American gynecologist and obstetrician, an international reference in women's health and longevity, author of the book 'Generation M: Living Well in Perimenopause and Menopause' and a regular contributor to top-rated television programs such as 'Good Morning America', Jessica Shepherd stands out for her evidence-based integrative approach to hormonal health, sexual well-being, and preventive medicine.
A member of the recently established International Scientific Advisory Council of SHA —comprised of highly esteemed experts in the field of health, whose mission is to oversee the scientific basis and innovative evolution of this global reference in longevity, with locations in the Spanish Mediterranean and Mexican Caribbean, and soon in the United Arab Emirates—, Dr. Shepherd argues that "longevity must fully integrate women's health in all stages of life", an approach in which, she adds, "SHA is uniquely positioned to drive sustainable, comprehensive change aimed at true health optimization".
Traditionally, menopause has been almost exclusively approached as a reproductive transition. Why has it taken so long to change that view from a medical perspective?
I believe this is deeply related to how society has historically perceived women. For a long time, their value has been almost exclusively associated with their reproductive years. When that stage ends, an implicit question arises: "what place do women occupy now?", especially regarding their health. Understanding what happens next requires research, data, and a perspective that takes into account how life evolves physiologically after the end of the fertile stage. However, for decades the opposite has happened: there has been a notable lack of attention and knowledge. To this is added the social component. Menopause has been surrounded by silence and, in many cases, shame. What was happening was not talked about out of fear, modesty, or simply because the environment did not facilitate those kinds of conversations. As a result, this issue remained invisible for a long time. Fortunately, today we are experiencing a moment of change. Women's health is beginning to take the place it deserves, gaining prominence in both research and social debate. More and more, women feel they can openly discuss this stage, and when given space, the conversation naturally arises. Hormones have ceased to be a taboo subject, and we now have a much stronger scientific basis on their long-term health impact. This allows us not only to offer women a space to understand and live through this phase naturally and proudly but also to provide them with tools and resources to help cushion or manage the effects of hormonal fluctuations.
All this 'revolution' was much needed and is fantastic, but... To what extent are we helping women or making them feel as if they are sick? Are we medicalizing menopause?
Yes, and sometimes, when we talk about symptoms, it may seem like there is something 'wrong' with us. All women will go through menopause, and the symptoms discussed are real. But the key lies in how we communicate that reality. It is true that when something starts to become visible, it generates a lot of conversation, which can be positive because many women identify with it, thinking "that happens to me too." However, it can also give the feeling that there is something not working well within them. Therefore, the message needs to be refined. Biologically, menopause is a natural transition. Symptoms may or may not occur, but it is part of life. The important thing is that we now have the tools to accompany this process, instead of conveying that it is something negative. I believe that in the coming years, we will better adjust this language and narrative. It is true that we are still in an early stage, but there are many professionals committed to changing that perception. The goal is for women to be able to experience menopause normally, without feeling sick, and if they experience symptoms, to understand that it is natural and that there are solutions.
One of the least talked about things is, precisely, your specialty: how the brain changes during this stage...
During menopause, numerous changes occur in the brain, mainly as a result of the decrease in hormones such as estrogen, progesterone, and testosterone. These hormonal variations not only affect brain health but also what we call emotional resilience. For example, mood regulation and memory - processes linked to the hippocampus - are altered with the drop in estrogen levels. This helps explain the increased incidence of anxiety and depression during this stage. Likewise, sleep quality is also compromised due to sleep disorders, which directly impacts the body's recovery capacity. Together, all these changes highlight the importance of the role of hormones. It is no longer just about isolated symptoms but a global experience that affects the entire body. The available evidence increasingly points to potential beneficial effects, not only during the transition but also in the long term. However, obviously, the decision to use hormonal therapy or not remains personal.
Exactly, that was my next question: can hormonal therapy become a longevity tool for women?
Yes. When we talk about longevity, we must understand that, as mentioned earlier, menopause had long been reduced to a purely reproductive issue. However, today we know that there are estrogen, progesterone, and testosterone receptors throughout the body: in muscles, bones, intestines, heart, and of course, in the brain. Therefore, when these hormones decrease, all these organs are affected. Currently, women live longer than ever, but there is a critical period - about 15 to 20 years, roughly between 50 and 70 or 80 - where many diseases begin to appear. That 'gap' has much to do with not having the right hormonal levels. Why? Because, as a result, bone density decreases, leading to osteoporosis; muscle mass is lost, causing frailty; and brain health is also affected, with sleep problems and cognitive decline that can lead to dementia. Achieving hormonal balance during menopause is essential for living longer and better.So, are there strong links between women's hormonal health and the evolution of certain neurodegenerative diseases?
Indeed. Hormones play a fundamental role in brain health. Therefore, upon reaching menopause, it is important to go beyond treating visible symptoms, such as hot flashes, to adopt a broader approach focused on education, prevention, and a deep understanding of hormonal impact on the body.
A curiosity. Is that very feminine tendency to do several things at once a mental dispersion or a search for efficiency?
The female brain is highly complex and functions in a particular way, influenced not only by biological factors but also by social learning. Traditionally, women have been taught to manage multiple tasks simultaneously, while many men tend to focus on one task at a time. Although these differences are not absolute and generalization can be misleading, they do reflect widely acquired behavioral patterns. This reality makes it particularly challenging for many women to pause and take a break, as they have been educated to do everything at the same time. However, this multitasking ability, along with the difficulty in focusing on a single activity, can have implications for cognitive health.
What are those 'implications'?
As various experts point out, these factors - combined with the aforementioned hormonal changes - can contribute to a higher risk of cognitive decline. In this sense, it is important to emphasize that there is no single cause that explains diseases like dementia or Alzheimer's, but rather a complex interaction of multiple elements. Among them are the decrease in estrogen levels, difficulties in maintaining sustained attention, and the tendency to process multiple stimuli simultaneously. This combination helps understand why the risk of developing Alzheimer's is higher in women, especially during and after menopause. Current research also indicates that the reduction of estrogen affects glucose metabolism in the brain, favoring alterations in its processing and utilization. This aspect is crucial because estrogen has a significant neuroprotective effect. When its levels decrease, this protection weakens, which can accelerate processes associated with cognitive decline.What will be your contribution to the new scientific committee of SHA?
As I mentioned earlier, for me, it is essential that women's health units emphasize education: explaining why these therapies are important and how they influence the way we live. SHA offers a unique environment because it allows for pausing and having a team dedicated to helping you build a personalized plan. It is also important to change certain ideas, such as thinking that women cannot or should not develop muscle. The focus on nutrition needs to be adjusted, looking for what works best for digestive and brain health. And, of course, there are hormones, which I believe will remain a very relevant - and also controversial - topic in the coming years. To progress, we need to continue generating evidence, sharing it with women, and offering them personalized tools to adapt treatments to their needs to live the best possible life.