For more than 20 years, menopausal hormone therapy carried an FDA black box warning that reshaped the way women — and their doctors — thought about estrogen. With the warning now removed from most forms of MHT, many women are asking what this change truly means for their breast cancer risk, cardiovascular health, and long-term brain function. In this article, I break down the science behind the original warning, what the updated evidence actually shows, and how to approach hormone therapy safely and thoughtfully in midlife.

If you’re wondering whether MHT is safer now, riskier, or simply better understood — this guide explains what every woman needs to know.

A 2024 meta-analysis showed a 57% increased risk of Alzheimer's Dementia in those with vitamin D deficiency…A 2023 study showed 40% lower dementia risk in people who took vitamin D supplementation compared to those who didn’t. Vitamin D level optimization is one of the easiest things you can to for your brain health. But like most things when it comes to our health, it’s not always straightforward..

The Faces of Dementia

When I think back on the thousands of patients I’ve cared for with dementia, I see the faces of women. Most were in their 70s and 80s, but just as vivid are the memories of the daughters, nieces, and sisters who stood beside them, offering care and support. Dementia affects men too — but the numbers are clear: dementia disproportionately affects women…For decades, the higher rates of Alzheimer’s in women were explained by longevity: women live longer, so dementia follows. But emerging science points to gender-specific risks that go far beyond lifespan. In fact, more than 30 risk factors for AD have been shown to affect women greater than men. Some are beyond our control. But many of these gender preferential risk factors are modifiable, such as…

This is where the concept of Medicine 3.0 (defined by Peter Attia, MD) comes in and it is particularly pointed towards optimizing neurologic healthspan. We start with a simple question, what do you want from your last decades of life in terms of cognitive wellbeing and what does your physical health need to be to support that. Next we take stock of where you are now and come up with the strategy to get you where you want to be, accounting for age expected decline. By breaking it down and knowing what data to objectively track, we can prioritize which tactics are best for you and then layer on over time.