The Biology of Female Aging: Hormones, Health, and Longevity (Part 1)

Understanding the Hormonal Cliff That Shapes Women's Healthspan

Did you know? The ovary is the first organ to age in humans. This reality shapes the trajectory of women’s health starting at around age 40—sometimes even as early as 35 - when they experience accelerated health deterioration that leaves them living, on average, 9 years in poorer health than men. This simple yet profound fact exposes the blind spot in today's "longevity" conversation: for women, aging well isn't primarily about optimization—it's about addressing the fundamental hormonal cliff happening in midlife, that traditional medicine still largely ignores.

I was lucky (or unlucky) to confront hormonal imbalances early, which led me down a deep dive into the intricate dance of female hormones, lifestyle, and life stages. Over the past couple of years, I’ve immersed myself in research, from conferences to books to podcasts. And while menopause and perimenopause are finally having their cultural moment (if you haven’t heard Gwyneth Paltrow & Oprah talk about menopause, you live under a rock), we’re still light-years away from truly informing—and, most importantly, treating—women properly.

This gap between knowledge and action has become my mission. I’m working on something new in this space, starting in France, to help bridge this divide (Know a top OB-GYN here or are a physician interested in collaborating? Reach out here: maud.pasturaud@gmail.com).

In this two-part newsletter series, I'll map out the biological changes affecting women 35+, their health implications, and the current landscape of treatments.

Let’s go.

Disclaimer: I am not a doctor, and this is not medical advice. This newsletter simplifies complex biological concepts.

Ovarian Aging = Female Aging

Science Fact

In women, the ovaries are the primary producers of hormones that regulate not just reproduction, but virtually every system in the body. Ovarian function—particularly egg (follicle) production—begins to decline before birth and continues to do so steadily throughout a woman’s life:

Women’s Ovarian Function Over Time

Women’s Ovarian Function Over Time

Eggs (follicles) are more than just reproductive cells—they also drive the production of estrogen and progesterone, the key hormones that influence everything from metabolism to brain function. As a woman’s egg pool depletes over time, this hormonal factory becomes less efficient, leading to major shifts in hormonal balance:

• First, ovulation becomes less predictable.

• Then, cycles become irregular (perimenopause).

• Finally, menstruation stops (menopause, officially defined as 12 months after the last period).

This is why defining menopause solely by the absence of periods misses the bigger picture: what’s actually happening is the gradual functional shutdown of the ovaries as a hormonal organ. This transition unfolds over decades—perimenopause often begins in the late 30s or early 40s, while postmenopause can last 30+ years, meaning a woman could spend a full third of her life in this hormonal state.

The Estrogen Question: Why It’s Central to Longevity

While both estrogen and progesterone decline as ovarian function wanes, estrogen loss is the real game-changer.

The drop in estrogen triggered by the extinction of ovarian function is—simply put—a tsunami in women’s bodies. Why? Because estrogen isn’t just a reproductive hormone—it’s a fundamental protective force. There are estrogen receptors in virtually every tissue in our body —from the brain to the bones, skin, heart, and kidneys—playing a central role in women’s overall health:

• Mitochondrial energy production & cellular repair - It increases ATP production, improves metabolic efficiency, and supports cellular repair mechanisms. This creates the energy foundation needed for optimal function of every organ system.

• Inflammation - Estrogen acts as a natural anti-inflammatory agent, modulating immune responses and suppressing pro-inflammatory cytokines (and we know that chronic inflammation is one of the key accelerators of aging).

• Bone density - Estrogen is crucial for bone health, balancing the continuous process of bone remodeling. It inhibits excessive bone resorption (breakdown) while supporting new bone formation.

• Brain function - The brain has abundant estrogen receptors, particularly in areas controlling memory, mood, and cognition. Estrogen enhances neurotransmitter function, supports neural connections, and protects against neurodegenerative processes.

• Cardiovascular health - Estrogen improves vascular function, helps maintain healthy cholesterol levels, and supports normal blood pressure regulation. These mechanisms explain why women's cardiovascular disease risk dramatically increases post-menopause.

In many ways, estrogen is the longevity hormone.

Dire Consequences for Women's Health and Longevity

Looking at these mechanisms, it becomes clear just how profoundly women’s health is affected starting at perimenopause:

• 50% of women in perimenopause experience symptoms

• That number jumps to over 70 - 80% during menopause itself

The Symptoms are Plentiful

• The well-knowns:

  • Vasomotor symptoms - 70-80% of women experience hot flashes, which last an average of 7 to 11 years. Up to 40% of women in their 60s and 10-15% in their 70s continue to have them (The Menopause Society). 50% of women experience night sweats, which have a dramatic impact on sleep quality.

  • Sexual symptoms - 40-54% of postmenopausal women and 15% of premenopausal women experience vaginal atrophy/shrinkage (causing painful sex) and urinary incontinence, collectively known as Genitourinary Syndrome of Menopause (GSM) (NIH Study)

  • Emotional + cognitive symptoms - Brain fog, memory issues, and concentration difficulties are common. 82% of women report memory problems and forgetfulness, with peak issues occurring between ages 50 to 54 (Midi Health)

• The less well-knowns: Anxiety and depression (when hormone levels drop, serotonin levels also fall, which contributes to increased irritability, anxiety and sadness), frozen shoulder, joint pain, skin changes, hair thinning —all linked to declining estrogen levels.

• And what’s happening in the background: Bone health deterioration—up to 20% of bone density can be lost in just the first few years of menopause. Increased Alzheimer’s risk, driven by changes in insulin sensitivity in the brain. Loss of skeletal muscle mass and strength—up to 15% muscle mass loss occurs in the first few years of menopause. Higher risk of Type 2 diabetes and, most importantly, heart disease—the leading cause of death in postmenopausal women.

Beyond health, these symptoms, if left untreated, spill over into other aspects of women’s lives - affecting intimacy, relationships, and careers.

Slide courtesy of Dr. Sarah Szal/Gottfried at the Eudemonia Summit, Nov 2024

Sounds overwhelming? It is.

This creates what I call the “longevity-healthspan gap”—women live longer than men but spend more years in poor health. While the longevity industry obsesses over extending lifespan with NAD+ IV drips and peptide therapies, women face a far more immediate challenge: navigating a biological transition that, if ignored, can accelerate aging and drastically reduce quality of life.

What's Coming in Part 2

In the next installment of this two-part newsletter, I'll explore the solutions available for women throughout these life stages, from hormone replacement therapy to lifestyle interventions. I'll also dig into why, despite effective options existing, so few women receive proper treatment, and share thoughts around the future of women's longevity.

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Thanks for reading! :)
- Maud