Episode 32: Still Exhausted? It’s Not Just Hormones, Stress, or Sleep (Part 2)

Episode 34: "I'm in Perimenopause — How Do I Know When It's Time to Start Estrogen?"

I’m in Perimenopause — How Do I Know When It’s Time to Start Estrogen? Episode Overview In this solo episode, Dr. Jillian Woodruff tackles one of the most common and nuanced questions in menopause medicine: How do you know when it’s time to start estrogen? Recorded while on a family vacation on the East Coast — because some topics are too important to wait — Dr. Jillian walks through the practical clinical framework she uses every day in her practice. She covers the signals she looks for, why laboratory results alone are not enough to guide this decision, and why perimenopause is often the optimal time to begin the conversation — not years later when symptoms have already disrupted sleep, mood, cognition, intimacy, and quality of life. The episode also covers the relationship between estrogen and periods — including why estrogen can sometimes make bleeding worse in early perimenopause — the non-negotiable role of progesterone in any woman with a uterus on systemic estrogen, and a full discussion of Genitourinary Syndrome of Menopause (GSM) and why painful sex, vaginal dryness, and recurrent UTIs are treatable and should never be accepted as inevitable parts of aging. Key Takeaways * You do not have to wait until symptoms become severe before discussing hormone therapy. * Perimenopause is often the ideal time to begin evaluating treatment options. * New symptoms matter more than isolated laboratory values. * Hot flashes and night sweats are more than inconveniences and can affect overall health and quality of life. * Early bone loss may be an important reason to discuss hormone therapy. * Mood and cognitive changes may have hormonal contributors. * Progesterone is often the first hormonal intervention considered in early perimenopause. * Women with a uterus who use systemic estrogen require endometrial protection with progesterone or a progestin. * Vaginal estrogen is a separate treatment category from systemic hormone therapy and has a different risk profile. * GSM is common, progressive, and highly treatable. Resources Mentioned * The  Menopause Society certified provider finder: www.menopause.org * Send your questions: connect@modernmidlifecollective.com * Watch the video version: youtube.com/@drjillianwoodruff (available June 10, 2026) * www.modernmidlifecollective.com [http://www.modernmidlifecollective.com] About Dr. Jillian Woodruff, MD Dr. Jillian Woodruff, MD is a board-certified OB-GYN, gynecologic surgeon, and Menopause Society Certified Practitioner. She is the founder of Modern Gynecology & Skin in Anchorage, Alaska, and co-host of The Modern Midlife Collective podcast with Dr. Ade Akindipe, DNP. SCIENTIFIC REFERENCES AND BIBLIOGRAPHY Professional Guidelines The Menopause Society. The 2022 Hormone Therapy Position Statement of The Menopause Society. Menopause. 2022;29(7):767–794. American College of Obstetricians and Gynecologists. Hormone Therapy for Menopause. ACOG Practice Guidance and FAQ. Washington, DC: ACOG; updated 2022. SWAN Study — Vasomotor Symptoms and Duration Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531–539. SWAN Study — Vasomotor Symptoms and Cardiovascular Risk Thurston RC, El Khoudary SR, Sutton-Tyrrell K, et al. Vasomotor symptoms and cardiovascular risk in midlife women. Menopause. 2011;18(2):146–151. Perimenopausal Depression and PMDD History Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for new onset of depression during the menopausal transition: the Harvard Study of Moods and Cycles. Arch Gen Psychiatry. 2006;63(4):385–390. Freeman EW, Sammel MD, Liu L, Gracia CR. Association of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry. 2004;61(1):62–70. GSM — Management and Treatment Faubion SS, Larkin LC, Stuenkel CA, et al. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer. Menopause. 2018;25(6):596–608. Faubion SS, Sood R, Kapoor E. Genitourinary syndrome of menopause: management strategies for the clinician. Mayo Clin Proc. 2017;92(12):1842–1849. Bone Loss and Estrogen in Perimenopause Sowers MR, Zheng H, Jannausch ML, et al. Amount of bone loss in relation to time around the final menstrual period and follicle-stimulating hormone staging of the transmenopause. J Clin Endocrinol Metab. 2010;95(5):2155–2162. Perimenopause as Clinical Diagnosis — Lab Limitations Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options. J Clin Endocrinol Metab. 2021;106(1):1–15. Endometrial Protection — Unopposed Estrogen Grady D, Gebretsadik T, Kerlikowske K, Ernster V, Petitti D. Hormone replacement therapy and endometrial cancer risk: a meta-analysis. Obstet Gynecol. 1995;85(2):304–313.

Episode 33: Why Your Doctor Says You're Fine — And Why You're Not" The Complete Protocol for Midlife Fatigue (Part 3)

You have been exhausted. You went to the doctor. Your labs came back normal. And somehow that made it worse — because now you have no explanation, no answers, and a quiet suspicion that something is still very wrong. You are not imagining it. And this episode is where it finally gets addressed. In the third and final episode of our fatigue series, Dr. Jillian and Dr. Ade deliver the complete clinical protocol: the labs that actually reveal what is driving your fatigue, the supplement stack with the full reasoning behind every ingredient, and the exact language to use when you sit down with your provider so you walk out with something more useful than a recommendation to sleep more. This is the episode you bring to your next appointment. Free Download Fatigue Protocol Everything covered in today's episode — the complete lab panel organized by tier, the supplement stack with ingredient breakdown and dosing, patient advocacy language, and a quick-reference symptom guide — is available as a free download. Get the Complete Fatigue Protocol at modernmidlifecollective.com/fatigue Missed Parts 1 and 2? Episode 31 — Why Am I Always Tired? The Root Causes of Fatigue Part 1 Covers: sex hormone dysregulation, thyroid dysfunction, and HPA axis dysregulation Episode 32 — Why Am I Always Tired? The Root Causes of Fatigue Part 2 Covers: blood sugar dysregulation, nutrient deficiencies, and chronic low-grade inflammation Labs Discussed in This Episode Tier One — First Visit Essentials Hormones: Estradiol (E2), Free and Total Testosterone, Progesterone, DHEA-S, FSH, LH, SHBG Thyroid: TSH, Free T3, Free T4, TPO Antibodies Metabolic: Fasting Insulin, Fasting Glucose, HOMA-IR, Hemoglobin A1c, Comprehensive Metabolic Panel, Fasting Lipid Panel Nutrients: Ferritin (target 70 to 100 ng/mL), 25-OH Vitamin D (target 50 to 80 ng/mL), Vitamin B12 Inflammation: High-Sensitivity CRP (hsCRP) Tier Two — Added Based on Clinical Picture Thyroid extended: Reverse T3, Anti-Thyroglobulin Antibodies Adrenal: 4-Point Salivary Cortisol and DHEA (functional lab — typically requires a functional medicine or integrative provider) Metabolic extended: Continuous Glucose Monitor (CGM) trial Nutrients extended: RBC Magnesium, Folate, Zinc, IGF-1 Gut: Comprehensive Stool Analysis (functional lab) Supplements Discussed Full supplement collection available through Dr. Jillian's professional dispensary: https://us.fullscript.com/plans/moderngynecology-modern-midlife-collective-s-fatigue-protocol [https://us.fullscript.com/plans/moderngynecology-modern-midlife-collective-s-fatigue-protocol] Magnesium Glycinate — sleep, nervous system support, restless legs. 300 to 400 mg at night. Magnesium Malate — daytime energy and muscle function. 200 to 400 mg with food. CoQ10 Ubiquinol — mitochondrial energy chain. Non-negotiable for statin users. 100 to 300 mg daily. Berberine — insulin sensitivity and metabolic support. 500 mg with meals, titrate slowly. Myo-Inositol with D-Chiro-Inositol (40:1 ratio) — insulin sensitivity and hormonal balance. 2 to 4 grams daily. Ashwagandha standardized extract — HPA axis and cortisol rhythm support. 300 to 600 mg daily. Rhodiola Rosea — cognitive fatigue and stress resilience. 200 to 400 mg in the morning. Phosphatidylserine — evening cortisol reduction; wired-but-tired pattern. 100 to 300 mg at night. Methylated B Complex — neurological energy and cortisol metabolism. Critical for women on oral contraceptives, PPIs, or metformin. Vitamin D3 with K2 MK-7 — immune, hormonal, and energy support. 5,000 IU D3 with 100 mcg K2 daily with food. Omega-3 EPA and DHA — anti-inflammatory and cardiovascular support. 2 to 4 grams of combined EPA and DHA daily. Full curated supplement collection with professional-grade brands: modernmidlifecollective.com/fatigue [http://modernmidlifecollective.com/fatigue] Research Cited Women's Health (London) — 67% Fatigue Prevalence in Perimenopausal Women (n=3,000+) Menopause Journal (March 2025) — AUB, Iron Depletion and Fatigue During Perimenopause (n=2,300+) AIMS Molecular Science (2024) — Estrogens and Mitochondrial Biogenesis Frontiers in Endocrinology (2024) — Mitochondrial Dysfunction and Insulin Resistance The American Journal of Medicine (2025) — HPA Axis Dysregulation: Integrative Review PMC UK Survey (2025) — Fatigue in Treated Hypothyroidism (n=1,251; 89% abnormal fatigue) XX Midlife Women's Health Study — Stress-Fatigue Coupling Across Menopause Transition WellnessExtract Research (2025) — IL-6, TNF-alpha, and Perimenopause Inflammation Connect With Us Website: modernmidlifecollective.com [http://modernmidlifecollective.com] Free Fatigue Protocol: modernmidlifecollective.com/fatigue [http://modernmidlifecollective.com/fatigue] Instagram: @modernmidlifecollective [https://www.instagram.com/modernmidlifecollective/] Email: connect@modernmidlifecollective.com Work With Dr. Jillian Modern Gynecology and Skin | Anchorage, Alaska  Instagram: @drjillianwoodruff Transcend Retreat Waitlist: https://moderntranscend.com/retreat-waitlist [https://moderntranscend.com/retreat-waitlist] Website: www.moderngynalaska.com  [http://ww.moderngynalaska.com] Work With Dr. Ade Rejuvenate Health and Wellness | Anchorage, Alaska   Website: www.rejuvenatehealthak.com  Download Dr. Ade’s Metabolic Reset Cheat Sheet https://rejuvenatehealthakrlt.com/metabolic-reset [https://rejuvenatehealthakrlt.com/metabolic-reset]  Take your Midlife Vitality Quiz https://dr-ade-the-vitality-gap-scorecard.scoreapp.com/ [https://dr-ade-the-vitality-gap-scorecard.scoreapp.com/]  Instagram: @rejuvenate_health_wellness | @dr.adeakindipednp Both practices serve patients in the state of Alaska. Leave a Review If this episode or this series helped you, leaving a review on Apple Podcasts takes 60 seconds and helps other women find the show. We read every one. The Modern Midlife Collective Dr. Jillian Woodruff, MD, FACOG, MSCP x Dr. Ade Akindipe, DNP, MBA, APRN modernmidlifecollective.com

Episode 32: Still Exhausted? It’s Not Just Hormones, Stress, or Sleep (Part 2)

You fixed your sleep. You tried the supplements. Your labs are “normal.” So why are you still exhausted? In Part 2 of our fatigue deep dive, Dr. Jillian and Dr. Ade uncover the hidden root causes of midlife fatigue that women are rarely told about — including blood sugar crashes, mitochondrial dysfunction, iron depletion, nutrient deficiencies, chronic inflammation, and metabolic changes during perimenopause. If you’ve ever felt dismissed, unheard, or frustrated by being told “everything looks fine,” this episode will change the way you understand your body — and your energy. This isn’t laziness. It isn’t weakness. And it’s not just aging. It’s physiology. #MidlifeWomen #Fatigue #Perimenopause #Hormones #WomenOver40 #FunctionalMedicine #MenopauseSupport #InsulinResistance #Mitochondria #Inflammation #EnergyCrisis #WomenHealth #DrJillian #DrAde #ModernMidlifeCollective

Episode 31: Why Am I So Tired All the Time? (It’s Not What You Think)

Do you feel exhausted all the time—even after sleeping? Like your energy just isn’t the same anymore… and no one can explain why? In this episode of The Modern Midlife Collective, Dr. Jillian Woodruff and Dr. Ade Akindipe break down midlife fatigue—why it’s so common in perimenopause and menopause, what’s actually happening in your body, and why “just pushing through” isn’t the answer. This isn’t normal tiredness. This is persistent, unexplained fatigue—and it’s often a combination of hormonal shifts, stress, sleep disruption, and metabolic changes happening at the same time. In this episode, you’ll learn: * The difference between tiredness vs true fatigue * Why estrogen decline affects cellular energy production (mitochondria) * How progesterone impacts sleep and nighttime anxiety * The role of testosterone in motivation, stamina, and mental clarity * Why thyroid dysfunction is often missed in women * What most doctors miss when only testing TSH * How chronic stress disrupts your cortisol rhythm (HPA axis) * What “wired but tired” really means * Why high-achieving women feel depleted—even when life looks “fine” ✨ You are not lazy. ✨ You are not unmotivated. ✨ Your body is responding to real physiological changes. If you’re in your 40s, 50s, or beyond and feel like your energy has completely changed—this episode will help you understand why. 🎧 Listen now—and don’t miss Part 2, where we break down exactly how to test, evaluate, and fix what’s driving your fatigue. 📩 Have questions or topics you want us to cover? Email us at connect@modernmidlifecollective.com #MidlifeFatigue #Perimenopause #Menopause #HormoneHealth #WomensHealth #ChronicFatigue #ThyroidHealth #AdrenalHealth #WomenOver40 #ModernMidlifeCollective

Episode 30: Why Women Live Longer—But Age Worse (And What to Do About It)

Women live longer than men—but often spend more years in poor health. So what’s missing? In this episode of The Modern Midlife Collective, Dr. Jillian Woodruff and Dr. Ade Akindipe unpack the critical difference between lifespan and healthspan—and why so many women are living longer but not necessarily living well. This conversation challenges the traditional narrative around aging and shifts the focus toward what actually matters: quality of life, metabolic health, muscle preservation, and hormonal balance. We explore how ovarian aging, hormonal shifts, and metabolic changes uniquely impact women in midlife—and why many mainstream health strategies fail to address these realities. If you’ve ever felt like the wellness world is full of noise, trends, and conflicting advice, this episode brings you back to what truly moves the needle. ✨ Living longer is not the goal.  ✨ Living well is.  ✨ And that starts with understanding how your body changes in midlife. In this episode, we discuss: *  The difference between lifespan and healthspan—and why it matters for women  *  Why women live longer but experience more chronic disease  *  How ovarian aging impacts overall health and longevity  *  The role of estrogen decline in metabolic and cardiovascular health  *  Why muscle is one of the most important factors in healthy aging  *  The connection between insulin resistance and midlife disease risk  *  How strength training supports longevity and metabolic health  *  The truth about “biohacking” and why more isn’t always better  *  Where hormone therapy fits into long-term health strategies  *  What actually moves the needle for aging well after 40  The truth about women’s longevity Longevity is not just about adding years to your life. It’s about preserving strength, function, independence, and vitality. For women, that means shifting the focus from quick fixes and trends to foundational health strategies that support the body through hormonal and metabolic transitions. Because aging is inevitable. But how you age is not. 🎧 If this episode resonated with you, share it with a woman who wants to feel strong, capable, and supported as she ages. 📩 Have a topic you want us to cover?  Email us at connect@modernmidlifecollective.com  #MidlifeWomen #MenopauseMatters #Healthspan #WomenOver40 #HormoneHealth #AgingWell #MetabolicHealth #LongevityForWomen #Perimenopause #StrongAtAnyAge