Menopause hormone therapy (HT), also known as hormone replacement therapy or HRT, has many benefits for perimenopausal and menopausal women, including reducing hot flashes, night sweats, brain fog, and vaginal dryness, as well as improving mood, sleep, and long-term bone health.
However, there have been decades of controversy regarding this therapy. In the early 1990s, HT was very popular and in 1993, the National Institutes of Health launched the Women’s Health Initiative (WHI), a clinical trial to evaluate the impact of hormone therapy on the risk of chronic disease, particularly heart disease, stroke, cancers, and bone fractures. In this landmark study, more than 16,000 healthy postmenopausal US women with an intact uterus aged 50 to 79 (average age 63) were put on a protocol of estrogen and progesterone, and roughly 11,000 who had had a hysterectomy were placed on estrogen alone.
Enrollment proceeded from 1993 to 1998. In 2002 the combined group of the trial was stopped three years early, and in 2004 the estrogen-alone group was stopped one year early. The trials came to a halt when the risks of invasive breast cancer, blood clots, heart disease, and stroke exceeded the benefits for prevention of bone fractures and colon cancer. These outcomes instilled a general fear in the public and medical community that HT increases the risk of breast cancer and/or cardiovascular disease.
But, in May 2024, WHI researchers published their 20-year follow-up data that showed no increase in deaths from breast cancer or cardiovascular disease in the women in the trials. The follow-up report also showed a decrease in all-cause mortality when HT was started under age 60 or less than 10 years after the final menstrual period, illustrating that hormone therapy can be beneficial for many women.
Regarding breast cancer risk specifically, in the WHI trial, there were only eight cases of breast cancer per 10,000 women per year in the combined group and a decrease in breast cancer rates in women on estrogen-alone therapy. “Obesity, a sedentary lifestyle, and alcohol use pose much greater risks for breast cancer than HT,” says Karen Adams, MD, Stanford clinical professor of obstetrics and gynecology.
“There’s a lot of fear and misinformation around HT, and one of the biggest myths is that HT is a highly significant cause of breast cancer,” says Dr. Adams. “Today, only around three percent of women who are candidates for hormone therapy are actually taking it because they’re afraid.”
Dr. Adams is the founder and director of the Stanford Menopause & Healthy Aging program, a multidisciplinary team of women’s health experts that aims to educate providers in the use of HT since many medical schools stopped teaching the treatment after the WHI results. Since providers were not prescribing HT, an entire generation of women (now aged 65 to 80) did not receive or benefit from the therapy.
“It’s important that we get the message out there that we have learned how to individualize HT for each woman’s situation. Risks and benefits regarding hormone therapy are different for each person, and many women will gain significant benefits from hormone use, especially if they are under age 60,” says Dr. Adams.
Reducing Fears About Menopausal Hormone Therapy
In the last 20 years, results from follow-up studies of the original WHI trial and other studies have shown that HT is safer when specific guidelines are followed, such as making sure women start HT at the right age, and the treatment is administered in the proper form.
When Should I Start Hormone Therapy?
The first safety guideline is starting hormone therapy at the right age. Analyses of the WHI trial data found that heart attacks and strokes occurred primarily in women who started HT over the age of 65, meaning that age made a difference in how women responded to the hormones.
This finding has led to the current recommendation of starting HT within 10 years of menopausal onset. In other words, if a woman’s last period occurred at age 50, she should start treatment by 60.
“There is a window of greatest opportunity to start hormones. If you start within 10 years of your last period, you almost always get benefits. But, if you start after 10 years, or after the age of 60, possibly not,” says Dr. Adams.
Also, Dr. Adams shares that many women are starting HT in their 40s to relieve perimenopausal symptoms. Unpredictable hormone fluctuations can cause irregular periods during the years leading up to menopause, sometimes resulting in Perimenopausal Mood Instability or PMI.
“Everyone knows about PMS, but no one talks about PMI because the conditions that women have in midlife aren’t talked about enough … and PMI is like PMS on steroids,” says Dr. Adams. “Starting hormone therapy during perimenopause can be incredibly helpful to stabilize the ups and downs of hormone levels that can cause hot flashes, night sweats, and changes in mood.”
Dr. Adams explains that HT offers a lower level of hormones than birth control pills, so it does not prevent pregnancy. Therefore, many of her patients in perimenopause (where pregnancy is still possible) opt for birth control pills if they are sexually active to provide both symptom relief and contraception. But, if patients are using another mode of birth control, HT could be a good option to relieve perimenopausal symptoms.
What Forms of Hormone Therapy Should I Take?
The second safety guideline is knowing the best way to take the hormone. Research has shown that when estrogen is taken in pill form, the liver releases clotting factors, which can result in blood clots and other cardiovascular conditions. But, if estrogen is administered non-orally, such as through a skin patch or gel, the hormone is delivered directly into the blood stream without going through the digestive system, which takes the clotting risk back to baseline.
“This study is helpful for providers to understand whether HT is a good idea for a particular patient in that it divides people into low, moderate, and high risk for cardiovascular disease,” says Dr. Adams, referring to Figure 5 of the study. “If a patient is at high risk for cardiovascular disease, HT would not be recommended.”
Even though estrogen should be administered non-orally to prevent blood clotting, Dr. Adams recommends taking progesterone as a pill that is swallowed at night, since sleepiness is a convenient side effect. The purpose of progesterone is to protect the lining of the uterus. Estrogen typically thickens the uterine lining, which can cause irregular bleeding, and even pre-cancer or cancer of the lining. If a woman has had a hysterectomy, she does not have this risk and therefore she does not need to take progesterone.
Lastly, the WHI trial administered chemical forms of estrogen and progesterone, but Dr. Adams emphasizes the importance of taking bioidentical forms so that the body “recognizes” them. “The hormones we now use are bioidentical, meaning they are the same forms that were circulating in your body in your reproductive years,” she says. “They are much less inflammatory than the chemical forms that were studied in the WHI. Since inflammation increases our risk for all age-related diseases, less inflammation is always a good thing.”
What are the Benefits of Menopause Hormone Therapy?
At the Stanford Menopause & Healthy Aging clinic, HT is tailored to the patient’s needs and includes transdermal estrogen (via a patch) and micronized progesterone (via a pill) for those with a uterus. The primary use of hormone therapy is for management of menopausal symptoms, which can be distressing and can last for years.
Benefits of Hormone Therapy:
- Reduction of hot flashes
- Reduction of night sweats
- Reduction of vaginal dryness that can cause painful sex
- Reduction of joint pain
- Reduction of brain fog
- Mood stabilization
- Sleep improvement
“Hormone therapy takes hot flashes and night sweats away in about three to four weeks. Regarding painful sex, the vagina gets more stretchy, moist, and flexible with estrogen,” says Dr. Adams. “HT also provides a small but measurable impact on lean body mass and can help to mitigate the ‘spare tire’ that women see in midlife.”
Long-term Benefits of Hormone Therapy:
- Reduced risk of osteoporosis and bone fracture
- Reduced risk of colorectal cancer
“Women take HT to not only relieve current menopause-related symptoms but also for improved long-term bone health. HT helps keep your bones strong and can potentially prevent osteoporosis,” says Dr. Adams. “Regarding heart health, we see a slowing of calcium deposition in the coronary arteries when HT is started under age 60, which may lead to a lowered risk for cardiovascular disease long-term.”
Benefits of Testosterone:
- Improved sex drive
“Testosterone is not part of a standard HT protocol since it’s not FDA approved for women. For that reason, insurance will not reimburse for it. The best data supports the use of testosterone in postmenopausal women with low sex drive. In those women we see small increases in desire, arousal, and orgasm, so some HT clinics do offer it for this purpose and follow a national guideline for administration,” says Dr. Adams. “Regarding improvements in muscle mass and energy, we don’t have enough data currently to conclude that testosterone mitigates the sarcopenia of aging or increases energy in women, but this may come in the future.”
Who Should Not Take Hormone Therapy?
Dr. Adams explains that people with the following conditions should not take hormone therapy:
- Women with a hormone-sensitive cancer, such as estrogen or progesterone positive breast cancer.
- People who have had a heart attack, stroke, or a blood clot in their leg, lung, or brain.
- People with gallstones, liver disease, gallbladder disease, or undiagnosed vaginal bleeding or pregnancy.
“It’s an exciting time to be a menopause specialist because there has been more attention being paid to menopause in recent years, which is great and long overdue,” says Dr. Adams.
“I want to send a message of hope. Once they figure out how to manage their menopausal symptoms, most women are happier than they’ve ever been in their lives. They are more confident, and their relationships tend to improve because they know themselves well. So, you just need to navigate these choppy waters of perimenopause to get to a time of life that is called ‘menopausal zest’. That is out there waiting for you, and it’s wonderful,” says Dr. Adams.
Learn more about Dr. Karen Adams’ recommendations for women’s healthy aging:
TED Talk: Sleep, Sex, and Menopausal Zest
SHE Talk: Taboos and Truths – A Frank Talk About Women’s Health
Marcia L. Stefanick, PhD has spent her career changing the way medicine understands both the differences and similarities in health across sex and gender. A professor of medicine at Stanford and a leading researcher in women’s health and sex differences, she has dedicated decades to advocating for the inclusion of women in clinical trials and challenging outdated medical norms. As a principal investigator in the landmark Women’s Health Initiative (WHI) and co-founder of Stanford’s Women’s Health and Sex Diversity in Medicine (WHSDM) Center, Dr. Stefanick has shaped public health policies and medical guidelines that continue to influence patient care all over the world.
“I’m interested in everything that relates to sex and gender across the life course,” says Dr. Stefanick. “My research has been very autobiographical—I first studied the menstrual cycle, then pregnancy complications, then midlife and menopause, and now aging.”
Early Life and Career Path
Born in Western Pennsylvania into a family of seven children, Dr. Stefanick developed an early curiosity about sex differences—wondering why puberty affected her brothers differently and why societal expectations varied by gender.
“I was always trying to figure out—when my brothers went through puberty, is that going to happen to me? Why do they get to do certain things, and I don’t? That made me interested in both biology and gender norms,” says Dr. Stefanick.
After spending a year in Germany as a Rotary International Exchange student, she pursued a degree in biology from the University of Pennsylvania, where she became interested in sex differences, particularly in primate behavior.
“When I graduated, I had hoped to study lowland gorillas in Africa, which led me to the Oregon Regional Primate Center. There, I became a research assistant in a sex hormone laboratory and developed a deeper interest in hormones and behavior and neuroendocrinology. This motivated me to pursue a PhD in Physiology with Julian Davidson at Stanford,” says Dr. Stefanick.
During graduate school, she realized she was not meant to be an animal researcher. Seeking a new direction, she connected with researchers at the Stanford Prevention Research Center (SPRC) who were focusing on physical activity and heart disease prevention.
Breaking Barriers in Research
At the SPRC, Dr. Stefanick’s research in the early 1990s primarily focused on body composition, weight loss, and exercise’s impact on cardiovascular risk. At the time, clinical trials were overwhelmingly conducted on men.
Her first two trials—one on exercise and HDL cholesterol and the other on diet, exercise, and weight loss—only included men because that was all that was funded. Frustrated by this, she refused to conduct another male-only study, successfully pushing for the inclusion of pre-menopausal and post-menopausal women in subsequent research.
“I told them, ‘I’m not doing another study without women. We have to include women in our research and not only study men’,” says Dr. Stefanick.
Her interest in sex and hormones led her to take on a National Institutes of Health (NIH) request for applications to study menopausal hormones and heart disease. At the time, doctors were widely prescribing menopausal hormone therapy (HT), often referred to as hormone replacement therapy (HRT), for older women despite a lack of research on its effects. Dr. Stefanick and her colleagues designed one of the first studies to examine these treatments.
This resulted in the Postmenopausal Estrogen/Progestin Interventions Trial (PEPI), published in 1995, which was the first clinical trial by the National Heart, Lung, and Blood Institute (NHLBI) conducted exclusively on women. “It was the first trial done by NHLBI that had only women in it,” says Dr. Stefanick with pride.
Women’s Health Initiative: A Landmark Study
Dr. Stefanick’s PEPI trial laid the foundation for the Women’s Health Initiative (WHI)—the largest study of women’s health ever conducted. Launched in the 1990s, WHI enrolled nearly 162,000 women at 40 clinical centers nationwide to study menopausal hormone therapy, diet and cancer risk, and calcium and vitamin D supplementation.
WHI is still ongoing, and Dr. Stefanick serves as Principal Investigator of the Western Regional Center. “It’s the biggest study of women’s health ever done—and it’s still going on,” says Dr. Stefanick.
The WHI hormone trials, published in 2002 and 2004, challenged long-held medical beliefs. Doctors were prescribing menopausal hormone therapy for older women to prevent heart disease, but the study found that HT actually increased the risk of strokes, heart attacks, breast cancer, and dementia. Within a year of publication, HT prescriptions in the US dropped from 20 million to 6 million. “Doctors became afraid to prescribe hormones for menopause management. Women now ask, ‘Why won’t anyone treat my menopause symptoms?’ There are alternative estrogen therapies that don’t carry the same risks, but they remain underutilized,” says Dr. Stefanick.
Dr. Stefanick is currently leading the largest-ever study on whether physical activity prevents heart disease—a question that, despite decades of research, has never been definitively proven.
“We’ve never actually proven that physical activity reduces heart disease. All our data is based on surrogate markers—blood pressure, cholesterol, glucose tolerance—but we haven’t studied enough men or women (or nonbinary people) to say for sure,” says Dr. Stefanick.
The WHSDM Center: Advancing Sex Differences Research
Dr. Stefanick believes that one of the biggest problems in sex differences research is the overemphasis on sex hormones while ignoring other biological factors and broader sociocultural influences. “People tend to believe it’s all about estrogen and testosterone, but the biggest biological difference is probably the X chromosome. Every cell in an XX (female) body is different from every cell in an XY (male) body and some people have other variations of X and Y combinations,” says Dr. Stefanick.
For example, women have a stronger immune response than men, yet medical studies rarely adjust for these differences. Even in vaccine development, the COVID-19 vaccine was given at the same dose to men and women, despite evidence that women may need much lower doses.
“We don’t need to treat women like men. We are not men. We need to treat women like women—XX people with estrogen between puberty and menopause and with low estrogen after menopause, which may be over a third of our lives,” says Dr. Stefanick.
To address these gaps, Dr. Stefanick co-founded the WHSDM Center at Stanford, which serves as a hub for sex and gender research in medicine. The center funds studies, ensures that departments consider sex and gender in research, and promotes the inclusion of underrepresented groups in medical studies.
“Our goal at the WHSDM Center is to encourage researchers to study sex differences at every level—cells, tissues, animals, people, and populations,” says Dr. Stefanick.
Future Research Priorities
Dr. Stefanick continues to advocate for more inclusive research in several key areas:
- Menopause and why some women have more severe symptoms than others and how to treat these more serious cases
- Adverse pregnancy outcomes and their link to increased risk of diabetes and premature heart attack
- Aging in women and why women live longer than men in many parts of the world
- LGBTQ+ health research and the need for broader representation
“Women are incredibly resilient,” says Dr. Stefanick. “Our culture doesn’t value women in the same way it values men, yet women persist. I just love women. Women are incredible.”
By Maya Shetty, BS and Felicia Song, BS
Midlife marks a significant life transition, bringing hormonal shifts that can reshape a woman’s body and well-being. As women navigate this period, their bodies undergo physiological changes that can impact muscle mass, bone density, metabolism, and overall well-being. Lifestyle factors play a fundamental role in healthy aging, but strategic supplementation can further support women in optimizing their health through midlife and beyond.
Nutrition and exercise researcher at Stanford Lifestyle Medicine Rachele Pojednic, PhD shares evidence-based strategies to help women maintain strength, vitality, and resilience as they age.
Different Supplements for Different Stages of Life
As women age, there are distinct shifts in body composition, and as a result, our nutritional needs change. For example, in our thirties, the focus should be on building and maintaining muscle mass, as bone formation peaks in the late teens and 20s. This foundation is critical because it helps offset the decline in estrogen during perimenopause, which reduces the body’s ability to preserve muscle and bone.
“Research shows that women begin losing skeletal muscle around age 30, with declines ranging from three to five percent per decade, and in some cases, up to 10 percent during the first postmenopausal decade,” states Dr. Pojednic.
After menopause, estrogen and other hormones stabilize at lower levels, making it more difficult for the body to build bone and muscle. Therefore, strength training, a nutrient-dense diet, and intentional supplementation become essential tools not just to mitigate loss of bone density and muscle mass, but to support long-term health.
Also, estrogen has anti-inflammatory properties throughout the body. When estrogen levels begin to decrease during perimenopause, systemic inflammation increases, contributing to a range of health concerns including changes in cognitive function, mood, and sleep. To help counter these effects, strategic supplementation can play a key role in supporting overall health, reducing inflammation, and maintaining balance.
Top 6 Supplements for Perimenopause and Menopause
1) Creatine
Creatine is a tripeptide that is naturally produced by the body and found in animal products. It plays a critical role in energy production and is crucial for maintaining muscle, bone, and brain health. In the body, creatine is stored in the muscles as phosphocreatine, which acts as a fast-acting energy reserve by donating a phosphate group to regenerate ATP, the primary energy currency of cells. This makes muscles more efficient, allowing for improved muscle function and greater overall strength.
“Creatine is one of the most extensively studied supplements in the world, and for good reason,” states Dr. Pojednic. “Recent research has shown considerable benefits in muscle, bone, and brain health.”
Why Creatine Matters for Women 40+
As women age, creatine levels naturally decline. In fact, women tend to have 70 to 80 percent lower creatine stores than men, and this difference becomes even more pronounced with age. This decline can contribute to age-related muscle loss, bone density reduction, and changes in cognitive and emotional health.
Benefits of Creatine Supplementation
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Muscle and Bone Health
Research suggests that creatine supplementation can help improve muscle function, increase muscle size, and enhance bone density in peri- and postmenopausal women, particularly when combined with resistance training.
“By enhancing ATP regeneration, creatine allows women to push their muscles a little harder during exercise, promoting more robust muscle mass and bone strength,” states Dr. Pojednic.
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Cognitive Health
The brain relies heavily on phosphocreatine for energy, and low levels can contribute to brain fog and mood changes. Studies have shown that creatine may enhance short-term memory and overall cognitive performance in adults aged 45 to 64.
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Mood Stability
Emerging research suggests that creatine supplementation may help offset mood changes associated with perimenopause, including anxiety, depression, and sympathetic overdrive. A recent study found that adding creatine to therapy for depression led to greater symptom improvement compared to therapy alone, highlighting its potential role in brain health as women age.
“Topping off creatine stores may help reduce brain fog, moodiness, and other cognitive side effects often experienced during perimenopause,” states Dr. Pojednic.
How to Supplement with Creatine
Dr. Pojednic recommends that women supplement with three-to-five grams of creatine per day. Timing doesn’t matter, so it can be taken at any time of the day that’s convenient. When choosing a supplement, look for one that uses a water-based wash rather than an acid-based wash, as the latter may cause gastrointestinal side effects.
2) Protein
Protein is a vital macronutrient made up of 20 amino acids, nine of which are essential, meaning they must come from food since the body cannot produce them. These essential amino acids—histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine—are crucial for muscle growth, maintenance, recovery, and overall health.
Why Protein Matters for Women 40+
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Increased Protein Needs
As women age, their ability to absorb and utilize protein efficiently declines, making adequate protein intake even more critical. Aging leads to anabolic resistance, meaning the body requires more protein and a greater resistance training stimulus to maintain and build muscle. Without sufficient protein, women may struggle to preserve lean mass, recover from exercise, and maintain metabolic health.
“Most women at all stages of life are not consuming enough protein, and this becomes more of a problem with age. While many women consume only 40 to 60 grams per day, research suggests that a more optimal range is 80 to 100 grams per day for muscle maintenance and growth,” states Dr. Pojednic.
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Muscle and Metabolic Health
Protein is necessary for preserving lean mass, which helps maintain strength, independence, and metabolic function. It also supports post-exercise recovery and reduces the risk of sarcopenia (age-related muscle loss).
How to Get Enough Protein
High-quality animal proteins like meat, dairy, and eggs naturally provide all nine essential amino acids needed for muscle maintenance. Plant-based options such as soy and pea protein can also be effective, but it’s important to ensure they offer a complete amino acid profile. Consuming protein after workouts is particularly beneficial for muscle recovery and growth. Dr. Pojednic recommends women aim for 1.2 to 1.6 grams of protein per kilogram of body weight per day, which translates to a more practical target of 80 to 100 grams.
While a food-first approach is ideal, strategic use of protein powders can help women meet their daily protein needs to support strength, metabolism, and longevity. When choosing a protein powder, look for one that contains all nine essential amino acids and has minimal additives, which can cause bloating or gut irritation. “I opt for unsweetened protein powders to limit additives and sweeten them with ingredients I prefer,” states Dr. Pojednic.
What About Collagen Protein?
While collagen supplements are often marketed for skin, hair, and nail health, collagen is an incomplete protein and does not contain all essential amino acids. It should not be relied upon as a primary protein source over complete protein supplements or whole foods.
3) Vitamin D3
Vitamin D3, in conjunction with calcium (next section), plays a critical role in maintaining bone density, muscle function, and overall health. While commonly associated with osteoporosis and osteopenia prevention, vitamin D is essential for many tissues beyond bone, including the muscles, immune system, cardiovascular health, and cognitive function.
“As women age, they experience a decline in skeletal muscle starting around age 30 and bone mass loss after 40, with both reducing at an accelerated rate during and after menopause,” states Dr. Pojednic. “Supplementation with Vitamin D3 can offer support with both muscle and bone health.”
Why Vitamin D3 Matters for Women 40+
Vitamin D3 is vital for calcium and phosphate regulation, ensuring that bones stay strong and muscles function properly. Additionally, estrogen and vitamin D interact to affect bone health, as estrogen regulates vitamin D metabolism. During perimenopause, declining estrogen levels reduce vitamin D’s effectiveness, making adequate intake even more important.
Key Benefits of Vitamin D3
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Bone and Muscle Health
Vitamin D plays a critical role in skeletal muscle function and bone maintenance. Deficiency in vitamin D (<50 nmol/L) is strongly associated with age-related muscle weakness and muscle mass loss. Inadequate vitamin D levels (<29 ng/ml) have been linked to poor lower body function, particularly in women, increasing the risk of falls and fractures. Studies have shown that supplementation with vitamin D3 improves muscle strength and function, particularly in postmenopausal women with insufficient levels.
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Iron Absorption and Recovery
Vitamin D plays a key role in iron regulation by reducing hepcidin levels, which helps improve iron absorption—particularly important for post-exercise recovery. Since training increases hepcidin, which inhibits iron absorption, taking vitamin D after exercise may counteract this effect, reducing the risk of low iron and anemia in active women.
How to Supplement with Vitamin D3
Vitamin D is difficult to obtain from diet alone, as it is naturally found in few foods, including fatty fish, liver, beef, and fortified foods like cereals, dairy, and juice. The body’s main source of vitamin D comes from sun exposure, but in many regions, the sun’s UVB rays are not strong enough to support vitamin D synthesis between October and April.
To ensure adequate levels, supplementation is often necessary. The recommended dose ranges from 800 to 4,000 IU per day, though higher doses can be detrimental to bone health.
“Finding the ‘sweet spot’ is key, as excessive intake of vitamin D offers diminishing returns. Blood testing can help determine individual needs, ensuring levels are sufficient without exceeding optimal ranges,” states Dr. Pojednic.
For best absorption, look for Vitamin D3 (cholecalciferol), the most bioavailable form. Additionally, taking a Vitamin D3 supplement with fat, such as an omega-3 supplement (keep reading for more on this) will enhance its absorption.
4) Calcium
Calcium is a key mineral required for bone rigidity, stability, and muscle contraction, yet many people—especially women—fail to consume enough from their diets. While green leafy vegetables and dairy are excellent sources, many people don’t eat enough of them, and dairy alternatives are often not fortified with calcium. Without sufficient intake, the body pulls calcium from bones, increasing the risk of osteopenia and osteoporosis with age.
“While calcium is crucial for bones, it also plays a role in nerve function, blood clotting, and muscle contractions—making it essential for heart health and overall mobility,” says Dr. Pojednic.
How Much Calcium Do You Need?
The recommended daily intake for women in their 40s is 1,000 mg of calcium per day. “However, balance is key—too little calcium weakens bones, but excessive calcium without proper nutrient pairing may lead to arterial calcification instead of proper bone mineralization,” warns Dr. Pojednic.
5) Omega-3 Fatty Acids (Fish Oil)
Omega-3 fatty acids are essential nutrients because the body cannot produce them, meaning they must come from food or supplements. These powerful antioxidants help scavenge free radicals, reducing tissue damage and supporting cell membrane integrity in every organ. Omega-3s are particularly important for vascular health, keeping blood vessels flexible and reducing the risk of cardiovascular disease and dementia. They also play a key role in brain function, supporting neurons, maintaining myelin, and helping to keep chronic inflammation low.
Why Omega-3s Matter for Women 40+
Estrogen has natural anti-inflammatory properties, offering protection against chronic inflammation throughout life. However, perimenopausal women lose some of this protective effect, increasing the need for anti-inflammatory support through other mechanisms.
Key Benefits of Omega-3s
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Cognitive Health
Omega-3s may help reduce the risk of Alzheimer’s disease by lowering brain inflammation and supporting nitric oxide production, which promotes blood flow to the brain.
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Muscle Health
Research shows that omega-3s enhance muscle protein synthesis and mitochondrial function, helping to counteract sarcopenia. Their anti-inflammatory properties may also aid recovery and improve performance in athletes.
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Inflammation Reduction
Omega-3s help regulate inflammatory cytokines like IL-1 and IL-6, which may support joint health and post-exercise recovery.
How to Supplement with Omega-3s
For optimal benefits, choose high-quality, purified fish oil supplements to avoid contaminants. If possible, prioritize whole food sources such as fatty fish (salmon, sardines, mackerel), which provide a naturally balanced omega-3 profile. While omega-3s have well-documented benefits, most research has been conducted in men, so more studies are needed to fully understand their effects in female athletes and aging women.
6) Fiber
Rather than a supplement, fiber should primarily be consumed in our diet. The current dietary guideline for fiber is 25 grams daily through fruits, vegetables, whole grains, legumes, beans, nuts, and seeds. Fiber is crucial for our gut health, helps to maintain our blood glucose levels and improve insulin sensitivity, and helps to lower LDL (the bad) cholesterol.
“If fiber is not sufficient through diet, I recommend a fiber supplement, such as psyllium husk, inulin, or methylcellulose daily to help you meet the fiber requirements,” says Gray Shimko, RD, leading dietician at the Stanford Menopause and Healthy Aging program.
The Importance of Exercise When Taking Supplements
While supplements like creatine, protein, vitamin D3, calcium, omega-3s, and fiber provide the body with essential nutrients for muscle, bone, and brain health, they cannot replace the need for exercise. Strength training serves as the necessary trigger for muscle growth and adaptation. While protein and creatine supply the raw materials for muscle repair, it is the physical act of contracting muscles through exercise that signals the body to build and strengthen them.
“To effectively build and maintain muscle as we age, women must actively engage in resistance training, as muscle follows a ‘use it or lose it’ principle,” states Dr. Pojednic. “Engaging in resistance training at least two-to-three times per week—whether through weightlifting, resistance bands, or bodyweight exercises—helps maintain muscle mass, improve bone density, and support metabolic health.”
Exercise also improves how the body absorbs and utilizes nutrients, making supplementation more effective. For example, creatine supplementation enhances strength and performance, but its full benefits are only realized when paired with resistance training. Similarly, omega-3s can reduce inflammation and support muscle recovery, but their impact is greatest when muscles are actively engaged in movement.
By combining strategic supplementation with regular strength training, women 40 plus can maximize muscle retention, protect bone health, and maintain cognitive function, ensuring long-term strength, mobility, and independence as they age.
Foundational Nutrition Before Supplementation
Lastly, when choosing supplements, quality and transparency are key. Look for third-party tested products to ensure two critical factors: first, that the ingredients listed on the bottle are actually present and in the correct doses. Second, third-party testing verifies that there are no undisclosed or harmful substances, such as heavy metals or adulterants. While supplements should complement–not replace–a nutrient-rich diet, the 40s decade is a pivotal transition, making it especially important to identify and address any dietary gaps.
“Think of supplementation as the icing on the cake—helpful for optimizing health, but most effective when approached with prudence and balance,” says Dr. Pojednic. “Supplements should be viewed as tools for marginal gains, not miracle solutions. Foundational nutrition—getting enough protein, fiber, and healthy fats from our food—remains crucial.”
For most women, discussions about the pelvic floor are typically tinged with embarrassment. When our pelvic floor muscles (which form a hammock-shaped barrier across the base of the pelvis) are compromised, we can experience a variety of taboo-laden symptoms such as incontinence, constipation, and painful sex. Even though pelvic floor disorders affect twenty percent of women in the U.S. (and more than half of women over 80), many suffer in silence because they are too embarrassed to speak about them, even to their healthcare providers.
“It’s time for us to normalize the discussion,” says Brooke Gurland, MD, FACS, colorectal surgeon and member of the Stanford Medicine Pelvic Health Center. “We don’t talk enough about what happens to women in middle age and beyond. But just like menopause, we need to have more discussions about pelvic floor health with middle-aged women so they can potentially prevent incontinence in their advanced years.”
What is the Pelvic Floor?
Pelvic floor muscles act as a sling that holds the organs within the pelvis in place so they can function correctly. A woman’s pelvis includes organs that serve urinary (the urethra and bladder), reproductive (the vagina and uterus), and digestive (the rectum and intestines) functions.
Pelvic floor disorders (PFDs) occur when pelvic floor muscles and connective tissue are too weak, too tight, or don’t have the coordination to facilitate proper functioning of the pelvic organs. The most common PFDs are urinary incontinence, fecal incontinence, and pelvic organ prolapse (when a pelvic organ drops from its original position).
When Pelvic Floor Muscles are Too Weak
During menopause, women’s estrogen levels begin to decline, resulting in the reduction of muscle mass and decreased capacity for muscle to adapt and recover from strenuous exercise. Also, as we age, we often experience sarcopenia, a decline in muscle mass and function. Women between the ages of 40 and 70 typically lose approximately 25 percent of their peak muscle mass. At 75, a dramatic decline often results in the loss of around 60 percent of peak muscle strength and 30 percent of physical function.
“We need to remember that we are not just losing muscle mass in our arms and legs; our pelvic floor muscles also weaken with age,” says Dr. Gurland. “Just as we need to lift weights in midlife to stay strong and mobile as we age, we also need pelvic floor strengthening activities to potentially prevent PFDs in the future.”
Dr. Gurland’s recommendations for strengthening pelvic floor muscles to reduce incontinence:
- Physical Exercise – Regularly practice Kegel exercises or other exercises that strengthen the pelvic floor, such as Pilates. To perform a Kegel exercise, contract the muscles you use to stop the flow of urine, the muscles of the perineum (located between the vulva and anus), and the muscles around the anus. “The great thing about Kegels is that you can do them while working at your desk, and no one knows you’re doing them,” says Dr. Gurland. “If you’re having trouble identifying the pelvic floor muscles, I recommend putting a rolled-up washcloth underneath the perineum while sitting in a chair and then tightening and pulling up from there.”
- Nutrition – Get enough fiber, whole grains, leafy greens and protein to support a well-balanced diet and benefit overall muscle mass.
Along with age-related strength decline of the pelvic floor muscles, childbirth can also cause weakening. Dr. Gurland shares that in France, pelvic floor physiotherapy is part of post-partum care; however, in the US, that care is not standard and pelvic floor care isn’t addressed until after the patient has a problem.
“I want to send the message that we can be proactive about our pelvic floor health and not wait until something goes wrong,” says Dr. Gurland. “PFDs are more common than you think, and you should talk to your provider about what you can do now to reduce their severity as you age and improve the quality of your life into your 80s and 90s.”
When Pelvic Floor Muscles are Too Tight
Although we don’t want our pelvic floor muscles to be weak, we can also experience PFDs when they are too tight. Symptoms of tight pelvic floor muscles include constipation or difficulty emptying the bowels, anal fissure and hemorrhoids, difficulty urinating and painful sex. Chronic stress and trauma can contribute to the pelvic floor muscles being too tight
“People tend to know about strengthening the pelvic floor, but many don’t understand that it’s equally important to relax the pelvic floor muscles to urinate and defecate properly,” says Dr. Gurland. “For example, some people can’t go to the bathroom in public. They feel too anxious, which causes the muscles to tighten up. There’s a mind-body connection. When we are too stressed in the mind, we aren’t able to relax the pelvic floor muscles in the body.”
Dr. Gurland’s recommendations for relaxing pelvic floor muscles and relieving constipation:
- Stress Reduction – Take deep breaths and visualize breathing into your pelvic floor to relax these muscles before going to the bathroom. Try a full body scan.
- Elevate Feet – When sitting on the toilet, putting the feet onto blocks or a toilet stool can relax the rectal muscles so you can defecate without straining. “You want to avoid straining to prevent hemorrhoids and prolapse,” says Dr. Gurland.
- Toileting Time – Carve out time in the morning to relax the body and defecate before starting your workday. “I recommend waking up an hour earlier, having a glass of water, and relaxing so your body can go to the bathroom. If you’re waking up last minute and running out the door, your body doesn’t always comply,” says Dr. Gurland.
- Nutrition – Drink adequate water daily and consume enough fiber in your diet.
What is Pelvic Floor Physical Therapy?
Regarding our pelvic floor, we can take a cue from Goldilocks. We don’t want them too weak or too tight, so how do we get them “just right”?
“When we talk about pelvic floor health, we consider not only the tightness and weakness but also the coordination of the pelvic floor muscles,” says Dr. Gurland. “For proper rectal functioning, the muscles must be coordinated enough to ‘hold it’ until you’re in the right place, then relax when the time is right.”
Unfortunately, many common things can lead to a loss of coordination of the pelvic floor muscles, such as nerve damage caused by chronic straining, childbirth injuries, back surgery, and radiation.
To help patients have more pliable and coordinated pelvic floor muscles, or that “just right” level of competence in their bladder, bowel, or sexual functioning, Dr. Gurland refers them to a Pelvic Floor Physical Therapist who offers exercises to strengthen, relax, and retrain their pelvic floor muscles to contract properly. This therapy is also recommended for pregnant and postpartum women.
“It is important for the provider and patient to have a good relationship because the work is very personal,” says Julia Barten, DPT, Pelvic Rehabilitation Practitioner at the Stanford Pelvic Health Center. “It may take a few sessions to fully figure out proper control or coordination for pelvic floor muscles and sometimes multiple techniques are required to find the best treatment plan. It helps when there is good communication and the patient has an open mind to treatment recommendations, however, if a patient is not comfortable with a recommendation, it is always best to speak up so that the therapist can modify the program to something that is effective for the individual.”
Pelvic Floor Exercises
1) To strengthen pelvic floor muscles (to prevent incontinence, organ prolapse):
Before starting the exercise, Barten emphasizes the importance of isolating the pelvic floor from other muscles (such as abdominal or gluteal) when building strength. She recommends practicing long holds as well as quick squeezes to address endurance, coordination, and flexibility. Even with quick squeezes, she stresses the importance of full relaxation between each squeeze.
“Pelvic floor strengthening is more than just squeezes. To strengthen the muscles effectively, they must contract and relax within a full range of motion,” says Barten. “Complete relaxation between each contraction is necessary to effectively build strength.”
Barten recommends these videos for pelvic floor strengthening:
- Pelvic floor isolation: https://youtu.be/LZpovAEIjBU
- Pelvic floor endurance holds: https://youtu.be/mu57PQ5-S64
- Pelvic floor quick squeezes: https://youtu.be/tFi_iAVknnc
2) To relax pelvic floor muscles (to relieve constipation, painful sex):
“Pelvic floor relaxation can be very difficult to sense,” says Barten. “There are ways to gently stretch your pelvic floor with breath and yoga stretches. It is also possible to gently drop the pelvic floor or bear down to actively lengthen the muscles.”
Barten recommends these videos for pelvic floor lengthening and relaxing:
- Diaphragmatic breathing for pelvic relaxation: https://youtu.be/FrJowV5-k1I
- Pelvic floor drop: https://youtu.be/9tA1Hak7y9M
- Pelvic Relaxation Stretches: https://youtu.be/ULepx3e9frU
3) To increase coordination of pelvic floor muscles (to improve incontinence):
Barten says that coordination of pelvic floor muscles is best assessed with an exam and individualized recommendations, but home biofeedback devices (i.e. Kegel exercisers or trainers) can also be helpful. These devices can be purchased over the counter and inserted vaginally to improve a woman’s awareness and control over her pelvic floor muscles.
Lastly, Barten is passionate about breaking the stigma of talking about pelvic floor issues and enjoys creating musical videos to spread awareness about the pelvic floor and bring some humor to the topic. Here she sings about “The Kegel Routine” while parodying a song from the musical Hamilton.
By Yasaman Nourkhalaj, BS and Sharon Brock, MS, MEd
If you’re in your 50s, you might have noticed that simple tasks like getting up from the floor or cleaning the bathroom aren’t as easy as they used to be. For decades, women have been bombarded with messages about getting thinner. But around the age of 50, the focus should shift from losing weight to gaining strength. Building muscle isn’t just about looking strong – it’s about living strong and extending your longevity.
The Link Between Age and Muscle Mass
Starting around age 30, muscle mass begins to decline at a rate of about .5 percent per year. When we reach age 50, that rate increases to 1 to 2 percent per year, then increases again to roughly 3 percent per year starting at age 60. This attrition of muscle mass is especially critical for women because estrogen plays a key role in muscle and bone health. The reduction of estrogen levels during perimenopause and menopause accelerates the onset of sarcopenia (age-related loss of muscle mass) and osteoporosis making strength training even more essential as women age for long-term health.
The head of Stanford Lifestyle Medicine Healthful Nutrition pillar, exercise and nutrition scientist, and health researcher Marily Oppezzo, PhD, explains why strength training is essential for women over 50.
“An important thing we can do for our longevity is strength train. And that is true for every age—even if you start training at age 102,” says Dr. Oppezzo. “During menopause, declining estrogen levels directly impact muscle maintenance and development. This natural process can accelerate muscle loss–but here’s the good news: strength training can certainly help combat these changes.”
5 Strength Training Movements for Women 50+
According to Dr. Oppezzo, an effective strength training program should include exercises that have these fundamental movements:
- Push movements to strengthen the chest (example exercises: wall push-ups, push-ups with knees on the floor, chest presses with weights)
- Pull movements to strengthen the back (example exercises: resistance band rows, rowing machine)
- Squat movements to improve ability to sit and stand (example exercises: chair squats — option to wear a backpack with a bottle of water for increased weight)
- Hinge movements to protect your back during daily activities (example exercises: hip bridges, dead lifts with weights)
- Single-leg movements to equalize strength in both legs (example exercises: step-ups onto a raised platform, single-leg sit-and-stand from a chair)
Sample Strength Training Routine for Women 50+
Here is a sample strength training routine recommended by Dr. Oppezzo for women over 50 to be performed two to three times per week:
- Chest Press: While lying on a bench hold your dumbbells in both hands with bent elbows, and push weights straight up toward the ceiling. 3 sets, 8 repetitions.
- Resistance Band Row: Wrap a light-medium resistance band around a pole or your feet. Sit on the ground and pull back the bands in a rowing motion, keeping elbows close to the body and hands at the waist, squeezing the back muscles together. 3 sets, 8 repetitions.
- Chair Squats: Bring hands together at your chest and slowly sit into a chair with a neutral spine (don’t arch or round) and strong core. Touch your butt to the seat bottom, but do not sit all the way into the chair. Stand back up again. 3 sets, 8 repetitions.
- Deadlift: Stand with feet hip width apart. Hinging at the hips with a slight bend in the knee, and keep your back straight, shoulders neutral (not rounded or excessively arched). Engage your core. Slide the weights down the line of your thighs and legs only as far as you can go without rounding your back. Slowly exhale as you stand up. The power to stand up comes from driving your hips forward. Keep your weights close to your body the whole time. You can practice this by rolling a foam roller down your legs with your hands to practice good form. 3 sets, 8 repetitions.
- Step-ups: Set up a 1-foot-high platform (using a box or stairs) and step onto the platform with one leg and lower the body slowly. 3 sets, 8 repetitions.
*Dr. Oppezzo recommends that you perform the exercises without weights first to master proper form.
How to Get the Most Out of Your Strength Training Routine
How many reps you should do:
“Reps in reserve” is a way to estimate how close you are to your max effort. Once you learn the moves, you will want to train so your sets leave you with “2 reps in reserve”, meaning you stopped feeling like you could do 2 more repetitions in good form, but that’s it.
How to choose your weights:
- Start Light. Begin with a weight that feels easy. Use the first set to warm up and estimate what you will use for the exercise.
- Gradually increase the weight until you can do 8 and 10 repetitions with good form but high effort.
- Check in with yourself: If after you’re done, you could have done more than 2 repetitions in good form, increase the weight. But, if after you’re done, you could NOT have done 2 more repetitions, it may be too heavy. The sweet spot is: if after you’re done, you could have done just 2 more repetitions with good form, you’ve got the right weight for you right now.
“To get stronger, you need to slightly increase the difficulty of the exercises each time you do your workout,” says Dr. Oppezzo. “You’re not going to get stronger if you do the same thing every time.”
How to gradually increase the difficulty of the exercises over time:
- Increase the weight (e.g., When the 5-pound weights become too easy, increase the weight to 8 pounds, then 10 pounds, and so on).
- Add an extra set of the exercise (e.g., Rather than only 3 sets, add a fourth).
- Increase the number of repetitions (e.g., When 8 reps become too easy, increase to 10 reps, and then progress to 12. When you’re able to do 12 reps without too much effort, it’s time to increase the weight).
- Slow down the tempo for each rep, especially on the “eccentric” or lengthening part of the movement.
“Be sure to wait 24 hours between strength training sessions to prevent injury and allow for muscle repair and recovery,” says Dr. Oppezzo. “Don’t do heavy strength training of the same muscle group on back-to-back days.”
The Importance of Protein to Build Strength
Proper nutrition is crucial for muscle development, particularly adequate protein intake. When we are strength training, our bodies need the raw material that protein provides to build muscle mass. Research shows that adults should aim to consume 1.2 to 1.6 grams of protein per kilogram of body weight, which translates to roughly 80 to 100 grams per day. Protein can come from both animal and plant-based sources, and Dr. Oppezzo recommends consuming protein throughout the day rather than having just one high-protein meal.
“Building muscle effectively requires both consistent strength training and adequate protein consumption,” says Dr. Oppezzo. “In order hit that 80 to 100 grams per day mark, we should try to consume 20 to 30 grams of protein at every meal.”
Strength Training for Longevity
Strength training isn’t just about lifting weights, it’s about lifting your quality of life. Whether you want to keep up with grandchildren, maintain independence, or simply feel stronger in your daily activities, it’s never too late to start. “If starting a weight training regime feels overwhelming, start with ‘strength snacks,’ which are short bursts of exercise throughout the day. Start small and focus on consistency over intensity, and track improvements in daily activities rather than just numbers on weights,” says Dr. Oppezzo.
“Start where you are, use what you have, and celebrate every small victory along the way. Your future self will thank you for the strength you build today,” says Dr. Oppezzo.
By Maya Shetty, BS and Sharon Brock, MEd, MS
“Salud!” If you’ve ever raised a glass to your health, you’re not alone. For decades, many have believed that minimal alcohol consumption is potentially beneficial for your health. However, not every researcher would agree. A growing body of evidence reveals health concerns about alcohol use, making it crucial to understand the spectrum from harmless to harmful levels of consumption to keep your body healthy.
“Alcohol will impact everyone’s health differently,” says Douglas Noordsy, MD, Clinical Professor of Psychiatry at Stanford University School of Medicine and Assistant Director of Stanford Lifestyle Medicine. “Rather than a daily habit, drinking alcohol should be seen as an indulgence, something you have once in a while to celebrate.”
Experts have conflicting views regarding how much alcohol carries risks. Some believe that drinking in moderation is safe, while others believe that even light drinking can cause harm.
“While many believe light to moderate alcohol intake is safe and even healthy, this reality is far from true,” states Cindy Kin, MD, a colorectal surgeon and Associate Professor of Surgery at Stanford University. “In fact, no level of alcohol can be considered beneficial for our health.”
Isn’t One Glass of Red Wine Good for the Heart?
“Studies have gone back and forth, with some suggesting potential cardiovascular benefits of light drinking, while others point to increased risk of cancer and liver disease even when consumed at low intake levels. As a result, many are confused about headlines proclaiming alcohol as either good or bad for health,” says Dr. Noordsy.
The origin of this belief traces back to the 1980s, rooted in a concept known as The French Paradox–the observation that despite consuming a diet high in saturated fat, France had a low incidence of heart disease. Researchers of the era decided that this unexpected trend was attributed to the widespread consumption of wine in the region. This correlation led to extensive research into wine and the identification of polyphenols, thought to be responsible for wine’s apparent cardioprotective potential.
Since then, numerous observational studies have claimed that light to moderate wine intake has beneficial effects. “However, these studies overlooked some crucial factors,” says Dr. Kin. While early observations indicated poorer cardiovascular outcomes for non-drinkers than for moderate drinkers, researchers overlooked that many non-drinkers abstained due to existing health conditions that led to overall poorer health outcomes. Additionally, those self-identified as light drinkers were more likely to lead healthier lifestyles overall. This oversight has fostered a misleading impression that associates better cardiovascular outcomes with light drinking, falsely implicating alcohol as the causal factor. As a result, enjoying a glass or two of wine a day has become widely accepted as a healthy habit.
While red wine contains antioxidants like resveratrol, found in grape skins as well as in peanuts, dark chocolate, and blueberries, which might have heart-healthy benefits like reducing cholesterol and lowering blood pressure, the quantities are often misunderstood. To achieve the levels of resveratrol observed beneficial in mice studies, one would need to consume an impractical amount of red wine—somewhere between a hundred to a thousand glasses daily. Thus, while the idea of resveratrol’s benefits is enticing, the practical reality makes it an unrealistic source for therapeutic effects.
How Much Alcohol is Too Much?
Many people believe alcohol becomes a concern only when consumed excessively. “Excessive alcohol use” is defined as exceeding the US Dietary Guidelines’ recommendations, which advise males to limit themselves to two drinks per day and females to one drink per day, on average. Two-thirds of adult drinkers report drinking above this level at least once a month.
However, a growing body of recent research shows that even modest quantities of alcohol can be harmful to our health. Such consistent findings have prompted the World Health Organization to assert that “when it comes to alcohol consumption, there is no safe amount that does not affect health.”
The main issue with alcohol is that it enters the bloodstream and quickly spreads throughout the entire body (especially when consumed without food). Unlike most substances, alcohol is both water- and fat-soluble, allowing it to permeate nearly every cell and tissue, including the highly secure blood-brain barrier that protects our central nervous system.
While the liver does most of the alcohol metabolism, other organs also process alcohol, such as the kidneys and lungs. As our organs work to break it down into a usable fuel source, acetaldehyde is produced, which is toxic due to its ability to damage and kill cells indiscriminately. As acetaldehyde enters the brain, it causes a disruption in our neural circuitry that creates the sensation of “tipsiness” associated with alcohol. And, the more “tipsy” one feels, the greater the amount of toxic acetaldehyde in the blood.
Rather than following strict guidelines about how much to drink, Dr. Noordsy recommends that individuals take note of their personal perceptions of intoxication and pace themselves accordingly. He recommends using the feeling of being “tipsy” as the signal to slow down or stop drinking. “The ‘tipsy’ feeling is the indicator that blood alcohol levels have risen to the point that you’re starting to put your health at risk. And the more ‘tipsy’ you become, the higher the risk,” states Dr. Noordsy. “If you’re having alcohol with food, your blood alcohol level won’t be as high as compared to having drinks by themselves. So, if you’re enjoying a glass of wine as part of your meal, that’s a very different thing than drinking in a way that’s leading to the feeling of intoxication.”
Health Concerns Linked to Alcohol Use
Recent data from the World Health Organization reveals that each year, alcohol contributes to three million deaths globally and accounts for 5.1 percent of the worldwide burden of disease and injury. Alcohol’s detrimental effects span more than 200 disease and injury conditions, encompassing everything from alcohol dependence and liver cirrhosis to a range of non-communicable diseases (such as heart disease, cancer, chronic respiratory disease, and diabetes) and mental health disorders.
Liver Disease
Acetaldehyde, a derivative of alcohol metabolism, inflicts significant harm on the body’s cells, especially within the liver. Given the liver’s primary role in detoxifying our bloodstream, it bears the brunt of the detrimental effects of alcohol metabolism. This continual strain can result in the buildup of fat, chronic inflammation, and potentially irreversible damage to the liver.
A study analyzing the livers of 3,649 participants discovered a concerning correlation: as daily alcohol intake increased, so did the accumulation of fat in the liver. Alarmingly, no identifiable threshold existed below which these harmful effects were absent, suggesting that even individuals who consume alcohol in minimal amounts are not immune to the accumulation of liver fat.
Fat accumulation hinders the liver’s vital metabolic functions, including blood sugar regulation, cholesterol processing, and nutrient absorption. It also increases the risk of inflammation around the liver, known as alcoholic hepatitis.
“The good news is that abstaining entirely from alcohol can reverse these changes, however, continuing to drink alcohol can lead to irreversible damage, scarring, liver dysfunction, and in advanced cases, liver failure,” states Dr. Kin. “This is especially concerning because fatty liver often presents no early symptoms, with individuals potentially unaware until it advances or results in serious complications.”
Another important consideration is that people who have non-alcoholic fatty liver disease, caused by obesity and other metabolic syndromes, have a much higher risk of developing alcoholic liver disease.
“This means that even small amounts of alcohol will cause the same level of alcohol-related liver disease (fibrosis, cirrhosis, etc.) as would larger amounts of alcohol consumed by someone without underlying fatty liver,” explains Dr. Kin. “Therefore, people who are already dealing with metabolic diseases should be extra cautious around alcohol because their livers are working extra hard already.”
Cancer
Alcohol is designated as a carcinogen by the International Agency for Research on Cancer due to its association with higher risk for many common cancers.
“Alcohol increases cancer risk specifically in areas it is in close contact with, such as the mouth, pharynx, and digestive tract. It also has carcinogenic effects throughout other parts of the body,” states Dr. Kin.
Underlying its harmful effects, chronic inflammation from alcohol consumption elevates cell turnover, heightening DNA mutation risks. Additionally, alcohol is believed to promote tumor growth while inhibiting tumor-suppressive molecules.
In 2017, the European Union reported nearly 23,000 cancer cases tied to light to moderate alcohol use, with half attributed to female breast cancers. Even at levels as low as three drinks per week on average, there is a slight but measurable increase in breast cancer risk. Notably, raising daily alcohol intake by just 10 grams—equivalent to what’s in a standard beer or wine—escalates the risk of breast cancer by 10 percent.
Cardiovascular Health
Despite popular belief, alcohol consumption, regardless of the amount, is linked to an increased risk of cardiovascular disease. A comprehensive study of 371,463 individuals found that as alcohol consumption increased, so did the risks of conditions like hypertension and coronary artery disease. Light alcohol intake (less than 8.4 drinks per week) led to a minimal but noticeable increase in cardiovascular risk. Researchers also found that when accounting for various lifestyle factors, the perceived protective benefits of modest alcohol intake against cardiovascular risks diminished significantly.
There are numerous reasons hypothesized for these detrimental effects, especially surrounding the metabolic effects of alcohol. “Alcohol offers no nutritional benefits; it’s essentially empty calories that are consumed on top of the calories required by your body. On top of this, alcohol interrupts the body’s regular metabolic functions. As the body prioritizes removing this toxic substance, it compromises processes like nutrient absorption and fat metabolism. This disruption promotes the storage of visceral fat, the harmful fat surrounding organs,” explains Dr. Kin. “This fat increases inflammation and poses significant risks, especially around the heart.”
Hormone Imbalance
Alcohol consumption raises estrogen levels in both males and females by increasing the activity of the enzyme responsible for converting androgens to estrogen. This accelerated conversion can lead to issues like gynecomastia (enlarged breasts in males), decreased libido, and increased fat accumulation. Additionally, consistent alcohol exposure can reduce testosterone levels over time, which is associated with reduced libido, fatigue, decreased bone density and muscle mass, and potential fertility issues in both males and females.
Additionally, regular alcohol consumption of more than 3.5 drinks per week for males and 2.6 drinks per week for females can cause chronic changes and reduced control of the hypothalamic-pituitary-adrenal axis. This disturbance may lead to an increase of the stress hormone cortisol released throughout the day.
Microbiome Issues
Alcohol also disrupts the gut microbiome by killing beneficial bacteria and other essential microbes. Additionally, alcohol’s pro-inflammatory properties trigger the release of inflammatory cytokines, causing gut inflammation and making the intestinal lining more permeable. This increased permeability can allow undigested food particles to enter the bloodstream. Over time, chronic alcohol consumption can further imbalance the gut microbiome, promoting bacterial overgrowth and dysbiosis. These disruptions can trigger immune responses, increasing susceptibility to food intolerances.
Brain Health
When alcohol is consumed, it enters the brain and suppresses neural networks involved in memory formation and storage. Through chronic consumption, this disruption can have permanent effects. A study involving over 36,000 middle-aged adults revealed that even moderate drinkers, consuming one to two drinks per day on average, displayed thinning of the neocortex and other brain regions, indicating neuron loss. This research also found that increased alcohol consumption correlates with diminished brain volume and reduced gray matter, which are the areas of the brain highly concentrated with neurons. As alcohol intake rose, so did the severity of these detrimental effects.
Fortunately, for most casual drinkers, abstaining from alcohol for two to six months can reverse damage to the prefrontal cortex and neural circuitry. However, chronic users may only experience partial recovery and might endure lasting effects.
“As alcohol consumption increases, so does one’s risk of cognitive decline and dementia,” states Dr. Noordsy.
Mental Health
As anxiety and depression continue to rise in the US, alcohol use also increases as individuals self-medicate to reduce stress. Also, the nightly glass of wine may cause more stress the following day since it impairs cognitive and physical performance, reducing one’s ability to cope. “During the pandemic, we observed a startling rise in cases of alcohol-induced hepatitis, indicating a growing reliance on alcohol as a coping mechanism,” says Dr. Kin.
One study, however, showed that light to moderate alcohol consumption may be beneficial to mental health by offering short-term relief by reducing stress signals in the brain. Although Dr. Noordsy acknowledges this study, he states that “learning to manage stress through physical exercise, mind-body and mindfulness practices can lead to safer and likely more effective mediation of impacts of stress than relying on alcohol use.”
Is There a Healthy Way to Consume Alcohol?
Given the extensive research on the detrimental health effects of alcohol, both Dr. Kin and Dr. Noordsy recommend abstaining from alcohol, or at least drinking very rarely, if one is experiencing or has a family history of liver disease, cancer, cardiovascular disease, hormone imbalances, gut microbiome issues, dementia, or mental health disorders, including addiction.
The precise amount of alcohol that is harmful is difficult for experts to confirm because it’s different for each person. Therefore, when it comes to alcohol and health, Dr. Noordsy recommends a balanced, personalized approach keeping in mind one’s individual risk factors and health goals.
“While heavy, regular consumption is linked to health problems, an occasional drink with meals may pose little risk for most adults,” says Dr. Noordsy. “However, individuals with personal or family histories of certain cancers or other conditions may need to be more careful with alcohol intake. We put thought into our nutrition and exercise habits, and we need to be just as thoughtful about the role that alcohol plays in our lives and make informed decisions regarding how much is the right amount for ourselves.”
Although less inclined to recommend light alcohol consumption, Dr. Kin acknowledges that it is an ingrained part of people’s social and cultural lives, similar to many other things that individuals consume that do not contribute to health. So, she encourages individuals to reframe their mindset around alcohol.
“Rather than viewing alcohol as a daily routine, consider it a treat reserved for special occasions or celebrations, much like enjoying a slice of birthday cake,” she says.
