Dr. Jila Senemar is a board-certified OB-GYN in Miami who's integrating longevity medicine with menopause care. After nearly two decades in traditional practice, part of her work is catching women in their 30s and 40s before chronic disease develops.

We discuss why your standard annual labs are missing the markers that actually predict heart disease and diabetes, how to finally break free from the cardio-only mentality that's keeping you from building muscle, and why eating more protein feels impossible when you've been trained to restrict food your entire life. Dr. Senemar reveals the advanced testing she runs on every patient and explains why most women are being managed reactively instead of proactively.

We cover transitioning out of insurance medicine to actually spend time with patients, why strength training won't make you bulky, and when peptides and longevity treatments fit into your health plan. Plus, we talk about what it means to optimize your health span, not just your lifespan.

Highlights:

• The critical biomarkers your doctor isn't checking (ApoB, Lp(a), fasting insulin, inflammatory markers).
• Why perimenopause accelerates your risk for heart disease and metabolic problems.
• How to shift from endless cardio to building muscle that protects your bones and metabolism.
• The real reason getting enough protein feels so hard and why it matters.
• When peptides, NAD, and supplements belong in your health plan.
• Starting health optimization in your 30s instead of waiting for disease in your 50s.

This show has grown over nearly two years thanks to viewers and listeners like you. While menopause and sexual health have become more mainstream, too many women still aren't getting the help or education they need. I'm working to change that. If you found this episode helpful, please subscribe to the show and leave a review on Apple Podcasts.

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Dr. Arthur "Bud" Burnett is a legend in urology whose pioneering work on nitric oxide helped make Viagra possible. As a Professor at Johns Hopkins and author of "The Manhood Prescription," he brings nearly 40 years of research to understanding how men's sexual health impacts their partners.

We discuss why erectile dysfunction in male partners directly affects female sexual dysfunction, the treatments for Peyronie's disease that most couples don't know exist, and why testosterone replacement is straightforward for men but controversial for women. Dr. Burnett explains his holistic approach beyond just prescribing pills and shares insights on helping prostate cancer survivors recover sexual function.

The conversation covers healthcare disparities in men's sexual health and how implicit bias affects treatment outcomes. Dr. Burnett emphasizes that sexual health is a right and encourages advocating for comprehensive care.

Highlights:

• How nitric oxide research led to Viagra and revolutionized treatment.
• Why one in 10 men develop Peyronie's disease and available treatments.
• Nerve-sparing surgery techniques that preserve function after prostate cancer.
• Healthcare disparities that affect men of color in sexual medicine.
• Why advocating for yourself matters when providers dismiss concerns.

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Mentioned in this episode:

GSM Collective

The GSM Collective - Chicago

GSM Collective

Last week was the Menopause Society meeting in Orlando, and while I couldn't attend in person due to getting sick, I spent the weekend watching all the sessions remotely from bed. What struck me most were the cardiovascular sessions.

Recording this on the eve of my mother's one-year death anniversary from a massive heart attack, I want to talk about the real changes that happen when estrogen leaves the chat and why cardiovascular disease awareness among women has actually dropped from 65% to 44% in recent years.

I talk through the key cardiovascular takeaways including why white coat hypertension isn't benign, how the 2025 American Heart Association guidelines changed what's considered normal blood pressure, and why perimenopause is a time of accelerated cardiovascular risk when cholesterol and blood pressure can spike suddenly.

The most fascinating session covered invisible heart disease: INOCA (ischemia with no obstructive coronary arteries) and microvascular dysfunction. This is when women have chest pain, get full cardiac workups showing wide-open arteries, yet still have reduced blood flow to the heart through tiny vessels that don't show up on standard angiograms.

I discuss mental stress ischemia, a hidden killer where emotional stress causes measurable damage and reduced perfusion to the heart even when exercise stress tests are normal. How many women were told they had panic attacks when they actually had coronary microvascular dysfunction?

The mind-heart connection is real, and the sympathetic nervous system surge during high stress can constrict small vessels cutting off microcirculation. I share practical steps including finding preventative cardiologists, getting CT angiograms if you have family history, understanding your blood pressure parameters, and why stress reduction isn't just self-care, it's cardiovascular medicine.

Highlights:

• Why awareness that heart disease is the #1 killer in women dropped from 65% to 44%.
• How white coat hypertension is NOT benign and leads to cardiovascular events.
• New 2025 blood pressure guidelines: normal is now less than 120/80.
• Why perimenopause causes accelerated cardiovascular risk with sudden cholesterol spikes.
• What INOCA and microvascular dysfunction mean for women with chest pain and normal angiograms.
• How mental stress ischemia causes measurable heart damage even with normal stress tests.

If this episode helped you understand cardiovascular risks in menopause and why symptoms like chest pain deserve thorough evaluation beyond standard testing, please share it with women who need this information. Subscribe and leave a review to help more people discover these critical discussions about heart health in midlife.

Resources:

Microvascular Network

INOCA

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Have you ever felt stuck, ashamed, or just plain confused about your sexual wellness? I am so excited about today’s conversation. I am diving deep with Dr. Jennifer Litner, a brilliant sex therapist and founder of Embrace Sexual Wellness, to talk about how we can unlearn sexual shame, communicate better in relationships, and teach the next generation about healthy sexuality.

I love exploring the how sexual wellness, shame, and communication, all need to work together. Jennifer shares her journey into the world of sex therapy, why she believes naming what we do is so powerful, and how shame around sex can impact us even if we are educated or in committed relationships. We also explore practical strategies for improving communication with your partner, overcoming desire mismatches, and creating a culture of openness in your relationship.

We also discuss how early sex education or the lack of it affects adults, how parents can start conversations with their kids without shame, and why understanding pornography and modern sexual culture is crucial for young people today. Plus, we touch on how sexual identity, including asexuality, is being more openly discussed and accepted in today’s world.

Whether you are a clinician, a parent, or just someone curious about your own sexual wellness, this conversation is packed with insights, practical advice, and validation that yes, you deserve pleasure and connection.

Highlights:

• How sexual shame develops and shows up in relationships.
• The power of naming what we do and embracing sexual wellness without fear.
• Tools and exercises for improving communication and connection in intimate relationships.
• Why early, open, and shame free conversations about sex matter for the next generation.
• Insights into modern sexual identity, desire discrepancies, and responsive desire.

If you are ready to explore your own sexual wellness, improve communication with your partner, or learn how to have these conversations with your kids, this episode is for you. Don’t forget to subscribe, leave a review, and share this episode with anyone who could benefit from a little sexual empowerment in their life.

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You've probably heard of cancer survivors, but have you heard of previvors? These are women with genetic mutations like BRCA1, BRCA2, or CHECK2 who are at higher risk for cancer but don't have it yet. October is both Breast Cancer Awareness Month and Menopause Awareness Month, making it the perfect time to discuss genetic testing, cancer risk assessment, and what previvors need to know about their options.

Using a 28-year-old patient with CHECK2 mutation as an example, I walk through when genetic testing makes sense, how to calculate your lifetime risk, and what screening protocols change when your risk is elevated.

I cover modifiable lifestyle factors that account for 30% of breast cancer cases, including alcohol intake, diet, exercise, and optimal body weight. The key message: genetic testing is about empowerment and prevention, not fear.

I also address surgical menopause after risk-reducing procedures. When you remove ovaries in your 30s or 40s to prevent cancer, you fall off a hormonal cliff with immediate consequences.

The critical issue: estrogen therapy is NOT contraindicated for previvors without personal cancer history, yet surgical patients are rarely given a menopause plan before going under anesthesia. Early estrogen loss increases cardiovascular disease, dementia, osteoporosis, and all-cause mortality risks.

Highlights:

• What CHECK2, BRCA1/2, and other mutations mean for lifetime cancer risk.
• How removing ovaries before age 45 without HRT increases all-cause mortality risk.
• Why previvors without cancer CAN and SHOULD take estrogen after preventative surgery.
• Why you should demand a menopause plan BEFORE risk-reducing surgery, not after.

If this episode empowered you to have conversations about family history and genetic testing, or helped you understand why hormone replacement matters after preventative surgery, please share it with women who need this information.

Subscribe and leave a review to help more people discover these critical discussions about cancer prevention and quality of life.

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Mentioned in this episode:

GSM Collective

The GSM Collective - Chicago

GSM Collective

GSM Collective

The GSM Collective - Chicago

GSM Collective

If you've been following along, you may have noticed things look a bit different around my practice. In this episode, I'm sitting down with my amazing team—Karen Bradley (NP) and Grace Prete (pelvic floor PT)—to talk about why we transitioned to concierge medicine, changed our name to the GSM Collective, and what this all means for the care we provide.

We discuss how insurance restrictions meant that even when we spent 30 minutes with patients more than most providers could offer it still wasn't enough time for patients with complex conditions like PGAD, vaginismus, and chronic pelvic pain who needed proper evaluation and treatment. Under our new concierge model with Ms. Medicine, we can now offer 90-minute first visits for pelvic floor patients, co-treat in the same appointment, and collaborate seamlessly to address the full spectrum of each patient's needs.

Grace walks through what actually happens in pelvic floor PT, dispelling the anxiety many patients feel about internal exams. She explains her three-year journey from orthopedics to discovering her passion for treating chronic pain with emotional and physical components. The conversation covers why "just do kegels" is often wrong advice, how tension creates weakness, and why a tight pelvic floor causes urinary incontinence despite conventional wisdom.

We also emphasize that pelvic floor dysfunction isn't just about postpartum issues it affects children with constipation, teenagers on hormonal birth control, athletes overworking their cores, and menopausal women with GSM.

Highlights:

• Why we left insurance-based model.
• How concierge medicine allows 90-minute first visits and same-day co-treatment between providers.
• Why pelvic floor PT should be preventative, not just reactive to pain and dysfunction.
• How nitrous oxide helps those who are anxious progress through dilators in single sessions.
• How TMJ, back pain, and anxiety all connect to pelvic floor tension and clenching.
• Why pregnancy itself damages the pelvic floor regardless of delivery method.

If this episode helped you understand the importance of pelvic floor therapy and comprehensive sexual medicine care, help other women discover this information by subscribing and leaving a review. Your reviews help more people find these discussions about different approaches to sexual health.

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Mentioned in this episode:

GSM Collective

The GSM Collective - Chicago

GSM Collective

Dr. Rachel Pope explains how her sister's cancer diagnosis and a patient in Malawi asking "can you fix my vagina" opened her eyes to the massive gap in sexual health education within gynecology.

As a fistula repair surgeon working in Sub-Saharan Africa for four years, Dr. Pope realized that even after successfully repairing bladder leaks, many patients couldn't have intercourse due to vaginal scar tissue yet providers never asked about sexual function.

Meanwhile, her sister battling cancer was asking basic questions about intimacy that Dr. Pope, despite all her training and a fellowship, couldn't answer.

These twin revelations led Dr. Pope to pursue sexual medicine education and eventually building Cleveland's first female sexual health division that spans multiple departments.

Her unique background in global women's health, fistula repair, and reconstructive gynecology informs her holistic approach to sexual medicine and menopause care.

The conversation also explores Dr. Pope's current research focus on perimenopause and cardiovascular health, believing this critical 10-year window before menopause holds the key to prevention rather than just treatment. She shares her proactive approach to her own perimenopause, including checking baseline testosterone levels at peak ovulation to guide future hormone therapy decisions.

Highlights:

• Sexual function should be assessed after every pelvic surgery, not just assumed
• Obstetric fistulas are still happening globally but were eliminated in the US once C-sections became accessible.
• Building a sexual medicine division works best when spanning multiple departments for true biopsychosocial care.
• The fellowship program accepts both urology and OBGYN applicants, with only two OBGYN programs in the country.
• Her work continues in Africa doing shorter trips and training local surgeons.

If this episode inspired you to think differently about international women's health and sexual medicine education, help others discover this conversation by subscribing and leaving a review. Your reviews help more clinicians and patients find these discussions about comprehensive sexual health care.

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This conversation with Lauren Tetenbaum revealed how her journey from reproductive rights lawyer to therapist led her to write "Millennial Menopause" after realizing she had no idea what was coming next in her late 30s. Her unique perspective combines legal advocacy, mental health expertise, and millennial pop culture references to make perimenopause education accessible and relatable.

Lauren emphasized that millennials are still being dismissed by providers with harmful phrases like "you're too young" and "your labs are normal so you're fine." She stressed that perimenopause can start in the late 30s and that normal lab results don't rule out hormonal changes. The shadow of the Women's Health Initiative continues to create unnecessary fear about hormone therapy, with breast cancer concerns being the most common question she receives.

The discussion highlighted how perimenopause intersects with major life transitions that define the millennial experience - career changes, relationship evaluations, and identity shifts. Lauren and I discussed while men experience "midlife crisis," women going through perimenopause often experience "midlife clarity" once they understand and treat their hormonal changes. This clarity sometimes leads to relationship changes as women reevaluate what they want and deserve.

A significant focus was placed on the mental health impact of perimenopause, particularly for women with previous anxiety or depression. Lauren explained that old coping mechanisms often stop working, and symptoms like rage, brain fog, and irritability can feel overwhelming. She advocates for psychoeducation as the first step, helping women understand that these changes are hormonally driven and treatable, not character flaws.

Lauren shared practical coping strategies including mindfulness techniques like box breathing, cold water on wrists or neck, and "putting the pause back in menopause." She emphasized the importance of partners getting educated and helping with the mental load rather than just witnessing the struggle. Her approach combines cognitive behavioral therapy with self-compassion work and acceptance.

Highlights:

• Why millennials need to start preparing for perimenopause now, even in their 30s.
• Debunking the "too young" myth and normal lab fallacy.
• How perimenopause creates "midlife clarity" vs traditional midlife crisis.
• Practical mindfulness techniques: box breathing, cold water therapy, five senses grounding.
• The connection between postpartum mental health and perimenopause preparation.
• Why partners need education and how to support without judgment.

If this episode helped you understand millennial perimenopause preparation and mental health support, help other women find this conversation by subscribing to the channel and leaving a review on Apple Podcasts. Your reviews help more women discover these important discussions about preparing for life's next phase.

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Mentioned in this episode:

GSM Collective

The GSM Collective - Chicago

GSM Collective

This conversation with Dr. Carolyn Moyers revealed how personal experience with perimenopause transformed her from a general OBGYN into a Menopause specialist. Her journey began when her youngest son pointed out she was getting "mean as she got older," leading her to recognize her own perimenopause symptoms and start estrogen therapy.

Dr. Moyers emphasized the critical importance of debunking perimenopause myths that continue to harm women. The most damaging myths include "it's all in your head," "your labs are normal so you're fine," "you're too young for perimenopause," and "hormone therapy just delays the inevitable." She stressed that perimenopause is a clinical diagnosis that can start in the early 30s and last 7-10 years before the final menstrual period.

The discussion highlighted the complexity of managing perimenopause versus menopause, with Dr. Moyers noting that perimenopause is actually more difficult to treat because of the "pesky period running around." She advocates strongly for the Mirena IUD, which reduces bleeding by 90% in the first six months, making hormone management much more straightforward.

A significant focus was placed on metabolic changes during the menopause transition, including the natural 0.6% annual decline in muscle mass. Dr. Moyers outlined a comprehensive approach including strength training, protein-rich diets, sleep prioritization, and stress management. She introduced the concept of "thought dumping" - an unedited journaling practice combined with identifying three daily wins and three goals for tomorrow.

Dr. Moyers shared her unique integration of osteopathic manipulation into menopause care, offering quarterly OMT sessions as part of her membership model. This hands-on approach helps balance the autonomic nervous system and addresses the physical manifestations of hormonal changes, particularly beneficial for pelvic pain and pregnancy-related discomfort.

Highlights:

• Debunking harmful myths: "you're too young" and "labs are normal".
• Why perimenopause is harder to manage than menopause.
• Osteopathic manipulation for hormonal balance and pelvic pain relief.
• "Thought dumping" stress management technique with daily wins tracking.
• Comprehensive metabolic support including strength training and nutrition.
• Strategic use of GLP-1 medications as jumpstart tools for sustainable change.

If this episode helped you understand perimenopause management and holistic care options, help other women find this conversation by subscribing to the channel and leaving a review on Apple Podcasts. Your reviews help more women discover these important discussions about comprehensive midlife health care.

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Mentioned in this episode:

GSM Collective

The GSM Collective - Chicago

GSM Collective

If you've always managed just fine but suddenly feel like everything is falling apart in your 40s, the problem might not be perimenopause alone it could be revealing ADHD that's been masked your entire life.

This conversation with therapist Mandi Dixon revealed a critical connection between ADHD and perimenopause that's leaving countless women struggling without answers. Dixon's work focuses on the intersection of neurodivergence and hormonal changes, addressing why so many women receive their first ADHD diagnosis during midlife transitions.

The discussion explored how ADHD in girls and women presents differently than in boys - with internal hyperactivity like daydreaming and anxiety rather than external disruption. This leads to years of successful masking, where women learn to follow rules and appear organized while struggling internally. The hormonal support of estrogen helps maintain these coping mechanisms until perimenopause strips away that scaffolding.

Dixon introduced the concept of "ugly perimenopause" - the severe mental health struggles that go beyond typical mood changes and require immediate attention. She emphasized that the highest suicide rates in women occur between ages 46-54, making this a critical period for intervention and support.

The conversation highlighted how neurodivergent women experience more intense perimenopause symptoms due to nervous system sensitivity. Sensory overload becomes overwhelming - from cooking exhaust fans to children's noise levels. Rejection sensitive dysphoria, already challenging for ADHD individuals, intensifies with hormonal fluctuations, making criticism feel devastating.

Dixon's therapeutic approach combines traditional counseling with EMDR (Eye Movement Desensitization and Reprocessing) therapy, which uses bilateral stimulation to help reprocess trauma. This technique proves particularly effective for both mental health recovery and physical conditions like pelvic pain where trauma responses interfere with healing.

The discussion addressed the "menno divorce" phenomenon, with Dixon explaining that divorce often results from pre-existing relationship issues becoming intolerable once women stop accommodating poor treatment. Perimenopause doesn't cause problems but reveals them, giving women clarity about what they will and won't accept.

Dixon stressed that neurodivergent women require specialized menopause care, describing them as "orchids" who need delicate handling during hormone therapy. The combination of hormonal treatment with mental health support often provides the best outcomes, with some women needing long-term antidepressant therapy as a "safety net" alongside hormone replacement.

Highlights:

• Why ADHD gets missed in girls due to internal vs. external symptoms.
• The "ugly perimenopause" requiring immediate mental health intervention.
• Sensory overload and rejection sensitivity intensifying with hormone changes.
• EMDR therapy for trauma processing and pelvic pain recovery.
• How menopause empowerment reveals relationship problems rather than causing them.
• Neurodivergent women needing specialist hormone care and patience with treatment.
• The importance of combining hormone therapy with mental health support.
• Suicide risk peaks between ages 46-54 in women.

If this episode helped you understand the ADHD-perimenopause connection, help other women find this conversation by subscribing to the channel and leaving a review on Apple Podcasts. Your reviews help more women discover these important discussions about neurodivergence and hormonal health.

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Mentioned in this episode:

GSM Collective

The GSM Collective - Chicago

GSM Collective