Two Studies, One Powerful Diet, and My Birthday
April Midlife Roundup [2025]
I often come across newly published studies on social media, and two of the most recent ones are top of mind.
The first headline I saw on Instagram, “Menopause Drives Inflammation,” caught my attention. It was a study that examined inflammatory markers in women going through menopause.
I saw several posts and shares about the same study, and many scary sounding soundbites about how detrimental menopause is.
The second study appeared in an Instagram story, where the influencer highlighted a study linking hormone replacement therapy (HRT) to tau accumulation in the brain
The influencer dismissed it as “fearmongering.” The only other post I found criticized the study because it was observational.
Beyond that, and unlike the first study (also observational), social media was radio silent. I saw some women make comments about the study, but no one in the menopause space seemed to be talking about it.
This happens a lot. Studies that fit the narrative get all the attention. Studies that don’t, not so much.
But don’t we need to look at all the data to figure out the best way forward?
So, I looked up both studies and wanted to provide all the relevant details to you. That and some other news are in this month’s roundup.
Study #1: Menopause and inflammation
This study, published in the Journal of Clinical Endocrinology & Metabolism, is from the SWAN cohort, which followed women through the menopause transition. Researchers recorded at least three measures of high sensitivity C-reactive protein in 1470 women (hs-CRP) or interleukin 6 (IL-6) in 779 women.
At 21 years follow up, the researchers identified three trajectories for these inflammatory markers.
1) Low-rise
2) Medium-stable or medium rise
3) High-decline or High-stable
The low rise showed significant increases of both markers at the year before the final menstrual period (FMP) and as late as 3 years after the FMP. The medium rise only saw in increase in IL-6.
The other trajectories showed either no change or a decline around the FMP. The soundbite, “menopause drives inflammation,” seems a bit misleading.
Yes, women with a low CRP may see rises around menopause. Sex hormones work as potent antioxidants and stimulate nitric oxide, taming the One Health Principle.
But those with an already elevated levels of inflammatory markers did not see an increase which I find interesting. This may be because of the healthy cell bias theory that estrogen has positive effects in a healthy body, but not so much when inflammation is already present.
We also know that hormonal changes can trigger other pro-inflammatory causes like elevating homocysteine and uric acid. But I’ll leave that for another post.
Study #2: Tau accumulation
A study in Scientific Advances looked at 146 healthy women, comparing those with a history of HT use and those without.
Average age of initiation of HT use was 55 and duration 7.5 years. And for the older women (>70) there was an average of 14 years after initiation of hormone therapy.
Researchers scanned the women’s brains for over 4.5 (AB) and 2.5 years (tau). HT users showed faster tau accumulation in the brain compared to non-users with an indirect effect on cognitive decline.
Younger women (<70) did not show this same effect.
Before digging into age and timing, I am stuck with a big old WHY. I mean, why wouldn’t it just be neutral in older women? What is increasing this risk?
I have my theory. It comes back to the FREED lab’s emerging research showing high, constant estrogen may hurt tiny blood vessels.
Small vessel disease, more common in women, not only increases dementia risk but also contributes to increased tau accumulation.
And that leads me to another study.
The over 65 crowd
In the tau study, researchers offer an explanation for the results. They suggest these older women may have received outdated prescriptions/routes, begun treatment at older ages, and had higher dosages.
This is because prescribing changed after the Women’s Health Initiative.
Some studies show that older women who start HRT, experience an increased risk of dementia. Although the timing hypothesis is a factor, I always wonder how this affects women who stay on hormone therapy until older age.
I come back to a large study that looked at women up to 65 on hormone therapy. What’s so nice about this study is they separate out results into type of hormones, route, and dosages.
You can read the details about the study here, but when I looked at it again, low doses of estrogen had a slightly decreased risk of dementia, while medium and high doses show increases.
As we get older, it’s important to know which hormone therapy works best and is safest. These studies can help us get there.
But we can’t do this if we just dismiss them. And I still see very prominent doctors saying hormone therapy protects against dementia, when the reality is these studies are very mixed.
I worry that with all the hype about physiological levels of hormones that we are heading in the wrong direction with older women. Of course, this is just a theory and we need more research to figure it all out.
In general, risk reductions appear to be greater with low rather than medium or high doses, vaginal or transdermal rather than oral preparations, and with E2 rather than CEE as emphasized by others.
- Baik et al, Menopause, 2024
Is there a best diet at midlife to be disease free at 70?
There were many headlines about a new study on diet in midlife and health in your 70s.
Researchers followed 105,015 participants, mostly women, for 30 years. Roughly, 23% remained free of 11 chronic conditions, 28% maintained intact physical function and 34% maintained intact cognitive function by 70.
To look at the role of diet, the researchers examined long-term consumption of eight different dietary patterns including the Alternative Healthy Eating Index (AHEI), Alternative Mediterranean Index (aMED) and the Dietary Approaches to Stop Hypertension (DASH) among others.
The AHEI showed the highest odds of healthy aging among all the dietary patterns. This association was stronger in women than men, and in smokers and those less physically active.
Those with the highest AHEI score were 86% more likely to achieve good health at 70 and were 2.24 more likely at age 75. Harvard nutritionists developed the AHEI, which gives a nutrient density score to different foods.
High-scoring foods included fruits, vegetables, whole grains, nuts and legumes. Low-scoring foods include red and processed meats, refined grains and sugary drinks.
Interestingly, in the study researchers identify different foods and how they relate to healthy aging (see list great is better than red). Ultra processed foods were low on the list, but food away from home and fried food showed benefit. They speculate that it could be because of the social aspect.
Eating doesn’t need to be complicated. This tells us we benefit from increasing nutrient-dense foods where you can.
Plant foods in particular are high in antioxidants and polyphenols, and feed a healthy gut, which helps tame that inflammation.
READ: Why Plant Foods?
Another birthday
My 56th birthday was on Saturday. It happened to be during my daughter’s last high school musical, so we rented out a place close to her school.
I started my morning with a long run with friends. Like we always do on birthdays, we ended with some mimosas and cupcakes.
Then I went shopping with my daughter and we celebrated before going to see her show, which was amazing.
While I’m not sure I’m officially menopausal, I’m pretty darn close. I just had inflammatory markers checked because I have a history of ulcerative colitis and there no signs of inflammation yet.
Everything I’ve learned on this journey I’ve applied from meeting my micronutrient needs to strength training, to boosting nitric oxide and strengthening my breathing.
I am going to get more extensive tests done and weigh the pros and cons of systemic hormone therapy as I’ve written before about this decision. And I’m already on vaginal estrogen.
But mostly I’m grateful. Grateful for feeling good at this stage in my life and eager to help other women see midlife with more clarity.
It’s really not as confusing and contradictory as all these messages seem – and women deserve to know about all the latest findings.
So, I hope you’ll stick around, because I’m also super grateful for every one of you, too.
Man, having a senior in high school sure does make you sentimental.
Let me know what you think about all of this in the comments!
Happy Birthday!! 🎉 And thank you for another fascinating article; you break down the research into digestible pieces without cherry picking snippets to support a particular narrative - which is one of the reasons I love reading your work. And I appreciate how you share your thoughts regarding small vessel disease and how it's a contributing factor to both dementia and increased tau accumulation. Thank you for talking about the stuff that isn't splashy or likely to get a lot of attention on social media, but it's the information women need to know.
Such a good point about studies that fit the narrative get more glow up!