Everyday Wellness: Midlife Hormones, Menopause, and Science for Women 35+

Welcome to the latest Midlife Minute.

This episode unpacks ongoing research on Lp(a), explores how women’s lipids change during the perimenopause-to-menopause transition, and clarifies what we can do about it.

Stay tuned for more!

IN THIS EPISODE, YOU WILL LEARN:

How total cholesterol, LDL, and ApoB tend to rise most steeply around the final menstrual period, rather than increasing gradually with chronological aging

Why women should have their Lp(a) checked both before and after menopause

How oral and transdermal estradiol can affect LDL, HDL, triglycerides, and Lp(a) differently

Why I recommend including ApoB when checking your lipids during the perimenopause window

How your lifestyle can reduce your cardiovascular risk, even when your Lp(a) is elevated

Why omega-3 fatty acids and commonly used lipid medications do not lower Lp(a)

Why supplements are not replacements for statins in genuinely high-risk patients

I review the various PCSK9 inhibitors currently available, how they are administered, and their effects

How a CAC, a CT angiogram, and an AI-assisted CT angiogram can help women and their providers determine how aggressive their approach should be when Lp(a) is elevated

Connect with Cynthia Thurlow

Follow on X, Instagram & LinkedIn

Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

References:

1. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.Circulation. 2020. El Khoudary SR, Aggarwal B, Beckie TM, et al.Guideline

2. Menopause: A Cardiometabolic Transition. The Lancet. Diabetes & Endocrinology. 2022. Nappi RE, Chedraui P, Lambrinoudaki I, Simoncini T.Review

3. Dyslipidemia Across the Menopause Transition: Mechanisms, Trajectories, and Opportunities for Cardiovascular Prevention. Maturitas. 2026. Castaneda R, Tatit CP, Hurtado Andrade MD, Faubion SS, Shufelt CL.RecentReview

4. Lipoprotein(a) and Women's Cardiovascular Health: A Review. JACC. Advances. 2026. Michos ED, Saucier S, Mehran R, Koschinsky ML.

5. Lipid Metabolism in Women: A Review. Atherosclerosis. 2025. van Oortmerssen JAE, Mulder JWCM, Kavousi M, Roeters van Lennep JE.Review

6. Are Changes in Cardiovascular Disease Risk Factors in Midlife Women Due to Chronological Aging or to the Menopausal Transition?. Journal of the American College of Cardiology. 2009. Matthews KA, Crawford SL, Chae CU, et al.Observational

7. Trajectories of Lipids Around the Menopause Transition in Chinese Women: Results of the Kailuan Cohort Study. Fertility and Sterility. 2023. Dai Q, Wu S, Cao Z, et al.

8. Lipid Management in Patients With Endocrine Disorders: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 2020. Newman CB, Blaha MJ, Boord JB, et al.Guideline

9. The Effects of Menopause Hormone Therapy on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2022. Nie G, Yang X, Wang Y, et al.SR

10. Perspectives on Dyslipidemia and Coronary Heart Disease in Women. Journal of the American College of Cardiology. 2005. Bittner V.Review

11. Dyslipidemia in Midlife Women: Approach and Considerations During the Menopausal Transition. Maturitas. 2022. Torosyan N, Visrodia P, Torbati T, Minissian MB, Shufelt CL.Review

12. Effects of gender, age and menopausal status on serum apolipoprotein concentrations.13.Lipoprotein(a).The Journal of the American Medical Association. 2025. Mora S, Kronenberg

14. Why, how and in whom should we measure levels of lipoprotein(a): A review of the latest evidence and clinical implications. Diabetes, Obesity & Metabolism. 2025. Razavi AC, Bhatia HS, Blumenthal RS, Shapiro MD, Mehta A.RecentReview

15. Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar. Journal of the American College of Cardiology. 2021. Cicero AFG, Fogacci F, Zambon A.Review

16. Overall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Drugs. 2023. Blais JE, Huang X, Zhao JV.SR

17. Non-Genetic Influences on Lipoprotein(a) Concentrations. Atherosclerosis. 2022. Enkhmaa B, Berglund L.Review

18. NHLBI Working Group Recommendations to Reduce Lipoprotein(a)-Mediated Risk of Cardiovascular Disease and Aortic Stenosis. Journal of the American College of Cardiology. 2018. Tsimikas S, Fazio S, Ferdinand KC, et al.Review

19. Consumption of a defined, plant‐based diet reduces lipoprotein(a), inflammation, and other atherogenic lipoproteins and particles within 4 weeks. Clinical Cardiology. 2018. Najjar RS, Moore CE, Montgomery BD.

20. Lipoprotein(a): Current Evidence for a Physiologic Role and the Effects of Nutraceutical Strategies. Clinical Therapeutics. 2019. Santos HO, Kones R, Rumana U, et al.Review

21. Effect of Lipid-Lowering Therapies on Lipoprotein(a) Levels: A Comprehensive Meta-Analysis of Randomized Controlled Trials. Atherosclerosis. 2025. Xie S, Galimberti F, Olmastroni E, et al.Recent

22. Effect of Omega-3 Fatty Acid Supplementation on the Postprandial Metabolism of Apolipoprotein(a) in Familial Hypercholesterolemia. Journal of Atherosclerosis and Thrombosis. 2023. Ying Q, Croyal M, Chan DC, et al.RCT

23.Lipoprotein(a) and Cardiovascular Disease. Lancet. 2024. Nordestgaard BG, Langsted A.Review

24. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology. 2022. Reyes-Soffer G, Ginsberg HN, Berglund L, et al.Guideline

25.Clinical Trial Design for Lipoprotein(a)-Lowering Therapies: JACC Focus Seminar 2/3.Journal of the American College of Cardiology. 2023. Malick WA, Goonewardena SN, Koenig W, Rosenson RS.Review

26.2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American Collegeof Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026. Writing Committee Members, Blumenthal RS, Morris PB, et al.Guideline

27. Noninvasive Coronary Atherosclerotic Plaque Imaging. JACC. Cardiovascular Imaging. 2023. Kwiecinski J, Tzolos E, Williams MC, et al.Review

28. Computed Tomography Angiography Versus Agatston Score for Diagnosis of Coronary Artery Disease in Patients With Stable Chest Pain: Individual Patient Data Meta-Analysis of the International COME-CCT Consortium. European Radiology. 2022. Wieske V, Walther M, Dubourg B, et al.SR

29. Association of Coronary Artery Calcium Score With Qualitatively and Quantitatively Assessed Adverse Plaque on Coronary CT Angiography in the SCOT-HEART Trial. European Heart Journal. Cardiovascular Imaging. 2022. Osborne-Grinter M, Kwiecinski J, Doris M, et al.Clinical Trial

30. AI-Guided Quantitative Plaque Staging Predicts Long-Term Cardiovascular Outcomes in Patients at Risk for Atherosclerotic CVD. JACC. Cardiovascular Imaging. 2024. Nurmohamed NS, Bom MJ, Jukema RA, et al.Observational

31. The Lancet Commission on Rethinking Coronary Artery Disease: Moving From Ischemia to Atheroma. Lancet. 2025. Zaman S, Wasfy JH, Kapil V, et al.Review

32. Efficacy and safety of novel lipoprotein(a)‐targeted therapies: A systematic review and meta‐analysis of randomized controlled trials. Diabetes, Obesity & Metabolism. 2026. Santana AUL, Yusufzai MO, Freitas APS, et al. Recent Opinion

Today, I am honored to connect with Dr. Zaldy Tan, a geriatric medicine and memory disorder specialist whose research career has centered on the Framingham Heart Studies Offspring Cohort. Dr. Tan currently directs Cedar Sinai’s memory and healthy aging programs, after previously leading the memory clinic at Beth Israel and Harvard Medical School. His book, Age Proof Your Mind, translates his clinical and research background into a practical framework for people trying to assess and protect their own cognitive trajectory.

In our conversation, Dr. Tan explains why middle age is the old age of youth and the youth of old age. We discuss common symptoms of memory issues and those that are reversible. We explore the Framingham Offspring Study and its impact on brain health over time, looking at the effects of sleep, depression, vitamin deficiencies, alcohol, loneliness, and nutrition, and Dr. Tan shares the three Ds, dementia, delirium, and depression- the red flags he sees in his clinical practice, explains how he helps prepare caregivers for caring for loved ones with neurocognitive memory loss, and discusses late-stage issues, medications, blood-based biomarkers, and the role of genetics in brain health.

Stay tuned for a truly fascinating discussion with Dr. Zaldy Tan.

IN THIS EPISODE, YOU WILL LEARN:

The importance of being sensitive to how your memory changes over time

Various factors that could contribute to memory problems

The profound effect alcohol has on the brain and neurologic function

How social isolation can increase the risk of dementia in future years

Dr. Tan discusses the Framingham Offspring Study and the links between metabolic dysregulation and brain MRI markers of brain aging.

How the 3 Ds, delirium, dementia, and depression, can overlap

The red flags in a patient’s history that lead Dr. Tan to believe there may be a more serious issue

What care partners should be aware of when a family member is experiencing dementia

The importance of protecting sleep and maintaining consistent sleep patterns for those with memory problems

How genetic testing is incorporated into Dr. Tan’s care model

Bio:

Dr. Zaldy Tan is the Director of the Memory & Healthy Aging Program at Cedars-Sinai Medical Center, which U.S. News & World Report ranked in 2024 as the best hospital on the U.S. West Coast and among the top hospitals in the country. He holds the Carmen & Louis Warschaw Endowed Chair in Neurology and is a professor at the David Geffen School of Medicine, University of California, Los Angeles. Dr. Tan was the founding director of the Memory Disorders Clinic at Harvard Medical School/Beth Israel Deaconess Medical Center. Dr. Tan performs aging and dementia research covered by The New York Times, Time, CNN, The Wall Street Journal, NPR, The Washington Post, The Chicago Tribune, Reuters, ABC News, and NBC News. He regularly speaks at major national and international conferences and is the author of Age-Proof Your Mind and What to Remember When You Are Forgetting.

Connect with Cynthia Thurlow

Follow on X, Instagram & LinkedIn

Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

Connect with Dr. Zaldy Tan

Dr. Tan at Cedars Sinai (Los Angeles)

On Instagram

Dr. Tan’s book, What to Remember When You Are Forgetting, is coming out on September 15th, 2026. Pre-order HERE.

Welcome to the latest episode in our series of highly vetted companies I like to share with my Everyday Wellness community.

Today, I’m delighted to connect with Leslie Kenny, Founder and CEO of Oxford Healthspan. After being diagnosed with multiple autoimmune conditions and being told she was unlikely to have any biological children, Leslie put her autoimmune conditions into remission through nutrition and lifestyle changes and later went on to conceive naturally at 43. Her personal experience led her into a research collaboration with Oxford immunologist Professor Katya Simon, where she was introduced to spermidine, a naturally occurring polyamine studied for its role in autophagy—our cells’ internal recycling and cleanup process. She later founded Oxford Healthspan to bring a whole-food Japan-sourced spermidine supplement, Primadine, to market. She also co-founded the non-profit Oxford Longevity Project alongside Oxford scientists to educate the public more broadly on healthspan research.

In our conversation, we discuss self-advocacy, autoimmunity, infertility, and empowerment, exploring how modern life affects perimenopause and menopause, as well as spermidine research and its mechanisms of action. We discuss intermittent fasting, autophagy, mitophagy, gut health, food-based sources of spermidine, how our spermidine levels decrease with age, and why supplementation is truly beneficial. Leslie also shares feedback on how Primadine impacts memory, cognition, hair, skin, and nails; how clock genes and circadian biology work; and biological versus chronological age.

Stay tuned for a truly fascinating conversation with Leslie Kenny- one you’ll most likely want to revisit more than once.

IN THIS EPISODE, YOU WILL LEARN:

The changes Leslie implemented after being diagnosed with rheumatoid arthritis and lupus

How patients need to ask questions and collaborate with their clinicians rather than simply following instructions

Leslie describes how she worked with doctors to monitor her symptoms and address problems early during the perimenopause-to-menopause transition.

How Leslie came to learn about spermidine and its connection to autophagy and mitophagy

How spermidine can support healthy aging

How ultra-processed foods can affect the gut, and foods that contain natural sources of spermidine

The types of improvements customers taking Primadine have reported

Leslie explains the distinction between biological and chronological age

Why intermittent fasting, although beneficial, may not work the same way for all women

Bio:

Leslie Kenny is an Oxford-based longevity entrepreneur, TEDx Oxford speaker, and healthspan advocate. She is the founder of Oxford Healthspan, creator of Primeadine®, co-founder of the Oxford Longevity Project, and Global Executive Ambassador for the Japan Autophagy Consortium, whose senior adviser is Yoshinori Ohsumi, recipient of the 2016 Nobel Prize in Physiology or Medicine for his pioneering research on autophagy.

She is a frequent international speaker and moderator on longevity, biological aging, and the future of preventive medicine, with a particular focus on translating emerging research into practical, evidence-based strategies for extending healthspan. Leslie has been an early advocate for the role of autophagy, cellular renewal, and nutrition in healthy aging, helping to pioneer broader awareness of spermidine and its relevance to longevity pathways.

Connect with Cynthia Thurlow

Follow on X, Instagram & LinkedIn

Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

Connect with Leslie Kenny

Oxford Longevity Project

Oxford Healthspan - Use discount code CYNTHIATHURLOW for 20% off your first Oxford Healthspan order

Leslie’s New Prime

I am delighted to welcome Dr. Shivani Gupta today for the first of two interviews. Dr. Gupta is the founder and CEO of Fusionary Formulas and the author of The Inflammation Code. She has both a master's degree and a PhD in Vedic sciences, where her dissertation focused on turmeric's role in inflammation, joint health, and cardiovascular health.

In today’s conversation, we explore the physical effects of chronic inflammation, habits to support stress reduction, the differences between inflammaging and normal physiologic aging, and ways to nurture ourselves in midlife (which Dr. Gupta calls the Vata season). We also discuss how ama can contribute to inflammatory processes in the body, digestive fire, constipation and strategies to address it, the importance of curcumin, and the research surrounding it.

Dr. Gupta and I will continue our conversation on our next podcast together. Stay tuned for part two!

IN THIS EPISODE, YOU WILL LEARN:

Dr. Gupta shares the personal experiences that motivated her to write The Inflammation Code

Environmental and lifestyle factors that contribute to the body’s inflammatory burden

Why inflammation can become more difficult to manage during the perimenopause and menopause transition

How the symptoms of normal aging could actually be signs of inflammaging

Dr. Gupta explains the Ayurvedic concept of Agni, or digestive fire, and shares ways to support digestion

Practical Ayurvedic ways to support regular bowel movements

How Dr. Gupta approaches gut and immune health after repeated antibiotic exposure

The Ayurvedic approach to diet differs from restrictive or extreme eating patterns.

The potential anti-inflammatory benefits of turmeric, curcumin, and other polyphenol-rich spices

How culinary turmeric differs from concentrated curcumin extracts

Bio:

Dr. Shivani Gupta is an Ayurvedic practitioner, turmeric researcher, and founder of Fusionary Formulas.

She holds a Master's degree in Ayurvedic Sciences and completed her PhD dissertation- specifically on turmeric making her one of the world's foremost experts on its pharmacology and clinical application.

She is the author of The Inflammation Code, published by Hay House, bridging ancient Ayurvedic wisdom with modern inflammation science. Dr. Gupta is known for making complex science accessible without dumbing it down — her work speaks equally to the everyday health-conscious woman and to clinicians who want to go deeper.

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Follow on X, Instagram & LinkedIn

Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

Connect with Dr. Shivani Gupta

FusionaryFormulas.com - Use the code CYNTHIA for 15% off!

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The Inflammation Code (Book Website)

The Inflammation Code Podcast

Welcome to the latest Midlife Minute.

Today, I’m answering listeners’ questions about cardiovascular risk, focusing on Lp(a), LDL, statins, and the changes women experience after menopause.

Stay tuned for more!

IN THIS EPISODE, YOU WILL LEARN:

Why women should have their Lp(a) checked both before and after menopause

How Lp(a) works as a risk enhancer, and how cardiovascular risk becomes more significant when elevated Lp(a) occurs alongside high LDL

Why family history is particularly helpful for women with a 10-year calculated cardiovascular risk that looks reassuringly low

I review the current guidelines for primary prevention

Why, even though research has shown reductions in major cardiac events with GLP-1s, GLP-1s do not replace statins for lowering LDL

What a CAC score can reveal about coronary artery calcification, and what it cannot detect

How AI-assisted CT angiography (such as Clearly) can map, quantify, and characterize plaque throughout the coronary branches

Connect with Cynthia Thurlow

Follow on X, Instagram & LinkedIn

Check out Cynthia’s website.

Submit your questions to support@cynthiathurlow.com

Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.

Purchase Cynthia’s book, The Menopause Gut.

Cynthia’s Intermittent Fasting Transformation Book

The Midlife Pause Supplement Line

References:

1. ​Lipoprotein(a) and Women's Cardiovascular Health: A Review. JACC. Advances. 2026. Michos ED, Saucier S, Mehran R, Koschinsky ML.Recent

2. ​Sex Differences of Lipoprotein(a) Levels and Associated Risk of Morbidity and Mortality by Age: The Copenhagen General Population Study. Atherosclerosis. 2022. Simony SB, Mortensen MB, Langsted A, et al.

3. Managing Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2022. Stone NJ, Smith SC, Orringer CE, et al.Review

4. Thirty-Year Risk of Cardiovascular Disease Among Healthy Women According to Clinical Thresholds of Lipoprotein(a). JAMA Cardiology. 2026. Nordestgaard AT, Chasman DI, Moorthy V, et al.RecentObservational

5. ​Lipoprotein(a).The Journal of the American Medical Association. 2025. Mora S, Kronenberg

6. Clinical Practice Guideline on Lipid Management for Cardiovascular Disease Risk Reduction.

Department of Veterans Affairs (2026). 2026. Paul Heidenreich, Lance Spacek, Neil Gregor, et al. Guideline

7. Lipoprotein(a) and Family History Predict Cardiovascular Disease Risk.

Journal of the American College of Cardiology. 2020. Mehta A, Virani SS, Ayers CR, et al.Observational

8. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2010. Greenland P, Alpert JS, Beller GA, et al.Guideline

9. Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women.

The Journal of the American Medical Association. 2016. Kavousi M, Desai CS, Ayers C, et al.SR

10. ​Coronary Artery Calcium Scores and Risk for Cardiovascular Events in Women Classified as “Low Risk” Based on Framingham Risk Score: The Multi-Ethnic Study of Atherosclerosis (MESA). Archives of Internal Medicine. 2007. Lakoski SG, Greenland P, Wong ND, et al.Observational

11. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2019. Arnett DK, Blumenthal RS, Albert MA, et al.Guideline

12. HOPE for Rational Statin Allocation for Primary Prevention: A Coronary Artery Calcium Picture Is Worth 1000 Words. Mayo Clinic Proceedings. 2020. Orringer CE, Maki KC.Review

13. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review.

Journal of the American College of Cardiology. 2020. Cho L, Davis M, Elgendy I, et al.Review

14. Health Maintenance in Postmenopausal Women.

American Family Physician. 2025. Plesa M, Wong A, Katsaggelos E.Guideline

15. ​Semaglutide and Cardiovascular Outcomes by Baseline HbA1c and Change in HbA1c in People With Overweight or Obesity but Without Diabetes in SELECT.

Diabetes Care. 2024. Lingvay I, Deanfield J, Kahn SE, et al.RCT

16. ​Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.

The New England Journal of Medicine. 2023. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al.RCT

17. Long-Term Weight Loss Effects of Semaglutide in Obesity Without Diabetes in the SELECT Trial. Nature Medicine. 2024. Ryan DH, Lingvay I, Deanfield J, et al.RCT

18. Interventions for the Prevention and Management of Cardiometabolic Multiple Long-Term Conditions. Lancet. 2026. Valabhji J, Hope D, Sayed NE, et al.RecentReview

19. Glucagon‐Like Peptide‐1 Receptor Agonists and Major Adverse Cardiovascular Events in Patients With and Without Diabetes: A Meta‐Analysis of Randomized‐Controlled Trials.

Clinical Cardiology. 2024. Hosseinpour A, Sood A, Kamalpour J, et al.SR

20. ​FDA Orange Book. FDA Orange Book. 2026.

21. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2026.

Diabetes Care. 2026. American Diabetes Association Professional Practice Committee for Diabetes*.RecentGuideline

22. Premature Coronary Artery Disease in Women: Sex-Specific Risk Factors, Pathogenetic Mechanisms and Clinical Implications. Annals of Medicine. 2026. Li F, Hong D, Yang M, et al.RecentReview

23. Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity: A Scientific Statement From the American Heart Association. Circulation. 2023. Mehta LS, Velarde GP, Lewey J, et al.Guideline

24. Preventing CVD in Women: Common Questions and Answers.

American Family Physician. 2023. Westfall E, Viere AB, Genewick JE.Review

25. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020. El Khoudary SR, Aggarwal B, Beckie TM, et al.Guideline