Extend Podcast with Dr. Darshan Shah, MD

Episode 134: Dr. Jessica Shepherd: Stop the Decline – Perimenopause Strategies

Released: January 29, 2026

Episode Overview

This episode discusses the misunderstood and often stigmatized topics of perimenopause and menopause, focusing on actionable strategies for women to optimize their health through midlife and beyond. Dr. Darshan Shah sits down with Dr. Jessica Shepherd, board-certified gynecologist and Chief Medical Officer for HERS, to break down myths, science, and empowering tools for managing this transition. The conversation covers outdated narratives from the Women’s Health Initiative, recognizing early perimenopausal symptoms, the interplay of hormones and emotional health, and how lifestyle changes—especially resistance training—can dramatically alter the trajectory of aging for women.

Guest Introduction and Motivation

• Dr. Jessica Shepherd: Board-certified gynecologist, Chief Medical Officer for HERS, author of Generation M, and founder of Sanctum Med & Wellness in Dallas.
• Journey to Longevity Medicine
  • Dr. Shepherd describes her pivot from traditional gynecology to a more holistic, longevity-focused approach, motivated by a desire to impact patients’ underlying health stories, not just treat symptoms.

    “What I found is that the fundamental story…was much more than why they were sitting there or the disease that got them there.” (05:46)

  • Importance of nutrition and exercise, recognizing limits of the standard “Matrix” of Western medicine (07:12–08:20).

Key Discussion Points and Insights

1. Outdated Menopause Narrative – The WHI Study (08:20)

• The Women’s Health Initiative (WHI) study nearly 25 years ago caused widespread fear of hormone replacement therapy (HRT), leading to over-cautiousness and stigma.

  “If there was a PR for bad information, that was it… we as providers really had a lot of fear, because that was the matrix, right? We can’t use it. We can’t use hormones.” – Dr. Shepherd (09:37)

• This led to under-treatment and dismissal of symptomatic women.

2. The Mindset Shift – Menopause Is NOT Inevitable Decline (11:13)

• Western culture frames menopause as an unstoppable decline, but modern science and mindset shifts show women can remain healthy, powerful, and active.

  “You don’t have to decline… There’s tools available now. It’s just a mindset shift.” – Dr. Shah (10:45–11:13)

• Cruise Ship Analogy:

  • Midlife is the time to gently but surely alter your health trajectory by a few degrees, which can mean the difference between decline and thriving in your later years.

    “I say the analogy is best used as in a tugboat you can change direction… but longevity is a cruise ship.” (11:56)

3. Recognizing Perimenopause – No “Magic Age” (13:01)

• Symptoms:

  • Brain fog, fatigue, hot flashes, sleep disturbance, diminished libido, emotional lability.

• Self-awareness is key.

  • Symptom tracking and proactivity are vital; don't dismiss early signals as “just stress.”

  “The real goal… is self-awareness, right? Embodiment where you’re like, something’s starting to happen and not kind of pushing it out of your mind…” (13:01–15:15)

• Personal Anecdote:

  • Even as an OB-GYN, Dr. Shepherd realized her own perimenopause symptoms only after months of diminished multitasking and word-finding issues.

    “Here I am, obgyn… really pays attention to it… it is taking months and months… Imagine for someone who… doesn’t even know…” (15:16)

4. Emotional & Relationship Impact (16:06)

• Neurotransmitter Changes:

  • Declining estrogen affects mood regulation via dopamine, norepinephrine, serotonin, and GABA.
  • Heightened irritability, decreased resilience, relational strain—often leading to increased midlife divorces.

    “As estrogen starts to decline…your amygdala… our mood… ability to hold emotional capacity is changing…” (16:06–18:28)

• Role of Partners:

  • Men and women both must adapt and show up differently in relationships during this transition.

5. Seeking Help – Diagnostic Steps (21:14)

• Ruling Out Other Causes:

  • Thyroid disorders, mental health issues, nutritional imbalances must be excluded.

• Collaborative Care:

  • Including mental health practitioners and functional nutritionists in the practice.

  “Thyroid disorder is very common, especially at the age of 40 and beyond…” (22:01) “If it doesn’t work out for you… you want to get off [HRT], guess what you get to do? Get off. That’s like perfect. Patient autonomy…” (22:31–23:53)

6. HRT—Destigmatization and Personalization (26:29)

• HRT is not “medication” in the traditional sense but replacing what the body naturally produced and now lacks due to increased life expectancy.
• Dangers of stigma and equating HRT with “medicating” a disease.

  “This is something that your body actually produced from birth… we haven’t accounted for that void of 20 years of lack of hormones.” (26:45–27:02)

• Customization:
  • Different delivery methods for HRT (sublingual, creams, pellets, etc.) to suit individual needs.

7. Estrogen Beyond Reproduction (28:11)

• Estrogen influences muscles, bone, cardiovascular and brain health—not just reproductive organs.

  “If it’s not getting the message, if it’s not getting the fuel, it really is like, I can’t function at the optimal level that you want me to without the fuel.” (28:33)

8. Muscle as the Organ of Longevity (29:38)

• Resistance Training:

  • After mid-30s, women begin to lose lean muscle mass and bone density. Resistance/weight training is essential; cardio is insufficient.

    “Muscle is the organ of longevity because it sustains us not only from a strength and power perspective, as well as your metabolic health.” (30:57)

  • Even 20 minutes, 3x weekly, can suffice.

  • Muscle is a major glucose sink—improves metabolic health and insulin sensitivity.

9. Bone Health & Early Testing (33:11)

• Early Screening:
  • DEXA scans should be done before age 65, ideally in midlife, to catch osteopenia/osteoporosis early.

    “Their bones are like, powdered at that point… We should be doing these DEXA scans much earlier…” (33:25)

• Interventions:
  • Nutrition, resistance training, supplementation, and HRT—all multi-modality approaches.

10. Functional Movement & Everyday Strength (36:21)

• Incorporating jumping, skipping, squatting, and grip strength into daily life as measures and builders of functional longevity.

  “When was the last time you jumped? When was the last time you broke out into a sprint?” (36:21)

• Sit-to-Stand Test/Grip Dynamometer/Farmer’s Carry:

  • Practical, actionable assessments to track and motivate improvement.

    “Little tests like that… can really accelerate someone’s health journey…” (38:26)

11. The Motivational Role of HRT and GLP-1 Medications (40:05)

• Synergy:
  • Hormone therapy and GLP-1s (weight loss peptides) are highly effective together; HRT improves GLP-1 success and vice versa.

    “Women who are on a GLP will actually see more success when they’re simultaneously taking HRT…” (41:12)

• Both are natural compounds or analogues already produced by the human body.
  • Destigmatizing their medical use is important.

12. The Future – Precision Medicine for Midlife (43:29)

• Seeing a future where hormone optimization is seen as a positive and normal aspect of health maintenance, not a shameful intervention.

  “I think this is artistry. I think everyone responds differently. And I want people to take it on as something that is adding to the beautiful picture… of what they want their life to show up as.” (44:24–45:23)

Notable Quotes & Memorable Moments

• “It’s almost like the movie the Matrix… and you start unraveling that thread and you realize your mind is blown with how much there’s out there that we don’t even talk about…” – Dr. Shah (07:12)
• “I really do believe midlife is that opportunity to switch the narrative, to kind of work on the glitches…” – Dr. Shepherd (11:13)
• “You can creep into it, crawl into it, run into hormones if you want, dive into it, whatever you want to do.” – Dr. Shepherd (24:47)
• “Your metabolism lives in your muscle… muscle is the organ of longevity.” – Dr. Shah (32:17)
• “This is not a one stop shop…there’s so much nuance… Doing it right really requires precision.” – Dr. Shah (45:23)

Timestamps for Key Segments

• [08:20] – The WHI study and its legacy
• [13:01] – Recognizing perimenopause symptoms
• [16:06] – Emotional & relationship impacts of estrogen decline
• [21:14] – Diagnostic steps: ruling out other causes
• [26:29] – Rethinking HRT: safety, necessity, misconceptions
• [29:38] – Muscle and resistance training for longevity
• [33:11] – Early bone scanning & osteoporosis prevention
• [36:21] – Everyday movement for functional longevity
• [40:05] – Motivation, HRT, and GLP-1 synergy
• [43:29] – The future of hormone replacement and personalized care

Actionable Takeaways

• Start the conversation in your 30s. Perimenopause can start earlier than most expect.
• Be proactive, not reactive. Don't accept decline as inevitable or wait for severe symptoms.
• Seek a comprehensive approach. Include emotional support, nutrition, exercise, and when appropriate, HRT.
• Test early, train differently. Get DEXA scans before the traditional cutoff; prioritize resistance training over just cardio.
• Make small, sustainable changes. Layer multiple lifestyle strategies for long-lasting impact.

Where to Find Dr. Shepherd

• Book: Generation M (Amazon, Barnes & Noble)
• Instagram: @jessicashepherdmd, @modernmenno
• Clinic: Sanctum Med & Wellness, Dallas

Conclusion

This episode is an empowering and pragmatic guide through perimenopause, blending clinical science with real-life strategies. Both Dr. Shah and Dr. Shepherd advocate a multi-modal, compassionate, and precision-based approach to women's aging—emphasizing strength, autonomy, and the possibility of a vibrant healthspan for every woman.