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What Every Woman MUST KNOW About Midlife Hormonal Changes | Gynecologic Oncologist Elizabeth Poynor

| 22 products mentioned
Rich Roll Rich Roll host
Elizabeth Poynor guest
Watch on YouTube midlife hormonal health perimenopause estrogen and progesterone menopausal hormone therapy women's health brain health and dementia prevention metabolic health and insulin resistance

Gynecologic oncologist Dr. Elizabeth Poynor discusses the often-overlooked hormonal changes women experience in their 30s, 40s, and 50s, explaining how subtle shifts in estrogen and progesterone affect metabolism, brain health, cardiovascular function, and bone density long before menopause officially begins. She challenges the outdated medical narrative dismissing these changes as "just aging" and advocates for modern menopausal hormone therapy (MHT) using transdermal estradiol and natural progesterone as safe, science-backed interventions—while emphasizing that lifestyle changes remain foundational to managing midlife health.

Key takeaways
  • • Ovarian aging begins as early as age 35-40, triggering subtle metabolic, cognitive, and cardiovascular changes decades before menopause, including insulin resistance, visceral fat accumulation, and brain fog that are often misattributed to normal aging.
  • • Modern transdermal estrogen preparations (patches, creams, gels) using estradiol are significantly safer than older oral formulations like Premarin because they don't increase inflammatory markers or blood clot risk, making early intervention potentially protective for brain and heart health.
  • • Women should prioritize strength training 3-4 days per week over aerobic exercise alone, maintain 1 gram of protein per pound of ideal body weight, and address sleep quality, as these lifestyle factors are critical for building and maintaining muscle mass during hormonal transitions.
  • • GLP-1 agonists can be valuable tools for women experiencing metabolic dysregulation and "hunger of menopause"—when insulin resistance makes traditional diet and exercise insufficient—by breaking both insulin resistance and food-related rumination.
  • • Key lab markers include day 3 FSH, cholesterol panels (including ApoB and Lipoprotein(a)), hemoglobin A1C, blood pressure, and waist-to-hip ratio, which better reflect metabolic and hormonal status than standard labs; emerging tests like DUTCH testing offer deeper hormone metabolite analysis.
  • • DEXA scans should begin in midlife (not at age 65 as current guidelines suggest) to catch bone density changes early, and supplementation with vitamin D, omega-3 fatty acids, CoQ10, and a multivitamin can support metabolic and cardiovascular health during this transition.
  • • Finding a women's health specialist who actively prescribes hormone therapy and understands the full spectrum of midlife physiology is critical; women should ask directly about their provider's views on MHT and consider telehealth platforms if local expertise is unavailable.

Recommendations (12)

Menopause Society recommends

"There's a group called the Menopause Society actually and there is the Menopause Society which does have a great resource of menopause practitioners actually."

Elizabeth Poynor · ▶ 45:01

PubMed uses

"I did a PubMed search and I just put in estrogen clinical trials, estrogen, women's brain health and got 300 pages on PubMed and that's like 10 studies a page"

Elizabeth Poynor · ▶ 38:05

DUTCH testing recommends

"You can move into some of this home urine testing, which I love actually. One is called DUTCH testing actually, which is very validated in terms of looking at estrogen and progesterone and estrogen..."

Elizabeth Poynor · ▶ 51:10

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CGM recommends

"I love CGMs because they can you put one on for a couple weeks and you can say you can see okay what's what's working what's not working and then take it off"

Elizabeth Poynor · ▶ 55:50

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GLP-1 agonists recommends

"This is where the GLP-1s actually I think are super super valuable because this is a problem of insulin resistance. The GLP ones break this insulin resistance. They also break food noise."

Elizabeth Poynor · ▶ 1:12:31

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Multivitamin recommends

"The Cosmos trial showed that individuals who took a multivitamin had better brain health protection. So, I'm actually I'm a supporter of multivitamins for women."

Elizabeth Poynor · ▶ 1:15:45

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Omega-3 fatty acids recommends

"Omega-3 fatty acids super super important. They decrease inflammation. Omega-3s are extremely important for women's midlife brain health."

Elizabeth Poynor · ▶ 1:16:05

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Creatine monohydrate recommends

"Creatine is like the one supplement that's been the most proven benefit. I think certainly supporters of creatine in terms of brain health currently."

Elizabeth Poynor · ▶ 1:16:39

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CoQ10 recommends

"If you're on a statin, you want to check your CoQ10 levels. You want to make sure that those are adequate not only from statin associated myopathies but also with brain health."

Elizabeth Poynor · ▶ 1:16:52

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Vitamin D recommends

"Many individuals are vitamin D deficient. And so vitamin D supplementation if you need it."

Elizabeth Poynor · ▶ 1:17:09

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Water filter recommends

"Getting a good water filter is important."

Elizabeth Poynor · ▶ 1:18:29

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DEXA scans recommends

"I like DEXA body comp. You get bone mass, you get your body comp and your bone mass with that DEXA."

Elizabeth Poynor · ▶ 52:22

Mentioned (10)

bazedoxifene "Bazedoxifene is a good example of this. So that this is a SERM that will actually that's part of ..." ▶ 28:03
Duavee "So that this is a SERM that will actually that's part of Duavee which is an oral estrogen. It's P..." ▶ 28:08
Veozah "There's a new class of drugs that's out that's a CNS acting class of drugs that really helps with..." ▶ 42:44
Parsley Health
Parsley Health "You know Robin Bersen Parsley Health. I mean, I think she's doing a fantastic job with what she's..." ▶ 46:21
B12 "B12, folate supplementation if you need it." ▶ 1:17:13
Folate "B12, folate supplementation if you need it." ▶ 1:17:13
Berberine "Berberine some people are fans of that type of thing." ▶ 1:17:21
NAD+ "When you begin to look at like NAD and peptides and other IVs and other interventions, I think th..." ▶ 1:22:42
Peptides "When you begin to look at like NAD and peptides and other IVs and other interventions, I think th..." ▶ 1:22:42
Spermidine "Spermidine is one, but we need the studies and this is what are being done." ▶ 1:22:49

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