Mid-Life, Reimagined: What Women Need to Know Now
June 30, 2026 | Episode 65
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Marcus Thorpe, Katie Lowe, Dr. Elizabeth Koffler
Katie Lowe 0:02
Hi, welcome back to the OhioHealth Wellness Conversation. I'm Katie Lowe,
Marcus Thorpe 0:18
And I'm Marcus Thorpe. We are certainly glad that you are with us, we're talking about something, diving into a topic that touches so many women, so many families, but it's also one of those things that sometimes people don't always want to talk about.
Katie Lowe 0:29
Yeah, we're talking about midlife, and today we're joined by Dr. Elizabeth Koffler an OhioHealth OBGYN. So, thank you so much for being here, Doctor Koffler. To start us off, why don't you just share with us some of the work that you've been doing with women in midlife, and maybe some of your background?
Dr. Elizabeth Koffler 0:46
Sure, I trained here at Riverside, finished in 2005 have been working as an OB-GYN since then, but over the past few years, as I have gotten older, I've taken an interest in midlife and menopause care, so now I'm certified menopause specialist, so I split my time between primary OBGYN and work at the midlife and menopause clinic in New Albany.
Marcus Thorpe 1:10
I'm so excited to have you, because you were on during Mother's Day, and we're talking about mental load of a mom, and it was such a hit. That episode really did well. It resonated with women and families, and so I think this is going to be a great conversation, because midlife is such an important part of a woman's life, but it's also one that I think gets lost in the shuffle between, you know, an older woman and one who's in those childbearing ages of early ages, so Dr. Koffler, let's talk a little bit about the term midlife. Can you explain what that means for people who maybe are in the dark a little bit about just defining it itself?
Dr. Elizabeth Koffler 1:50
Perfect, that's a perfect way to start. So midlife is not just a moment in time, it's a transition period where we're no longer in our reproductive years, we're going into the second half of our lives, and with that comes a lot of changes, both physical and emotional, and a lot of women don't know that it's attributed to hormonal changes or the stage of midlife that they're in, and so it's this time period that can start anywhere from your late 30s all the way to and last all the way till mid-50s to late 50s,
Marcus Thorpe 2:22
OhioHealth really leaned into this too. Midlife clinic, making sure that we are seeing and hearing these women who have been maybe not taken care of the right way. Talk about that, and why it's been so important for you to kind of lean into this space and be a part of the solution for women in midlife,
Dr. Elizabeth Koffler 2:41
OhioHealth really, you know, pioneered this space, and when I was asked to work in this midlife clinic in New Albany, you know, I didn't really know what to expect. I knew the medicine, but I didn't realize the impact it was going to have on women. They just do not feel heard, you know, or they feel dismissed, or they think that the symptoms that they were feeling have no treatment, no possible way to feel to remedy them, and so it's actually been very fulfilling and rewarding for me. And so, it is so important to start this conversation, because we know that not this isn't just a moment in time, it's that transition period that we were talking about, and it's an opportunity to promote lifelong health. So, we know there is this window of opportunity in midlife through the transition to menopause, where using hormones can benefit longevity and be more of disease prevention, and so this space fosters that for these women, and it's actually just been so amazing to touch and help so many women.
Marcus Thorpe 3:49
I love that. I love the passion, you know, you can hear it, you know how much it really matters to us and you. So, I think that's a really, really cool way to lean into it.
Katie Lowe 3:57 Yeah, and it's so interesting, like we've been talking about how misunderstood this pretty long phase of life can be for so many women, and just from my interactions from women, they talk about when they finally do hit this stage, all these things that they're experiencing that they didn't expect, no one kind of told them or talked about it. So I'm so glad again that we are having this conversation. Let's start with what's happening physiologically. What are some of the biggest hormonal changes that women are experiencing in midlife?
Dr. Elizabeth Koffler 4:32
Yeah, that's a great question, because I think most women think hot flashes mean I'm going through menopause, but really that's one of the last things that they'll experience, so if you think about the hormones that your ovary produces, it's progesterone, estrogen, and testosterone. So, as we get older, the first one to really decrease is progesterone, and what is that responsible for? Mood stability, sleep, feeling. Are balanced, and when that's off, those are the first symptoms women have. So, they feel like maybe they have more emotional variability. They don't tolerate stress as well. They're waking up in the middle of the night, they can't get back to sleep, and then they can't function the next day, and they have children to take care of, or careers that they're trying to be to grow in, and they're unable to do that, and so they don't. A lot of times, they don't really realize this is perimenopause, because they're still having a menstrual cycle. Then the next to drop is estrogen, and your estrogen can be so variable during perimenopause, it can spike to two to three times what it was in your 20s and 30s and then fall off the cliff and so that makes women feel awful and then they start to experience what we call the vasomotor symptoms or the hot flashes and then the last hormone testosterone that drops a little bit later in life and that's responsible for libido.
Marcus Thorpe 6:00
You talked about perimenopause. We hear about menopause probably way more than we hear about perimenopause. Can you kind of put those two out there again for people to understand? I like this podcast because we're able to dig a little bit more just the defining factors of some of these things. So, could you open the door for people to understand just what those topics mean and what part of the life they are in, for people.
Dr. Elizabeth Koffler 6:22
Sure, you know, when we first started this conversation today, we talked about how midlife is this transitional period. Well, if you look at perimenopause through menopause, it is a transition, transitional period, but menopause is just this one day where you have now gone one year without a period, but most of the symptoms in the treatment plan start in perimenopause, and that is where the hormones fluctuate the most, and that is the most challenging time for women, and then once you've gone past that one year, that's the postmenopausal period, and so it's perimenopause, menopause, postmenopause, and in perimenopause, there are actually different stages, and you can be early perimenopause and late perimenopause, and that comes with again those symptoms of progesterone drop or estrogen fluctuations and changes in your period, where you're all of a sudden having frequent heavy period, so perimenopause is actually more of a challenging time for women, and often a little bit more of a challenge for me to help treat.
Katie Lowe 7:31
Interesting, so when it comes to these symptoms that these women are experiencing that you're saying is completely normal, frankly, you know, when they're going through these, at what point do they decide, okay, this is actually something I need to have a conversation with my doctor about, versus, you know, what I think so many women do is just kind of think, well, this is uncomfortable, and I'm just going to put up with it, because that's life.
Dr. Elizabeth Koffler 8:00
I would say most women should seek care in this stage of their life, just to have the discussion to talk about the symptoms that they're having, and oftentimes they don't know they're having the symptoms until somebody asks them, and that's why it's good to go to a menopause, a certified menopause specialist, because we know what's happening with your hormones and the symptoms that come along with those fluctuations. So, I would say every woman should be seen at this time in life, just because a lot of things that they're, you know, trying to deal with or push through are not normal. But working in this space for so long, there are a lot of other kind of red flags that you can't just attribute to perimenopause or menopause, so if you're having extreme amount of fatigue or sleep disturbance, that could be something like sleep apnea. If you have these massive weight fluctuations, it could be a thyroid disorder, you know. If you're having a lot of muscular weakness or joint pain, maybe it's a muscular condition like MS, so there are things that women shouldn't ignore, but it's important for them to seek care, so we can start that conversation.
Marcus Thorpe 9:11
I think about just general life, and there are markers like, hey, you should get a colonoscopy at 45 or hey, you need to get this test at this time in your life. I would imagine when it comes to perimenopause, or what you would consider midlife, it's different for everybody, isn't it? I mean, there's not like, hey, I'm 42 and I've had two babies and now I'm entering perimenopause. How challenging does that make it? Because somebody might be maybe in an earlier stage than somebody else that's maybe in a later stage. Is that a real thing, or is that just something that I'm making up in my head?
Dr. Elizabeth Koffler 9:42
No, that's a real thing, and that's a great question, because people think, oh, I have young kids, there's no way I could be having these hormone fluctuations in my early 40s, but again, that's why you come in for evaluation, and women need to understand the importance of preventive care, so you mentioned, you know. Routine screening, just because you're past your childbearing age, doesn't mean that you don't need OB-GYN care anymore, or GYN care, right? So every woman should have both a primary care doctor and a gynecologist, because it's important to still have that full preventive exam, and then start this conversation about perimenopause and what benefits would they have from possible hormone replacement therapy going into menopause?
Marcus Thorpe 10:26
You know, what makes me feel really good is, you know, obviously this is mostly a women's health podcast. It’s when a women's health physician says, 'Hey, you asked a great question, nailed it,
Katie Lowe 10:39
Validated. Yes.
Marcus Thorpe 10:41
Thank you. I feel seen.
Katie Lowe 10:42
You mentioned one thing that kind of leads me to my next question, and you were saying a lot of some women, at least, think you know, just because I'm done with kids, I don't really need a gynecologist anymore, and that's kind of a myth that people just tend to believe. Are there any other myths about this midlife stage of life or hormones that you'd like to debunk or clear up for anybody listening?
Dr. Elizabeth Koffler 11:09
Oh, for sure. I mean, I think that a large portion of my visit with patients are debunking these myths, and when you go through the recent data, and how the past information was just so misrepresented. Women feel a lot more comfort, comfortable seeking care. So, I think the first thing is this is a normal stage. You just need to push through it, you know? When, okay, it is a stage of our lives, but we don't need to push through it if we can't handle the symptoms and changes that are happening to us both physically and emotionally, so in no way should the mantra be just push through, suck it up, because it's not fair to women, and it, it unmasks so many other conditions that if you could just get them in that optimal window of opportunity, you could really put them on like the best part trajectory of their life, so they could have this most beautiful second half to their life. So, I think that would be the first thing. The second thing is that hormones are going to cause me to get cancer or give me a blood clot. Again, we have so much information, and we've had so much evidence-based medicine that kind of has really debunked most of that, and every patient is different. Nothing in medicine is algorithmic, so you know it's important to have a full evaluation of your medical and family history, but I think that women often come in and think this is going to give me cancer, that's why I don't want to be on it.
Marcus Thorpe 12:50
While I think about social media and kind of the part that it can play in some misinformation, which obviously is a negative, I do think compared to like my grandmother or my mother's age, in some ways it's been a really big positive, because more people are talking about it. You hear it in regular conversations, where I think past lives, we probably just said, 'No, this is normal, I'm just going to deal with this, I don't have to do anything.
Katie Lowe 13:15
Exactly. It's such an interesting concept. We always associate normal equals, okay, you're good. Don't need to see the doctor, don't need to get anything fixed, etc. But yeah, it's so interesting that you know just because this is considered a normal symptom does not mean you have to live so uncomfortably.
Marcus Thorpe 13:37
Let's talk about metabolism, let's talk about weight gain. Let's talk about overall energy levels during kind of the midlife phase for women and their lives. What do you see, and what can be done? I guess, besides what you would normally traditionally tell someone, you know, hey, we need to exercise, we need to eat right. Are there things that people can be thinking about beyond just the regular staples, or is that where we should be looking first.
Dr. Elizabeth Koffler 14:02
Well, I think it's all of those things, right? So it's multifactorial. So I would say over 80% of women come in with either mood complaints or weight concerns, and the number one thing I think of as the most important is how is your sleep, right? Because if you're not going to sleep well, that affects your cortisol, that affects your hunger hormones, that affects what you decide to eat. So it's there, and there is weight gain with perimenopause and menopause, and you know we're doing more and more research on why, so a lot of women will have a lot of weight gain in their midsection, and that could be attributed to the loss or fluctuation of the hormone, so that is a big concern for women. So, yeah, you know, this stage decreases your muscle mass, we just decrease our muscle mass, and it changes your basal metabolic rate, which you. Can help fight with strength training and resistance training, so when I was, you know, in my 20s, it was all about like aerobic cardio exercise. Now we realize strength training is very important, both for that muscle mass and for bone support. So I focus on sleep, and then strength training. Cardio is always good for your cardiovascular system, and so those would be the first few things I talk about, and then their diet, so we do have to get more protein, and most women are very educated and do follow things on social media, so they're aware of that, and they have tried all of it, and they haven't seen a benefit, so when they come to see me, hopefully some of these medications I can provide will help them with those symptom relief, and I always say, you know, our hormones are not weight loss medications, but they can get you back to the energy level that you used to have to make better food choices and to be able to exercise like you need.
Marcus Thorpe 16:01
Yeah, I think it's really interesting. Because my wife is in kind of the perimenopause stage of her life, and I feel like she's eating less, and then she's seeing her weight kind of stay right where it was, or even up just a little bit. She's thinking to herself,
Katie Lowe 16:14
"How unfair is this? This doesn't work.
Marcus Thorpe 16:16
I'm not eating as much as I maybe was five or 10 years ago, but this weight is not falling off, it's just staying stable, or be bumping up. I think it's a frustrating part for women.
Dr. Elizabeth Koffler 16:25
It's so frustrating, especially when you know you see your husband eating whatever he wants, and then they don't imagine a pound.
Dr. Elizabeth Koffler 16:38
Yes, it's very frustrating.
Katie Lowe 16:39
And Mikaela did give Marcus the green light to share what stage of life that she’s in!
Marcus Thorpe 16:44
I’ m a smart man, I've been married long enough to know that I can still talk about these kind of things.
Katie Lowe 16:48
Let's talk about screenings and checkups, or just preventative care steps that women can take to set them up for success as they go into this stage of life, is there really anything that you can do to start off on the right path?
Dr. Elizabeth Koffler 17:07
Well, I think having the conversation, so I think podcasts like this make women aware that maybe if they're not having, you know, severe symptoms that are affecting their quality of life, they should still should talk about perimenopause or menopause, depending on what stage they're in. Where I practice in New Albany, it's more of a consultation service, so we, we don't do the preventive physical exams, but women need still need mammography, colon cancer screening, pap smears, a full physical exam, and then really, as they get into the stage of life, it's cardiovascular health. We know that cardiovascular disease is the number one killer of women, and so that is just these diseases that disproportionately affect women, like dementia and osteoporosis and depression, and then also cardiovascular disease. Those just increase in menopause, in the menopause transition. So you really want to stay on top of your cardiovascular health. Okay, which includes a lipid profile. Make sure your blood pressure is under control, because we as women could have had normal to low blood pressure our whole lives, and I see it every day at the menopause clinic, and they come in, their blood pressure's high, and they're like, I never had high blood pressure. Well, you may now, because of the changes and the lack of the hormones, and so you don't want to leave that untreated.
Marcus Thorpe 18:36
I think it's smart. Continuum of care is everything, right? And then it leads to, okay, well, we need to open this door for you, and here's the path for you to get to where you need to. If you never get to that first person, you may not get to the second or third door that you need to take care of yourself.
Dr. Elizabeth Koffler 18:51
And I have really actually formed a relationship with the cardiologist who's upstairs from me, because I have seen this so often, and women are like, okay, what should I do, and I'll refer them to the cardiology smart, yeah.
Katie Lowe 19:04
And when you get those tests done and screenings, how often should you be checking up and getting, you know, a panel work done and things like that to see what's really going on in your body?
Dr. Elizabeth Koffler 19:17
Well, it depends, like, if you know if it's normal or abnormal, but you should definitely have a yearly exam with your primary care physician to do your routine blood work screening, which also includes your thyroid hormone, and a yearly exam with a gyn.
Marcus Thorpe 19:31
Okay, we have time for a couple more questions. I think it's always important in these discussions to talk about kind of the emotional and mental health part of it too. You know, the physical part is obviously important in getting the right kind of blood work and those kind of things, but how much do you spend in your clinic and with your patients talking about that emotional and mental health, and obviously sleep and diet is such an important part of that, but it's got to be a big conversation you must have on a pretty regular basis, right?
Dr. Elizabeth Koffler 19:59
Yes. Very regular basis, and I think the setup at our office is really nice, because it's a conversation, so and patients feel comfortable just kind of opening up and sharing about the concerns they're having, you know, they feel like they're short fused, they feel like maybe they shouldn't have said that to their husband or their child, and then they come in and they're very tearful, full of guilt, because of this, you know, emotional variability that they feel like they can't control. I had a patient come in and say, I used to be a colorful painting, and now I'm black and white. Yeah, and so it really does affect them, and 80% of women will have some kind of like brain concern, so either like depression, anxiety, brain fog, mood instability, and again it's it's it's out of their control, and so they're trying to do all the right things, but sometimes that's not enough to really help them, and like I said earlier, I think perimenopause unmasks things that we used to be able to suppress when we were younger, right? So, like, you see a lot more diagnosis of ADHD, anxiety, and depression, and that's okay, right? It's okay to know that you can be treated for these, and maybe the hormones would benefit you as well.
Katie Lowe 21:20
Yeah, and it's a phase of life. I mean, this is exist, not forever, it's just you're right now, and there is a next chapter, and we have to look forward to that too. It's got to be so frustrating too, because these are all things, obviously, that you can't see, and at least when, when women are having babies, people know, oh, you just had a baby, they're understanding you're not getting sleep. People just sort of seem to get it a little bit more, whereas I'm hearing a lot of the same symptoms as, as someone who's postpartum or something like that, but the people don't really seem to take that into a little more invisible.
Dr. Elizabeth Koffler 22:01
Such a good point. That's actually so true, that, but you have this village around you, and you're postpartum, and then when you're this stage, you don't get leave because you have hot flashes, and you can't sleep at night, like, yeah, you know, that is such a good way to put it. And, yeah, I mean, you get much more support, because, but then that postpartum period is temporary, which this is the next chapter of your life. So we do have to find ways to cope and deal with it.
Katie Lowe 22:30
So, for these women who just feeling like something is off, any advice for them on ways that they can advocate for themselves and their health,
Dr. Elizabeth Koffler 22:41
yeah. If they don't feel like they're being heard or seen, and they're being told, "Oh, maybe you're too young or you're still having periods, there's no way. You know, these are hormonal fluctuations. Then you know, seek a second opinion. A lot more people are becoming more and more versed on menopause care, and more and more people are getting this menopause certification, so you can get online and check and see if somebody has a menopause certification, but if you don't feel like you're getting your questions answered, there is somebody who will be willing to help you and listen, so you really do have to advocate for yourselves, and I think podcasts like this give information, and information is empowering to women, so yeah, I just think keep asking, and if your symptoms are affecting your quality of life, like really try to be an advocate for yourself.
Marcus Thorpe 23:37
I think this is exactly why, when we're kind of thinking, well, what topic should we really dive into? This podcast is really, I think, cemented why we wanted this one, especially why we wanted you to come back and do it, because we knew you'd be the right person for it, Dr. Koffler. So, we can't thank you enough for being part of this discussion, and we know that we're gonna have you back for more, because you do really explain it in a way I think that's easy for people to understand, and that you need to push for yourself. You need to advocate for yourself. So, thanks. Thanks for joining us.
Dr. Elizabeth Koffler 24:05
Thank you. This is fun.
Katie Lowe 24:07
It’s really eye-opening for me as well. I learned a lot. For those listening, who.. I mean, we talked for over 20 minutes, but I still feel like we're kind of just scratching the surface, and they want to learn a little bit more. Where would you suggest they look to or turn to to learn more and take that next step for themselves?
Dr. Elizabeth Koffler 24:26
I mean, there's a lot of good books about menopause therapy. The one I would recommend is one called Estrogen Matters. I think it's very well written, and you don't have to be in medicine to understand it. And then the Menopause Society website is another good source.
Marcus Thorpe 24:44
We'll check that out. Dr. Koffler thank you again. We really appreciate it. And, of course, we thank you for joining us for this episode of The Wellness Conversation and OhioHealth Podcast. Before we let you go, we always invite you to like, favorite, subscribe, and of course, share this podcast and other podcasts that maybe. You come across that you think might be good for somebody else to hear, it helps us grow our community as well,
Katie Lowe 25:05
And we'll see you next time.