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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Ade Akindipe, DNP, APRN (00:00)
So let me paint a picture for you. There is a man in Silicon Valley who spends $2 million a year trying not to age. He takes multiple hundreds of supplements a day. He monitors his body like he's on NASA mission. He's become the face of longevity movements. And I respect that ambition. really do. But here's the thing though. Almost everything in that playbook was designed around
the male biology.
Jillian Woodruff MD (00:28)
That's exactly
the problem because women don't age the same way men do, not even close. Here's a stat that stopped me in my tracks when I heard it. A woman's ovaries age two and a half times faster than any other organ in her body. Let that sink in. The organ that drives so much of female physiology, cardiovascular health, bone density, brain function, metabolism.
is aging at an accelerated rate and most women don't even know it.
Ade Akindipe, DNP, APRN (00:57)
So that longevity playbook needs to be written for women. And that's exactly what this episode is about.
Jillian Woodruff MD (01:02)
And now that we have the title of your next book, the Longevity Playbook for Women, welcome to the Modern Midlife Collective Podcast.
Ade Akindipe, DNP, APRN (01:10)
Also, this is episode 30. Yay! Which, you know, we have to take a second and just say we are so grateful to our listeners. It's not easy to do 30 episodes, you know, to stay consistent. It's been about a year when we started this. So the community has really built up around the show, the messages, the feedback, the women telling us...
you know, how they've been different just from listening to the conversations we have here. So that means a whole lot to both of us.
Jillian Woodruff MD (01:37)
Yeah, it really
does. Thank you so much for being here, for sharing these episodes, for trusting us with your time. 30-step episodes in, we're just getting started. And thank you to you, Dr. Adai. I'm glad that we get to have this time where we get to talk to each other and share things that we've each learned along the way with each other. And I remember when we had this idea and we put this together and I was thinking, how are we going to make this work? How would we have
such busy lives, will we do this? So thank you. I'm glad to be here.
Ade Akindipe, DNP, APRN (02:07)
Here we are.
Thank you
for sticking through it. All right. So today's episode is one we've been wanting to do for a while. Last week, we talked about a lot about hormones and how that can impact us. We talked about metabolic longevity, but we're talking about longevity today, but specifically what longevity and health span actually mean for women. Because the conversation out there right now is like we talked about earlier, it's dominated by men.
the biohacking influencers, the tech brothers, the cold plunges and peptide stacks. But we need to also look at what some of the science is saying. some of the science is interesting, but it's not necessarily built for the female body.
Jillian Woodruff MD (02:50)
That's right. So here's what we're going to cover today. We're going to define what health span actually means and why it's different from lifespan. We're going to explain the biology of why women age differently. And then we're going to give you the evidence-based playbook, not the two million dollar biohacking version, but what the science actually says is working for midlife women right now.
Ade Akindipe, DNP, APRN (03:15)
Let's get into it.
Jillian Woodruff MD (03:16)
Okay, so here's the paradox that most people don't fully appreciate. live longer than men. Globally, data shows women live to about 83.7 years old on average compared to men who live to about 78.5 years. In the United States, that gap actually widened to 5.8 years in 2021. So women were living 5.8 years longer.
than men. So on paper, women are winning in the longevity game.
Ade Akindipe, DNP, APRN (03:47)
Yes, but, and this is a big but, women are spending most of those extra years sick. A major study published in the JAMA Network in 2024 looked at 183 countries through the WHO database and found that the global gap between health span and lifespan is about 9.6 years. So that means that on average people spend nearly a decade of their life in poor health.
But for women, that gap is 2.4 years larger than it is for men.
Jillian Woodruff MD (04:20)
In the US specifically, it's even worse. The data show that women's health span, lifespan gap went from 12.2 years to 13.7 years. So we're talking about American women potentially spending almost 14 years at the end of life with a severe disability or chronic disease, a diminished quality of life.
Ade Akindipe, DNP, APRN (04:42)
⁓ and when you look at what's driving that gap for women, we're finding that the culprits are not just random. Number one is musculoskeletal diseases like osteoporosis and sarcopenia, so muscle loss, arthritis. And number two are neurological conditions, especially Alzheimer's disease. Women make up two thirds of Alzheimer's patients. And number three are autoimmune conditions.
80 % of people with autoimmune diseases are women.
Jillian Woodruff MD (05:12)
Sorry you were talking
and my desk just had a malfunction. So you were talking about our chronic diseases and malfunctioning.
Ade Akindipe, DNP, APRN (05:16)
you
That's right. Malfunction things are
malfunctioning.
Jillian Woodruff MD (05:24)
If you heard something, I don't know what happened, but everything's okay. So now that I've developed some cardiovascular disease now, but yes, there's also the cardiovascular piece to what you were saying. And women are developing heart disease about 10 years later than men. And this is in part believed due to estrogen's protective effects. But after menopause, when estrogen declines, that risk doesn't
Ade Akindipe, DNP, APRN (05:27)
But everything's fine.
No.
Jillian Woodruff MD (05:52)
just catch up, it actually surpasses men's risk. So there's this false sense of security that many women carry through their 40s and 50s. And then later, they're surpassing the risk of cardiovascular disease that a man would carry.
Ade Akindipe, DNP, APRN (06:07)
And this is the reframe that I think so many of our listeners need to listen to. It's important. The goal is not just to live longer. Living to 90 but spending the last 15 years with a disability, pain, and mental health decline, that's not the goal. The health span has to be the focus. So how many years are you living well? That's the question.
Jillian Woodruff MD (06:30)
Exactly. I tell my husband this all the time because I tell him I'm going to live until 102. But it's not just that I want to live that long. I want to be in good health and be living independently. And so that's what I think of when I'm thinking of my health span or my lifespan, my longevity. So lifespan is more the years and like health span is how long we're living well. I don't want to be dependent on other people.
Ade Akindipe, DNP, APRN (06:42)
Yes.
Right.
Jillian Woodruff MD (06:58)
maybe a dependent on for fun, but I want to be able to move about independently and enjoy myself and have a great quality of life for those, for all of that time, right? Yeah. So it's not just about the years.
Ade Akindipe, DNP, APRN (07:07)
That's what's important. Yeah, absolutely. You want to be able to pick yourself up
and not have to depend on someone to pick you up.
Jillian Woodruff MD (07:14)
Exactly. And so good news, we are going to get into this because our lifespan, our longevity is modifiable. But we need to understand the biology first of what is happening in our bodies.
Ade Akindipe, DNP, APRN (07:26)
Absolutely. So this section, we're going to talk about the biology that I genuinely believe every woman needs to understand. And I'll tell you, when I first came across some of this research, it's like I just wanted to just shout it from the rooftops and talk to every single woman about it. So let's get into it.
Jillian Woodruff MD (07:41)
Right, I agree. Same thing. Whenever we learn something or hear a new study, you want to share it with everybody. So I'm glad we have the opportunity to. Of course, I want to start with the ovary. Most people think of ovaries purely in terms of reproduction, fertility, eggs, and menopause. But the ovary is actually one of the earliest organs in our body to show measurable signs of aging.
fertility starts declining in your late 20s and then accelerates at 35 by 40. It's like falling off a cliff. And then by menopause, which is around age 51, 52 in the U.S., there's fewer than a thousand follicles remaining. And the follicles are what, you know, how's the egg and your follicles mature and then release the egg during ovulation. And that's what could be fertilized and lead to pregnancy.
Ade Akindipe, DNP, APRN (08:30)
So we're pretty much done at this point. There's no more follicles left. my goodness. But just those numbers, my goodness. ⁓ And then looking into more of the landmark reviews that we found, described the ovary as aging two and a half times faster than other organs in the female body. So they use the term pacemaker of system.
Jillian Woodruff MD (08:32)
Pretty much like.
Life is over! No, it is not. It is not over.
Right?
Ade Akindipe, DNP, APRN (08:58)
systemic aging, meaning that the ovary isn't just aging on its own, it's setting the pace for aging throughout the entire body. So let that sink in, your ovaries make all these hormones, they stop producing all the other hormones like we talked about, like Dr. Jill says, so it's going to impact everything else and accelerate aging.
Jillian Woodruff MD (09:17)
You know,
I did not read that study. That's really interesting. And I've not heard it. Yeah. Pacemaker makes a lot of sense. Wow. I wanted to think about that one some more, but it's so true. that's what setting our clock and it's like a metronome. And then it runs out of batteries. And then there you go. Oh, man. Well, that's kind of sad. Well, this makes sense when you understand what estrogen actually does.
Ade Akindipe, DNP, APRN (09:22)
a taste-maid of systemic aging.
Mm-hmm.
Yeah.
Gosh.
Jillian Woodruff MD (09:43)
It's not just a reproductive hormone. It maintains our cardiovascular health, our bone health, our immune system, our cognitive function, our skin integrity, kidney function, metabolic health. We've said it many times, I think on every episode we say that you have, right? Ostrich and receptors exist across virtually every tissue or organ in our body, brain.
Ade Akindipe, DNP, APRN (10:01)
Absolutely.
Jillian Woodruff MD (10:09)
salivary glands are hard or blood vessels everywhere. They're going to have estrogen receptors are needed, estrogen for functioning, efficient functioning and longevity.
Ade Akindipe, DNP, APRN (10:21)
Yeah, so when ovarian function declines and estrogen drops, the effects are systemic. those systemic effects is what we feel in our bones, osteoporosis, joint aches, heart, the arteries stiffening, so cardiovascular risk goes up, cognitive impairment, even things as simple as brain fog, walking into a room not realizing why you're there, blood sugars start to become more unstable, fatty liver.
even chronic kidney disease. So there's a lot of cascades of, you know, the things that happen as the rapid decline occurs.
Jillian Woodruff MD (10:53)
Yeah, and here's
where it gets really fascinating and honestly a little alarming. There's research published by the National Academy of Sciences showed that menopause literally accelerates biological aging as measured by the epigenetic clock. So again, epigenetic is just your biological age, not the chronological age. So this is essentially a way of measuring how fast your body is aging at a cellular level.
And what they found is menopause actually accelerates that clock. In other words, after menopause, your body starts aging faster biologically than it is chronologically. And it doesn't stop there. Women who go through menopause earlier, so an early menopause showed even faster biological aging. And women who underwent surgical menopause, meaning their ovaries were removed perhaps at the time of hysterectomy or another surgery, if they had both ovaries removed.
This showed the most rapid acceleration of all.
Ade Akindipe, DNP, APRN (11:52)
I mean that makes total sense. You take those ovaries out and it's like right away. So you're not even getting the chance to really have that decline. You just get your ovaries removed. So those numbers bear this. The numbers bears this out. A woman's aging accelerates by approximately 6 % after menopause. And for each three-year delay in natural menopause, overall mortality risk drops by about 1.6%.
So women who naturally reach menopause between 50 and 55 have a 15 to 25 higher chance of living past 90 compared to women who stopped cycling in their early 40s. That's pretty interesting.
Jillian Woodruff MD (12:32)
It is, yeah. Well, this is why the conversation about hormone replacement therapy or hormone therapy matters so much. It's not just for hot flashes and sleep, but can be for longevity. That same study found an inverse association between menopausal hormone therapy and your biological age acceleration. So as menopausal hormone therapy was increasing, they found the biological aging was decreasing. So HRT may actually slow the biological aging.
process. And literature on surgical menopause tells us that removing both ovaries is not the same as letting menopause happen naturally. So just like we mentioned, natural menopause is a gradual decline of hormones. Surgical menopause is very abrupt. And that sudden hormone loss is associated with more severe symptoms and higher long-term risks to your bones, to your cardiovascular health, your cognitive health, your sexual health.
especially when your ovaries are removed before the average age of menopause. So I would always counsel my perimenopausal or even early menopausal patients who are in need of a hysterectomy to really ask themselves, stop and ask, or let's discuss, is ovary removal truly necessary? Because I feel like some people may just have them removed because they're having a surgery and so they're thinking, ⁓ we should...
remove them so we don't have to go back in later in the future is decreasing other risks. Yes, removing ovaries can decrease your risk of ovarian cancer. And so they may just think you're already in menopause, nothing's happening, but really, yeah, you can still even after menopause have some release of hormones from your ovaries. So you really wanna think about that. But this caution to really reconsider doesn't apply in the same way to women who may have a high risk.
like a high genetic risk or high cancer risk such as the BRCA gene mutation, they have a high risk of ovarian cancer, then in that case, the cancer prevention benefit of removing the ovaries may outweigh these menopause related risks. But always a conversation, right? Because everyone is different.
Ade Akindipe, DNP, APRN (14:38)
Absolutely.
Yeah, very important to have that conversation for sure and talking about the risks, especially if you're going to have your ovaries removed, talking about the implications, that abruptness and what happens when women lose it. So good job, Dr. Jill, as usual. I also want to mention this incredible work coming out of Northwestern by Dr. Francesca Duncan. So
Her team has spent about 10 years studying the ovarian microenvironment and discovered that with age, the ovaries become inflammatory. They become fibrotic and stiff. So this research is opening up an entirely new, know, therapeutics targets for female aging. So it's really exciting to kind of see people looking into more about women's, you know, organ of longevity, which is your ovaries.
Jillian Woodruff MD (15:22)
Right, it is and it underscores the point the ovary is not just a reproductive organ, it's a longevity organ and understanding that changes how we think about everything from menopause management to preventive care.
Ade Akindipe, DNP, APRN (15:35)
Yeah, so let's get practical. So we've laid out the problem. We've talked about what happens with ovarian decline and estrogen decline. We've explained the biology. So what do we actually do about it? Dr. Jill and I have distilled this down to three non-negotiable pillars for women's health span. And I want to be clear, these are not trendy biohacks, know, peptide stacks, but these are the ones that we believe that really provide the highest return.
when it comes to, and it's backed by science, backed by evidence.
Jillian Woodruff MD (16:06)
Yes, and I do want to be clear that, you know, when they say like doctors make the worst patients, these are not all things that I do, but I there are things that I need to do. So I see you Dr. Day killing it in the gym and doing your lifting and all the things you're supposed to do. And I'm like, oh, let me watch. I wish that it could just come to me and I could get the benefits just from watching you. Because I'm like, yeah.
Ade Akindipe, DNP, APRN (16:06)
that make you one.
No.
I'm going to just
come to your house one day and just bring you to the gym with me. I'm going to put you in the car and then go.
Jillian Woodruff MD (16:37)
You may have
to. Yes, I would appreciate it. All right. Pillar number one, muscle. Muscle is your longevity organ. And I don't say that lightly. Starting in midlife, women lose about half a percent to one percent of muscle mass per year. And this is called sarcopenia. Muscle strength decreases one and a half to five percent per year.
Ade Akindipe, DNP, APRN (16:56)
Mm.
Jillian Woodruff MD (17:04)
between ages 65 and 80, you could lose 8 % of your muscle mass per decade. And you know, I'm sure you've had people that are saying like, I just don't feel strong. You know, they're not as strong as they used to be. Sometimes it may even be just like opening a jar. They're not as strong or more difficult to stand up, you know, like just takes more effort, things that they wouldn't have thought of before. Now they're thinking of it.
Ade Akindipe, DNP, APRN (17:21)
Yes.
Yeah, for me, was opening just opening jars with my, you know, just your hands that for what for a while there, I was like, wow, what's what's what's happening there? And then of course, bone health, right? So almost half of women over 50 will experience an osteoporotic fracture, almost half. So women have lower peak bone mass than men to begin with. And then they experience this rapid bone bone density loss after menopause. So
Bone mass peaks by early 30s and is in decline by 50. So if you're in your 40s or 50s, it's kind of already, you're already in the progress, it's in progress.
Jillian Woodruff MD (18:08)
Yeah, if you think about these hip fractures, this is a huge cause of not only mortality, but morbidity. So a huge cause of, you know, being hospitalized, having decreased quality of life and then actually dying from this bone break and the many complications that come with this. So it's serious. Yeah, it's just it's not one of those like sexy diseases that you talk about a lot, you know, but it's it's important.
Ade Akindipe, DNP, APRN (18:16)
Okay.
Sure.
It's not, but
it allows us to build more nursing homes and more assisted living, that's just what happens as a repercussion of all of this.
Jillian Woodruff MD (18:37)
Yeah.
Yeah, because it's hard to take care of, you know, it's hard for families to take care of family members that have this. Yeah, you need specialized care and a lot of, you know, attention. It's terrible. So what's the intervention resistance training full stop? It's the single most effective intervention for both sarcopenia and low bone density.
Ade Akindipe, DNP, APRN (18:46)
It is.
Jillian Woodruff MD (19:04)
There was a study in the Journal of Orthopedic Surgery and Research, was a 2025, it's a meta-analysis. So a comparison of many articles. And this found that high intensity resistance training, we're talking at least 70 % of your one rep max, three times per week, at least 40 minutes per session, significantly improved bone mineral density at the lumbar spine, so the low back.
at the femoral neck, which is the hip, and then the total hip in post-menopausal women. So, do you do that?
Ade Akindipe, DNP, APRN (19:39)
I try. I I try to get my 30 minutes full body strength at least three times a week. That's what I have time for. And I've switched my focus to mostly strength training versus cardio. And I do feel the difference. The strength, you feel better. Your blood sugars are more stable. So it's got a lot of wonderful benefits, and of course, stronger. But yeah, to put another finer point on it, the review and the frontiers in sports and active living.
And in 2025, found that resistance training remains more effective than protein supplements alone. So I know that's a big thing out there. Women are like, I got to get my protein shakes in and you know, all of this, but resistance training really is non-negotiable at this point, even if it doesn't, it doesn't mean you have to lift heavy, but at least starting small with your body weight. So protein alone offers, and I'm quoting here, modest improvements in muscle health without exercise. So.
You can't out supplement your way out of muscle loss.
Jillian Woodruff MD (20:36)
Yes, can't supplement your way out of it. Well, did you know that only 14 to 26 percent of women globally participate in resistance training? That's shockingly low, right? Especially now given what we know about the benefits that's really low.
Ade Akindipe, DNP, APRN (20:39)
Yeah.
Mm.
It's really low.
Yeah, you know, I don't know if you follow Dr. Vonda Wright. She's an orthopedic surgeon. Yeah, I follow on social media. She is doing some amazing things up there. I don't know if I can do some of the things that she does, but she really has put this at the forefront. you know, let's reframe this for anyone who's thinking of weight training as a vanity thing. It's not. I like to talk about Dr. Vonda Wright is doing it and she is stronger than ever. is.
Jillian Woodruff MD (20:58)
yeah.
Ade Akindipe, DNP, APRN (21:18)
Your muscle is your metabolically active tissue. So it is great for so many different reasons. Your blood sugar, insulin sensitivity, if you've been told you have insulin resistance, it can help protect you against falls and fractures. So muscle really is your health span. So it's not, it's not vanity at all.
Jillian Woodruff MD (21:36)
Yeah, you think about how many of the women that we see have insulin resistance and high blood sugar. And we try to talk to them about nutrition and, you know, I'm recommending lots of supplements like berberine to help with their insulin sensitivity and, you know, all of these things, right? Where really we do need to be talking more about, OK, although I'm not an exercise physiologist, but we have something that has been shown and proven.
that can decrease our blood sugar levels without, you know, this is not medication and increase our insulin sensitivity. So something that, you know, you can really add to your regimen. So instead of opening up all the supplements, maybe we have to, you know, get out there and get to work in your home. You know, you don't have to go anywhere to do this. But yeah, I see. Yeah, you can do it. Yeah.
Ade Akindipe, DNP, APRN (22:09)
Yeah.
Yeah.
Absolutely. Mine takes place in my living room sometimes. 30 minutes. You
can do it.
Jillian Woodruff MD (22:33)
And then on the nutrition side, yes, nutrition is still important. Protein is important, especially if you're doing that work, you know, especially if you're doing that training, you need to have the building blocks there. So protein is important. For midlife women, we're looking at around half a gram per pound of body weight. So I kind of think about however many kilograms you are of your weight, then that's how much protein you need. That's just like the fast thing, but it's
0.45 to 0.55 grams of protein per pound of body weight every day. And a focus should be on leucine rich sources. So dairy, which I don't have, but that's a source. Because everything, you know, there's always other issues, right? So you have to do what works for you, you know.
Ade Akindipe, DNP, APRN (23:23)
Of course. Yeah.
Jillian Woodruff MD (23:24)
Lean meats, of course, fish, legumes, I love. A Mediterranean style eating pattern has been associated with better muscle function and reduced sarcopenia risk. So better function and less loss of muscle.
Ade Akindipe, DNP, APRN (23:40)
Yeah. And pillar number two is metabolic resilience. So this one doesn't get enough attention. Here's a stat that should make everyone sit up. So only 12 % of American adults are metabolically healthy. 12%.
Jillian Woodruff MD (23:53)
Well,
that's scary. And perimenopause specifically worsens this, right? Most every patient, you know, I hate to say every patient, but a lot of our patients have a metabolic issue of some sort. So there was the landmark Swan study that showed that the odds of developing metabolic syndrome per year were actually higher during perimenopause. And just to put this in focus, like metabolic...
Ade Akindipe, DNP, APRN (23:55)
Hmm.
Jillian Woodruff MD (24:20)
syndrome, one of them is PCOS, polycystic ovarian syndrome, that's a metabolic syndrome. And so that can be exacerbated or even first time diagnosed in perimenopause. So metabolic syndrome development higher in perimenopause with an odds ratio of 1.45. So that means 45 % higher risk per year in perimenopause than after menopause, which had a 24 % higher risk.
Ade Akindipe, DNP, APRN (24:32)
Yes.
Jillian Woodruff MD (24:49)
of developing per year. A 2025 study of nearly a thousand women confirmed that early menopausal women had higher insulin resistance with the waist to hip ratio. you you measure around your waist and then measure around your hips. That was the most reliable predictor of insulin resistance. So the biggest metabolic changes aren't happening after menopause. They're really happening in those years.
leading up to menopause in those perimenopausal years.
Ade Akindipe, DNP, APRN (25:19)
Yeah, so this really brings home why I decided to start doing body compositions on every single woman on their initial intake. We don't just weigh them anymore. It's like the weight doesn't really mean anything. If your BMI is 25, yeah, you're healthy. But then we see from what you just said right here, how your waist to hip ratio, know, visceral fat, all of those are already early signs that you're already developing metabolic issues. you know, signs of insulin resistance.
When I tell women, and what you said, Dr. Jill, is so right, PCOS, we start to see some of those symptoms when they're in perimenopause. They start to develop all of those other, because they don't have the ovarian cysts, doesn't mean you don't have those metabolic dysfunction that comes with it. But weight gain around the midsection, visceral fat that's very high, comes out of nowhere. The cravings for carbs specifically, sweets, salt, really, really tired after meals, brain fog.
elevated triglycerides, ⁓ you start to see early fatty liver disease and skin changes, right? So the skin changes that could mean you have metabolic syndrome or even already progressed to type 2 diabetes. So if you're noticing all of those symptoms, you are checking, yes, yes, yes, please get your metabolic markers checked immediately. And don't accept everything as normal. If you have these symptoms,
Jillian Woodruff MD (26:30)
Yeah.
Ade Akindipe, DNP, APRN (26:33)
You may not be showing up on your normal metabolic panel, but make sure that you're going a little further getting a fasting insulin check and things like that.
Jillian Woodruff MD (26:40)
Yes, fasting insulin. So not just getting the fasting glucose level, but yes, you want to do the fasting insulin. Many women have normal glucose for years while insulin is already elevated. And I think most of the people that may come to see me from other outside providers are just, you know, with the regular annual labs are just saying, ⁓ my hemoglobin A1c is normal. So it's showing over the past three months, they have a normal average sugar level, glucose level.
but insulin's never been checked. And so then they may be having complaints of difficulty with losing weight and weight gain around the midsection. And we look at this insulin level and it's very high. right? And we could have been checking this a little along the way. Maybe even there's also a C-peptide level. I don't know if you check that, but I checked that especially if the...
Ade Akindipe, DNP, APRN (27:25)
Yeah.
Jillian Woodruff MD (27:32)
situation is a little, if something is normal, another thing is borderline, then you want to see how much insulin your body is making. So I do like to look at that. So if you have a high insulin level and your C-peptide level is normal, you know, you're making, you may not have a high blood sugar level right now, but your cells or your tissues are just, you know, resistant to the insulin. So it's just hanging out there with the glucose, having a party, messing up your blood vessels. So that's why you think about it.
Ade Akindipe, DNP, APRN (27:54)
Absolutely.
Yeah,
absolutely. All of that is true. unfortunately, like you said, C-peptide is not something that's checked by most providers or HOMA-IR and all of those other markers. Inflammatory markers could also signal that too. But we're seeing more encouraging data that we are seeing the correlations between estrogen and metabolic health. Another study.
through Drexel University showed that random randomized controlled trials involving 29,000 postmenopausal women found that both oral and transdermal hormone replacement therapy significantly reduced insulin resistance. And something as simple as eating regular meals and not skipping breakfast, not doing extreme fasting has been shown to decrease the risk of metabolic syndrome.
by 60 to 70%. So not even doing a whole lot just yet, just by replacing the hormones and eating, nourishing the body, we're seeing metabolic syndrome reverse. That's amazing.
Jillian Woodruff MD (29:02)
You may need to say that again because you mentioned eating regular meals, not skipping breakfast, not, right? And not doing extreme fasting. Well, we don't have to talk about that.
Ade Akindipe, DNP, APRN (29:09)
Not skipping breakfast. Not living off of coffee till 2 p.m.
Jillian Woodruff MD (29:19)
But you know if you're metabolic, if your metabolism is slowing down, you're noticing putting on weight, the answer that comes to people is really to eat less, you know? And that's doing a damage, you know? It's not helping. It's actually making it worse to solve that problem. So just very important to you to mention that. Like eat your food. Do not starve yourself. So okay, pillar number
Three, hormone optimization. And so I want to frame this carefully because we're not just talking about symptom relief when it comes to hormone therapy. We're talking about hormones as a longevity intervention and the data on estrogen for all cause, mortality reduction, fracture, risk reduction, cardiovascular protection. When started within those, you know, 10 years of menopause, it's really compelling. However, I do need to say that
current guidance of the Menopause Society still says hormone therapy is first line for bothersome vasomotor symptoms. So that's hot flashes and night sweats. It's also indicated for genitourinary syndrome of menopause. So this is vaginal dryness and issues related to that such as recurrent urinary tract infections or bladder spasms leading to frequent urination or even
recurrent infections of the vagina. So that's genitourinary syndrome of menopause. It's also indicated for primary ovarian insufficiencies. So these are women that have gone through menopause before the age of 40. And then for prevention of bone loss and reduction of fracture risk, specifically really in people that have low bone density like osteopenia. It's to prevent the osteoporosis or prevent or decrease risk, I should say, of fracture.
So this is what the guidance says to use hormone therapy for first line for hot flashes and night sweats that are bothersome. I don't know which ones would not be bothersome, but there must be some somewhere. But this doesn't mean that hormone therapy can't be used for other indications. It's just saying first line it is used for vasomotor symptoms. So I think this is just where, you know, people get caught up with hormones. they're not for.
you these other things, you're not using them for cardiovascular protection, you're not using it for cognition, even though we know that we have less brain fog and clarity, we have more clarity of thought when we have hormones. It is just saying first line for hot flashes. Not that it cannot be used for these other things. It's just first line. Yes, yes.
Ade Akindipe, DNP, APRN (31:46)
Yeah.
That's the first line. This is what it's approved for. Yeah. Yeah.
But it's got so many other benefits. And it's like, you have to have that ongoing conversation with patients about, yes, I understand you don't have these, but these are some great benefits. Lots of beautiful, wonderful benefits, longevity, et cetera, et cetera, for why you need to be on this.
Jillian Woodruff MD (32:02)
There's still other benefits, yeah.
Ade Akindipe, DNP, APRN (32:10)
And let's not miss this milestone, okay? So we remember back in 2025, the FDA removed that black box warning from hormone therapy, yay. That was a huge shift in how we are starting to look at hormone replacement therapy. It signals that the evidence has moved and it's moved in favor of hormone therapy, but of course we still have a lot of ways to go. know, testosterone is still not, you know, for women, you know, we don't need testosterone, you know, it's just your estrogen.
So, but again, we're starting to see now the importance of how these hormones impact our longevity and much more our health span.
Jillian Woodruff MD (32:46)
Yeah, it has to be patient by patient. You we have to talk with each patient about the risks and their benefits that are specific to them. Testosterone, that's another conversation. It's also, like you said, under recognized for women. Emerging research shows, and for a long time we've known, you know, that there's benefit for women in terms of libido, their mood, their bone health, their cognitive function, especially in postmenopausal women.
And so we're not talking about their bodybuilder doses, we're talking about physiologic replacement.
Ade Akindipe, DNP, APRN (33:15)
Absolutely. Bottom line here is that hormones are not optional add-ons. For many women, they are foundational to health span. So if you're a candidate, this should be a conversation you're having with your doctor. And it's important to frame it as a longevity conversation, not just, know, I don't have hot flashes, I don't need it, or my hot flashes are unbearable conversation. This is for longevity.
Jillian Woodruff MD (33:36)
All right, we know that this segment is one that people have been waiting for. We're gonna talk about supplements. so you cannot scroll through social media without seeing someone promoting NAD, I like NAD, NMN, I like that too, rapamycin, or the latest longevity molecule. So let's be honest about what the evidence actually says.
Ade Akindipe, DNP, APRN (33:58)
Okay, so let's talk about NAD and NMN. So if you have not heard about these, they basically look at it as your battery, your cell's battery charger. So every single cell in your body needs it to make energy, repair damaged DNA, and activate proteins that slow down your aging process. So if you are having trouble with, you you're tired, you're foggy, you're slow to recover, some of these things have been advertised that they help. So when we talk about support, what we're talking about is giving yourselves what they need.
So your NAD levels drop as you get older and they may decline faster in women due to hormonal fluctuations during perimenopause and menopause. So ⁓ this is why this is really out there. There was a mouse study that showed promising treatment, that they live longer, maintained better health. But the reality is human trials are still limited and haven't really yield the kind of results that we're looking for.
Jillian Woodruff MD (34:51)
Yeah, modest results at best. There's a 2025 analysis found that NMN and NAD plus supplements provided minimal to no advantages for metabolic health. And some smaller studies showed slight improvements in sleep quality and insulin sensitivity, but only over short periods. So these supplements are not FDA approved for longevity, or they're not FDA approved, they're supplements.
And under the Dietary Supplement Health and Education Act, they don't need FDA approval for safety or effectiveness, like any supplement, before they hit the market. They're not, what is the word? The FDA doesn't control vitamins and supplements. Not regulated, that's the word.
Ade Akindipe, DNP, APRN (35:31)
They're not regulated. not regulated. Yeah, that's true. And there's
also potential concerns. Entity improved cellular functions across the board. So that includes cancer cells. So there are some theoretical cancer risk questions that have not been fully addressed. So long-term effects on the liver also are not known. So right now, short-term safety data has been reassuring.
No serious adverse effects at doses up to 1200 milligrams per day, but we simply don't have long-term human data.
Jillian Woodruff MD (36:04)
Yeah. Now I've liked NED and I like it in a, I don't know if you've used a push ⁓ patch, like a vitamin patch. Yeah. And it seemed like a boost of energy. Now you know that I've got the injection before and I don't recall if I felt anything. Yeah.
Ade Akindipe, DNP, APRN (36:10)
No, I haven't actually, no.
Hmm.
Yes, I remember.
Yeah, I remember you said that. I didn't really notice any difference then. That
was sub-Q. That was a sub-Q injection. Yeah.
Jillian Woodruff MD (36:27)
Yes. And so you're
getting that and it disappears so quickly. Whereas the patch, was like over, and I think it was probably 1200. It was somewhere between 1200 and 1400, but it relieved it over a 12 hour period. So you had a longer time with it and you do that for a few days. Anyway, I liked that and I'm actually, want to try it again. But yeah, the thing about improving cellular function across the board, yeah, if you have a cancer.
Ade Akindipe, DNP, APRN (36:31)
Yeah.
⁓ Yeah.
Jillian Woodruff MD (36:56)
Those are cells that replicate, know, and so yeah, they certainly could. The same with, you know, estrogen helps things grow and flourish and do the same if you were to have a cancer. So screening is, you know, really important, your regular screening.
Ade Akindipe, DNP, APRN (37:05)
Right?
Absolutely.
Jillian Woodruff MD (37:12)
rapamycin. I'm supposed to talk about that? Rapamycin. This is also interesting, especially for women. There's a Pearl trial published just this past year. It was the longest human rapamycin longevity study to date. You know, people, don't, they haven't been talking about it for that long in the past few years, I guess. In the study, it was pretty small. There were 114 participants over 48 weeks randomized and it was a placebo controlled study.
and low dose rapamycin at 10 milligrams per week was safe and well tolerated. And what caught my attention is that female participants had the greatest benefits overall.
Ade Akindipe, DNP, APRN (37:50)
Hmm. Women in the study also showed a 5 % or greater increase in lean tissue mass and reduced pain. Men did not see these benefits. That's interesting. The 5 mg per week dose improved emotional well-being and general health for both sexes, but this is still a prescription drug. It's FDA approved for transplant rejection.
and being used off label in longevity medicine. It's promising, but it's early. So small sample sizes, not ready for mainstream recommendation just yet.
Jillian Woodruff MD (38:21)
Yeah, I haven't tried this and I haven't given this to any patients yet. And then there's another thing we've been hearing about is I don't know that much about this one. Urolipin, ⁓
Ade Akindipe, DNP, APRN (38:25)
Yeah, me neither.
Yeah, this is something I found interesting. I haven't heard a whole lot about it too, just from research.
Jillian Woodruff MD (38:38)
Mm-hmm. It's a their experts are calling it one of the more grounded longevity supplements. It's safe It's well tolerated and there is some human data that backs it. It supports mitochondrial health You know the mitochondria is our workhorse of the cells. So I guess of these trendy molecules It's probably one that has the most solid foundation, which is interesting since it's not something that you know, I've heard as much about as
wrap in my center NAD. So that one we'll have to look more into. Have you used this?
Ade Akindipe, DNP, APRN (39:08)
Yeah.
Yeah, have never used it. That's definitely something I just found out just from researching for this podcast. So I was just an interesting looking into that more. You're like, hey, but yeah, definitely. It sounds like what we where we really are landing with this episode is that, you know, don't be distracted by all the things that's out there supplements, you know.
Jillian Woodruff MD (39:22)
Mm-hmm. Okay.
Ade Akindipe, DNP, APRN (39:34)
all of these longevity peptides and whatnot. ⁓ It looks like the highest return on your investment in longevity is, know, strength training, eating enough protein, managing your metabolic health, optimizing your hormones. Supplements may add some benefit on top of the strong foundation that you're ⁓ building for yourself, but they're not the foundation.
Jillian Woodruff MD (39:56)
Yeah, if you're spending $300 a month on longevity supplements, but you're not lifting weights, then you may be doing it wrong, right? I say that with love because I love you.
Ade Akindipe, DNP, APRN (40:04)
All
right. All right. Let's bring this home. We want to leave you with five specific things you can do this month. Not next year, but right now, this month.
Jillian Woodruff MD (40:14)
Okay, number one, start resistance training. If you're not already doing it, two to three times per week, progressively loading your weight. Single highest impact longevity intervention available.
Ade Akindipe, DNP, APRN (40:24)
Yeah, absolutely. There's actually some pretty great training for women in town here. There's a chiropractor that is teaching women how to lift weights, which I thought was ⁓ pretty interesting. I've got some information for you so you can get that done. Number two, get a DEXA scan, please. It gives you both your body composition and your bone density in one test. Think of it as your longevity baseline. So you need to know where you stand so you know how you're improving.
Jillian Woodruff MD (40:35)
That's great.
You have to be careful where you get it because all of the data that Dr. Ade is talking about is not always shared with you. Sometimes they are only looking at your bone density and they're looking at the lumbar spine and the hips. So if you want these other things that she's talking about, sometimes it may be a question of if you have insurance, it may not give you that versus if you're paying cash.
maybe the place where you're going, you can just ask them if they share other parts of your body composition, like your muscle mass to fat ratio and that sort of thing. Because we all have the capability of doing that.
Ade Akindipe, DNP, APRN (41:22)
Yeah.
That's a good point.
Jillian Woodruff MD (41:25)
Number three, check your fasting insulin, not just your fasting glucose. This is your metabolic early warning system that most standard panels miss.
Ade Akindipe, DNP, APRN (41:34)
Absolutely. And number four, talk to your doctor about hormone replacement therapy and frame it like we said before, a longevity conversation, not even if you don't have any symptoms, ask about it. If you're a candidate, the evidence supports that you could benefit from it.
Jillian Woodruff MD (41:48)
And I think it would be important to bring up that you understand that that is not first line treatment for longevity. There is no first line treatment, I guess, except the resistance training first line, but that you understand that that is not the FDA approved treatment protocol for this longevity conversation. However, that doesn't mean that you don't want to know about other benefits and want to pursue hormone for its other benefits.
Ade Akindipe, DNP, APRN (42:14)
Absolutely.
Jillian Woodruff MD (42:15)
Number five, calculate your protein intake for one week. So track it, see where you are. Most midlife women are dramatically under eating the protein. So aim for 0.45 to 0.55 grams. So about half a gram of protein eaten per pound of body weight every day.
Ade Akindipe, DNP, APRN (42:32)
Yeah, longevity is not about buying the most expensive supplements. So we're following a tech billionaire's protocol. It's about understanding your biology as a woman. And I really hope this episode helps you realize that it's about protecting the things that actually matter, your muscles, your bones, your metabolic health, your hormones, and taking action now in midlife when it can make a difference for how you're doing later in
Jillian Woodruff MD (42:54)
Yeah, you have more agency over your health span than you might think. And the interventions we talked about today, they're not exclusive, they're not expensive. They're evidence-based and they're available to you right now.
Ade Akindipe, DNP, APRN (43:05)
If this episode was helpful, please follow and subscribe to the Modern Midlife Collective. Wherever you listen to podcasts, share it with a friend, share it with your sister, share it with your doctor. The more women who hear this, the better.
Jillian Woodruff MD (43:18)
Yes, I'm sure you know someone that could benefit from today's conversation, someone you care about. Next episode, we will dive deeper into one of these pillars. And I think it's going to be a good one. I've been enjoying these conversations, so I hope you are too. Until then, take care of yourselves.
Ade Akindipe, DNP, APRN (43:31)
I think so too.
See you next time.
Jillian Woodruff MD (43:37)
Bye.