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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.
Jillian Woodruff MD (00:26)
Welcome back to the Modern Midlife Collective. Today's episode is going to hit home for a lot of women. We're unpacking the season before the change. That's right, it is perimenopause.
Aderonke Akindipe, DNP (00:38)
Yes, perimenopause isn't menopause. It's that messy middle where the years your body starts to whisper or maybe yelling that something is happening. Some changes are happening, but you're too busy juggling work, kids, and life to even notice what's happening.
Jillian Woodruff MD (00:54)
That's right. Let's dive into what is really happening, what's normal, how to get the help that you need before things hit that crisis point.
Aderonke Akindipe, DNP (01:02)
Yes. So let's begin with that biggest myth. You are too young for menopause. So most women, I'm sure you see a Dr. in your clinic that women think it starts in their fifties, but perimenopause can show up even as young as your mid to late thirties. So I see this sometimes where they say, I'm too young. They think it's distress. They think it's kids, maybe they're thyroid or that they're just tired. But perimenopause doesn't send you this calendar invite like here, I'm here.
But it just kind of shows up like puberty, right? You weren't expecting it, but you kind of knew about it. The only problem is we don't talk about it as much. So women go through years of confusion where they're kind of bouncing between specialists, supplements, and Google at 2 AM in the morning. But they're trying to make sense of it. So I'm hoping that we can clear that up today and make you start to feel like you're comfortable. Because if you don't know what it is, you can't treat what you don't name, right?
Jillian Woodruff MD (01:55)
That's right. You brought up puberty and I am thinking that things are changing because now I have a daughter that soon will go through puberty and they are talking about it. It's so different than before. They are planning. They expect it. They know what it is and they're not ashamed of it. And I'm just like so proud whenever she says something about what's going to happen when she becomes a woman. You know, that's what she talks about.
Aderonke Akindipe, DNP (02:07)
AR.
you
Jillian Woodruff MD (02:22)
But so we need to do the same thing with perimenopause and I think we're working towards that. And it's not menopause, it is a transition. It's that messy middle, the years when your body starts whispering as you said, sometimes yelling just like you said, change is coming. And you might still be having periods, but something just feels off. And it's our hormones. know, we love to talk about the hormones, but we've got estrogen and progesterone and... ⁓
What they're supposed to do is work in this perfect balance and they have a synchronization by impairment of pause. start fluctuating wildly and your body's just like trying to adapt to run off, like run after this roller coaster that is flying away. So first your progesterone level starts to decline because you may not be opulating as regularly and progesterone is our calm and steady hormone keeps us feeling nice and without
progesterone or without enough progesterone, then our estrogen becomes more dominant and estrogen leads to those heavier periods of more bleeding and it leads to that breast tenderness and bloating and irritability, anxiety, you know, when it's too high. And it's kind of the same symptoms when it's too low as well, which is very interesting. And then as you get closer to menopause, there's more fluctuations of those more
wild swings of the estrogen level, super high, super low. And you have these crashes within days of having these really high highs. And so one week you're feeling unstoppable, like you can do anything. And the next week you're crying over commercials and you're feeling low and depressed and you can't sleep.
Aderonke Akindipe, DNP (04:00)
my goodness, you mentioned so many different changes, right? And imagine going from really high to low at one minute. So that starts to affect so many other things in our system, right? So women will complain of irregular periods. One minute it's heavy, one minute it's lighter. Or if they had heavier periods, it can get heavier. And then of course mood changes too. Our hormones are ⁓ vacillating, so you can get anxiety.
Out of nowhere, women will say they just feel like their brain is full. They can't get clear. They got that brain fog. And of course, those night sweats. I remember one patient that came in and said, she was convinced her house was on fire because she was always hot, taking off the blankets off and everything like that. So hormones are crashing. You're not sleeping well. And it can be embarrassing to talk about that going into the clinic. So.
Hopefully, you understand a lot after this episode that perimenopause is not just those physical things that happen. It can be emotional, it can be mental. People will say, what, am I losing it? You're not. Unfortunately, this is something that happens, but it doesn't mean that we can't find our way through it. So it just leaves a lot of women questioning. And hopefully, we get to resolve that for you today.
Jillian Woodruff MD (05:13)
Yeah, absolutely. So right. It may be something that typically happens, but it doesn't mean that it's something we need to continue to let happen. One thing that I'm really interested in learning more about or speaking to an expert about is ADHD and how we are being diagnosed more in our midlife with ADHD. So
Aderonke Akindipe, DNP (05:29)
Hmm.
Jillian Woodruff MD (05:37)
My question would be, so obviously you can't get into it today, but maybe this is something that other people would be interested in as well, is if we are being diagnosed more because when we were not middle-aged, ⁓ most of the children that were diagnosed had hyperactivity. And so maybe we didn't have hyperactivity. We were able to pay attention or not disrupt others.
Aderonke Akindipe, DNP (05:55)
Mm.
Jillian Woodruff MD (06:02)
And so then you're not being diagnosed at these earlier ages. Or is it really that, is it perimenopause leading to very similar symptoms? And I know we know more now like hyperactivity, they're talking about hyperactivity in your brain, like your brain thinking about several different things. But is this something that really just is something that's very similar to perimenopausal transition?
Aderonke Akindipe, DNP (06:23)
Yeah, yeah, absolutely.
I think that is such an important point because with my own experiences too, just realizing how you were able to juggle things before and not being able to do that maybe quite as well, or maybe focusing even becomes a little harder. And I wonder, it our lifestyle or is it because the hormones, the decline, or is it a mix of both? The natural decline in...
our hormones with cells dying off or generation? Are we messing with that with our lifestyle by not sleeping, by not eating well? What's going on with that? I would like to know more and hopefully one day we get somebody on the show to kind of walk us through this and tell us, give us their opinion about that. So I look forward to seeing more because it can really mimic so many different things, right? Is it ADHD or adult ADHD is what we're calling it now. Is it just weight gain?
Is it that you're just not sleeping well? We talked about progesterone and how is the calming hormone. Is that the reason why you're not sleeping well or is it your lifestyle? So anyway, this awareness really matters. If you're feeling off, it's not pulling your head. You just need to get it checked and start from there.
Jillian Woodruff MD (07:31)
Right. And then night sweats. That pops up in perimenopause. Talk about a sleep disruptor. I mean, that is a major sleep disruptor. And another thing that happens is women do start getting treated and diagnosed more with depression. And so it may not be, I don't know if it's depression or is it depression symptoms from our hormone imbalance, which is what I usually treat is
I say I don't treat depression, however, some mimickers of depression are perimenopause. so typically a lot of times when we start treating that perimenopause imbalance or menopause lack of hormones, people start feeling more like themselves. Thyroid issues, that's another thing, mimics a lot of the issues of perimenopause or the thyroid issues also happen to be exacerbated by perimenopause and menopause. It's a whole...
cycle your hormones are on the cycle with everything affecting something else and so you kind of have to jump in and disrupt the cycle but then pay attention to every other checkpoint on the cycle you can't just fix one thing.
Aderonke Akindipe, DNP (08:38)
Right, exactly. The fact that you said it's mimicked so many things. I remember one lady that was diagnosed with fibromyalgia. I'm not sure if I mentioned that before. And once she started bioidentical hormone replacement, she was able to get off of some of those medications that she was taking for many years. So again, know, ⁓ hormone decline, perimenopause can mimic so many different things, even cardiovascular. Some women will complain of palpitations where it's just, you know, those hormones, you know, kind of yo-yoing.
is what's causing that. So yeah, it's important to really talk about how that can really impact you, what lifestyle changes you might need to make too. So true.
Jillian Woodruff MD (09:15)
Do you know how I knew that I was in midlife? Impossibly perimenopause. I ended up in the emergency room with vertigo and I just felt, it was awful. just, you know, I remember I made such an impact on me because I've never had anything like that. And I just started feeling dizzy and I'm like, I don't feel dizzy. Why would I feel dizzy?
Aderonke Akindipe, DNP (09:19)
How did you know?
We talked about this. remember that.
Jillian Woodruff MD (09:41)
and it just didn't go away and it got so bad. Every time I moved, I was feeling dizzy and I thought, I'm sure I can just sleep this off, but you know, good friends and my husband were like, no, you need to go and be checked out. And I went there and you know, there was nothing wrong with me. Nothing at all wrong. You know, I got the million dollar workup and they gave me some meclizine.
Aderonke Akindipe, DNP (09:57)
Mm.
Jillian Woodruff MD (10:04)
and sent me home later after the full day they were playing in the emergency room. Maybe I just needed some rest. But what I realized from that and what I see in many of my patients are symptoms of perimenopause are so vast and different and they don't all make sense. But they do when you look deep at the science of why these things are happening and why that was happening right then, it makes sense hormonally and it's never happened again.
which is interesting, but people have some strange things like they start getting, you know, heart palpitations, like you said, or headaches is another one. And sometimes these are people that have always had headaches and they're just worse now. And other times they're people who've never gotten headaches and now all of a sudden they're getting them. So let's talk about some of the physical signs when your body's trying to show you, hey, perimenopause is here.
Aderonke Akindipe, DNP (10:35)
Yes.
Yeah.
yes, so true. Maybe you notice your PMS is worse than ever. You start to notice the jeans start to fit differently. This is one of the common ones we see is, yep, I was size six before, but all of a sudden now I can't fit those pants. I'm getting a lot more belly fat. Or the way they handle stress, this is another big one, it's just a feeling of overwhelm. One woman was like, I just feel overwhelmed.
The things that didn't used to bother me, bother me now. I get easily irritated. that, you I mean, granted we live in the world where there's so much coming at us. You know, we've got social media, we've got work, know, moms are out there working one, maybe even two jobs and you've got kids, you know. So there's a lot of competing priorities. And then if you're now adding these paramedicopausal changes,
You can just imagine how that could be wreaking havoc and making that hormonal shift even worse.
Jillian Woodruff MD (11:50)
Yeah, that's what's so tough about this time is this is the time where typically you're feeling more self assured. You're confident in yourself. You've experienced so many things. You're at the top of your game, maybe professionally, but there are all of these things. You have kids. They could be young kids. If you've had kids in an older age, they could be kids going off to college, which take a lot of financial finances. And then you also have your
Aderonke Akindipe, DNP (11:59)
Yeah.
Jillian Woodruff MD (12:17)
aging parents, which is a big deal, even if your parents are independent. There's a lot of time and attention and worry that you have about aging family members. So yet all these things are pulling on your attention. So even if you didn't have these hormone changes, can you imagine how are we doing it? And then you add in the hormone fluctuations and yeah, you don't feel like yourself. It's a lot, yeah.
Aderonke Akindipe, DNP (12:40)
It's a lot. It's a lot just thinking
about it now, you know, having to do all of this and still squeezing time on a Sunday to record a podcast. A lot. There's a lot going on, but it is I don't know how it makes me wonder how our parents did it back then. You know, how did they navigate all these? Did they even notice these changes or were they eating better? Did they have better ways of managing?
Jillian Woodruff MD (12:48)
That's right. I know. I know.
Aderonke Akindipe, DNP (13:08)
these changes. I'm just sometimes I think about I'm like, man, this is I don't know how they did it back then.
Jillian Woodruff MD (13:13)
That could be another show. mean, that's really good. have, right? Yes, yes. wow. That would be something. But I think, know, back then they didn't compare as much to other people because people's lives weren't out there on social media for you to see and compare yourself with the perfection that has been placed. And that sort of thing really attacks your mental health. There's so much in children about them not being on social media at all.
Aderonke Akindipe, DNP (13:14)
Maybe get our moms on.
You
There you go.
Jillian Woodruff MD (13:41)
really, it's the same. Yes, their brains are still developing, but those things also affect us. Now, of course, here we are, you know, on social media trying to promote, it's a great way to spread information. And so we want to be that voice of clarity and a sea of information, but we do have to really, you know, take that time away from it too, for our mental health. And I did that recently one day without my phone and it, I...
Aderonke Akindipe, DNP (13:52)
Yeah.
How did you manage with just
one day?
Jillian Woodruff MD (14:09)
easily. I didn't think I would, but it was easy. I loved it. And I thought, how can I incorporate this more? Yeah. Yeah.
Aderonke Akindipe, DNP (14:13)
That's my next challenge.
That's my
next challenge, taking a break from it and not feeling like you're missing out on something because there's just so much going on and the notifications, it's like, somebody else just posted. And it's like, that alone can just take away from your focus. And that's all day long and emails and social media and all of things.
Jillian Woodruff MD (14:35)
Yes, I even just simply I started with stopping my notifications. So most things I don't get any notifications from and you know what happens? Yeah, you miss out whatever you'll miss things but people fill you in, you know, because that connection you have is more important like face to face with people or over the phone and they'll tell you, hey, did you see such and such and then you could go back and look at it. But yeah, it's that.
Aderonke Akindipe, DNP (14:48)
They do.
Yeah
And sometimes it's not even important stuff that just notifies you. It's like you don't miss
a thing sometimes.
Jillian Woodruff MD (15:06)
Right.
Okay, back to these hormones and midsection weight gain that you mentioned. So, you know, our estrogen as it declines, cortisol then goes up and then your metabolism slows down, your body starts storing fat differently. And we kind of talked about this in our nutrition episode. So people like women, when they come in, they're telling me, I am putting on weight around my midsection, I'm gaining weight.
Even though I'm working out so much more and I'm eating so much less, this makes me cringe. I hate to hear this because how does your body respond to you working out more eating nothing? Yeah, it's stressed. You release even more cortisol and you lead to even more fat storage. And then if you do lose weight in this time, it's usually like your muscle weight is your body when it's stressed. It's going to store fat. It's preparing for you know that fight or flight, right? ⁓
Aderonke Akindipe, DNP (15:39)
Yes.
That's
right. That's right.
Jillian Woodruff MD (16:01)
I hate to hear
that we're doing this to ourselves sometimes.
Aderonke Akindipe, DNP (16:05)
I mean, it's biology. mean, our bodies are changing, but I feel like we have this culture, this diet culture. When you're on social media, there is like somebody who lost 50 pounds doing this diet and that diet and intermittent fasting. And then we have that on top of the hustle culture. We just talked about how busy women are. And then on top of that, you're trying to lose weight going on the next diet. So you already have high cortisol, high inflammation, you're not adding on top of that.
And like you said, eat less, move more, push through, just keep pushing. This advice just doesn't work anymore. know, perimenopause, we need to flip that script and say, how do we make sure that your metabolism is working for the way you are right now? It doesn't mean that you are declining. Yes, hormones are decreasing as you get to menopause, but adding fuel to the fire by working out five days a week isn't going to be the case. So what we need to do is actually make sure that we're fueling
your body with those, you know, we need to not starve. We can't do all the things and then starve ourselves on top of that. And then your cortisol rises in the middle of the night because you're starving, you wake up and then you're not sleeping well. So you can see how that cycle just continues. until we manage all these things and align everything, right, the weight starts to fall off at that time. So you're not starving, your body feels safe. It's not running away from a tiger. And then, you you start to feel better.
about yourself and maybe the weight just kind of becomes a byproduct of that.
Jillian Woodruff MD (17:29)
Right, so we said there's so many symptoms in perimenopause. How do we know it's perimenopause and not something else? How do we, you know, describe that or tell patients about
Aderonke Akindipe, DNP (17:39)
man, I feel like this is a loaded question. It's so hard to tell, You know, we always say a lot of women tend to think when your periods are irregular, or they'll say, well, I'm still very regular, so I'm not in perimenopause, or, they're not having mood swings or hot flashes, all those things that you would normally see. So I think, like you talked about, you had that symptom of the syncope, really making sure that we're
jotting things down, aligning it with what time, when is this happening? Are my cycles getting longer and longer? Am I not as regular as I am? How is my mood? What time of the day? How was my sleep? All of those can start to give us clues, but it's not the same for everyone. For me, when I noticed those symptoms, it was more like my vision isn't the same anymore. I don't know why, blurry. have to like...
really focus. I didn't put it together then, but that's one of those signs. Recovery, I would work out five days a week before that, and I just could not bounce back as fast. That was another thing, the tiredness, not being able to get libido, decline in libido, right? As you lose your hormones, your testosterone levels, your libido starts to go down.
So this is just some of it, right? But ⁓ if you're not sure, I think it's important to talk to someone that could potentially figure it out. And unfortunately, not everyone thinks about it, but we are getting better at it. I know there's a lot more talk about it on social media now about what it could possibly be, but yeah, there's a list of symptoms that we're discovering more that could be perimenopause.
Jillian Woodruff MD (19:15)
Right. And some red flags. So if you're having heavy bleeding, so heavy periods or irregular heavy bleeding where you're soaking through pads every hour, you need to see somebody. Because even that you're like, I can handle this or deal with it, it causes a multitude of other problems as well. So low iron, iron deficiency, anemia, and then you're having shortness of breath just walking upstairs and brain fog. So it's, it's
what do you call it, like a tumbling downhill. So that needs to be evaluated if you're having persistent pelvic pain, chronic pelvic pain, severe depression, you need to evaluate that from multiple routes. That's a big deal. So even if you're feeling like it's managed, if it's a change, have it evaluated.
If you're noticing a hot flashes or night sweats, they could be perimenopause, could be menopause, could be something else. And so that is not a normal thing to experience. Even though it's typically experienced, that has to be, it should be evaluated. Fatigue, where maybe, and this is a type you may be trying to have like even more coffee. And that coffee maybe isn't even helping you anymore because you're just that tired. You need to have that evaluated.
And there's never a problem with asking questions. You can always, I know it's pretty, not everybody likes to evaluate hormone levels and things and it may be a change. You need to look for a change. So it may not be a one-stop spot check. Maybe check them now and then check them in the next cycle at a different time of the cycle. It's not always, I know I don't do like same, like some people.
for fertility, you're evaluating fertility, they'd have you get your blood levels for your hormones checked at a specific time of your cycle. So right at the beginning. And I don't typically do that because I'm very familiar with how your hormones cycle. So for me, it's more important to see your change and how your body cycles at different times instead of comparing you to a baseline that other people have because we all know.
We are all very different.
Aderonke Akindipe, DNP (21:23)
Yes, absolutely. You know, it's important to know what normal is and what what it's not normal. And it's not normal to be miserable, right? Just because you're navigating hormonal changes doesn't mean well, this is how it's going to be there are solutions. But it's important to also note that lifestyle can have a huge impact on it. So if you maybe grew up in a setting where, you know,
It just wasn't a habit to eat nutritious foods. And nutrition can look different for everyone. Cultural influences also impact that. But this is the time where nutrition is really important. How are you with alcohol? Alcohol can exacerbate some of the symptoms that we noticed, like talked about sleep, hot flashes, and those kind of things. How are you managing stress?
How are you exercising? know, exercise is a huge part of navigating hormonal changes, you know, making sure that you're getting strength training in at least two to three times a week. Things that lower cortisol, because we talked about how hormones, as they decline, one of the ones that goes up is cortisol. So you don't want to add on to that stress on the body. things like yoga, meditation, mindfulness, taking walks, even something as simple as walk can help that.
Hormone therapy, you know, can't say enough about that. That has been and made a significant impact on me. I always talk about that. Of course, you have to talk to a provider to figure out what will work for you. But it starts with naming what's actually happening. So what people didn't tell you about perimenopause or telling you now, talk to a provider matters. Get a full assessment done. Get your labs checked for thyroid screen for metabolic changes because it starts to change. Women will start to notice that they're
blood sugar's a-climbing, so we're not chasing numbers necessarily, but sometimes I can help clue in the provider about what's happening. So it's important to connect the symptoms with the science behind them to get you where you need to be.
Jillian Woodruff MD (23:18)
Right, and remember, hormone therapy is not one size fits all. And it's not just for women after menopause. Studies show that menopausal hormone therapy, starting it during or within 10 years of your final period, and so within, not necessarily after, not necessarily 10 years after your period, but within 10 years of your final period, is the most effective and the safest option for hormone.
Aderonke Akindipe, DNP (23:24)
Right.
Jillian Woodruff MD (23:45)
for symptom relief. So I mean, think that, let me say that again, because I think it's like so important to understand is menopausal hormone therapy started during menopause or within 10 years of your final period can be effective and safe for your symptom relief. And so, you know, we're talking about balancing our sex hormones. So that's estrogen, progesterone, testosterone.
Aderonke Akindipe, DNP (23:52)
Yes.
Jillian Woodruff MD (24:10)
either individually or in combination. And the one that you start first really depends on your individual situation.
Aderonke Akindipe, DNP (24:19)
Absolutely, I'm glad you brought that up about that because there's a lot of confusion around that it's so unfortunate that people are being told Oh, you're past that time. You cannot benefit from it. So Dr. Jill has said it again So and of course we already talked about how important it is to not just look at hormone therapy hormone therapy isn't for everyone you have to look at what You know fits you but we talked about lifestyle, but there's also met you know, the metabolic health vitamin D
super, super, super important for a lot of different things in our body, supports metabolic health, how you recover, your mood, things like that. So you can't just patch one thing. I know one woman that said, well, I started hormone replacement therapy, I feel better, but I'm not losing any weight, or all those other things, everything has to work together, right? Can't be in isolation, it's part of this whole ecosystem, if you will. So when you're stressed out, we need to manage stress.
If you have high insulin levels, we need to make sure that you are not eating things that are triggering high insulin and making you store fat, especially when you're starting to notice more fat around the belly area. yeah, talk about the big picture. Metabolic health and perimenopause is super, super important.
Jillian Woodruff MD (25:31)
And it may be surprising for people to know that vitamin D is not just a vitamin supplement. It's actually a hormone precursor. And when your body activates it, it acts as a hormone. So it binds to receptors in your brain, in your bones, in your ovaries, and it influences everything from mood to immunity to estrogen balance to muscle strength. So
Vitamin D is really important and I think it just doesn't get enough attention because it's so easy really to supplement and I don't think we really pay like put enough emphasis on it.
Aderonke Akindipe, DNP (26:00)
very, very important.
I agree. I agree. Absolutely.
Jillian Woodruff MD (26:13)
So perimenopause is a transition. So it's not just about symptoms. It's a checkpoint. Your body is saying, pay attention to me.
Aderonke Akindipe, DNP (26:21)
Yes, absolutely. So this episode is your invitation that you need to reframe your thinking around midlife. That we like we talked about before, you're more confident. You've already had a lot of experiences. You can't let these changes slow you down. Right. You want, still have a lot of life in you. You want to do things. So just learning how to work with your hormones, your body, supporting your metabolism and restoring your energy. That's when life really gets better and you can definitely get there.
Jillian Woodruff MD (26:50)
Yes. Well, I think we've talked a lot today and we have to cut this off at some point. So if this episode hit home, please share it with a friend. There's power in knowing you're not alone and there's power in information and education. Also share comments with us, share questions, prompts for future shows. Email us at connect at modern midlife collective.com or deem us on Instagram at modern midlife collective.
Aderonke Akindipe, DNP (27:17)
And don't wait until you're in the thick of it. Get your labs, talk to your provider and start building your midlife blueprint right now. You are evolving and it's trying to show you the way forward. So listen to your body. Thank you for listening. Bye bye.
Jillian Woodruff MD (27:32)
Bye.