Ep 37: Midlife & Menopause: The 2025 Report

In this episode of Reset Recharge, Dr. Komal Patil-Sisodia highlights the transformative year of 2025 in women's health, focusing on menopause care. Key topics include the FDA's rewording of black box warnings on hormone therapy, breakthrough non-hormonal treatments, and the American Heart Association's new cardiovascular guidelines. The podcast also covers advances in weight management, bone health, and preventive screenings, along with the elevation of lifestyle medicine and the growing field of fem tech.

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Audio Stamps:

00:00 Introduction to Reset Recharge

00:50 Reflecting on 2025: A Year of Change in Women's Health

01:36 Breaking the Black Box Barrier

03:00 Non-Hormonal Breakthroughs in Menopause Care

04:16 Cardiovascular Milestones in Menopause

05:44 Weight Management and Bone Health Updates

07:44 Prevention and Early Detection Strategies

08:22 Lifestyle Medicine Takes Center Stage

09:12 Advancements in Sexual and Public Health

10:05 The Rise of Menopause-Specific Fem Tech

10:39 Multidisciplinary Approaches to Menopause Care

11:10 Conclusion: Embracing the New Chapter

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Transcript

Dr. Komal Patil-Sisodia 0:00

Welcome to Reset Recharge, the podcast where women's health takes center stage. I'm your host, Dr. Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert. This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider. Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place. As a physician, my goal is to educate on this podcast. The content shared here is for informational purposes only and should not replace personalized medical advice. If something we discuss resonates with you, please talk to your healthcare provider at your next visit. Now let's dive in and help you reset, recharge, and take control of your health. Welcome back to Reset Recharge. As we close out 2025, I want to take a step back and acknowledge something I don't say lightly. This year changed the trajectory of women's health, especially for women in midlife. For decades, menopause care was driven more by fear than by data, and women were told to wait it out, minimize treatment, or accept symptoms as an inevitable part of aging. As a physician, I can tell you that advice was never rooted in good science. And in 2025 it feels like medicine is finally catching up. Today I want to walk you through what I think are the most important clinical shifts of the year from FDA decisions to cardiovascular prevention, to how we think about long-term vitality during and after menopause. First on the list is breaking the black box barrier. One of the most significant changes in 2025 came from the FDA thanks, largely in part to advocacy from a group of incredible who pointed out that the black box warnings were based on old, outdated data. That created a lot of fear in both patients and clinicians For years, menopause hormone therapy carried the black box warnings that were based on data from studies like the Women's Health Initiative. This year, the FDA began removing or substantially rewording those warnings on many hormone therapy products. Because of advocacy. I am deeply grateful for my colleagues who pushed that effort and got these things changed. And why does that matter clinically? Because decades of follow-up data have shown that for healthy women under 60 or within. 10 years of menopause, the benefits of hormone therapy, cardiovascular health, bone density, and cognitive protection often outweigh the risks. Equally important, we finally moved away from the rigid rule of the lowest dose for the shortest time. In 2025, menopause care became more individualized. The duration of treatments is no longer arbitrary. It is a shared decision between you and your clinician based on your symptoms, personal risk factors, and long-term health goals. This is what evidence-based care looks like. There were also some non-hormonal breakthroughs. This year, 2025 delivered meaningful progress for women who can't or choose not to use hormone therapy. We saw approvals and expanded access to dual action non-hormonal medications like elinzanetant, which is a dual action, non-hormonal medication that works centrally in the brain and targets the Thermo Regulatory Center, responsible for hot flashes. Previous medications in this class would only work on one receptor in the thermo regulatory zone. This particular medication works on two, and so not only did we see a substantial reduction in vasomotor symptoms, we also saw improved sleep quality independent of the hot flashes., which is the first time we can say that a medicine does both of these. For breast cancer survivors, women who've had gynecologic cancers and women with clotting risk, this represents a long overdue option that does not involve estrogen. So what a win. Next on the list is menopause. As a cardiovascular milestone, one of the most important shifts came from cardiology. The American Heart Association in 2020 formally recognized menopause transition as a female specific cardiovascular risk factor. And this is critical because cardiovascular disease remains the leading cause of death in women, and menopause is a key inflection point. We've known for some time that frequent persistent hot flashes are biomarkers and not just symptoms. And women who have ongoing vasomotor symptoms have a significantly higher risk of cardiovascular disease. This tells us that menopause symptoms are often a signal and not just noise. As a result, the American Heart Association 2025 guidelines now encourages clinicians to intervene earlier by checking APO lipoprotein B for more precise. Cholesterol related risk to heart disease and also hemoglobin A1C to identify insulin resistance sooner. There were also additional studies that showed that in the one to two years leading up to menopause, we see an increase in lipoprotein little A and blood pressure spikes. And while these two recommendations were not incorporated in the American Heart Association 2025 guidelines, I think there will be more of a spotlight on those. To help make sure that we are preventing heart disease and not just responding to it later. This is no longer about reassuring patients. It's about prevention. Weight management in menopause also saw important updates. New data in 2025 showed women using both hormone therapy and a GLP one agonist called tirzepatide experienced greater weight loss around 20% compared to 16% in women using the GLP one medication alone. Estrogen appears to enhance the metabolic responsiveness to therapies like GLP one agonists, so I often encourage my patients to consider a dual approach, if they are, affected by overweight or obesity and are going through a menopause transition, this is something important you can bring up with your healthcare provider. These are nuanced, individualized decisions, but they are now within the scope of standard care, which is amazing. We need women to have more options and more access to both of these types of therapies. We also learned quite a bit about bone health this year, which reinforced something that many of us suspected. The most rapid bone loss up to 10% occurs one to two years before the final menstrual period. This makes sense because bone turnover and bone buildup are regulated by estrogen. So if we are losing that, it makes sense that the bone will deteriorate more in that time period, waiting until osteoporosis develops is no longer acceptable and earlier screening and prevention strategies are an essential part of midlife care. The U-S-P-S-T-F and ACOG currently recommend that women be screened for osteoporosis at age 65. We know that's too late. The Endocrine Society has been advocating for osteoporosis screening at age 50 with risk factors for osteoporosis. I've shifted my practice over the last few years to start screening women as soon as they hit menopause, or we've established that they're in menopause, so we know what's happening with their bone density. I'm very curious to see how the professional society guidelines evolve based on this new data. We also looked more at prevention overall across major organizations. There was consensus reached on two important screening tests for midlife women. Number one, mammograms should begin no later than age 40. And number two, colorectal cancer screening is set at age 45 for everyone regardless of gender. I think this is very important in the context of midlife health. The shift is clear. We are now prioritizing early detection during the decades of life when intervention is the most effective. We are not waiting for people to have disease that we have to treat and can't prevent. One of my favorite developments of 2025 was the elevation of Lifestyle Medicine at the Menopause Society Conference in Orlando this year. This was front and center. There were several large scale reviews that confirmed that nutrition, physical activity, and restorative sleep are not just suggestions anymore. They are first line evidence-based foundational care. This is a huge departure from the medical community telling women that they had to suffer more or they weren't suffering enough before they could get therapy. These are tools that women can start implementing now as they discuss their symptoms with their healthcare providers to be able to get treated with a lens of prevention as opposed to dealing with the end stage or later stage of a disease. I love that we are seeing this change. There were also several developments in the sexual and public health arena. The genitourinary syndrome of menopause is now openly discussed and routinely treated. I loved seeing the changes in the American Urologic Association guidelines. Low dose vaginal estrogen, DHEA and oral ospemifene are now recognized and recommended as safe and effective. Testosterone therapy is now formally acknowledged as evidence-based treatment for hypoactive sexual desire disorder in postmenopausal women, and I'm excited to see how additional studies may change the landscape of this. There was one that was presented at the Menopause Society this year that didn't show much in terms of promising results outside of hypoactive sexual desire disorder, but I think that we need more research in that arena. Technology has also been evolving. in 2025, we saw menopause specific fem tech start to increase. There are wearables, like rings and watches that are introducing menopause specific tracking modes so that women can monitor core temperature and heart rate variability to document their symptoms more objectively. I'm excited to see how this arena expands because it's so much easier to take objective data to your doctor as opposed to trying to go off memory. I think this will help transform clinical visits from being a guessing game to actually having data driven conversations. And finally, menopause care evolved beyond a single provider. The most effective care models in 2025 were multidisciplinary and integrated primary care, gynecology, endocrinology, cardiology, and sleep, medicine to address menopause as. The systemic transition that it is, and I'm excited to see how this evolves even more. Every day. We're learning more about how menopause affects all the different organ systems in our body, which makes sense. We have estrogen receptors from head to toe. As we reflect on 2025, the message is unmistakable. Midlife care has changed and it needed to. We now have evidence that menopause symptoms are meaningful signals that lifestyle interventions are powerful medicine, and that hormone therapy, when appropriate and desired is. Safer and more flexible than we were once taught. You don't need to wait until your symptoms become debilitating to seek care, and this phase of life is an opportunity to reset your health trajectory. You're not just aging, you're entering a new chapter. When we're proactive, informed care can make a profound difference, and you deserve a medical team that recognizes that. Stay informed, stay empowered, and keep advocating for your health. Thank you all for tuning in, and I'll see you on the next episode in 2026.