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

Welcome to the latest Midlife Minute.

Today, I’m answering listeners’ questions about cardiovascular risk, focusing on Lp(a), LDL, statins, and the changes women experience after menopause.

Stay tuned for more!

IN THIS EPISODE, YOU WILL LEARN:

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

How Lp(a) works as a risk enhancer, and how cardiovascular risk becomes more significant when elevated Lp(a) occurs alongside high LDL

Why family history is particularly helpful for women with a 10-year calculated cardiovascular risk that looks reassuringly low

I review the current guidelines for primary prevention

Why, even though research has shown reductions in major cardiac events with GLP-1s, GLP-1s do not replace statins for lowering LDL

What a CAC score can reveal about coronary artery calcification, and what it cannot detect

How AI-assisted CT angiography (such as Clearly) can map, quantify, and characterize plaque throughout the coronary branches

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

2. ​Sex Differences of Lipoprotein(a) Levels and Associated Risk of Morbidity and Mortality by Age: The Copenhagen General Population Study. Atherosclerosis. 2022. Simony SB, Mortensen MB, Langsted A, et al.

3. Managing Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2022. Stone NJ, Smith SC, Orringer CE, et al.Review

4. Thirty-Year Risk of Cardiovascular Disease Among Healthy Women According to Clinical Thresholds of Lipoprotein(a). JAMA Cardiology. 2026. Nordestgaard AT, Chasman DI, Moorthy V, et al.RecentObservational

5. ​Lipoprotein(a).The Journal of the American Medical Association. 2025. Mora S, Kronenberg

6. Clinical Practice Guideline on Lipid Management for Cardiovascular Disease Risk Reduction.

Department of Veterans Affairs (2026). 2026. Paul Heidenreich, Lance Spacek, Neil Gregor, et al. Guideline

7. Lipoprotein(a) and Family History Predict Cardiovascular Disease Risk.

Journal of the American College of Cardiology. 2020. Mehta A, Virani SS, Ayers CR, et al.Observational

8. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2010. Greenland P, Alpert JS, Beller GA, et al.Guideline

9. Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women.

The Journal of the American Medical Association. 2016. Kavousi M, Desai CS, Ayers C, et al.SR

10. ​Coronary Artery Calcium Scores and Risk for Cardiovascular Events in Women Classified as “Low Risk” Based on Framingham Risk Score: The Multi-Ethnic Study of Atherosclerosis (MESA). Archives of Internal Medicine. 2007. Lakoski SG, Greenland P, Wong ND, et al.Observational

11. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2019. Arnett DK, Blumenthal RS, Albert MA, et al.Guideline

12. HOPE for Rational Statin Allocation for Primary Prevention: A Coronary Artery Calcium Picture Is Worth 1000 Words. Mayo Clinic Proceedings. 2020. Orringer CE, Maki KC.Review

13. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review.

Journal of the American College of Cardiology. 2020. Cho L, Davis M, Elgendy I, et al.Review

14. Health Maintenance in Postmenopausal Women.

American Family Physician. 2025. Plesa M, Wong A, Katsaggelos E.Guideline

15. ​Semaglutide and Cardiovascular Outcomes by Baseline HbA1c and Change in HbA1c in People With Overweight or Obesity but Without Diabetes in SELECT.

Diabetes Care. 2024. Lingvay I, Deanfield J, Kahn SE, et al.RCT

16. ​Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.

The New England Journal of Medicine. 2023. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al.RCT

17. Long-Term Weight Loss Effects of Semaglutide in Obesity Without Diabetes in the SELECT Trial. Nature Medicine. 2024. Ryan DH, Lingvay I, Deanfield J, et al.RCT

18. Interventions for the Prevention and Management of Cardiometabolic Multiple Long-Term Conditions. Lancet. 2026. Valabhji J, Hope D, Sayed NE, et al.RecentReview

19. Glucagon‐Like Peptide‐1 Receptor Agonists and Major Adverse Cardiovascular Events in Patients With and Without Diabetes: A Meta‐Analysis of Randomized‐Controlled Trials.

Clinical Cardiology. 2024. Hosseinpour A, Sood A, Kamalpour J, et al.SR

20. ​FDA Orange Book. FDA Orange Book. 2026.

21. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2026.

Diabetes Care. 2026. American Diabetes Association Professional Practice Committee for Diabetes*.RecentGuideline

22. Premature Coronary Artery Disease in Women: Sex-Specific Risk Factors, Pathogenetic Mechanisms and Clinical Implications. Annals of Medicine. 2026. Li F, Hong D, Yang M, et al.RecentReview

23. Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity: A Scientific Statement From the American Heart Association. Circulation. 2023. Mehta LS, Velarde GP, Lewey J, et al.Guideline

24. Preventing CVD in Women: Common Questions and Answers.

American Family Physician. 2023. Westfall E, Viere AB, Genewick JE.Review

25. 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

I’m honored to connect with Dr. John La Puma today. Dr. La Puma spent three decades building the case that food, nature, and light are clinical tools, not just lifestyle add-ons. He was the first physician to complete a professional cooking curriculum, and he used that training to co-develop the first cooking and nutrition course taught in a U.S. medical school, a course now adapted across roughly 80% of U.S. medical schools. He later did the same thing for Nature, co-developing and teaching the first skills-based Nature as Medicine CME course for physicians with UCLA. His most recent work extends the same logic to the built environment, coining the phrase "digital obesity and indoor epidemic" to describe a specific underdiagnosed driver of modern fatigue tied to how little time people spend outdoors and how much artificial light and screen exposure they get instead.

In our conversation, Dr. La Puma discusses how we went from chefs' training to co-developing the first culinary medicine course; the indoor epidemic and digital obesity; how most people spend about 93% of their lives indoors; how light impacts bone health; and deep sleep metrics. We also explore how poor air quality can reduce cognitive performance, the significance of phthalate exposure and other endocrine-mimicking chemicals, and green dopamine. Dr. La Puma highlights the health benefits of gardening, explaining how it exposes us to microbes and stimulates serotonin. We also cover nervous system awe, movement, how forest bathing can boost your immune system while reducing inflammatory markers, how exercise can help us live longer, nighttime red light therapy exposure, sleep and recovery, and animal companionship as a health intervention.

Stay tuned for today’s interesting and highly informative conversation about lifestyle as medicine with Dr. John La Puma. I highly recommend his book, The Indoor Epidemic, with the actionable information it contains.

IN THIS EPISODE, YOU WILL LEARN:

Dr. La Puma shares his motivation for bringing nutritional science and cooking into his medical practice

How spending much of your life indoors can affect your nervous system, circadian biology, and metabolism

The value of morning light for supporting sleep and rebuilding bones during perimenopause, menopause, and andropause

How indoor air quality impacts cognitive performance

Dr. La Puma shares his approach to reducing exposure to chemicals from household cleaning products

The potential benefits of gardening and spending time with your hands in the soil

How intentional time outdoors can support sleep, mood, energy, and memory

A bright blue-white light at night may interfere with restorative sleep.

Animal companionship and how it can improve our health and wellbeing

Bio:

John La Puma, MD, ChefMD™ is a two-time New York Times bestselling author, board-certified internist, and professionally trained chef who pioneered Culinary Medicine. He now pioneers EcoMedicine from his small regenerative teaching farm. His upcoming book, Indoor Epidemic, reveals how spending 93% of life indoors steals sleep, focus, and years, and how reclaiming just 7% outdoors can restore them using the evidence-based Outdoor Rx framework. This is a clinically validated intervention, presenting nature as foundational medicine, an essential component of health and the missing pillar in optimizing longevity and healthspan.

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. John La Puma

On his website

The (Indoor Epidemic) book website

This episode is another in our podcast series of conversations with highly vetted brands I feel confident recommending to my community.

Today, I was delighted to connect with Julie Sawaya, Co-founder and Co-CEO of Needed, a women's health company advancing nutrition standards across the mother span, from fertility through menopause. Julie holds a degree from Northwestern and an MBA from Stanford.

In our conversation, Julie and I discuss the silent epidemic of nutritional deficiency. We explore how oral contraceptives and food restriction can contribute to nutrient depletion, current RDA standards, and the impact of pregnancy, breastfeeding, the postpartum period, and perimenopause on women's nutritional needs. We examine the MTHFR SNP and its variants, explain how to read supplement labels and what pixie dusting is, and discuss why it's important to know your omega-3 index and how this can influence both food choices and supplementation. Julie also shares a "repletion, not restriction" reframe for midlife and discusses the policies and standards she would like to see improved, including updated recommendations for pregnant and breastfeeding women and a straightforward perimenopause RDA. We also discuss practical takeaways, including specific supplement recommendations and testing that may be helpful.

Stay tuned for another conversation you'll likely want to listen to more than once.

IN THIS EPISODE, YOU WILL LEARN:

How depleted food, environmental toxins, and normalized fatigue have contributed to the silent nutrient deficiency epidemic among women

How oral contraceptives can deplete key vitamins and minerals, and how pregnancy, breastfeeding, postpartum, and perimenopause increase women’s nutritional needs

What the current RDA standards were developed for—and how the research underpinning them largely excluded women of reproductive age

How symptoms and cycle changes can overlap between perimenopause and nutrient depletion

Nutrients that are essential for bone health, cognitive function, energy, nutrient absorption, and overall health during the menopause transition

Julie reviews the evidence surrounding MTHFR variants

What to look for on supplement labels

Why nourishing your body properly can support your metabolism more effectively than food restriction

How your omega-3 index can help you decide whether supplementation is needed

Julie shares practical recommendations for supporting your nutritional health during perimenopause.

Bio:

Julie Sawaya is the Co-Founder and Co-CEO of Needed, a women’s health company advancing nutrition standards across the motherspan—from fertility through menopause.

Julie earned departmental honors in Economics at Northwestern University for her work on nutritional access and her MBA from the Stanford Graduate School of Business. She is a frequent speaker and writer on women’s health and modern motherhood.

Julie is a trained nutritionist and a mother of three.

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 Julie Sawaya

Needed

Instagram

TikTok

Today, I’m thrilled to connect with Dr. Aleksandra Gajer. Dr. Gajer was previously an academic emergency medicine physician who pivoted after realizing ER medicine was functioning less as a place that saves lives and more as a place that manages chronic conditions that should have been caught and addressed years earlier. That observation led her to leave ER medicine and take over an established Northern Virginia internal medicine practice focusing on hormone optimization, peptide therapy, and preventative longevity-oriented care.

In our conversation today, we discuss how perimenopause is treatable and suffering through it is optional. Dr. Gajer explains how she manages body composition changes, weight loss resistance, bone health, and orthopedic-related complaints in midlife. We take a deep dive into the sourcing and research limitations of peptides, exploring healing peptides, growth hormone-promoting peptides, and thymic peptides, and also discussing immunosenescence, bioregulators, mitochondrial RNA-coded peptides, pheno age testing, and using low-dose ketamine, when appropriate, for mental health challenges.

Stay tuned for a fascinating conversation about the science and limitations of research on peptide therapies, and what Dr. Gajer is looking forward to in the near future.

IN THIS EPISODE, YOU WILL LEARN:

The health struggles Dr. Gajer experienced that led her to explore integrative therapies

Why women may wake up at 2 or 3 a.m. during perimenopause

How hormone changes in midlife can contribute to weight loss resistance

Why Dr. Gajer encourages women to have their bone mass assessed earlier than conventionally recommended

How declining estrogen and estradiol can contribute to orthopedic-related symptoms during perimenopause and menopause

What women need to understand about sourcing peptides and the limitations of peptide research

The different ways in which growth hormone-promoting peptides, thymic peptides, epitalon, and MOTC work

How GLP-1s can be helpful for midlife women beyond changing their body composition and assisting with weight loss

How Dr. Gajer uses low-dose ketamine lozenges for treatment-resistant anxiety and depression

Bio:

Dr. Aleksandra Gajer is a board-certified physician and founder of The Gajer Practice. In this precision and longevity medicine clinic, she helps high-performing patients optimize their healthspan through a whole-person, root-cause approach. Trained in emergency medicine at the University of Maryland and George Washington University, she brings rigorous clinical thinking to hormone optimization, peptide therapy, metabolic health, and gut healing. Her own journey through Lyme, alongside more than twenty years of contemplative practice, shapes her belief that emotional and spiritual health underlie physical wellness. A recurring Fox 5 DC health expert with more than fifty podcast appearances, she is also building physician education around the responsible, evidence-based use of peptides.

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. Aleksandra Gajer

The Gajer Practice

Welcome to this week’s Midlife Minute episode.

Today, we’re diving into listener questions about HRT dosing and the confusion surrounding administration. We explore several key themes, including absorption issues, lab draws, and cycling versus daily continuous dosing. I also compare oral progesterone with vaginal and transdermal progesterone.

Stay tuned for more!

IN THIS EPISODE, YOU WILL LEARN:

The estradiol dosage range I prefer, for bone protection

How heart disease risk can influence the route you select for HRT

I clarify the “start low and slow” approach to HRT dosing

Why women with uteruses need progesterone when taking estrogen

Why HRT dosing can become more complicated during perimenopause

How FDA-approved bioidentical hormones differ from compounded preparations

Various factors to consider when using an estradiol patch

Alternative routes of administration for women who feel unwell when taking progesterone orally

How providers can safely transition women from transdermal estradiol patches to other options

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

Research:

Please visit https://www.cynthiathurlow.com/podcast for research.