Hit Play Not Pause

October is Breast Cancer Awareness Month. So, this week breast oncologist and lifestyle medicine physician Dr. Amy Comander returns to explain what comes after a diagnosis: why breast cancer isn't one disease, how treatment decisions get made, and why cancer guidelines tell oncologists to talk about exercise. We cover training through treatment (including when to postpone the race), how chemo and aromatase inhibitors can bring on "menopause 2.0," and the non-hormonal options for hot flashes and aching joints. We also get into the harder question of hormone therapy after hormone-sensitive breast cancer, why "estrogen doesn't cause breast cancer" leaves a lot out, and what the research on vaginal estrogen, Duavee, and women with BRCA mutations shows so far.
Amy Comander, MD, DipABLM, FACLM, MSCP, is a breast oncologist and Medical Director of the Mass General Brigham Cancer Institute in Waltham. She also directs the Cancer Institute's Lifestyle Medicine Program and is an instructor in medicine at Harvard Medical School. With Dr. Beth Frates, she launched the PAVING the Path to Wellness program for breast cancer survivors and co-authored "PAVING Your Path Through Breast Cancer and Beyond." She was the first oncologist to serve on the Board of Directors of the American College of Lifestyle Medicine and the first oncologist named a Fellow of the College. She's also a marathoner who has run 13 consecutive Boston Marathons.
Resources
Link to the PAVING workbook
Menopausal hormone therapy for breast cancer patients: what is the current evidence? Here
Menopausal Hormone Therapy After Breast Cancer: Personalization, Not Prohibition Here
Menopausal hormone therapy and the risk of breast cancer in women with a pathogenic variant in BRCA1 or BRCA2 Here
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It's been three years since Leka Fineman last joined the show — and in that time she won the CrossFit Games at 56, retired from competition, took up surfing for the first time in her 50s, started menopause hormone therapy (including testosterone), and lost her partner to cancer just seven months ago. Leka pulls back the curtain on the “identity grief” she experienced after working so hard to meet her goals and so hard to take care of her partner that she no longer knew who she was when it was all over. Physically and emotionally drained, Leka looked past her usual pursuits and turned to yoga, equine therapy, and a community of surfer women to pull her through. She shares what her hormone therapy journey has looked like, how she fuels and trains now compared to her competitive days, and how turning 60 this October is inspiring her to quiet her mind, connect with her inner self, and embrace what comes next.
Leka Fineman is a health, wellness, and mindset coach, CrossFit Games champion, and lifelong athlete based in Southern California. A three-time CrossFit competitor turned five-time CrossFit Games athlete, she won the world title at age 56 before retiring from competition to focus on coaching, surfing, and yoga. Leka works with clients on strength, nutrition, and mindset — building personalized plans that help people identify their motivation and values, and using meditation, visualization, and breathwork to help them show up from a strong, calm center in any part of life. Since stepping away from competitive CrossFit, she's become an avid surfer, a certified yoga teacher, and an equine-therapy volunteer, and she continues to coach women on strength training, hormone health, and midlife reinvention. Learn more about Leka and her coaching at lekafineman.com.
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When people go on GLP-1 medications, part of the treatment plan is to encourage them to exercise. But what about all the already active–even athletic–women who are layering them onto serious training? That’s less clear…and far less researched. Performance nutritionist Heidi Skolnik, author of the new book Your GLP-1 Game Plan, returns to break down how these medications really work, the side effects you may be prepared for (as well as some important ones nobody warns you about), and how to protect your muscles and bones and build a fueling strategy that actually works. We also get into hydration, supplements, eating-disorder red flags, and whether serious performance and GLP-1s can coexist. This one is filled with real talk, no shame, and no easy answers.
Considered a thought leader in nutrition, Heidi Skolnik, MS, CDN, is a NY Times best-selling co author, part of The Women’s Sports Medicine Center at Hospital for Special Surgery in NYC and oversees the Performance Nutrition program at The Juilliard School. She started the Performance Nutrition program at the School of American Ballet and worked as team nutritionist for the WNBA NY Liberty, NBA Knicks, NFL Giants and MLB Mets. Heidi sits on the medical advisory board of the National Menopause Foundation and The NYRR (New York Road Runners) and sat on the board of The National Bone Health and Osteoporosis Foundation for 10 years. Heidi has earned two Master’s degrees (exercise physiology and human nutrition) and is a Fellow with the American College of Sports Medicine. Heidi began her career in corporate fitness and wellness at Morgan Stanley for the Sports Training Institute. As a realist, Heidi believes M&M’s can fit into a healthy eating style along with red peppers, red meat, broccoli, and fresh fruit. You can learn more about her work and get the book at www.heidiskolnik.com
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Today's menopause conversation is dominated by hormone therapy, which leaves many women who can't use it feeling left out and worried about their current and future health and well-being. This week's guests, Drs. Rebecca Dunsmoor-Su and Amy Voedisch — co-authors of Estrogen, Interrupted and hosts of the OvaryActive podcast — are here to bring some evidence-backed hope. Because no HT doesn't mean "sorry, you'll just have to suffer." Together we map out who actually shouldn't use hormone therapy versus outdated "rules" that no longer apply. The doctors break down the new NK3/NK1 "candy neuron" blockers Veozah and Lynkuet, the underrated combo drug Duavee, why vaginal estrogen is nearly contraindication-free, and how CBT, clinical hypnosis, and old-school options like gabapentin fit into the non-hormonal toolbox. Plus: bone health, DEXA scan timing, and why perimenopause — not menopause — is often the hardest stretch. Check out their book Estrogen, Interrupted and their podcast OvaryActive to learn more.
Dr. Rebecca Dunsmoor-Su is a board-certified OB-GYN and Menopause Society-certified practitioner. She is the chief medical officer at Gennev, a telemedicine platform specializing in perimenopause and menopause, medical director at Seattle Clinical Research Center, and an associate clinical professor of obstetrics and gynecology at Washington State University. She holds a Masters of Clinical Epidemiology from the University of Pennsylvania.
Dr. Amy Voedisch is a board certified OB-GYN and certified menopause practitioner through The Menopause Society. She is an associate clinical professor of obstetrics and gynecology at Stanford University and board-certified in Complex Family Planning. She holds a Masters of Epidemiology and Clinical Research from Stanford University.
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Anxiety, rage, depression, 3am wake-ups, fear that freezes you in your tracks — psychiatrist Dr. Allie Sharma joins us this week to explain why perimenopause is a real window of mental health risk. We unpack how shifting and declining estrogen and progesterone levels drive mood, sleep, and anxiety changes (and why anxiety is often the first symptom, even before hot flashes), plus how hormone therapy, medication, testosterone, acupuncture, and CBT can help, often in combination. We close with a guided breathing and full body-scan exercise to help calm the nerves during this often emotionally-fraught time.
Dr. Allie Sharma (Sonali Sharma, MD) is a Cornell-trained, board-certified adult psychiatrist who ran a private Manhattan practice for over a decade. She's currently Co-Founder and Chief Medical Officer of Being Health, a Women's Health Advisor for menopause care startup Evernow, and an advisor to Kenneth Cole's Mental Health Coalition, following a role as Associate Medical Director at Cityblock Health. Her background spans emergency and student psychiatry at Columbia, mental health work with NYC's homeless population, and global public health leadership, including advising post-conflict countries and the World Health Organization (Libya, Ethiopia, mhGAP guidelines) and directing a ThriveNYC workforce initiative. She earned her MD from Weill Cornell, trained at NewYork-Presbyterian/Weill Cornell and UCSF, and holds a master's from the London School of Economics. She is a mother of two and lives in Brooklyn, NY. You can learn more about her and her work at sonalisharmamd.com and Beinghealth.co.
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Wahoo: Use the code FEISTY2026 to get a free Headwind Smart Fan (value $300) with the purchase of a Wahoo KICKR RUN at https://shorturl.at/WVhdr