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Summary
On episode 602 of 40+ Fitness, Coach Allan sits down with Dr. Heather Hirsch, founder of the Menopause and Midlife Clinic at Brigham and Women’s Hospital and a former faculty member at Harvard Medical School, whose practice focuses on menopausal hormone therapy, perimenopause, breast cancer survivorship, sexual dysfunction, and bone health.
They discuss her book, Unlock Your Menopause Type: Personalized Treatments, the Last Word on Hormones, and Remedies That Work, and the six menopause types she uses to help women match treatment to their actual symptoms and history instead of a one-size-fits-all approach.
The conversation also covers the safety data behind hormone replacement therapy, what diet and exercise should look like for each menopause type, and why partners and family need to be part of the conversation.
Links
- https://www.heatherhirschmd.com
Key Takeaways
- There is no single menopause experience. Dr. Hirsch groups symptoms into six types, premature, sudden, full throttle, mind altering, lingering, and silent, so women can target treatment to their actual pattern instead of a generic checklist.
- Premature and early menopause are more common than most people think. Premature menopause (before age 40) and early menopause (ages 40 to 45) affect roughly 1 to 5 percent of women, an estimated 50,000 or more per year, and the true number is likely underreported since many go undiagnosed.
- Silent menopause can be the most dangerous type. A woman can have zero outward symptoms and still be losing bone density, so weight-bearing exercise and screening stay essential even when nothing “feels” wrong.
- Hormone replacement therapy has a strong safety record for most women. Started within 10 years of menopause using FDA approved formulations like estradiol and prometrium, HRT is linked to living longer, fewer diabetes cases, and better bone health, with no statistical increase in breast cancer risk, yet only about 7 to 10 percent of eligible women currently use it.
- Diet, lifestyle, and sleep are the foundation, not an afterthought. Whatever medication decision a woman makes, those daily habits determine how well she does before, during, and after treatment.
- Weight-bearing exercise matters for every type, not just the “silent” cases. Dr. Hirsch describes a fit, active patient with a normal BMI who fractured her spine simply standing up, because she had never done resistance training and did not know she had osteoporosis.
- Protein needs go up in midlife. She recommends at least 80 to 100 grams of protein a day to support muscle and metabolic health through the menopause transition.
- Bring your partner and family into the conversation. Talking openly with a spouse or kids about symptoms, the way partners are included during pregnancy, helps everyone understand that mood and energy changes are physiological, not personal attacks.
- Dr. Hirsch’s three strategies to get and stay well: work through therapy or journaling to offload mental load, get about 20 minutes of exercise most days mixing cardio and weight-bearing work, and practice staying present in everyday moments instead of scrolling past them.
“We should not demonize an endocrine dysfunction or disorder.”
Dr. Heather Hirsch
Another Episode You May Enjoy
Episode 603 – Unsaid things during your urologist appointment with Dr. Martha Boone
Episode Notes
Podcast: 40+ Fitness
Episode: 602
Published: 2023-08-08
Host: Allan Misner (aka Coach Allan), author of The Wellness Roadmap
Guest(s): Dr. Heather Hirsch, the founder of the Menopause and Midlife Clinic at the Brigham and Women’s Hospital and has also served on the faculty at Harvard Medical School, Unlock Your Menopause Type
Listen & Subscribe: Apple Podcasts · Spotify · YouTube (audio only)
