Women's Longevity Protocol
Training, Hormones & Nutrition for Every Life Stage
Synthesized from 15+ expert interviews on Huberman Lab and The Drive. What actually works for women's health, performance, and longevity.
In This Guide
Hubermanlab
Dr. Stacy Sims, Dr. Mary Claire Haver interviews
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Peterattiamd
Dr. Rachel Rubin, in-depth HRT discussions
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1. Why Women's Health Is Different
"Women are not small men. The research is clear: women's physiology requires different approaches to training, nutrition, and recovery."
— Dr. Stacy Sims, Exercise Physiologist
For decades, most exercise and nutrition research was conducted primarily on men. The protocols that emerged—intermittent fasting, fasted cardio, high-volume training—were assumed to work equally well for women. They often don't.
Women have fundamentally different hormonal environments that change across the menstrual cycle and dramatically shift during perimenopause and menopause. These hormonal differences affect:
Muscle Fiber Composition
Women have a higher proportion of type I (oxidative) muscle fibers, affecting how they respond to fasting and training.
Stress Response
Women's HPA axis responds differently to training stress, making recovery and cortisol management critical.
Bone Metabolism
Estrogen is protective for bone density. When it declines, women need specific interventions to maintain bone health.
Energy Availability
Low energy availability disrupts women's hormonal function faster and more severely than in men.
2. Training by Life Stage
Dr. Stacy Sims outlines distinct training approaches for each decade of a woman's life. The key insight: what works in your 20s won't work in your 40s.
Building the Foundation
This is the time to build metabolic and muscular reserves. Your hormonal environment is generally supportive of adaptation.
Protocol
- ✓ Strength training to failure — You can push harder in this phase
- ✓ Variety in cardio — Mix steady-state and intervals
- ✓ Focus on movement quality — Build proper mechanics
- ✓ Build bone density — Impact and resistance training
The Transition Phase
Perimenopause often begins in the late 30s to early 40s. Hormonal fluctuations begin, and training must adapt.
Protocol Shift
- ✓ Heavier weights, fewer reps — Shift from volume to intensity
- ✓ Reps in reserve — Stop 2-3 reps before failure to manage recovery
- ✓ Prioritize recovery — Sleep becomes even more critical
- ✓ Add sprint intervals — Short, intense efforts for metabolic health
Preservation & Optimization
With declining estrogen, the body becomes less forgiving. Training must be strategic, not just hard.
Critical Protocols
- ✓ Heavy resistance training 3-4x/week — Non-negotiable for muscle preservation
- ✓ Jumping/plyometrics — 10-20 jumps per session for bone density
- ✓ Sprint interval training — 30-second all-out efforts with full recovery
- ✓ Adequate protein — 1.6-2.2g/kg body weight
Dr. Sims' Key Point: "Women over 40 should NOT train to failure. The recovery cost is too high. Lift heavy, keep 2-3 reps in reserve, and focus on quality over quantity."
3. Navigating Perimenopause
"Perimenopause is not a single event. It's a 7-10 year transition that starts earlier than most women realize."
— Dr. Mary Claire Haver, Menopause Specialist
Most women expect menopause to hit suddenly around age 50. The reality is that the hormonal shifts begin years earlier, often causing symptoms that go unrecognized or are attributed to "stress" or "aging."
Early Signs of Perimenopause
Waking at 3-4am, difficulty falling back asleep
Cycles becoming shorter or longer, heavier periods
Anxiety, irritability, or depression
Weight gain around the midsection despite same habits
Difficulty concentrating, memory issues
Often start before periods stop
The Testing Challenge
Standard hormone tests often come back "normal" during perimenopause because hormones fluctuate wildly. Dr. Haver emphasizes that symptoms matter more than lab values during this phase.
If you're experiencing symptoms but your labs are "normal," find a provider who understands perimenopause and will treat based on clinical presentation.
4. HRT: What the Evidence Shows
Disclaimer
Hormone replacement therapy is a personal medical decision. This guide synthesizes what experts discuss on these podcasts but is not medical advice. Work with a qualified healthcare provider.
The 2002 Women's Health Initiative (WHI) study caused widespread fear of HRT. However, subsequent analysis and newer research have substantially changed our understanding. Here's what the experts discuss:
Key Points from Expert Interviews
The Timing Hypothesis
Starting HRT within 10 years of menopause (or before age 60) appears to have cardiovascular benefits. Starting later may not provide the same protection but can still help with other symptoms.
Estrogen + Progesterone
Women with a uterus need both estrogen and progesterone. The type and delivery method matter—transdermal estrogen and micronized progesterone are generally preferred.
"It's Not Too Late"
Dr. Rachel Rubin emphasizes that even women who start HRT years after menopause can see significant benefits for bone health, sexual function, and quality of life.
Testosterone for Women
Often overlooked, testosterone plays important roles in women's health. Dr. Rachel Rubin discusses this extensively on The Drive.
Potential Benefits
- ✓ Improved libido and sexual function
- ✓ Better energy and reduced fatigue
- ✓ Muscle mass preservation
- ✓ Mood stabilization
Key Point: Testosterone therapy for women uses much lower doses than for men. The goal is to restore levels to the normal female range, not to achieve male levels.
5. Bone Health Protocols
"Women can lose up to 20% of their bone density in the 5-7 years after menopause. This is the time for aggressive intervention, not waiting."
— Peter Attia, The Drive
Bone health is one of the most critical—and most overlooked—aspects of women's longevity. A hip fracture after age 65 carries significant mortality risk. Prevention starts decades earlier.
The Bone-Building Protocol
1. Resistance Training
Heavy compound lifts that load the skeleton:
- Squats and deadlifts
- Hip hinges and lunges
- Overhead pressing
- Rows and carries
2. Impact Loading
Jumping creates piezoelectric signals that stimulate bone formation:
- 10-20 jumps per day (can be spread throughout day)
- Box jumps, jump rope, or simple hops
- Even stepping off a small platform provides stimulus
3. Key Nutrients
Testing & Monitoring
Get a baseline DEXA scan in your 40s
Know your starting point before menopause
Repeat every 2 years during/after menopause
Track changes and adjust interventions
Discuss medications if needed
Bisphosphonates or other treatments for osteopenia/osteoporosis
6. Nutrition: What NOT to Do
The Intermittent Fasting Mistake
Dr. Stacy Sims is emphatic: active women should generally avoid intermittent fasting and fasted training. Women's physiology responds differently to caloric restriction.
What happens when active women fast or train fasted:
Cortisol Elevation
Fasting raises cortisol more in women, increasing stress and potentially disrupting hormones.
Thyroid Suppression
Low energy availability can quickly downregulate thyroid function in women.
Muscle Loss
Without pre-workout fuel, women may catabolize muscle more readily.
Cycle Disruption
Low energy availability can cause menstrual irregularities.
What TO Do Instead
Even 15-20g protein before a workout supports performance
30-40g per meal, especially important as you age
Carbohydrates support high-intensity work and recovery
Chronic under-eating is more harmful than most women realize
Key Supplements for Women
Creatine (3-5g/day)
Supports muscle, brain function, and may help with mood
Vitamin D3
Test levels and supplement to maintain 40-60 ng/mL
Omega-3s
EPA/DHA for inflammation and heart health
Magnesium
Often deficient; supports sleep and muscle function
7. Training Around Your Cycle
For premenopausal women, understanding how your menstrual cycle affects training can optimize results. Dr. Stacy Sims breaks it down:
Follicular Phase
Low hormone phase (after period starts through ovulation)
Best for: PRs, intense intervals, new training stimuli
Luteal Phase
High hormone phase (after ovulation through period)
Best for: Technique work, moderate intensity, deload weeks
Practical Takeaway
You don't need to completely restructure training around your cycle, but being aware of these patterns can help explain day-to-day variations in performance and recovery. Consistency over the month matters more than perfect periodization.
8. FAQ from 2,300+ Comments
These are the most common questions from real viewers of Huberman Lab and The Drive episodes on women's health.
Q: I'm 38 and feeling "off" but my labs are normal. Could it be perimenopause?
Yes. Perimenopause can begin in the late 30s, and standard hormone tests often miss it because hormone levels fluctuate wildly during this transition. Dr. Haver emphasizes that symptoms are often more diagnostic than labs. If you're experiencing sleep disruption, mood changes, cycle irregularities, or unexplained weight changes, it's worth finding a provider who specializes in perimenopause.
Q: Should I keep training the same way during menopause?
The fundamentals stay the same (resistance training, adequate protein, movement), but the approach shifts. Dr. Sims recommends: heavier weights with reps in reserve instead of training to failure, more emphasis on recovery, and adding sprint intervals and plyometrics. The goal is quality over quantity.
Q: Is HRT safe? I'm scared because of what I've heard.
The 2002 WHI study created widespread fear, but subsequent research has provided more nuance. Current evidence suggests that for most women under 60 or within 10 years of menopause, the benefits of HRT (using transdermal estrogen and micronized progesterone) often outweigh risks. However, this is highly individual—family history, personal risk factors, and type of HRT all matter. Work with a knowledgeable provider.
Q: I've been doing intermittent fasting and it's not working anymore. Why?
What worked in your 20s may backfire in your 40s. As Dr. Sims explains, women's hormonal environment becomes more stress-sensitive during perimenopause. Fasting elevates cortisol, which can disrupt sleep, increase belly fat, and impair recovery. Try eating regular meals with adequate protein and see if symptoms improve.
Q: What's the single most important thing for women's longevity?
If forced to choose one thing, the experts consistently emphasize resistance training. Maintaining muscle mass and bone density protects against falls, preserves metabolic health, supports independence in later life, and may even protect brain function. Start now, lift heavy (relative to your ability), and never stop.
Q: My doctor won't prescribe HRT. What should I do?
Unfortunately, many providers received limited menopause training. The North American Menopause Society (NAMS) maintains a directory of certified menopause practitioners. You can also look for providers who specialize in women's health or integrative medicine. Telehealth options have expanded access in recent years.
Q: How much protein do I really need?
The experts consistently recommend 1.6-2.2g of protein per kg of body weight for active women, with the higher end being more important during perimenopause and menopause. This is significantly more than the RDA. Distribute it across meals—30-40g per meal—rather than having most at dinner.
Key Experts Referenced
Dr. Stacy Sims
Exercise physiologist specializing in female-specific training and nutrition
Dr. Mary Claire Haver
OB-GYN and menopause specialist, creator of The Galveston Diet
Dr. Rachel Rubin
Urologist specializing in sexual medicine and women's health
Dr. Natalie Crawford
Reproductive endocrinologist specializing in fertility
Dr. Thaïs Aliabadi
OB-GYN specializing in hormonal health
Peter Attia, MD
Longevity-focused physician, host of The Drive podcast
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