“Is it time for ‘Ask Dr. Suzy’?”
Years ago, as a medical student spending time with my non-medical friends, every gathering would end in ‘Ask Dr. Suzy’ and all the questions my girlfriends were dying to ask would pour out. I laughed at their expectations that I knew anything after a few semesters of medical school, but this game became an ongoing tradition.
Twenty-five years into practice as an integrative gynecologist, I have compiled my top twenty-five tips for 2025, by the decade, for women’s health. Don’t despair if your decades are off; it’s never too early and never too late to start!
The Twenties:
1) Create a Daily Routine. Nature is based on routines—the twenty-four-hour rotation of the Earth, the monthly lunar cycle, the rhythm of the tides—and the ancient practice of Ayurveda teaches that when we’re in sync with these rhythms we achieve optimal health. Managing our daily behavior and attempting to reach goals is energy-intensive, but creating habits saves mental energy and makes us more likely to follow through. Stacking habits—adding new habits to existing habits, like brushing your teeth—is a trick that works. Start and end your day with variations on the following themes:
Morning:
- Make your bed (and immediately have one thing done for the day!)
- Exercise—The World Health Organization (WHO) recommends 150 minutes of moderate intensity or 75 minutes of vigorous intensity per week at every age. Vigorous means you are barely able to speak during the activity; moderate means you can speak a sentence or two. Start early with strength and resistance training too, at least two days per week.
Evening:
- Meditate
- Take an evening walk—this is my best tip for lowering blood glucose and improving sleep!
- Relaxation/reflection/journaling
2) Limit Toxins. Become a label reader and work to reduce your risk! We are inundated with exposure to endocrine disrupting chemicals like parabens in our personal care products, phthalates in our household cleaners and detergents, and pesticides and herbicides, all of which are linked with fertility problems, neurological diseases, and many types of cancer, to name a few. It’s also never too late to reduce your exposure to plastic—and certainly avoid eating and drinking out of it—as 93% of Americans have the plastic bisphenol-A (BPA) in their blood stream and a recent study found four out of six placentas had microplastics in them. Check your products’ safety with the Environmental Working Group at www.EWG.org.
3) See a Therapist. A recent study found since the COVID-19 pandemic, the incidence of depression, anxiety, psychological distress, loneliness, and poor mental wellbeing have risen. Take it from so many celebrities who have spoken out about their mental health journeys—it’s ok not to be ok. Help is available and if you or someone you know is in crisis or considering suicide, there is always someone to talk to. Call the suicide and crisis hotline at 988.
4) Learn (and use) 4-7-8 Breathing. I know of no other trick that breaks the cycle of stress and anxiety as fast as 4-7-8 Breathing, taught and popularized by my teacher and mentor, Dr. Andrew Weil. I have watched this technique resolve issues from heart arrhythmia to tremors and I use it every day whether I’m speaking before an audience or sitting in traffic. It’s simple: Breathe in for the count of four, hold your breath for the count of seven, exhale for the count of eight and repeat four times. Try it now!
5) Start a Gratitude Practice. Taking time to count our blessings has been shown to improve mental health, sleep, our relationships and self-esteem. By reducing stress, it can even lower blood pressure, reduce inflammation, and improve cardiovascular health. As one of your daily habits, start a gratitude journal, or name three things from your day you’re grateful for at bedtime, or play the alphabet game, listing gratitude from A to Z.
The Thirties:
1) Maintain Bone Density. First in the category of “no one ever told me this”: we build bone up to age thirty-five and it’s all downhill from there. Be sure you’re getting adequate calcium, magnesium and phosphorus in your diet. Get Vitamin D through exposure to early morning sun or by supplementing (have your level checked if you’re not sure how much to take), practice weight bearing exercise, avoid smoking and excess alcohol, and limit use of corticosteroids, if possible.
2) Reduce or Eliminate Alcohol. The message that alcohol is good for your health has been disproven. A study found an amount of alcohol less than one drink per day was associated with a five percent increased breast cancer risk, and in another study there was no safe level of alcohol consumption for dementia risk. Additionally, oxidation (or burning) of alcohol delays fat oxidation which can hamper weight loss efforts.
3) Floss Your Teeth. Stack flossing onto the habit of brushing your teeth, as research shows those who don’t floss have higher levels of the inflammatory marker C-reactive protein in their blood and have higher prevalence of and mortality from cardiovascular events such as heart attacks.
4) Eat the Rainbow. Ayurveda also teaches us to incorporate every color of the rainbow into every meal, or at least into every day. Each color in a plant-forward diet, from vitamins and minerals to phytonutrients and antioxidants, offers specific health benefits. To name a few, we get beta-carotene (good for the eyes) from the orange pigments in such foods as carrots, yams, and oranges; lutein (good for eye, brain, and heart health) from the green pigments in kiwis and broccoli; and lycopene (important for cancer protection and the immune system) in red foods such as tomatoes, watermelon and beets.
5) Spend Time in Nature. If you know me at all, you know I am a firm believer that time in nature heals much of what ails us. Research finds it boosts the immune system, improves blood pressure, reduces production of stress hormones, and improves memory and mood. Schedule time outdoors as part of your regular routine—I recommend 150 minutes per week, just like the recommendation for physical activity.
The Forties:
1) Prepare for Perimenopause. Perimenopause starts before menopause and continues through one year after the final menstrual period. It can start as early as age thirty-five and can last for seven to ten years. It’s a time of massive hormonal fluctuation and symptoms can include mood changes, hot flashes and night sweats, weight gain, fatigue, menstrual irregularities, skin/hair/nail changes, sensory changes, brain fog, insomnia, GI changes, muscle/joint aches, libido changes, and genitourinary issues. Treatment options exist, so women should seek the guidance of a Menopause Certified Practitioner. We know that the health and fitness women possess in their forties and fifties predicts their level of wellness into the eighties and beyond.
2) Manage Weight Now. Second in the category of “no one ever told me this,” managing weight becomes harder in perimenopause. A study found the percentage of women’s visceral fat changes from an average of 8% of their body weight before menopause to an average of 20% after menopause without changes in diet or exercise. For this reason, I recommend working to manage weight before the hormonal changes kick in. Options now exist for weight management, so talk to your doctor.
3) Learn to Meditate. Two of my mentors in their seventies and eighties regretted not learning meditation earlier in life—so I listened to them, started my own meditation practice, and became certified to teach meditation. When under chronic stress, our sympathetic nervous system—our fight/flight/freeze state—is continuously engaged. This accelerates brain aging and contributes to multiple chronic conditions in lab animals and humans. Meditation induces a state of deep rest which allows the body and mind to heal itself. During this process of parasympathetic—rest/digest/restore—regulation, blood vessels expand, muscles relax, digestion occurs, blood pressure drops, and the brain releases neurotransmitters linked to happiness and calm. Meditation can contribute to the healing of both mental and physical illness, and it is never too late to start.
4) Optimize your Nutrition. The forties are a crucial time to take stock of your diet. A plant-forward, anti-inflammatory diet that is low in added sugars (aim for less than 25 grams of added sugar per day), eliminates processed food, is high in fiber and prebiotics (aim for at least 25 grams of fiber per day), and offers 1.3-1.6 grams of protein per kilogram of ideal body weight per day. Not only will this optimize your cardiovascular, brain, and bone health, these recommendations aid in the conversion of dangerous estrogen metabolites (those that promote cancer development) to healthy, cancer-fighting estrogen metabolites in the body.
5) Consider Life Goals. Health goals such as “I want to lose fifty pounds” or “I want to lower my blood pressure” are meaningless unless they’re attached to life goals: “I want to be fit enough to hike to a landmark on my upcoming vacation,” “I want to be able to carry my grandchildren someday,” or “I want to live to see my children/grandchildren graduate from high school/college.” Spend time considering your life goals and how your health goals might help you get there.
The Fifties:
1) Feed your Microbiome. With lower levels of estrogen during menopause, our microbiome—the array of healthy bacteria and yeast that live in our gut—becomes less diverse, shifting towards a more male-like composition associated with increased heart disease risk. The decline in hormones may also contribute to “leaky gut” which allows external toxins to enter the blood stream. Eating probiotic foods, such as fermented (low or no-added sugar) yogurt, kefir, sauerkraut, kombucha, miso and tempeh, as well as prebiotic foods like chicory root, onions and root vegetables is the optimal way to support your microbiome.
2) Learn your Menopause Treatment Options. Over the twenty-nine years I have treated women in menopause, the pendulum of menopausal hormone therapy has swung from favorable to “deadly” to (oftentimes) favorable again. This shift was a major contributor to my decision to study integrative, herbal, lifestyle, and Ayurvedic medicine, as I was seeking to find options for my patients and, I knew, eventually for myself. There are so many ways to deal with the myriad of menopausal symptoms—ranging from hormonal to herbal to nutritional—and you owe it to yourself to see a Menopause Society Certified, ideally integrative gynecologist to learn what’s right for you.
3) Strengthen your Grip. Grip strength in midlife (and beyond) correlates with overall mortality risk. In fact, research shows lower baseline grip strength is correlated with increased risk of mortality over ten years. Improve yours by using the Farmer’s Carry: walk for one minute with a weight in each hand. Increase the difficulty level by bending your elbows at 90 degrees. You can also “dead hang” from a pull-up bar with arms straight. At age forty, women should be able to dead hang for ninety seconds, and this will decrease slightly each decade. Finally, you can purchase an inexpensive dynamometer at a sporting goods store which will measure your grip strength and may be incorporated into your strength training routine.
4) Improve your Balance, Agility, and Stability. The American College of Lifestyle Medicine recommends older adults incorporate two hours per week of balance and agility exercise into their routine to reduce the risk of falls. Join a class designed for balance, agility and stability; practice yoga; or hike on uneven terrain to meet this guideline. It’s also beneficial to practice step-down exercises: spend two to three seconds slowly stepping down from one step to the next on a set of stairs; repeat five times on each leg. This trains the body to catch itself when falling forward.
5) Ask about a DEXA Scan. Estrogen loss at menopause hastens bone loss but the US Preventive Services Task Force does not recommend a bone density test—or DEXA scan—until age sixty-five. This is often too late, depending on risk factors, so discuss with your doctor at menopause. It is disheartening to learn that in over forty years, the mortality of hip fractures has remained unchanged: up to a third of people over sixty-five who fracture their hip are dead within the year.
The Sixties and Beyond:
1) Pay Attention “Down There.” Current guidelines are for women to discontinue pap smears at age sixty-five, UNLESS there is a new sexual partner after that time or other risk factors apply. This means women often stop having regular pelvic exams and often ignore other gynecologic symptoms. Any vulvar or vaginal itching or burning, vaginal bulge or prolapse, postmenopausal bleeding, or leakage of urine should be evaluated by your gynecologist. Treatment options exist!
2) Maintain your Tribe. The Surgeon General says “Loneliness is the New Smoking” with research finding mortality risk from loneliness is equivalent to the mortality risk of smoking fifteen cigarettes per day and is higher than the risks from alcoholism, obesity, and lack of physical activity. It’s good for your health and longevity, therefore, to find and maintain a tribe of people who matter to you.
3) Stay Active. Remember that the WHO’s physical activity recommendations apply at all ages—150 minutes of moderate or 75 minutes of vigorous activity per week, plus strength and resistance training at least twice per week (see tip #1). Find safe and enjoyable activities and keep them going!
4) Forgive (Or Don’t). There is research supporting forgiveness and there is research against it. While forgiving others can benefit mental and physical health for some, there is also evidence suggesting that feeling pressured to forgive their offenders can lead trauma survivors to avoid seeking support. Work with a qualified mental health professional if this is an issue in your life and approach this subject with mindfulness and self-compassion.
5) Write your Story. You matter, your life story matters, and you deserve to have it preserved. Write it down. I have been enjoying a daily writing prompt I created for this and look forward to sharing it with you soon.
And thus completes the latest installation of ‘Ask Dr. Suzy.’ Let’s thrive in 2025!
Integrative Initiative 