Women go on hormone therapy to manage peri/menopause symptoms and feel better. But sometimes to their surprise, they feel worse. Or some symptoms go away while others pop up. That’s because of the hormones! We have hormone receptors all over our body and whenever we switch up the signals they’re receiving, whether through the menopause transition itself or through the hormones we use, they’re going to respond to those changes, and sometimes not in the way we want. Most side effects are manageable with time or by dialing in delivery methods and/or doses. It’s just important to know what to expect. We talk all about it this week with our resident menopause specialist Dr. Carla DiGirolamo.

Carla DiGirolamo, MD, PhD, is a Double Board Certified Reproductive Endocrinologist and Obstetrician/Gynecologist specializing in infertility and menopausal medicine. She is also a Crossfit Level 1 trainer, Certified Nutrition Coach, and member of CrossFit Health. She is a MedFit Care provider and provides weekly workouts and medical updates at her Substack Athletic Aging. She is an Endocrine Consultant for Wild Health. Most recently, she has launched her own private practice specializing in helping active and high-performing women reach their performance potential from puberty through menopause. Dr. DiGirolamo is now seeing patients for virtual consultations for menopausal care and performance optimization. Visit her website www.drcarlad.com to learn more about her services and schedule an appointment.

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Many of us have spent a lifetime trying to shrink ourselves. We grew up being told you could never be too thin. As athletes, especially in endurance sports, smaller, lighter, faster was the ethos of the day. That is changing as we see athletes, especially women, discover that being fueled and strong yields even better performance–and longevity. This week’s guest, trainer and nutrition coach Steph Gaudreau embodies that journey through both her personal and professional life. She shares how, for 40+ women especially, growing muscles is the key to better energy and performance in sport and life, and how strength training is the gateway to midlife self-acceptance. 

Steph Gaudreau, CISSN, CPT, helps athletic women over 40 fuel themselves better, get stronger, increase their energy, and perform better in the gym. She’s a sports nutritionist and strength coach with multiple certifications including USA Weightlifting coach, Menopause Health & Fitness Specialist, Girls Gone Strong Women’s Coaching Specialist, and Intuitive Eating Counselor. She shares her advice on building strength, proper fueling, and much more as the host of the Fuel Your Strength Podcast. You can learn more about Steph and her work at www.stephgaudreau.com

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Women have been left on the sidelines when it comes to sport and exercise research. Research finds a measly 6% of studies in the field have exclusively focused on women. That’s bad. But for menopausal women, it’s worse. Of that 6%, menopausal women account for only 9% of total study participants, with only 16% of female-only studies focusing exclusively on older women. This despite the fact that 40+ women have been lining up in greater numbers in sports of all kinds. We deserve better and this week’s guest, women’s health and performance researcher, Kelly McNulty, PhD, has a lot to say about it. We talk about what she has learned studying menopausal women of all walks of life and how education and information can make our lives exponentially better. 

Kelly McNulty, PhD, is a research assistant at Northumbria University currently investigating endocrinological, lifestyle, and psychosocial determinants of brain health outcomes in female veterans. She is a graduate from Northumbria University, with both a Bachelor of Science (BSc) degree in Sport and Exercise Science and a Master of Science (MSc) degree in Strength & Conditioning. Her research interests are in the area of female physiology; the menstrual cycle, hormonal contraception, breast health, pelvic floor health, pregnancy, menopause, as applied to sport and exercise. Kelly is the founder and podcast host of 'The Period of the Period'; a digital education platform on a mission to change the narrative for women's health and performance in sport and exercise by promoting awareness, increasing evidence-based education & providing support.

Resources

Experience of the menopause transition in Irish women and how it impacts motivators, facilitators, and barriers to physical activity engagement here

Invisibility of female participants in midlife and beyond in sport and exercise science research: a call to action here

“Invisible Sportswomen 2.0”—Digging Deeper Into Gender Bias in Sport and Exercise Science Research: Author Gender, Editorial Board Gender, and Research Quality here

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Lots of experts have training and nutrition advice for midlife and menopausal women that is grounded in scientific evidence. Yet, the advice doesn’t always agree…and doesn’t necessarily work the same for everyone. That’s because, while there are general guidelines that are helpful for many women, in the end, we are all scientific studies of one, and no one approach will work exactly the same way for every single woman. So, you need to be willing to experiment and trust yourself, which no one knows better than this week’s guest, Hailey Babcock. Hailey offers her own training services and she partners with some of the biggest names in the business, helping turn their training and nutrition philosophies into practical advice on a personal level–something we talk all about this week.

Hailey Babcock is the owner of Hailey Happens Fitness. She is a past gymnast, runner, and triathlete, and has been a certified classical Pilates instructor for over 20 years. She has multiple certifications including TRX, kettlebell, barbell, and foundational training, along with being an ACE Certified Personal Trainer. Today she has made it her mission to convert women, especially those in their 40s and beyond, to the miracle of strength training. She uses her experience, training, and knowledge to help anybody looking to find more health and happiness through fitness. You can learn more about Hailey and her work at www.haileyhappensfitness.com

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Phantom smells. Lack of focus. Dizziness. While everyone is talking about hot flashes and night sweats, women know that the transition to menopause brings on tons of signs and symptoms that no one ever talks about. This week’s guest, menopause educator and researcher Andrea Donsky is on a mission to change that. As the co-founder of Morphus, Inc., Donsky has become a data collecting machine and has recently published four abstracts in the journal Menopause, including The Wide Range of Symptoms of Perimenopause and Menopause and the Means By Which Women Seek Support, where she addresses the dozens (103 and counting…) signs and symptoms of perimenopause and menopause. We talk about the importance of specific symptom tracking, the need for better healthcare provider education, and much more this week. 

Known as the “Menopause Educator and Researcher” to her nearly 350,000+ TikTok followers, Andrea Donsky is a nutritionist on a mission to change the conversation around perimenopause and menopause. Andrea is a four-time published menopause researcher and entrepreneur with 25 years of experience in the health and wellness space. Andrea hosts the popular podcast ‘Menopause Reimagined,’ and appears as a Menopause Expert on television across North America. Her latest venture, www.wearemorphus.com helps women to “Reimagine Menopause” as a journey of empowerment so they feel heard, supported, and validated. Morphus empowers women to take control of their symptoms and health with nutrition, lifestyle, research, and science-backed supplements. Follow her on TikTok and Instagram @andreadonsky and @wearemorphus to learn more.

Resources

Andrea Donsky’s four poster presentation abstracts published in Menopause here (page 23)

Morphus White Papers on women’s health during perimenopause and menopause here

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Veterinary surgeon Debbie Tacium, 55, wanted to flip the script of my menopause. After suffering pain, loss of coordination, weakness, and changes in body composition during perimenopause, she went back to the sport she loved most in life–gymnastics. She wanted to use it to bring herself back to herself and remember what it was like to be a child who could fly. This week she shares her journey, what it’s brought her, and what we can all learn from challenging our beliefs about what’s possible during this season of life.

Debbie (Debra) Tacium, DMV, works as a veterinary surgeon and is an adult gymnast, former competitive child and pre-teen gymnast, and all around self described “gymnastics nerd.” She came up through the sport in a time when you were schooled to push through pain and do what it took to be as small and light as possible. Acute and chronic injuries took her out of the sport until perimenopause when she returned to the sport determined to reclaim her body and open her mind to what was possible in your 50s. Now, she’s experiencing joy instead of heartbreak and excited about where she can go next.

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Bill Campbell, PhD, has spent his entire career as a fat loss researcher. So when his wife hit menopause and wanted help with body composition changes, he thought it would be easy. Spoiler alert: It was not. Which made him realize his field had a lot to learn, especially about active women whose bodies change even when their training and nutrition has not. Now he’s on a mission, diving into the literature and conducting research of his own to further our understanding of body composition changes during this time of life. We talk all about it, what he’s learned, and his work developing a Female Fitness Menopause Survey to learn more.

Bill Campbell, PhD is a Professor of Exercise Science and Director of the Performance and Physique Enhancement Laboratory at the University of South Florida. He is also a Certified Strength & Conditioning Specialist from the National Strength & Conditioning Association and former president of the International Society of Sports Nutrition (where he is also 1 of 35 individuals to be recognized as a ‘Fellow’ of the organization—an honor reserved for those individuals who have outstanding contributions to the field of sports nutrition). He has published over 200 scientific papers and abstracts, three textbooks, and 20 book chapters in areas related to physique enhancement, sports nutrition, resistance training, and dietary supplementation. You can learn more about him and his work at www.billcampbellphd.com

Resources

Estrogen modulates metabolic risk profile after resistance training in early postmenopausal women: a randomized controlled trial, here

Transdermal Estrogen Therapy Improves Gains in Skeletal Muscle Mass After 12 Weeks of Resistance Training in Early Postmenopausal Women, here

Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism, here

Powerpenia Should be Considered a Biomarker of Healthy Aging, here

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Running through the menopause transition can be challenging. If you feel like throwing in the towel sometimes, you’re not alone. This week’s guest, distance runner and blogger at runandbebrave.com has faced it all: injuries, setbacks, poor sleep, fatigue, vanishing motivation, hot flashes, and all the joint pain that accompanies the musculoskeletal syndrome of menopause. Through it all, she found a way to keep going, and she believes you can, too. She talks all about how this week.

Normi Coto, PhD, is an English teacher by day and a writer by night. She writes about running, writing, prayer, rhetoric, and mindset. A runner since 1983, Normi ran through three pregnancies back when running was misunderstood almost as poorly as women’s health. She has run 6 marathons, and is most proud of qualifying for Boston twice, running it once (2001), and finishing her first 50K ultramarathon in 2023 in Washington D.C. at the age of 54. Normi’s PhD dissertation was Persuasion by Word of Foot: A Rhetorical-Ontological Inquiry into Barefoot Running as a Health Practice–a practice she has found helpful for resolving her own stubborn running injuries. 2024 was her hardest year yet when she ran straight into menopause. But she’s still going. You can learn more about her and her work at www.runandbebrave.com

Resources:

Running and Menopause: The 9 Ways I Made It Through the Roughest Running Year to Date, blog post here

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Welcome to Menopause Research Review! Now that menopause has hit the mainstream, we’re swimming in a steady stream of studies, which is great and can also be overwhelming. So for 2025, we’re introducing a regular segment called Menopause Research Review where we break down key research as it comes out with resident reproductive endocrinologist and menopause performance specialist Dr. Carla DiGirolamo. This week we kick it off with a study published in Menopause: The range and variation in serum estradiol concentration in perimenopausal and postmenopausal women treated with transdermal estradiol in a real-world setting: a cross-sectional study. We dive into hormone testing, what it tells us (and what it doesn’t) as well as what it means (or not) to have therapeutic levels.

Carla DiGirolamo, MD, PhD, is a Double Board Certified Reproductive Endocrinologist and Obstetrician/Gynecologist specializing in infertility and menopausal medicine. She is also a Crossfit Level 1 trainer, Certified Nutrition Coach, and member of CrossFit Health. She is a MedFit Care provider and provides weekly workouts and medical updates at her Substack Athletic Aging. She is an Endocrine Consultant for Wild Health. Most recently, she has launched her own private practice specializing in helping active and high-performing women reach their performance potential from puberty through menopause. Dr. DiGirolamo is now seeing patients for virtual consultations for menopausal care and performance optimization. Visit her website www.drcarlad.com to learn more about her services and schedule an appointment.

Resources

The range and variation in serum estradiol concentration in perimenopausal and postmenopausal women treated with transdermal estradiol in a real-world setting: a cross-sectional study, Menopause 

Hormone replacement therapy (oestradiol-only preparations): can the laboratory recommend a concentration of plasma oestradiol to protect against osteoporosis?, The Association of Clinical Biochemists 

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Spikes, crashes, excursions, and elevated numbers. Blood sugar is on a lot of active midlife women’s minds. But what do we really know about what this all means…and what it doesn’t, especially when it comes to long term health? This week’s guest Oxford nutrition scientist and globally recognized type 2 diabetes expert Dr. Nicola Guess helps sort through all things elevated glucose and helps separate what we need to worry about with what we don’t. 

Nicola Guess, RD, MPH, PhD, is a dietitian based in London specializing in the prevention and management of type 2 diabetes. She is currently an associate professor at the University of Westminster, Research Fellow at King’s College London, and Head of Nutrition Research at the Dasman Diabetes Institute in Kuwait. She also runs her own private clinical practice. Her primary research interests are in the prevention and management of type 2 diabetes, including the effects of nutrients on the underlying pathophysiology of type 2 diabetes. Dr Guess is a National Institute of Clinical Excellent (NICE) scholar investigating meal provision for inpatients with diabetes; a member of the NICE expert committee; a member of the Diabetes UK Clinical Study Group, and previously a Winston Churchill Travel Scholar investigating approaches to type 2 diabetes prevention in the UK and China and a Diabetes UK Academic Health Partnership Fellow investigating the role of diet in the prevention of type 2 diabetes. You can learn more about her work and follow her research at drguess.substack.com/

Resources

Erratic glucose in normoglycaemic athletes: insufficient protein? blog

How useful are CGMs for athletes? blog

Blood Glucose Levels of Subelite Athletes During 6 Days of Free Living, Journal of Diabetes Science and Technology (JDST)

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