For too many women, midlife arrives with a frustrating message: sleep gets worse, weight changes, mood shifts, energy drops, joints ache, libido disappears, and everyone around them acts like this is just what happens. In a recent episode of Thriving to the Finish Line, Shannon Miller sat down with Dr. Anamaria Yeung and Dr. Rachel Coleman of Empower Lifestyle Medicine to talk about a different way forward — one rooted in evidence, education, and the belief that women do not have to simply “get smaller” as they age.
Their conversation covered a lot of ground: the six pillars of lifestyle medicine, what actually happens in perimenopause, how the Women’s Health Initiative shaped decades of fear around hormones, why vaginal estrogen deserves more attention, and why women over 60 still deserve a real risk-benefit conversation about treatment.
What Is Lifestyle Medicine?
Dr. Coleman explained that lifestyle medicine is built around six pillars: nutrition, sleep, exercise, stress management, strong social connections, and minimizing risky substances. She described it as preventive medicine with a stronger evidence-based framework and more time spent helping people make meaningful change — not just prescribing a pill and moving on.
That matters, especially in midlife. Both physicians described how traditional healthcare often becomes a “sick care system,” focused on managing problems after they start rather than helping patients prevent or reverse chronic conditions. Dr. Yeung said lifestyle medicine gave her a new path: instead of treating disease after the fact, she could help patients build health before chronic illness takes over.
Why Menopause Can Feel So Disruptive
One of the clearest takeaways from the episode is that perimenopause is not a small hormonal shift. Dr. Yeung explained that it often begins sometime in a woman’s 40s and can last 10 years or more. During that time, estrogen levels do not decline in a smooth, steady line — they fluctuate wildly. She described it as “like puberty in reverse”: sometimes estrogen is high, sometimes it bottoms out, and the result can be a chaotic mix of symptoms.
That helps explain why so many women say the same thing: “I don’t feel like myself anymore.” Dr. Yeung said the most common patient they see is a woman in perimenopause struggling with mood, sleep, weight gain, pain, low energy, and low libido — often while still eating and living in ways that used to work for her.
Why “Menopausal Hormone Therapy” Is a Better Term
The doctors made an important distinction: they prefer “menopausal hormone therapy” rather than “hormone replacement therapy.” Why? Because the goal is not to restore hormone levels to what they were at age 25. The goal is to provide a steady, therapeutic level that helps with symptoms and long-term health without trying to recreate a full cycling reproductive system.
They also emphasized that treatment decisions are usually driven by symptoms, not just lab values. Blood levels do not always match what a woman is actually experiencing, especially during perimenopause when hormones can swing dramatically.
The Lasting Damage of the Women’s Health Initiative
A major section of the conversation focused on the long-term effect of the Women’s Health Initiative (WHI). Dr. Coleman described it as deeply damaging to women’s healthcare because its interpretation led to decades of fear around hormone therapy, despite the fact that the absolute breast cancer difference discussed was small and did not translate into a statistically significant difference in breast cancer deaths. She also noted that avoiding hormone therapy has real consequences: more osteoporosis, more UTIs, and more serious outcomes from fractures and infections.
Dr. Yeung added that in the estrogen-only arm of the WHI, women actually had a reduced rate of breast cancer compared to placebo, and that those women were receiving conjugated equine estrogen, not estradiol — the form that more closely matches what the body naturally produces.
The doctors also pushed back on the idea that hormone therapy must stop at age 60. They discussed later WHI analyses showing that while women ages 50 to 59 saw a cardiovascular benefit, the older age groups did not show increased cardiovascular disease or all-cause mortality compared with placebo. Their conclusion: there is no data supporting a hard cutoff at age 60.
Why Vaginal Estrogen Deserves More Attention
One of the most practical parts of the episode was the discussion of vaginal estrogen. Dr. Yeung described it as “amazing” and said almost every woman in menopause — or even perimenopause — could potentially benefit from it. Because it acts locally in vaginal and vulvar tissues, it does not appreciably raise systemic estrogen levels, and studies discussed in the episode showed no increase in blood clot risk, stroke, or breast cancer recurrence for most users.
The doctors stressed that the small group needing special discussion includes women with a history of breast cancer who are on an aromatase inhibitor; for them, the decision should be individualized with their oncologist. But the broader message was simple: too many women assume that because they are “done with menopause,” vaginal estrogen is no longer relevant, when in reality it may help with urinary symptoms, tissue health, sexual comfort, and quality of life.
Testosterone: Helpful for Some Women, but Still Understudied
The conversation also addressed testosterone therapy for women. Dr. Yeung explained that testosterone is a natural hormone in women’s bodies and that the strongest evidence for its use is in treating hypoactive sexual desire disorder. Beyond libido, many women report better energy, better workouts, and an overall sense of feeling more like themselves again — but the doctors were careful to note that the broader evidence base is still limited.
Their preferred route is transdermal testosterone gel, using about one-tenth of the male dose, with follow-up bloodwork to avoid excessively high levels. They expressed concern about pellets because the dose is not as easily adjusted, and side effects at supraphysiologic levels can include acne, hair changes, or even voice changes that may not fully reverse.
Why Lifestyle Change Still Matters — Even with Hormone Therapy
One of the strongest messages from both doctors was that hormone therapy is not the whole answer. Women may feel significantly better on menopausal hormone therapy, but Dr. Yeung and Dr. Coleman emphasized that the biggest improvements happen when it is paired with nutrition, exercise, and other lifestyle changes. In their experience, many women begin to feel better within a month, and the more meaningful shifts often become clear around three months when they fully commit to the process.
Shannon shared her own experience with glucose tracking and body composition, noting how surprising it was to see visceral fat and post-meal blood sugar spikes that were not obvious from the outside. The doctors echoed that point: what feels like a “small change” — such as walking after a meal, doing zone 2 cardio, or adding heavy strength training — can have a major impact.
Menopause as an Opportunity, Not a Decline
Perhaps the most refreshing part of the conversation was its tone. Instead of framing menopause as a slow decline, the doctors described it as a wake-up call and even an opportunity. Dr. Coleman said women spend decades putting everyone else first, and menopause often forces a change: if you keep ignoring yourself, your body eventually stops cooperating. But that shift can also create space to finally invest in your own health.
That idea fits closely with how we think about aging at Miller Elder Law Firm. Healthy aging is not about shrinking into a smaller life. It is about building support, staying engaged, and making intentional choices that protect your body, your mind, and your independence.
A Direct Care Model That Gives Patients More Time
Another important part of the discussion was Empower Lifestyle Medicine’s choice to operate as a direct care practice rather than taking insurance. The doctors explained that this allows them to spend more time with patients, educate thoroughly, and avoid the numbers-driven pressure of an insurance-based model. They also noted that telemedicine can be especially helpful for older adults who do not want to spend hours traveling, waiting, and missing meals or hydration just to get seen.
That kind of model matters when the goal is not just to manage a diagnosis, but to help someone actually change how they live.
Men Need Lifestyle Medicine Too
The episode also touched briefly on men. Dr. Yeung said men make up about 20% of their practice, and they work through the same pillars of lifestyle medicine with them. Empower also treats obesity and uses GLP-1 medications when appropriate, while emphasizing that these tools work best when combined with broader lifestyle change.
The Bottom Line
This conversation makes one thing clear: women deserve better information, more nuanced care, and more individualized conversations about menopause and aging. The idea that suffering through perimenopause is normal, or that hormone therapy is automatically unsafe after a certain age, simply does not match what these physicians are seeing in practice or how they interpret the evidence.
Lifestyle medicine, strength training, better nutrition, stress management, vaginal estrogen, menopausal hormone therapy, or testosterone may not be the right fit for every person. But women deserve the chance to have those options explained clearly — and to make informed decisions based on real risk and real benefit.
Thinking about how health, aging, and long-term planning fit together?
At The Miller Elder Law Firm, we help families plan for the future while also connecting them with the right medical, care, and community resources through our Life Care Planning program. If you are navigating aging, caregiving, chronic illness, or questions about long-term care, we are here to help.
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