Women’s Health for the Long Run: Inside My Metabolic Plan
How I’m using labs, devices, and medication to navigate midlife metabolism.
Okay. Real talk.
My dad had his first stroke at 49. Triple bypass at 60. More than twenty surgeries over his lifetime. My mom’s side carries thyroid disease and diabetes.
For a long time I held this as background information. Filed under “noted.” Like information that mattered, just not yet. I thought discipline was how you outran a genetic landscape: eat clean, move more, apply enough willpower, and the numbers would stay on your side.
Part one of this series is what happens when that stops being true.
This is part two. Where I tell you what I’m actually doing about it — the labs I care about, the devices I’m experimenting with, and an honest walk through my medication situation, which has evolved a lot since I first drafted this post. Bear with me. There’s a lot to cover, and I’d rather tell you all of it than pretend it’s simpler than it is.
The labs that actually tell me something
I used to think labs meant cholesterol and blood sugar. Normal. See you next year. Now I ask a different question: which numbers tell me where I’m headed, not just whether I’m passing today’s test?
Fasting insulin.
Blood sugar can look completely fine while your pancreas is quietly working overtime to keep it there. Fasting insulin catches that earlier, sometimes years before anything shows up on a standard panel. I wish I’d known to ask for this sooner.
HOMA-IR.
A calculation combining fasting glucose and fasting insulin. I care less about any single result and more about which direction it’s trending as I add protein, lift, and actually sleep.
ApoB and lipids.
ApoB tells me how many atherogenic particles are circulating. Perimenopause shifts lipid profiles even when nothing else visibly changes, often in the wrong direction. I want to see whether my interventions are actually moving something or just making me feel productive.
Blood pressure.
Boring. Matters more than I ever gave it credit for.
Body composition, not just weight.
Lean mass, fat mass, visceral fat. DEXA for the real picture, a consistent home scale to track direction between scans. Neither is perfect. Together they’re more informative than whatever the bathroom scale says on a Monday morning.
The gap between knowing and doing — which is where I actually live
Here’s the version of this section I wanted to write: I wake up, check my sleep data, make a protein-forward breakfast, block 45 minutes to lift like it’s a meeting. Metabolic intention from morning to night.
Here’s what’s actually true: I still look up at 4pm and realize I haven’t eaten.
My challenge was never information. It’s always been implementation — specifically, implementation inside a life that doesn’t pause for protocols.
So I stopped trying to do everything at once.
Right now my only goal is 30 grams of protein at two or three meals a day. That’s the whole plan this month. Not because nothing else matters, but because it’s what I can realistically execute while everything else is still in motion.
I’m working in three-week blocks. One change. Twenty-one days. Then reassess.
Life still disrupts it. I miss meals. I’m trying to stay gracious with myself and remember that perfection isn’t the goal. One day I get it right, the next I don’t, and the day after, I try again.
The devices I’m using (and the one I haven’t started yet)
None of these are required to be healthy. They’re feedback loops.
CGM (continuous glucose monitor).
Haven’t started yet but I plan to use one in short windows, a few weeks at a time, a couple of times a year. Pattern recognition, not permanent tracking. Which foods spike me. Whether walking after meals actually blunts the rise. What a bad night of sleep actually costs me metabolically. Then I take it off. The point is insight, not another thing to manage.
DEXA scan.
Twice a year or so. Bone density, muscle mass, visceral fat: three signals in one scan. I’d rather catch early whispers than wait for late headlines.
Whoop.
I’ve used Oura. I wear Whoop now. No brand argument, it just fits how I think. I mainly track deep and REM sleep and treat the numbers as a nudge, not a verdict.
My rule with all of it: if the device starts increasing anxiety, I stop using it. The moment a number can ruin my morning, something has gone wrong with how I’m relating to the tool.
The medications — okay, sit down, because this section has changed
A lot has shifted since I first wrote this draft over a month ago. I’ve started new things, adjusted others, and learned more about my own hormonal landscape than I expected to. So I’m just going to walk you through exactly where I am right now.
GLP-1: Zepbound, 2.5mg
Still on it. This is Zepbound’s starting dose — I’m microdosing, essentially. And I’m not increasing until I see my doctor in April.
Do I want to lose weight? Yes. Do I want to reduce visceral fat? Desperately. Am I rushing the dose to get there faster? No. I want my protein intake and strength training dialed in first. I’m not interested in losing weight at the expense of muscle. I want fat loss, not just a smaller version of myself.
I used to judge GLP-1s. Hard. I thought they were for people who weren’t willing to do the real work. Then I actually listened to endocrinologists explain what they do to insulin signaling, satiety, and visceral fat distribution in ways that, for some women, in some phases of life, diet and movement alone genuinely cannot replicate.
Before I said yes, I needed three answers: What specific outcome are we targeting? What are my personal risks? What’s the exit strategy?
Estrogen and progesterone — this is where it got more nuanced
Before I get into what I’m taking, I need to explain why, because for a while, my symptoms didn’t line up cleanly.
Last year, I did a DUTCH test (Dried Urine Test for Comprehensive Hormones). It’s not a standard blood test, it’s more like a systems-level map of how your hormones are behaving over time.
A blood test tells you: “Your estrogen is X.”
The DUTCH test shows how much estrogen you’re producing, how you’re metabolizing it, how well you’re clearing it, and how it interacts with progesterone, cortisol, and androgens.
What mine showed explained a lot.
First: my estrogen levels were low. Across the board.
So from a quantity perspective, I’m not estrogen dominant. I’m estrogen deficient. That alone explains things like fatigue, low libido, mood shifts, and changes in skin and tissue.
But that wasn’t the full picture.
The second layer was how I was processing estrogen. My results showed that I wasn’t favoring the more protective metabolic pathway, and that I wasn’t clearing estrogen as efficiently as I could.
So the reality wasn’t: “Too much estrogen” or “too little estrogen.”
It was: low estrogen + suboptimal metabolism + a clearance system working harder than it should, which explains why things felt inconsistent.
Some symptoms pointed to low estrogen. Others looked more like what people describe as “estrogen dominance.”
Why I’m using estrogen
Once I understood that my estrogen levels were genuinely low, the decision became more practical than philosophical.
I’m using a transdermal estrogen gel: one pump daily. This is systemic, and it’s helping with sleep, mood, and overall stability in a way I could actually feel within a few weeks. I’m treating this as replacing something my body is no longer producing at the same level and seeing how my body responds.
I’m also using an estradiol cream applied locally to the vulvar tissue.
This is something we don’t talk about enough.
Estrogen decline in perimenopause affects that tissue — elasticity, hydration, sensitivity, even urinary comfort — in ways that have nothing to do with vanity and everything to do with quality of life.
The cream works locally, in ways the systemic gel doesn’t reach.
Different tools. Different jobs.
Progesterone — the one that’s been a whole journey
This one has not been straightforward.
December: I tried oral progesterone at a standard dose (100mg). It was a disaster. I could not wake up. Sleeping around the clock and still exhausted. And the irritability? Zero tolerance. My body was not having it.
We cut the dose in half. Same issue.
January and February: I stopped.
Last cycle: I tried again but a much lower dose (25mg), bioidentical, non-soy, taken only during the luteal phase (days 14–25).
This version was better. But I had insomnia, and we’re honestly not sure if that’s from the progesterone itself or from having relatively more estrogen than this dose can balance.
We don’t know yet. I’m running this cycle again to see if it repeats.
DIM and I3C Supplements
The DUTCH test didn’t just explain what was off, it showed me where I had a bottleneck.
If I’m going to support estrogen levels, I also need to support how my body processes and clears that estrogen.
That’s where DIM (diindolylmethane) and I3C (indole-3-carbinol) come in.
Both are compounds derived from cruciferous vegetables (broccoli, kale) that support healthy estrogen metabolism and balance. I3C converts into DIM in the stomach, which then helps reduce "bad" estrogen metabolites.
Given my pattern — low estrogen, but not processing it optimally — the goal isn’t to reduce estrogen. It’s to help my body handle it more cleanly.
I’ve been on them for a few months now.
(If you’re on medications like tamoxifen, this is something to discuss with your doctor — there are known interactions.)
For the woman wondering if she needs all of it
Probably not. Not yet. Maybe not ever in this form.
I hear this a lot from women I respect:
“I feel fine. I don’t have any of those symptoms.”
I get it. I would have said the same not that long ago.
What I’ve come to understand, slowly, and a little reluctantly, is that a lot of this doesn’t start with obvious symptoms. It starts as drift. Small changes in insulin, lipids, body composition — things you don’t necessarily feel until they’ve compounded.
So part of why I’m sharing this isn’t because everyone needs to do what I’m doing. It’s because I wish I had understood earlier what to look for and what I could have started before things felt off.
As women in midlife, we are navigating a body whose rules shifted mid-game, usually while we were busy holding everything else together.
The question isn’t whether you should be doing what I’m doing. It’s:
What would help you feel less in the dark about your own trajectory, before your body forces the question?
In part one, I wrote about muscle and metabolism as infrastructure. This is about the measurement tools and support beams I’m using to keep that infrastructure standing — imperfectly, inconsistently, but pointed in the right direction.
The question I’m holding:
What would we do differently if we stopped waiting for our bodies to feel “not fine” — and started paying attention while things still feel okay?
xoxo💋
Paola
This post is part of Women’s Health for the Long Run—a series grounded in lived experience, careful listening to experts, and shared learning. It is not medical advice.