Podcast Summary: The mindbodygreen Podcast

Episode 610: Your Guide to HRT & Lifestyle Changes for Menopause | Jila Senemar, M.D., FACOG

Date: August 10, 2025
Host: Jason Wachob
Guest: Dr. Jila Senemar, Board-Certified OB/GYN & Menopause Specialist

Overview

In this insightful episode, Jason Wachob sits down with Dr. Jila Senemar to unravel the complexities of menopause, the role and current understanding of hormone replacement therapy (HRT), and how lifestyle modifications can empower women through this significant life change. Dr. Senemar shares the latest science, clears up longstanding myths (especially around HRT and cancer), and lays out practical, actionable advice for diet, movement, sleep, supplements, and community—highlighting the importance of a personalized, compassionate approach to menopausal health.

Key Discussion Points & Insights

1. Rethinking HRT: Debunking the WHI Study

• The 2002 Women's Health Initiative (WHI) study led to widespread HRT fear due to its association with breast cancer, but the design and medications used then are now outdated.

• Later data republished by the WHI showed the estrogen-only arm actually saw reduced breast cancer incidence, but these findings never made headlines.

  "A lot of the researchers on that study didn’t agree with the headlines...they had to go on and publish a book to talk about how everything was twisted."
  — Dr. Senemar [01:53]

• There is increasing acceptance today that the original warnings were overblown. Many women suffered unnecessarily from lack of treatment.

  "There’s a whole generation of women who suffered because of it and not getting those hormones that they may have needed at the time."
  — Dr. Senemar [04:36]

2. Navigating the Pendulum Swing: From Fear to Over-Exuberance

• The conversation has pendulum shifted: from widespread avoidance of HRT to it being almost a panacea.

• Dr. Senemar stresses the need for individualized discussion and “living in the gray” — not every woman needs HRT, but education and choice are key.

  "Most women, as long as they’re educated about it, can digest the information for themselves and come back with more questions and then decide whether they want to approach it that way or...start with lifestyle modifications."
  — Dr. Senemar [05:39]

3. Lifestyle Modifications: The Foundation of Menopausal Well-Being

Nutrition

• Move away from the word “diet”—focus on strength, muscle mass, and sustainability.

• A Mediterranean-style, whole-foods, omnivorous diet:

  • Emphasize real, minimally processed foods (e.g., fish, vegetables, olive oil, whole grains)
  • Avoid exclusion of whole food groups.

  "You need protein, you need fruits, you need vegetables. There should not be any one component of the food pyramid that is excluded."
  — Dr. Senemar [10:17]

  • Quality matters—fresh sourdough or local bread vs. shelf-stable Wonder Bread.

Exercise

• Cardio isn’t king—resistance training is essential for women in midlife.

• Build and maintain muscle mass for metabolic health, bone strength, and functional independence.

  "You build your muscle in your 20s, 30s the most, and your bone strength is its highest in your 30s, so [resistance training] helps you maintain yourself going forward...when estrogen levels decline."
  — Dr. Senemar [14:49]

• Guidance is key, especially for midlife beginners to prevent injury.

• Find something enjoyable and sustainable—community and connection boost adherence and joy.

  “Her method brought us all together, but then our friendships just blossomed out of it, and even the husbands are all friends now and we travel sometimes.”
  — Dr. Senemar, on the Tracy Anderson “Tamily” [21:27]

Sleep

• Absolutely foundational for energy, recovery, mood, and hormonal balance.

• Wearables (like Oura rings) help discern sleep quantity vs. quality and identify triggers (late meals, alcohol, etc.).

  "Some people think they get eight hours of sleep, but was it really quality sleep?"
  — Dr. Senemar [25:05]

4. Supplements in Menopause

• Core recommendations:

  • Vitamin D3 + K2 (bones, brain, immune health)
  • Omega 3 fatty acids
  • Magnesium (glycinate for sleep, L-threonate for focus)
  • Creatine (muscle/brain)

  "Creatine, obviously...It's not just for muscle...It helps the body, muscle, brain activity, everything."
  — Dr. Senemar [29:43]

• Keep regimen targeted and individualized, add one supplement at a time to gauge impact.

5. When (and How) to Consider HRT

Candidate Assessment

• Evaluate medical history: hypertension, diabetes, lipid profile, genetic cancer risks, clot history.

• Most women qualify; only a few major contraindications (e.g., current/recent hormone-sensitive cancers, unexplained uterine bleeding, history of blood clots).

  "Most women tend to be candidates for hormone therapy...only a few major contraindications."
  — Dr. Senemar [31:19]

Delivery Methods: Bioidentical vs. Synthetic

• Bioidentical hormones: Estradiol, micronized progesterone—chemically identical to human body’s hormones.

• Delivery forms:

  • Transdermal (patch, cream, mist, vaginal ring) preferred.
  • Pellets—bioidentical but not first line due to irreversibility if side effects arise.
  • Progesterone typically in oral (micronized capsule) form.
  • Testosterone (for some women) via topical prescription; off-label but evidence supports use.

• Adjustments are based on symptoms far more than labs.

  "It's really driven by symptoms...I'm talking to the patient: 'How are you feeling?'"
  — Dr. Senemar [34:32]

Timing: When Should HRT Start?

• Perimenopause (symptoms but still cycling): Adequate time to start, no need to “wait” for menopause.

• Can continue for up to 10-15 years for health benefits.

• Even women over 60 may be candidates with proper cardiac screening.

  "Average age of menopause is 51. So...Even women at 60 who come in with severe enough symptoms...can actually still be a candidate."
  — Dr. Senemar [40:22]

6. Benefits of HRT Beyond Symptom Relief

• HRT is not just a short-term fix:

  • Protects long-term cardiovascular health (reduces disease risk highlighted by vasomotor symptoms)
  • Supports bone density and prevents osteoporosis
  • Brain health and possibly cognitive preservation

  "You're doing yourself a benefit by being on them. It's not just a matter of let me be on it just to feel better. It's working for you in the long term."
  — Dr. Senemar [43:17]

7. The Power of Community

• Menopause is increasingly mainstream in women’s conversations; community support helps normalize experience and share wisdom.

• Women should feel empowered, not isolated or “washed up.”

  "I want women to know they're not alone, that there's a lot of people out there willing to help them...Just because you're in menopause doesn't mean you're old, doesn't mean you're washed up and done with. You're just starting."
  — Dr. Senemar [43:48]

Notable Quotes & Memorable Moments

• On the myth of HRT and breast cancer:

  “At the end of the discussion, they’ll still look at me and say, okay, but am I going to get breast cancer?”
  — Dr. Senemar [01:53]

• Personalizing care:

  "Everyone’s an individual, but if you had to generalize..."
  — Jason Wachob [10:04]

• The exercise evolution:

  “Fast forward now we know that [resistance training] keeps...you build your muscle in your 20s, 30s, the most...you need that muscle mass to kind of get you through in terms of metabolism, in terms of strength and bone well-being."
  — Dr. Senemar [14:49]

• On practical change and handholding:

  "They literally need handholding... these little tweaks can help women address a lot of their symptoms until they’re further into the perimenopause, menopause stage."
  — Dr. Senemar [07:52]

• On creating joy and connection:

  “Her method brought us all together...our friendship just kind of blossomed out of it, even the husbands are now friends.”
  — Dr. Senemar [21:27]

Timestamps for Key Segments

• [01:53] WHI study myths & long-term HRT fears
• [05:39] Is HRT the new "must do?"—finding the gray zone
• [10:17] Nutrition advice (Mediterranean, omnivorous, sustainable)
• [14:49] Exercise: the shift from cardio to strength/resistance training
• [21:27] Building community and joy in movement
• [25:05] Sleep's pivotal role, wearables for troubleshooting
• [29:43] Supplement recommendations for menopausal wellness
• [31:19] HRT candidacy—medical considerations and risk factors
• [34:32] HRT forms: bioidentical, transdermal, pellets, and monitoring by symptoms
• [38:51] When to start HRT—perimenopause, menopause, after 60
• [41:24] HRT for long-term heart, bone, and brain health
• [43:48] Importance of community & not going it alone

Resources & Contact

• Dr. Jila Senemar’s Practice: Coral Gables, Miami — Open to new patients
• Instagram: @drjilasemenar
• Podcast: "Her Time, Her Health" (Spotify & Apple)
• Mindbodygreen Perimenopause+ Course: Features Dr. Senemar and other experts

For Women Considering HRT

• Seek informed, nuanced medical advice
• Prioritize strong lifestyle foundations
• Find community, ask questions, and expect comprehensive care that values how you feel
• Know you’re not alone on this journey

This summary omits ad reads and peripheral content, focusing on educational and empowering information for women navigating menopause.