4. Lipoprotein(a) and Women's Cardiovascular Health: A Review. JACC. Advances. 2026. Michos ED, Saucier S, Mehran R, Koschinsky ML.

5. Lipid Metabolism in Women: A Review. Atherosclerosis. 2025. van Oortmerssen JAE, Mulder JWCM, Kavousi M, Roeters van Lennep JE.Review

6. Are Changes in Cardiovascular Disease Risk Factors in Midlife Women Due to Chronological Aging or to the Menopausal Transition?. Journal of the American College of Cardiology. 2009. Matthews KA, Crawford SL, Chae CU, et al.Observational

7. Trajectories of Lipids Around the Menopause Transition in Chinese Women: Results of the Kailuan Cohort Study. Fertility and Sterility. 2023. Dai Q, Wu S, Cao Z, et al.

8. Lipid Management in Patients With Endocrine Disorders: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 2020. Newman CB, Blaha MJ, Boord JB, et al.Guideline

9. The Effects of Menopause Hormone Therapy on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2022. Nie G, Yang X, Wang Y, et al.SR

10. Perspectives on Dyslipidemia and Coronary Heart Disease in Women. Journal of the American College of Cardiology. 2005. Bittner V.Review

11. Dyslipidemia in Midlife Women: Approach and Considerations During the Menopausal Transition. Maturitas. 2022. Torosyan N, Visrodia P, Torbati T, Minissian MB, Shufelt CL.Review

12. Effects of gender, age and menopausal status on serum apolipoprotein concentrations.13.Lipoprotein(a).The Journal of the American Medical Association. 2025. Mora S, Kronenberg

14. Why, how and in whom should we measure levels of lipoprotein(a): A review of the latest evidence and clinical implications. Diabetes, Obesity & Metabolism. 2025. Razavi AC, Bhatia HS, Blumenthal RS, Shapiro MD, Mehta A.RecentReview

15. Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar. Journal of the American College of Cardiology. 2021. Cicero AFG, Fogacci F, Zambon A.Review

16. Overall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Drugs. 2023. Blais JE, Huang X, Zhao JV.SR

17. Non-Genetic Influences on Lipoprotein(a) Concentrations. Atherosclerosis. 2022. Enkhmaa B, Berglund L.Review

18. NHLBI Working Group Recommendations to Reduce Lipoprotein(a)-Mediated Risk of Cardiovascular Disease and Aortic Stenosis. Journal of the American College of Cardiology. 2018. Tsimikas S, Fazio S, Ferdinand KC, et al.Review

19. Consumption of a defined, plant‐based diet reduces lipoprotein(a), inflammation, and other atherogenic lipoproteins and particles within 4 weeks. Clinical Cardiology. 2018. Najjar RS, Moore CE, Montgomery BD.

20. Lipoprotein(a): Current Evidence for a Physiologic Role and the Effects of Nutraceutical Strategies. Clinical Therapeutics. 2019. Santos HO, Kones R, Rumana U, et al.Review

21. Effect of Lipid-Lowering Therapies on Lipoprotein(a) Levels: A Comprehensive Meta-Analysis of Randomized Controlled Trials. Atherosclerosis. 2025. Xie S, Galimberti F, Olmastroni E, et al.Recent

22. Effect of Omega-3 Fatty Acid Supplementation on the Postprandial Metabolism of Apolipoprotein(a) in Familial Hypercholesterolemia. Journal of Atherosclerosis and Thrombosis. 2023. Ying Q, Croyal M, Chan DC, et al.RCT

23.Lipoprotein(a) and Cardiovascular Disease. Lancet. 2024. Nordestgaard BG, Langsted A.Review

24. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology. 2022. Reyes-Soffer G, Ginsberg HN, Berglund L, et al.Guideline

25.Clinical Trial Design for Lipoprotein(a)-Lowering Therapies: JACC Focus Seminar 2/3.Journal of the American College of Cardiology. 2023. Malick WA, Goonewardena SN, Koenig W, Rosenson RS.Review

26.2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American Collegeof Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026. Writing Committee Members, Blumenthal RS, Morris PB, et al.Guideline

27. Noninvasive Coronary Atherosclerotic Plaque Imaging. JACC. Cardiovascular Imaging. 2023. Kwiecinski J, Tzolos E, Williams MC, et al.Review

28. Computed Tomography Angiography Versus Agatston Score for Diagnosis of Coronary Artery Disease in Patients With Stable Chest Pain: Individual Patient Data Meta-Analysis of the International COME-CCT Consortium. European Radiology. 2022. Wieske V, Walther M, Dubourg B, et al.SR

29. Association of Coronary Artery Calcium Score With Qualitatively and Quantitatively Assessed Adverse Plaque on Coronary CT Angiography in the SCOT-HEART Trial. European Heart Journal. Cardiovascular Imaging. 2022. Osborne-Grinter M, Kwiecinski J, Doris M, et al.Clinical Trial

30. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. JACC. Cardiovascular Imaging. 2024. Nurmohamed NS, Bom MJ, Jukema RA, et al.Observational

31. The Lancet Commission on Rethinking Coronary Artery Disease: Moving From Ischemia to Atheroma. Lancet. 2025. Zaman S, Wasfy JH, Kapil V, et al.Review

32. Efficacy and safety of novel lipoprotein(a)‐targeted therapies: A systematic review and meta‐analysis of randomized controlled trials. Diabetes, Obesity & Metabolism. 2026. Santana AUL, Yusufzai MO, Freitas APS, et al. Recent Opinion

Today, I am honored to connect with Dr. Zaldy Tan, a geriatric medicine and memory disorder specialist whose research career has centered on the Framingham Heart Studies Offspring Cohort. Dr. Tan currently directs Cedar Sinai’s memory and healthy aging programs, after previously leading the memory clinic at Beth Israel and Harvard Medical School. His book, Age Proof Your Mind, translates his clinical and research background into a practical framework for people trying to assess and protect their own cognitive trajectory.

In our conversation, Dr. Tan explains why middle age is the old age of youth and the youth of old age. We discuss common symptoms of memory issues and those that are reversible. We explore the Framingham Offspring Study and its impact on brain health over time, looking at the effects of sleep, depression, vitamin deficiencies, alcohol, loneliness, and nutrition, and Dr. Tan shares the three Ds, dementia, delirium, and depression- the red flags he sees in his clinical practice, explains how he helps prepare caregivers for caring for loved ones with neurocognitive memory loss, and discusses late-stage issues, medications, blood-based biomarkers, and the role of genetics in brain health.

Stay tuned for a truly fascinating discussion with Dr. Zaldy Tan.

IN THIS EPISODE, YOU WILL LEARN:

The importance of being sensitive to how your memory changes over time

Various factors that could contribute to memory problems

The profound effect alcohol has on the brain and neurologic function

How social isolation can increase the risk of dementia in future years

Dr. Tan discusses the Framingham Offspring Study and the links between metabolic dysregulation and brain MRI markers of brain aging.

How the 3 Ds, delirium, dementia, and depression, can overlap

The red flags in a patient’s history that lead Dr. Tan to believe there may be a more serious issue

What care partners should be aware of when a family member is experiencing dementia

The importance of protecting sleep and maintaining consistent sleep patterns for those with memory problems

How genetic testing is incorporated into Dr. Tan’s care model

Bio:

Dr. Zaldy Tan is the Director of the Memory & Healthy Aging Program at Cedars-Sinai Medical Center, which U.S. News & World Report ranked in 2024 as the best hospital on the U.S. West Coast and among the top hospitals in the country. He holds the Carmen & Louis Warschaw Endowed Chair in Neurology and is a professor at the David Geffen School of Medicine, University of California, Los Angeles. Dr. Tan was the founding director of the Memory Disorders Clinic at Harvard Medical School/Beth Israel Deaconess Medical Center. Dr. Tan performs aging and dementia research covered by The New York Times, Time, CNN, The Wall Street Journal, NPR, The Washington Post, The Chicago Tribune, Reuters, ABC News, and NBC News. He regularly speaks at major national and international conferences and is the author of Age-Proof Your Mind and What to Remember When You Are Forgetting.

Connect with Cynthia Thurlow

Follow on X, Instagram & LinkedIn

Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

Connect with Dr. Zaldy Tan

Dr. Tan at Cedars Sinai (Los Angeles)

On Instagram

Dr. Tan’s book, What to Remember When You Are Forgetting, is coming out on September 15th, 2026. Pre-order HERE.

Welcome to the latest episode in our series of highly vetted companies I like to share with my Everyday Wellness community.

Today, I’m delighted to connect with Leslie Kenny, Founder and CEO of Oxford Healthspan. After being diagnosed with multiple autoimmune conditions and being told she was unlikely to have any biological children, Leslie put her autoimmune conditions into remission through nutrition and lifestyle changes and later went on to conceive naturally at 43. Her personal experience led her into a research collaboration with Oxford immunologist Professor Katya Simon, where she was introduced to spermidine, a naturally occurring polyamine studied for its role in autophagy—our cells’ internal recycling and cleanup process. She later founded Oxford Healthspan to bring a whole-food Japan-sourced spermidine supplement, Primadine, to market. She also co-founded the non-profit Oxford Longevity Project alongside Oxford scientists to educate the public more broadly on healthspan research.

In our conversation, we discuss self-advocacy, autoimmunity, infertility, and empowerment, exploring how modern life affects perimenopause and menopause, as well as spermidine research and its mechanisms of action. We discuss intermittent fasting, autophagy, mitophagy, gut health, food-based sources of spermidine, how our spermidine levels decrease with age, and why supplementation is truly beneficial. Leslie also shares feedback on how Primadine impacts memory, cognition, hair, skin, and nails; how clock genes and circadian biology work; and biological versus chronological age.

Stay tuned for a truly fascinating conversation with Leslie Kenny- one you’ll most likely want to revisit more than once.

IN THIS EPISODE, YOU WILL LEARN:

The changes Leslie implemented after being diagnosed with rheumatoid arthritis and lupus

How patients need to ask questions and collaborate with their clinicians rather than simply following instructions

Leslie describes how she worked with doctors to monitor her symptoms and address problems early during the perimenopause-to-menopause transition.

How Leslie came to learn about spermidine and its connection to autophagy and mitophagy

How spermidine can support healthy aging

How ultra-processed foods can affect the gut, and foods that contain natural sources of spermidine

The types of improvements customers taking Primadine have reported

Leslie explains the distinction between biological and chronological age

Why intermittent fasting, although beneficial, may not work the same way for all women

Bio:

Leslie Kenny is an Oxford-based longevity entrepreneur, TEDx Oxford speaker, and healthspan advocate. She is the founder of Oxford Healthspan, creator of Primeadine®, co-founder of the Oxford Longevity Project, and Global Executive Ambassador for the Japan Autophagy Consortium, whose senior adviser is Yoshinori Ohsumi, recipient of the 2016 Nobel Prize in Physiology or Medicine for his pioneering research on autophagy.

She is a frequent international speaker and moderator on longevity, biological aging, and the future of preventive medicine, with a particular focus on translating emerging research into practical, evidence-based strategies for extending healthspan. Leslie has been an early advocate for the role of autophagy, cellular renewal, and nutrition in healthy aging, helping to pioneer broader awareness of spermidine and its relevance to longevity pathways.

Connect with Cynthia Thurlow

Follow on X, Instagram & LinkedIn

Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

Connect with Leslie Kenny

Oxford Longevity Project

Oxford Healthspan - Use discount code CYNTHIATHURLOW for 20% off your first Oxford Healthspan order

Leslie’s New Prime