Why Menopause is "Hot" Right Now with Dr. Jessica Shepherd

Summary

The Dan Buettner Podcast

Episode: "Why Menopause is 'Hot' Right Now" with Dr. Jessica Shepherd

Date: January 29, 2026
Guest: Dr. Jessica Shepherd (OB-GYN, Longevity Medicine Expert, Author of Generation M)

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Main Theme / Purpose

This dynamic, information-packed episode, recorded live at the Eudaimonia Summit, features National Geographic explorer and Blue Zones researcher Dan Buettner interviewing Dr. Jessica Shepherd about the rapidly shifting conversation around menopause. Together, they explore why menopause is receiving more attention than ever, what modern science reveals about its health impacts, and how both lifestyle and innovative medical approaches can empower women through this life transition. The discussion goes deep into the hormonal, cultural, social, and practical realities of menopause—delivering wisdom not just for women, but for anyone interested in longevity and well-being.

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Key Discussion Points & Insights

1. The Changing Conversation Around Menopause

• Menopause's New Spotlight: Dr. Shepherd comments on the historic silence and emerging openness around menopause.
  • "Menopause, one, has been around for ages... but the context of men is really what we're seeing in change. And I'm so delighted to be a part of society that we're starting to talk about it more, we are starting to honor it more and not create this shame factor." — Dr. Shepherd [02:12]
• Longevity and Estrogen: Life expectancy for women has increased dramatically since 1900, leaving a 20-year gap where post-menopausal health was not previously considered in medical research or societal planning.
  • "What we haven't accounted for in that gap is what happens to a woman's health. And a lot of what her health depends on is estrogen." — Dr. Shepherd [03:06]

2. Menopause, Age, and Health Outcomes

• Early vs. Later Menopause: Women who experience menopause at a younger age may have shorter life expectancy.
  • "Women who begin menopause younger actually have lower life expectancy than women who get their menopause later... there seems to be a sweet spot." — Dan Buettner [04:13]
• Can We Delay Menopause?
  • "We have delayed life expectancy... but we haven't accounted for the actual menopausal transition to be delayed. And that's what we are starting to see in data and research." — Dr. Shepherd [04:48]

3. Common Symptoms and Misconceptions

• Symptoms Beyond Hot Flashes:
  • Only 45% of women suffer from hot flashes; top symptoms include sleep disturbance, brain fog, and anxiety.
  • "The number one symptom that accompanies menopause is sleep disturbance." — Dan Buettner [05:21]
• Importance of Sleep:
  • "Now that switching is how much better you can function on more sleep. And that's proven in data and decreasing comorbidities and what we see later on in life..." — Dr. Shepherd [06:04]
• Optimal Sleep Duration:
  • "If you're sleeping less than six hours, you're shaving about three years off your life expectancy. If you're sleeping more than nine hours, you're shaving two off your life expectancy." — Dan Buettner [06:51]

4. Hormones, Hair Loss, and Nutritional Needs

• Hair Changes in Midlife:
  • Both men and women experience hair changes driven by hormonal shifts, especially estrogen.
  • "Estrogen receptors are all over our body... when we see these systemic things occurring with hair loss, with muscle mass, our bone mineral density or gut health, all have to do with estrogen decline." — Dr. Shepherd [08:37]
• Approaches to Hair Loss:
  • Importance of ruling out thyroid problems, rapid weight loss, and nutritional deficiencies.
  • "I'm a big fan of minoxidil. Actually one, it's been proven it works. It's been around since the 70s to the 80s." — Dr. Shepherd [11:12]
  • Saw palmetto leaf may help some; addressing root causes is key. [11:53]

5. Weight Management and Movement in Menopause

• Metabolic Slowdown:
  • Weight gain is expected as metabolism slows and estrogen declines, but prevention via movement is vital.
  • "Movement is medicine. And we don't incorporate a lot of that into our culture. Especially when we think of resistance training and weight training for women..." — Dr. Shepherd [13:34]
• Rethinking Fitness:
  • Dan notes Blue Zones centenarians do not pump iron but walk and garden regularly instead.
  • "Nobody's pumping iron, nobody's building their muscle... They're walking." — Dan Buettner [20:06]
  • "A garden is arguably the best physical activity for the long run." — Dan Buettner [20:20]

6. Diet, Protein, and Processed Foods

• Macronutrients in the Menopausal Diet:
  • Protein is essential to combat accelerated muscle loss (sarcopenia) during menopause.
  • "Protein really is going to be that macro that's going to substantiate the building of our muscle and preventing sarcopenia..." — Dr. Shepherd [18:27]
• Plant-Based vs. Animal Protein:
  • Dan advocates for plant-based diets as observed in Blue Zones, where low meat consumption is correlated with longevity.
  • "They're eating about one tenth the amount of meat that we're eating... they're getting their protein mostly from a grain and a bean." — Dan Buettner [19:25]
• Ultra-Processed Foods:
  • Increased processed food consumption is linked to inflammation and gut health issues, impacting menopause symptoms and colon cancer risk.
  • "We know that we're going to increase inflammation. We know that we're going to increase the risk of having leaky gut..." — Dr. Shepherd [16:32]

7. Environment & Social Connections for Long-Term Health

• Lifestyle and Environmental Design:
  • Sustainable habit change comes from designing one's environment, not sheer willpower.
  • "If you want to live longer, you have to think about things that you're gonna do every day for decades... set up your environment so that the healthy choice is mindless." — Dan Buettner [22:16]
• Ideas for a Supportive Environment:
  • Morning sunlight, sleep hygiene, gardening, changing one's mattress, and, crucially, curating friendships that support healthy behaviors.
  • "Connection for me has been one of the biggest parts that I've learned in this transition... Negative connections can also detract a lot from your life." — Dr. Shepherd [23:09]
  • "Think about curating your immediate social circle... health behaviors are as contagious as catching a cold and friends are long term adventures." — Dan Buettner [24:39]

8. Menopause, Relationships, and Cultural Attitudes

• Men's Role & Relationships:
  • Menopause has been stigmatized and kept secret, straining relationships; men are encouraged to become allies.
  • "It's not for them to fix. It's sometimes just to allow to be... for a woman to be heard and understood." — Dr. Shepherd [29:22]
• Global Perspectives:
  • Japan’s "konenki" frames menopause as an honored new phase. Diversity in menopause experience is shaped by ethnicity, culture, and community support.
  • "The belief behind it is it's unfolding, unturning into a new chapter. And that's one that sounds inviting, right?" — Dr. Shepherd [31:11]
• Evolutionary Angle:
  • The grandmother effect: Menopause may have evolved to help older women contribute to family and community by supporting younger generations.
  • "You can see how menopause could be an evolutionary benefit not necessarily to the individual, but to the survival of the generation, family." — Dan Buettner [33:33]

9. Hormone Therapy: Timing, Types, and Alternatives

• Early Intervention Matters:
  • Starting hormone therapy around menopause’s onset (not years after) may better protect heart, brain, and muscle health.
  • "If we can start before the depletion of a certain hormone, namely estrogen, then we are kind of giving rave way to the ability for our organs to transition..." — Dr. Shepherd [34:32]
• Role of Estrogen:
  • "Estrogen is protective... decreasing inflammation and decreasing plaque formation for cognitive decline. And then in your muscles, sarcopenia..." — Dr. Shepherd [36:09]
• Alternatives & Supplements:
  • Prohormones like DHEA and pregnenolone can be options for those opposed to direct hormones.
  • Supplements such as ashwagandha, black cohosh, vitamin D, and especially dietary fiber may support well-being and symptom management.
  • "I typically will [recommend] ashwagandha, black cohosh can be helpful... finding [vitamin D] in a food source and or supplement..." — Dr. Shepherd [39:01]

10. The Big Picture: Menopause as an Ecosystem

• No Silver Bullets—It's About the Whole Life:
  • Both experts stress the importance of seeing menopause through the lens of whole-person health: movement, environment, community, nutrition, and, when appropriate, medical intervention.
  • "At the end of the day, it's an ecosystem." — Dan Buettner [41:08]

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Memorable Moments & Quotes

• "We start to see in the late 30s and the early 40s...that taper off of the reproductive years. So it made sense biologically that as estrogen was completely depleted at that menopausal age... the rest of her body... could no longer do that." — Dr. Shepherd [02:46]
• "There are estrogen receptors all over the body, so it would make sense that when we see these systemic things occurring with hair loss, muscle mass, bone mineral density, gut health, all have to do with estrogen decline..." — Dr. Shepherd [08:37]
• "Protein is that thing that I really feel that we have not learned throughout our years as women who were younger to focus on." — Dr. Shepherd [17:45]
• "Health behaviors are as contagious as catching a cold and friends are long-term adventures." — Dan Buettner [24:39]
• "Menopause is not for [men] to fix. It's sometimes just to allow to be—to be heard, for a woman to be heard and understood." — Dr. Shepherd [29:22]
• "The belief behind [konenki] is it's unfolding, unturning into a new chapter. And that's one that sounds inviting, right? Versus, 'This is the worst stage of your life. Good luck.'" — Dr. Shepherd [31:11]
• "If you want to live longer... set up your environment so that the healthy choice is mindless. It's the default." — Dan Buettner [22:16]
• "At the end of the day, it's an ecosystem." — Dan Buettner [41:08]

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Timestamps for Important Segments

• [02:12] — The shifting conversation and stigma around menopause
• [04:13] — Menopause timing and its impact on longevity
• [05:21] — Common misconceptions and symptoms, especially sleep disruption
• [08:09] — Hair loss & hormonal impacts
• [11:12] — Solutions for hair thinning: minoxidil, supplements, and nutrition
• [13:34] — Weight gain and the importance of movement
• [16:32] — The dangers of ultra-processed foods
• [18:27] — Building a “menopausal diet” with increased protein
• [20:06] — Movement vs. muscle-building: Blue Zones insights
• [22:16] — How to design your environment for sustainable health
• [23:09] — The power of social connections during menopause
• [29:22] — Men's role in menopause conversations and relationships
• [31:11] — Cultural and ethnic differences in menopause experience
• [34:32] — Hormone therapy: why timing and dosage matter
• [39:01] — Non-hormonal supplements and symptom support
• [41:08] — The ecosystem approach: No simple fixes—holistic support matters

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Conclusion

This lively, empowering episode demystifies menopause, offering practical advice, a message of acceptance, and holistic strategies for thriving in midlife and beyond. Dr. Shepherd and Dan Buettner agree: The menopause journey is about more than hormones—it's about community, environment, and lasting wellness habits tailored to the rhythms of each life.

Transcript

[A]

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[B]

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[A]

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[B]

How do we delay menopause? Because we know the vitality and longevity behind estrogen itself. There's also ways that you can get what we call pre cruc. And so if you were to talk to a hormone specialist and you said, I don't really want the actual hormone, what are some other things that I can get?

[A]

What do men need to know about menopause? Hi everyone. This episode was recorded live at the Eudaimonia Summit in West Palm Beach, Florida. I was joined on stage by Dr. Jessica shepherd, an absolute powerhouse in the world of OB GYN and longevity medicine. Now, while we dive deep into the specific lifestyle shifts that move the needle for women's health, I want to be clear. There's incredible information in here for men too. Whether you're looking to better understand the women in your life, and that's why I loved it, or applying these longevity principles to your own routine, there's a takeaway for everyone. You're gonna love this one, I promise you. You're a board certified OB GYN and Good Morning America celebrity and you run a center. But just to jump right in, why is menopause hot right now? And I don't mean in the flashy sort of way.

[B]

Right. No pun intended. I think, you know, menopause, one has been around for ages. Imagine that. As long as women have been around, there's, there's been menopause. But the context of men is really what we're seeing in change. And I'm so delighted to be a part of society that we're starting to talk about it more, we are starting to honor it more and not create this shame factor. But it's been around for centuries. And I think for when we look at life expectancy in general, which is exactly what you discuss with such amazing features, I might say I'm honored to be here with you, is that the life expectancy of a woman in the early 1900s was about 58, 59. Right. And now we have jump forward Gratefully, because I'm part of being able to live longer is the life expectancy of a woman now is around 79. So if you put that in years, roughly 20 years of what we've expanded the life expectancy of women now what we haven't accounted for in that gap is what happens to a woman's health. And a lot of what her health depends on is estrogen. And so when you had that life expectancy of 59, a lot of it had to do with reproductive years. Biologically. If you were to just put in biological features of when a woman is reproductive, obviously with the menstrual cycle starting in teens and then we start to see in the late 30s and the early 40s is where you had that taper off of the reproductive years. So it made sense biologically that as estrogen was completely depleted at that menopausal age of average age of 52, that the rest of her body and her organs and the functionality of it which is dependent on estrogen could no longer do that. And so because we didn't have the science and medicine that we see today in technology, women would typically have a shorter life expectancy or if you they would die.

[A]

So to connect the dots between what I do, I I studied the world's longest lived people and try to understand the cluster of factors that drive longevity. It it seems that, that women who who begin menopause younger actually have lower life expectancy than women who get their menopause later. You can't have it too late, but there seems to be a sweet spot.

[B]

Yeah.

[A]

Can you control when you're gonna get menopause? Can you delay it or speed it up? Or is it body clock has got its own ideas.

[B]

You're putting us now another 30 years of what we'll see in innovation and technology is what we are actually doing now from a science perspective of how do we delay menopause? Cause what we have delayed is life expectancy. Right. But we haven't accounted for the actual menopausal transition to be delayed. And that's what we are starting to see in data and research. And behind the scene of what we are trying to do is not for reproductive purposes is to expand menopause because we know the vitality and longevity behind estrogen itself.

[A]

I had dinner last night with one of the chief scientists over at Zoe, Dr. Federico Amati. And she sent me some really interesting stats. And I'm sure you probably know em, but nearly all women experience at least one symptom of menopause with 99.8% of women experiencing some. And it turns out we tend to associate hot flashes with menopause. But only 45% of women suffer from hot flashes. 68% of them suffer brain fog, 65% anxiety. But the number one symptom that accompanies menopause is sleep disturbance. Yeah, menopause interferes with your sleep.

[B]

It absolutely does. And I know you know the implication that comes with poor sleep and poor sleep habits. And I don't think we really had that intersection of how sleep was so important, even for me, you know, when I was training many years ago as a resident is we really didn't look at sleep that way. It was more of you sleep when you know when you die and you can, you know, which you do for a very long time. But we also would be like, almost like a badge of honor of how little sleep you could get and how much you could function on little sleep. And I think now that switching is how much better you can function on more sleep. And that's proven in data and decreasing comorbidities and what we see later on in life with cardiovascular disease, diabetes and obesity.

[A]

I can put an actually pretty fine point on it. The sweet spot it seems to be about is seven hours right around for most people. If you're sleeping less than six hours, you're saving about three years off of your life expectancy. And if you're sleeping more than nine hours, you're shaving two off your life expectancy.

[B]

So there's a sweet spot for women. They need typically a little bit longer sleep in minutes. And that in the reproductive years of a woman, it can be based on where she is on her cycle. But in menopause, because we don't have those fluctuations as much as reproductive women are, it typically still is more than men. We need more sleep, so you need to let us sleep is really important.

[A]

Note to sell. I want to learn here. I want to learn. So most of what you study is hormone driven, right? I mean, you sort of look at longevity and health and sleep through the prism of hormones. One thing that happens in both men and women driven by hormones is hair loss. Of course, you never see it because, you know, women are always beautiful and you don't know what they're doing to.

[B]

That was good. I see. I just looked that in there. Women are almost beautiful.

[A]

They are.

[B]

You were.

[A]

I'm just a reporter. But what do you do if you get to middle age and your hair starts thinning? Does it happen to most women or is it a minority I would say most.

[B]

I think most women have an experience with hair changes and it's not always hair loss. It can be hair texture, it can be their hair doesn't grow as long or as bountiful. But I.

[A]

What if we want hair like yours?

[B]

Well, actually the reason why I was like, the hair change is different because even me for like my hair, it just won't. It just like has these baby hairs that just won't go anywhere. Right. So I'm constantly doing like that cowlick approach here.

[A]

My problem is my hair goes everywhere.

[B]

And someone would want that issue, maybe not on the face, but, you know, on the head. But it is something that we typically see with hair loss and hair integrity. And that has to do with multiple features. Which is why I don't always like to kind of push everything into the hormone and estrogen decline. But estrogen receptors are all over our body. I think I start most of my talks and most of my podcasts with estrogen receptors are all over the body. So it would make sense that when we see these systemic things occurring with hair loss, when we have muscle mass, our bone mineral density or gut health all have to do with estrogen decline because there's receptors all over. But in. Let's get back to the hair is the reason why we typically do see hair loss is because estrogen is a very kind of vitality. It likes to bring a lot of blood flow to the area. And so hair follicles do take a hit when we have a decrease in estrogen and the blood flow to the actual hair follicles are actually impeded. And that's where we see some of that as well as testosterone shifts as well as. So testosterone plays a feature in the menopause experience too.

[A]

So the Dan Buhner podcast. I always love to give the audience specific things for people to do. So I am a 40 year old woman and my hair is getting lighter. What do I turn to? Minoxidil or finasteride?

[B]

I always say pull back and look at the grand scheme and the big approach. Right. Cause sometimes it can be thyroid. Thyroid actually is an endocrine kind of issue. Is very common in women, especially after they turn the age of. We start to see a lot of disruption in thyroid. So it can be thyroid, not necessarily disease, but maybe thyroid is not optimized. Even if it's in the normal state and looking at its functionality of it and then going to estrogen. Is there a kind of imbalance or a ratio between estrogen and progesterone that needs to be 10 to 2. The other thing that I would say, now that we are in the age of glp, with rapid weight loss, we typically can see hair loss as well. And then the other thing, which is why I love looking at really the full experience of menopause, is nutrition and diet. Our dietary needs shift. But also with gut health and how it may play a part in that we see what we call leaky gut and we're not keeping in the best nutrients that we need. So a lot of people are actually deficient in nutrients which impact hair loss.

[A]

I want to get to nutrients. But before we move on from hair loss, are you saying if I'm starting to lose my hair and I'm a 40 year old woman, I need to go see a doctor to get my hormones checked out? Or are there any over the counter things?

[B]

I'm a big fan of minoxidil. Actually one, it's been proven it works. It's been around since the 70s to the 80s. So I always say you can do a topical, you can do a pill with minoxidil and you can just get.

[A]

That over the counter.

[B]

So you can get some very wheat forms over the counter, but you can also get it prescribed, obviously. You know, I'm a chief medical officer for hers. So we have minoxidil as well. So that's a great way to get it. We have it in gummy form, but outside of minoxidil. Are you interested now as a 40.

[A]

Year old, I could use some more hair follicles up there.

[B]

No, we're going with you. As a 40 year old woman, I love it. But yeah, there's minoxidil.

[A]

How about like this palmetto leaf and these supplements you can just, you can order up on Amazon.

[B]

I'm glad you brought up supplements. That always seems to be some very controversial discussion when we think of supplements. But palmetto leaf has been shown to help with hair. Does it help everybody? No. But does that mean that someone should not try it if they don't want to? Or maybe they haven't been to their doctor to talk about all the other things we said? Absolutely. But the goal is everyone who hears about a specific need and what they need for that should look at it from a broad base of what are the different things I can do and what options do I have and approach it that way.

[A]

Love it. How about weight gain? The average American woman man too. We all tend to gain weight as we get older. Our metabolism slows down. I'm guessing some of it is estrogen driven. But what is the healthy way at middle age to start to manage your health?

[B]

It always is. You know, prevention is key. And so for weight, because we know that estrogen is declining, because we know that metabolically how estrogen interacts with our glucose and insulin and allows for that metabolic shift to happen and we start to gain weight. But the other thing is aging in general, and you've seen this with the amount of people that you've studied and talked to, is that our bodies does start to slow down. And with that, that's where we have to push against it and be a little bit more exercise prone, moving, make sure we're not sedentary. And that also contributes to weight gain. So for women, again, looking at it from a hormonal standpoint, I always emphasize movement. I believe movement is medicine. And we don't incorporate a lot of that into our culture. Especially when we think of resistance training and weight training for women rather than just meant.

[A]

Yeah, yeah. We always think of guys getting all beefy.

[B]

Yeah, but do they?

[A]

Some of them get a little porky.

[B]

Yeah, they get porky. Pew.

[A]

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[B]

Yes. So I think that, you know, when I look at women's health in general, I feel that there's not enough people attention paid to it. So think about it from research, from a research perspective. Women were not always included in research. So, you know, think of Jane Fonda, who I love. I heard her on a podcast the other day and she is simply amazing. That was the cardio years, right? You put on your leotards and your headband.

[A]

Yeah, yeah. Jazzer size, right? Yeah. Which I look great in a headband.

[B]

He was great. But now we're leaning more towards into weight training because what we know, that muscle is the organ of longevity and that's what's going to improve our muscle.

[A]

We could debate about that one.

[B]

We can debate. We're going to be here for another hour to debate just about muscle. Yes.

[A]

So how about ultra processed foods and menopause?

[B]

Oh, yes, let's touch on ultra processed foods. So going to nutrition and dietary needs for women as they start to go through that transition, we start to see a shift in metabolic features. We also see a shift in glucose insulin ratios, and that has to do all with estrogen. So we live in a society obviously in the Western world where we really place a lot of emphasis on convenience and flexibility. And what that yields is getting foods that's not prepared at home, going through that process where we actually have literally processed foods and ultra processed foods. And so when that plays a part in our body internally, we know that we're going to increase inflammation. We know that we're going to increase the risk of having leaky gut, and we're also going to increase the risk of where we're not using and utilizing the food that we're intaking to actually help the function of what our body is going through in that moment of a transition for a woman in midlife.

[A]

So if you were going to give us a menopausal diet, and I love.

[B]

Menopausal diet, we're going to brand it right here. Boom.

[A]

You were here first. So with specificity, other than, of course, beans, what's going to be in our menopausal diet?

[B]

So the menopause diet, if I were to look at macros, right. So taking our macros of what, whether that's carbohydrates, proteins and fat. We live in a westernized world where we focus usually on our carbohydrates especially because we were able to metabolize it at a much faster rate in our younger years as our metabolism slows and our requirements change, which we talked about muscle mass and loss. 3 to 5% of muscle is lost a decade, but it's actually increased at menopause because of the estrogen loss. So protein, protein is that thing that I really feel that we have not learned throughout our years as women who were younger to focus on protein. Now, I'm not gonna get into the debate about whether that's plant based or meat based.

[A]

Oh, I'm gonna jump right in here, Jim.

[B]

But I don't like to shade the other side. But you know, obviously with meat protein you're gonna get your full composite of amino acids versus plant protein. You just have to be a little bit more creative. And I actually am a fan of plant protein. But protein really is going to be that macro that's then going to substantiate the building of our muscle and preventing sarcopenia, which is the loss of lean muscle mass. And that has everything to do. I know you said we're gonna argue about the muscle of longevity being muscle or the organ of longevity rather. But as we start to increase our protein intake, it's kind of like a seesaw. Everyone, if you were to think of a seesaw, and what's gonna keep that balanced is if you are not eating protein, you're not going to substantiate the muscle loss that's occurring. Right. So you're going to increase that protein intake to down regulate the muscle loss and improve your muscle mass.

[A]

Well, you know, this is sort of my beef with the, no pun intended, we are full of puns. But I'll tell you, the world's longest lived populations, these people who are living 10 years longer than we are, without cardiovascular disease, without type 2 diabetes, without about 40% of the cancers we're suffering from a fraction rate dementia. They're eating about one tenth the amount of meat that we're eating from animal products. They're getting their protein, but mostly from a grain and a bean. If you put those two together, you get a whole protein. But the other thing is in blue zones, remember, they're living a decade, nobody's pumping iron, nobody's building their muscle.

[B]

But what are they doing?

[A]

They're walking.

[B]

Yeah. The consistent movement.

[A]

But I think honestly, we get it wrong. If we tell the American masses, you need a gym membership, you need to get to the gym. I think what people need to do is change their streets so that they're not just built for cars, they're made for human beings. I think a garden is arguably the best physical activity for the long run because you're nudged to go there every day and it's low intensity and you can do it till you're 100.

[B]

You don't have to also look what you get from it. You get like amazing food and boom.

[A]

Part of our menopausal diet.

[B]

And so, yeah, I do believe when people really understand the fundamentals of protein, they could do a really good plant based protein diet. I think also one thing to kind of like nudge back at your beef with protein is the process. Even though they're eating much less of a meat protein within their diet, we also over process our meats. So I think that plays a part in it as well. I would love to see a study that was done on specific proteins and how they're processed and what the outcomes are. For example, I love Farmer's Market, right? So even though I've decreased my red meat intake, from a protein perspective, I would say, well, now I'm going to look at the quality of what protein and where I'm getting that meat and seeing if that makes a difference as well. But one of the other topics that we talked about on TV today was colon cancer. And that has a lot to do with ultra processed foods not moving the leaky gut and how our gut is impacted by the foods that we eat and the lack of movement that we have. So everything that you were able to see over the course of traveling the world is really, when you look at it, it wasn't fundamental basics that are missing as far as community and the foods that we eat and the preparation that goes towards that. And like you said, it doesn't have to necessarily be a gym members, but having a garden. And we've kind of missed those basics. In what we have created as like the most perfect environment of what we expect to be with only technology, we.

[A]

My fundamental argument is that if you want to live longer or be healthier, don't try to change your behavior because you'll fail in the long run. More than 95% of people who start a new diet, a new exercise program, a new longevity hack, are no longer doing it in two years. If you want to live longer, you have to think about things that you're gonna do every day for decades. And that generally taps into our unconscious behavior. My general pitch is set up your environment so that the healthy choice is mindless. It's the default. And if you were going to set up an environment that helps women through menopause. What would that environment look like?

[B]

Yes. Now we've gone from a diet to building environments. I love this all here on the podcast. We are creating your entire lifestyle. If I were to think of environmentally.

[A]

One stop shopping, right.

[B]

One stop shop here is, I really believe, like you said, your environment. So I'm very big on grounding as far as. And it doesn't have to be a big significant part of the day of setting intention, looking at the sun, getting sunlight as quick as you can. I'm a big believer in gardens as well. And that doesn't have to be a big garden in the backyard, but you can start somewhere on your front yard. I've seen really how again in technology we've created micro gardens. Right. So even starting there, I think is one way that I've incorporated into my personal life of changing my environment. How we sleep. We don't pay attention to how we sleep and the quality of sleep that we get. So I actually advocate for a lot of my patients who are having poor sleep going to the other things that they can do is to change their mattress and what kind of mattress are they sleeping on. And I think connection. Connection for me has been one of the biggest parts that I've learned in this transition as a perimenopausal woman is that at some point we actually have to maybe skim some people out of our lives and put more people in who are going to create this environment. Because negative connections can also detract a lot from your life.

[A]

I actually think one of the best New Year's resolutions you can do instead of getting on a diet or say, I'm gonna change my exercise pattern, which fails usually by January 19th.

[B]

Oh, you're better than me. I'm January 10th.

[A]

Okay, I get extra 90. Yeah, but actually think about curating your immediate social circle and while not outright dumping your unhealthy friends, but say, this January, I'm gonna identify one friend in my social network who I know cares about me on a bad day. I know their idea of recreation's physical activity. I know they're eating healthy, mostly a whole food, plant based, right amount of protein, menopausal diet, and proactively bring them closer into your circle. Invite them out for a cup of coffee or invite them to dinner and say, over the next month, I'm gonna make them our friend. Why? Because health behaviors are as contagious as catching a cold and friends are long term adventures. And remember, there's nothing you can do this week, this month or this year, other than not die that will have any impact at all on whether you're still alive and thriving in 2030. So you have to think about what's gonna influence me for the long run. And your friends are huge.

[B]

Creates consistency. It creates consistency in a fashion where they're going to enjoy doing the things I've had a lot of my patients who even when it's about alcohol, right? So if we wanted to bring alcohol in the mix of we know that that can cause cancer, but it also metabolically ruins our glucose insulin as we start to age and go through menopause is many of my friends don't know what to do or my patients rather when they have friend circles that don't encourage their decline in alcohol intake and it becomes uncomfort. And so those are even the things that become hard for individuals to have to navigate. And so that's why the emotional part of menopause is also a big feature. Because having to have these awkward, difficult conversations or someone might think you have something against them and really you're just trying to curate a different circle for yourself.

[A]

The Dan Peter podcast is brought to you by Progressive Insurance. Financially responsible financial geniuses, monetary magicians. These are all things people say about the drivers who switch their car insurance to Progressive and save hundreds. Because Progressive offers discounts for pain in full, owning a home and more. Plus, you can count on their great customer service to help you when you need it. So your dollar goes a long way. Visit progressive.com to see if you could save on your car insurance. Progressive Casualty Insurance company and affiliates. Potential savings will vary. Not available in all states and situations. We tend to think that luxury means more. More plans, more movement, more stuff. But everywhere I've gone to study the world's longest lived people, I found the opposite. In the blue zones, the real luxury is time. Time to walk instead of rush. Time to sit at the table a little bit longer. Time to finish a conversation without checking the clock. That's not indulgent. That's how people stay healthy and happy for decades. When I'm at my lake house in Wisconsin, slowing down happens naturally. Mornings start quiet, meals stretch out, evenings end early. It's not flashy, but it's deeply restorative. When I head back on the road, I like knowing my home doesn't sit still. I host it on Airbnb so someone else can experience that same pause, that same sense of ease. You don't realize you're missing it until you feel it again. Hosting fits Seamlessly into my life. It's a simple, practical way to earn extra income while staying connected to a slower, more intentional way of living. Your home might be worth more than you think. Find out how much at airbnb.com/host. What do men need to know about menopause? You know, I'm your perfect student because I'm actually interested and I'm clueless.

[B]

I think it's like this mystery. It was. It's always been looked at as this stigmatized. Don't talk about it. Women weren't even talking about it, so it became very uncomfortable and awkward. But even more so was the connectivity that they were having with their partners, spouses, or I've even had some younger men when they remember their mother is going through menopause. Right. So there's a connectivity part of it that was missing because it was not an open discussion. And so the more that men become allies in understanding the transition, that it's not them. Right. There's the ego that's involved in that of like, oh, this isn't about finally change. We're trying to give you a break here. We're saying it's not about you and learning how to weave through that connection. There's obviously a lot. Social media is, you know, can be something that's really good or bad. But right now, we're seeing a lot of menopause and divorce and menopause and relationship changes. And I believe that has to do with. As women are understanding more of this emotional and this hormonal shift, then we're not. We're not talking to them. So how are we going to advance women in this kind of transition through. I understand what's going on with me now. I know why I feel the way that I do emotionally or connectivity wise. But then we're not talking to the men. Then there's gonna be. There's not gonna be this kind of equal playing or this level setting between two, and then that's creating only more diversion. So for men, I would say lean into it. It's not for them to fix. It's sometimes just to allow to be. To be heard for a woman to be heard and understood. Especially when it comes to intimacy, There are a lot of women who has nothing to do with their partner, but because of decreased libido or how they feel about themselves and their body changing can play on their mind, and they don't want to be intimate with their partner. And so even, like, little discussions like that can help people be more aware of saying, oh, we can journey this together because we're now more both understanding of this transition.

[A]

How do other cultures look at menopause? Is it stigmatized? Is it accepted? Is it true?

[B]

It is generally actually embraced more in some cultures. And I'll give you an example. So in my book Generation M, I opened the book with discussing how menopause is discussed in the Japanese culture and interesting konenki. And what is.

[A]

What is it?

[B]

Kinenki.

[A]

Oh, that sounds fun.

[B]

It doesn't. It sounds so much better than menopause. But the belief behind it is it's unfolding, unturning into a new chapter. And that's one that sounds inviting. Right? Versus this is the worst stage of your life. Good luck.

[A]

Yeah, yeah.

[B]

So in general, what we do see one experientially, I really want to place some emphasis on experience because there was a study that was done called the Swan study, and they looked at the experience of women and in their actual symptoms based on ethnicity, which is so important because everyone is gonna go through it differently. And the average of when we were just looking at maybe vasomotor symptoms, hot flashes and night sweats was as little as 4.5 years. When they looked at Japanese women to as much as 11 to 12 years for black women. Right. So in between there, they had Caucasian women, they had Hispanic women and Native American. And so you can see that, the breadth of those years of experience. So imagine if on average, someone may go through it 4.5 years and someone 12, what that might bring about as far as stress, having to deal with something, with relationships. So there's one, an ethnicity background to it as far as contextually what women feel based on ethnicity, but also culturally, how that culture kind of creates around this actual transition that will happen for all women. How are we going to take that in and how are we going to express that and allow women to transition into that? And I think that has a big key outcome on how women are going to do. It's kind of like the positive effect of we have this thing that's happening, but we're going to make sure that you go through it in a way where you understand it and you're kind of leaning into it rather than shunning it.

[A]

There's actually this hypothesis around the evolutionary rationale for menopause called the reproductive conflict hypothesis, which is essentially that if you never go through menopause, in other words, if you can have babies at any age, there, it would set up.

[B]

I would not want anyone.

[A]

Exactly. It would set up this competition between grandma and Daughter because grandma still wants to have kids of her own. And in blue zones, we see this grandmother effect, where grandmothers who no longer having kids are helping their daughters raise their children, which actually favors the survival of grandkids. So you can see how menopause could be an evolutionary benefit not necessarily to the individual, but to the survival of the generation, family.

[B]

Absolutely. And I think that's where we do see everyone. Everyone plays a role. Right. Everyone plays a role in how our life kind of unfolds. And that's the reason why we do have biologically ending of fertility and reproduction and moving into a new phase. What I think we haven't done a good job at is how do we turn this chapter in a book and create where it is fundamentally something that can be looked forward to rather than something that is fearful and dreaded. Yeah.

[A]

And pulling the shroud off and getting rid of the black box labeling. I know that all steps in the right direction. So why might it be better to start hormone replacement therapy early? And not only why, but what are some of the mechanisms behind it?

[B]

Yeah, the mechanisms behind that. And just to kind of frame that. We used to only offer hormone therapy to women who had like definitively reached menopause and had no more cycles. And that's what we did for decades. Then we had the whi and then we just like forgot it all. We were just like, forget hormones in general. So now where we are is looking at that data, and timing is everything. And the WHO actually helped create that. Timing does play a part in when we start hormone therapy. So if we were to start in our mid to early 50s of hormone therapy. Hormones are chemical messengers and have a very important role in how our body functions. And how our body functions is based on that, like you said, that consistency, that message that's being sent every day at a certain time in order for the brain to respond, the muscle to respond, the heart to respond. I'll start with those three organs because they're probably our most vital organs. So if timing is important and we can start before the depletion of a certain hormone, namely estrogen, then we are kind of giving Runway to the ability for our organs to transition to a different level of hormone, but not depletion. And also the sustainability of that. That of that organ to create that function with that consistent mechanism that will give you longevity. And so where we were seeing this in science and data is women, typically 53% cardiovascular disease is going to be the cause of death. When we look at muscle mass. Yeah.

[A]

Is it the Estrogen somehow protects the arteries or protects the heart muscle. What is it?

[B]

It's protective in a way. So as we age, so there's aging and menopause kind of have an overlay. And so aging, yes, you will see more plaque in your arteries. You're going to see the heart muscle not be as, as kind of profound and how it pumps and how it brings in blood, also our brain, and decreasing inflammation and decreasing plaque formation for cognitive decline. And then in your muscles, sarcopenia, it really has, it plays a part in how your myokines are able to release the stimulation for your muscles to grow. So when that's completely depleted in menopause.

[A]

And when you say that, that, what.

[B]

Do you mean when estrogen is, is depleted.

[A]

Okay, so if I understand you correctly, if we're starting early with estrogen, you don't undergo these negative changes profoundly. As if you wait.

[B]

Correct. Your body will respond to what it's given and if there's nothing being given to it, it can only function to that capacity. And so the goal with hormones in a timing fashion is to allow the hormone to create some sustainability on a low level, to decrease symptoms, but also allow for your organs to maintain the functionality of what they were built to do.

[A]

If you replace all your progesterone and your testosterone and your hormone to the levels of a 13 year old girl, why, why, why do we even go through menopause at all?

[B]

I think it's, it's kind of biologically how our bodies were designed to go through a process of, of not reproducing anymore. What we haven't accounted for is that gap, that gap that I, which I started with with our life expectancy of 59 and men's weren't much more either. It's just that now we've expanded that we haven' the mainstay of estrogen, progesterone and testosterone playing a huge role in how our body internally is going to respond to that. And quite frankly, you'd made a point. I wanted to make sure we understood when we think of hormone therapy, we're not giving you hormones to what we want you in age 13 through 24, even in your early 30s. We are really providing you with a nice low level of hormones that can allow your body to still function and a level at which your symptoms can be resolved and decreased. That's really what we're trying to accomplish other than herbs.

[A]

I mean, if you, if you go to the Internet and you look for herbal supplements and other pills, is there anything else that Helps with the root cause of menopause symptoms.

[B]

Yeah, I would maybe go right to the symptoms. And I think a lot of what we see is the symptoms have everything to do with what you have studied, which is nutrition, which is movement. There have been studies, even mindfulness practice have been shown to decrease what we see as hot flashes, night sweats, changes.

[A]

Give us some supplements that we supplements.

[B]

So I typically will Ashwagandha flat cohosh can be helpful. Also deficiencies in minerals and vitamins, vitamin D. Typically women come in with very low vitamin D. So finding that in a food source and or supplement because typically you're not going to find all you need in a diet or consume it and then fiber. I think fiber is also something that we lack. And that's why we start to see what we were talking about, colon cancer. But just how the gut is able to interact with the brain as well.

[A]

Yeah, the gut makes a lot of the vitamins. It's a factory. And our microbiome only produces those vitamins if we feed it get fiber. What are some other alternatives to hormonal replacement?

[B]

Yeah, we've talked about supplements and food choices I think are important. But there's also ways that you can get what we call precursors to hormones. And so if you were to talk to a hormone specialist and you said I don't really want the actual hormone for whatever reason, what are some other things that I can get? And you can get precursors. So if you think of hormones and how they're made, if you were to put them in like a, a production kit, there are things that are called pro hormones and they're right before you get the actual hormone that we're giving you. So for example, progesterone could be pregnenolone or testosterone can have a precursor called dhea. So I do multiple things with pre hormones or pro hormones is I can give that patient just that. If they don't want the actual hormone for whatever reason, we have a thorough discussion of why. But the other thing is I have patients who are on hormones and maybe not reaching the potential of what they can get with that outcome. And then I will still add a pro hormone if they need it as well. So there's multiple ways to do that. I have always said that hormone therapy1 is not a drug. We are giving you something that your body had. Now we're trying to give it back in a very small amount to get you those outcomes. But the other part of that is big part is lifestyle factors. What are you doing outside of the hormones in your everyday life as you're starting to age that are going to also create this like really rich, diverse environment that will ultimately also help your symptoms and getting through menopause.

[A]

In a way, I think this is such an important theme as with longevity and menopause. At the end of the day, it's an ecosystem.

[B]

It is.

[A]

And it's not just a silver bullet. Well, Dr. Jessica shepherd, it's a hot topic. I can't imagine a better person to deliver the message. Thank you for taking time out of your Good Morning American schedule to talk to us. And we hope to see you all when you're 100. And we hope you get through that menopause with grace and with joy. The Dan Peter Podcast is brought to you by Progressive Insurance Financially responsible financial geniuses, Monetary magicians. These are all things people say about the drivers who switch their car insurance to Progressive and save hundreds. Because Progressive offers discounts for paid in full, owning a home and more. Plus, you can count on their great customer service to help you when you need it. So your dollar goes a long way. Visit progressive.com to see if you could save on your car insurance. Progressive Casualty Insurance Company and affiliates. Potential savings will vary. Not available in all states and situations.