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This week, I prepare to drop off all three of my kids at their respective colleges for the first time. Which, I guess, makes me what people call an empty nester. But why do they call it an empty nest? When baby birds grow up and fly away, the mama bird also abandons the nest. Yet in my case—and maybe yours—you have to return to the nest. So what exactly are you returning to?

Today, we’re continuing our discussion of the risks and benefits of estrogen. And this week, we’re tackling some of the bigger health concerns: heart disease, stroke, blood clots, and cancer. There is a lot of information here, so find a comfy chair and a fan (if you’ve got hot flashes, like me), and let’s get started.

Let's talk about estrogen: what it's actually approved to treat, where the evidence is strong, and where we're still waiting for better data.

So instead of a medical lesson this week, you get pure emotion. When my dad was diagnosed with pancreatic cancer, I knew. I knew he was going to die from this horrible disease. You could tell me I was being negative. You could say I never gave him a chance. Maybe you're right.

Studies estimate that 45–70% of women experience depressive symptoms during perimenopause, compared with roughly 25–30% of premenopausal women. One small study even found that the risk of depression was 14 times higher during the two years leading up to menopause than during the preceding three decades. No wonder so many of us feel like we're losing our minds.

Progesterone is an essential part of hormone replacement therapy for many women with a uterus. While most women tolerate it well—and some even sleep better because of it—a small percentage experience unexpected side effects like increased anxiety, mood changes, or feeling "not like themselves." If that's you, you're not imagining it.

Twenty-four years ago, I graduated from medical school. Since then, I've had the privilege of experiencing medicine from many different perspectives: community-based research, teaching medical students and residents, working in a group practice, and owning a direct primary care practice. About five years ago, I found myself at a crossroads. Between the pandemic, burnout, and the growing divide around science and healthcare, I realized I needed to step back and reconnect with

oday, we're tackling another common—but surprisingly under-discussed—cause of painful sex: Genitourinary Syndrome of Menopause (GSM). GSM is a collection of symptoms caused by falling estrogen levels that affect the vagina, vulva, labia, clitoris, bladder, and urethra.

For women who have spent decades trying to be the perfect mother, physician, partner, daughter, or friend, it can feel like we're suddenly failing at things that once came easily. But maybe we're looking at it all wrong. Maybe this stage of life isn't teaching us how to avoid mistakes. Maybe it's teaching us how to make peace with them.

The pelvic floor is a group of 14 muscles located at the bottom of your pelvis. These muscles support your bladder, rectum, and reproductive organs. Imagine a hammock or sling stretching across the bottom of your pelvis. That supportive hammock is your pelvic floor. When it's functioning well, you probably don't think about it. When it's not, you'll know.

Why aren't we talking about perimenopausal sexual dysfunction? Women's health has spent decades being the black sheep of medicine. Conditions affecting millions of women have often been dismissed, minimized, or simply ignored. Sexual health may be one of the best examples. Let's fix that.

Why does the brain take risks? The answer is complicated, but dopamine plays a starring role. Dopamine is often called the "feel-good" neurotransmitter, but that's only part of the story. It's released not only when we experience something pleasurable, but also when we anticipate a reward. Sometimes the possibility of joy can be just as powerful as the joy itself.

Adult friendships are hard. But you know what’s even harder? Losing the childhood friendships, you thought would survive every stage of life. And when I say childhood, I don’t mean elementary school. I mean that long stretch of time before adulthood fully settled in — before marriages, careers, children, and grief reshaped us. My twenties still felt young enough to be considered childhood in their own way. Honestly, at twenty-eight, I was still very much a kid. A couple of we

PMOS can look very different from person to person, which is one reason it is often overlooked.

Motherhood changes people in ways that are difficult to explain until you live it yourself. Whether you are raising toddlers, teenagers, adult children, stepchildren, or supporting others in a caregiving role, becoming a mother shifts your priorities, identity, emotions, and understanding of love. For me, motherhood has been humbling, exhausting, funny, overwhelming, and deeply meaningful all at once. These are the biggest lessons I’ve learned from being a mother. 1) Motherho

Let’s talk bones. Not the Halloween kind—the ones quietly holding you together while you scroll this. Osteoporosis is a condition where bone density decreases and the internal structure of bone weakens, increasing fracture risk. Osteopenia is the early stage of bone loss—the warning sign before osteoporosis develops. Osteoporosis affects 200 million people worldwide. Eighty percent of cases are women. After age 50, 1 in 2 women will have an osteoporosis-related fracture.

Burning mouth syndrome- an often overlooked condition of middle age

A blog about photos and what the story they tell.

Estrogen. Let’s talk about the positive. More people in perimenopause are finally having their symptoms taken seriously and addressed. And in 2025, the FDA removed the black box warning on estrogen products—a pretty big shift. Back in 2002, the Women’s Health Initiative study linked hormone therapy to increased risks of heart attacks, strokes, and pulmonary embolism. That study changed practice overnight. But over the following decades, more nuanced research showed that those

Have you heard about this Tik Tok trend? (Yes. Yes. I am in the know). Mom—what were you like in the ’90s? ahem… cue Iris by the Goo Goo Dolls… and begin In the 1990s, I was: 1) Ditzy (on purpose).I had been a full-on nerd growing up—mathletes, teacher’s pet, the whole deal. But in the ’90s, being smart wasn’t exactly cool. Life goals involved being like Kelly Taylor, not Andrea Zuckerman (Thursday night 90210 viewings were quintessential ’90s dogma). Then, my sophomore year,