Hit Play Not Pause

Midlife and menopause can bring real physical and psychological changes that affect libido, arousal, and pleasure—but that doesn’t mean desire or a satisfying sex life are destined to disappear. This week we sat down with registered nurse and Permission for Pleasure author Cindy Scharkey to unpack what actually happens to desire, arousal, pleasure, and our bodies as we move through perimenopause, menopause, and beyond. We explore why so many women stop wanting sex in midlife, how hormones, stress, body image, and long-term relationships play a role, and why waiting to be “in the mood” often doesn’t work anymore (and more importantly, what does).
Cindy Scharkey, RN, BSN, PHN, is a healthcare professional with almost 4 decades of experience. Throughout her career as a Certified Childbirth Educator, OB/GYN nurse and speaker, she has been consistently exposed to the taboos and silence surrounding women’s sexuality. Cindy is passionate about providing women with the content and self-confidence they need to find freedom on their own sexual wellness journey. As the author of Permission for Pleasure: Tending Your Sexual Garden, and Host of the Permission for Pleasure podcast, Cindy offers education and conversations about expressing, experiencing and enjoying your sexuality. You can learn more about her, her book, and her work at www.cindyscharkey.com
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This week we welcome back our resident reproductive endocrinologist and menopause specialist, Dr. Carla DiGirolamo, for another candid conversation. We pull back the curtain on Carla’s own menopause experience—how she navigates her symptoms, what she’s learned, and what she practices herself. We also dig into the hard conversations so many of us are having as we navigate this ever-evolving space, and how years of working closely with active midlife women have shaped her thinking on hormone therapy, GLP-1 medications, testosterone, hormone testing, and what actually moves the needle for athletic women in the transition.
Carla DiGirolamo, MD, PhD, is a Double Board Certified Reproductive Endocrinologist and Obstetrician/Gynecologist specializing in women’s performance and menopausal medicine. She is also a Crossfit Level 1 trainer, Certified Nutrition Coach, and member of CrossFit Medical Society. She is a MedFit Care provider and provides weekly workouts and medical updates at her Substack Athletic Aging. She is an Endocrine Consultant for Wild Health and Women’s Health Director at Eternal Health. Most recently, she has launched her own private practice specializing in helping active and high-performing women reach their performance potential from puberty through menopause. Dr. DiGirolamo is now seeing patients for virtual consultations for menopausal care and performance optimization. Visit her website www.drcarlad.com to learn more about her services and schedule an appointment.
Resources
Athletic Aging with Dr. Carla DiGirolamo on Substack
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In this special episode, your Feisty Women's Performance podcast host Dr. Erin Ayala brings together a group of experts on mental health to talk about the science and psychology of stress and collective trauma.
Along with being a sports psychologist & therapist in her own right, Erin also lives in Minneapolis, Minnesota — which has been at the center of the news over the last month since it became the target of the largest immigration enforcement action to date in the U.S. Thousands of federal agents have patrolled the streets and detained residents, and, over this past weekend, shot and killed a second bystander — leading to hundreds of thousands of people protesting in Minneapolis and around the country.
In this tense environment, how do we show up as athletes, as members of our community, as our best and healthiest selves?
Join Dr. Tess Kilwein, Dr. Quincy Guinadi, and Christine Bright as they discuss how these experiences shape mental health and performance, and how you can respond to stress and trauma — whether you're going through it right now with the news or you're dealing with your challenges.
Key Takeaways:
• What is collective trauma? Learn how collective trauma impacts communities and individuals, and why this understanding is crucial for athletes and coaches.
• Recognize that intentional rest in times of stress can be essential for long-term sustainability.
• Know that movement and sport can be powerful tools in community healing.
• Get tips on how to navigate the complexities of wanting to help without feeling performative or overwhelmed, and how to effectively engage in difficult conversations without shame or guilt.
Don't be perfect. Be brave.
Guest Introductions:
• Dr. Tess Kilwein: A board-certified clinical, health, and sport psychologist with expertise in mental performance and athlete wellness.
• Dr. Quincy Guinadi: A postdoctoral resident specializing in identity, mental health, and the experiences of marginalized communities.
• Christine Bright: Lead consultant at the Center for Healing and Justice through Sport, focusing on trauma-informed coaching and community support.
Resources Mentioned:
• Center for Healing and Justice through Sport
• Nothing Heals like Sport Playbook
• "What Happened to You" by Dr. Bruce Perry and Oprah
• Beyond Ally by Dr. Maysa Akbar
• Find ways to help at standwithminnesota.com

Exercise is supposed to be healthy—but when does dedication cross into compulsion? In this episode, we sat down with sports psychologist and new host of the Feisty Women’s Performance Podcast, Dr. Erin Ayala to explore the murky, often misunderstood concept of exercise addiction. We unpack why it’s not an official diagnosis, how it overlaps with perfectionism, anxiety, body image, and control, and why endurance athletes—especially midlife women—can be uniquely vulnerable. We also dive into identity, boundaries, training culture, and how to tell whether exercise is supporting your life—or quietly running it.
Erin Ayala, PhD, LP, CMPC is a Licensed Psychologist and Certified Mental Performance Consultant (CMPC) offering virtual mental health therapy for athletes aged 14 and above. She provides one-on-one performance coaching, CMPC mentorship, clinical supervision, and group workshops for teams and sport organizations. She supports athletes in injury recovery, managing performance anxiety, depression, pre-competition stress, confidence, and self-criticism. Located in Minnesota, she is licensed to work with athletes in 40 states. You can learn more about Dr. Ayala and her work at www.skadisportpsychology.com.
Follow the newly launched The Feisty Women’s Performance Podcast here.
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This week we welcome back protein and fat-loss researcher Dr. Bill Campbell to unpack early findings from what may be the largest menopause fitness survey to date, designed to finally study women who actively train. We dive into what thousands of fit midlife women report about calorie and protein intake, hormone therapy use, and the widely felt—but poorly studied—experience of weight-loss resistance during peri- and postmenopause. The conversation also explores why hormone therapy use appears far higher in fitness-engaged women than in national estimates, how muscle quality and power may decline even before we notice muscle loss, and why high-intensity interval work appears especially promising for reducing visceral fat.
Bill Campbell, PhD is a Professor of Exercise Science and Director of the Performance and Physique Enhancement Laboratory at the University of South Florida. He is also a Certified Strength & Conditioning Specialist from the National Strength & Conditioning Association and former president of the International Society of Sports Nutrition (where he is also 1 of 35 individuals to be recognized as a ‘Fellow’ of the organization—an honor reserved for those individuals who have outstanding contributions to the field of sports nutrition). He has published over 200 scientific papers and abstracts, three textbooks, and 20 book chapters in areas related to physique enhancement, sports nutrition, resistance training, and dietary supplementation. You can learn more about him and his work at www.billcampbellphd.com
Resources
Investigating weight loss resistance across the menopausal transition: a preliminary quantitative survey of resistance-trained women here
Insufficient sleep undermines dietary efforts to reduce adiposity here
Why the Calories In/Calories Out Equation Can Fail Women with Jody Dushay, MD here
Sign up for our FREE Feisty 40+ newsletter: https://feisty.co/feisty-40/
Feisty Strong Retreat, April 17-19, 2026 - Atlanta https://feisty.co/events/feisty-strong-retreat-atlanta/
Learn More about our 2026 Feisty Events, including Bike Camps and Cycling Trips: https://feisty.co/events/
Follow Us on Instagram:
Feisty Menopause: @feistymenopause
Hit Play Not Pause Facebook Group: https://www.facebook.com/groups/807943973376099
Support our Partners:
Midi Health: You Deserve to Feel Great. Book your virtual visit today at https://www.joinmidi.com/
Hettas: Use code STAYFEISTY for 20% off at https://hettas.com/
Previnex: Get 15% off your first order with code HITPLAY at https://www.previnex.com/
Wahoo: Use the code FEISTY2026 to get a free Headwind Smart Fan (value $300) with the purchase of a Wahoo KICKR RUN at https://shorturl.at/WVhdr