SHE MD

Why does sleep suddenly become so much harder for so many women in their 30s, 40s and 50s?
Eight Sleep cofounder Alexandra Zatarain joins SheMD to explore how hormones, temperature and the brain’s natural circadian rhythm affect the way women sleep throughout different stages of life.
Dr. Thaïs Aliabadi explains why fluctuations in estrogen and progesterone during perimenopause can contribute to night sweats, temperature changes, anxiety, racing thoughts and middle-of-the-night wake-ups.
Alexandra shares what years of sleep research and data have taught the Eight Sleep team about deep sleep, REM sleep, temperature regulation, pregnancy, menopause and recovery.
We also break down how much sleep adults actually need, why consistency matters and why alcohol, caffeine and late-night exercise may interfere with recovery even when you are technically getting enough hours.
Plus, Alexandra shares five practical habits she recommends for better sleep and helps us tackle common sleep myths, including whether you can really catch up on lost sleep over the weekend and whether a nightcap actually helps you sleep.
If your sleep has changed and you cannot figure out why, this episode is for you.

Sponsors
Eight Sleep is featured in this episode through a conversation with co-founder Alexandra Zatarain about sleep science and the company’s sleep technology. No formal sponsorship or promotional offer is mentioned.

What You’ll Learn
How Alexandra Zatarain's personal experiences inspired the creation of Eight Sleep and its approach to improving sleep through technology.
Why perimenopause and menopause can disrupt sleep, including the roles of fluctuating estrogen, declining progesterone, night sweats, and anxiety.
How body temperature and circadian rhythms influence when we fall asleep, stay asleep, and wake up.
Why pregnancy and postpartum hormonal changes can affect temperature regulation, snoring, and sleep quality.
The differences between deep sleep and REM sleep, and why both are essential for physical recovery, memory, and emotional processing.
How much sleep adults generally need, why individual sleep requirements vary, and how to recognize whether you're getting enough rest.
Why alcohol may make it easier to fall asleep while negatively affecting overnight recovery.
Why catching up on sleep over the weekend cannot fully compensate for consistently getting too little sleep during the week.
How sleep-tracking technology can help monitor sleep patterns, recovery, temperature preferences, and potential signs of sleep apnea.
Five practical ways to improve sleep, including prioritizing sufficient rest, maintaining a consistent schedule, optimizing your sleep environment, adjusting daily habits, and working with your partner.
Why women experiencing persistent sleep disruptions should consider underlying factors, including hormonal changes and other health conditions, with guidance from a healthcare provider.

Key Takeaways
Sleep is a foundational pillar of health. Prioritizing exercise and nutrition while consistently sacrificing sleep can undermine overall well-being. Making enough time for rest is an essential part of supporting long-term health.
Hormonal changes can significantly disrupt women's sleep. Fluctuating estrogen and progesterone levels during perimenopause and menopause may contribute to temperature sensitivity, night sweats, anxiety, and nighttime awakenings. Persistent sleep difficulties deserve attention rather than being dismissed as an inevitable part of aging.
Temperature plays an important role in sleep. Core body temperature naturally declines as we approach sleep and rises toward morning. A comfortable, cool sleeping environment can support this process, although individual temperature preferences vary.
Deep sleep and REM sleep serve different but complementary functions. Deep sleep is associated with physical restoration, while REM sleep supports processes involving memory, learning, and emotional processing. Getting sufficient sleep allows the body to cycle through both.
Alcohol can interfere with overnight recovery. Although alcohol may help someone fall asleep more quickly, it can affect recovery metrics, including resting heart rate and heart rate variability. Falling asleep faster does not necessarily mean sleeping well.
Consistency matters as much as duration. Maintaining relatively consistent bedtimes and wake-up times can support the body's circadian rhythm. Alexandra recommends aiming for seven to nine hours of sleep for most adults while paying attention to individual needs.
Sleep quality can be affected by more than personal habits. Snoring, possible sleep apnea, hormonal changes, stress, and a partner's sleep patterns can all contribute to disrupted rest. Persistent symptoms may warrant evaluation by a healthcare professional.
Small, sustainable changes can improve sleep habits. Gradually extending sleep time, keeping the bedroom cool, dark, and quiet, limiting late-day caffeine and alcohol, and avoiding heavy meals close to bedtime are practical starting points.
Women's sleep deserves more research and individualized care. Pregnancy, postpartum recovery, perimenopause, and menopause each present different challenges. Understanding these life stages can help inform better research, technology, and healthcare support.

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Naomi Watts joins SheMD alongside renowned sexual arousal researcher Dr. Cindy Meston for a candid conversation about sex, desire and what happens to women’s bodies during perimenopause and menopause.
Naomi shares her experience learning in her 30s that she was likely entering early menopause, the shame and isolation she initially felt and how opening up about her changing body ultimately transformed her relationship with intimacy.
Dr. Meston explains why female sexual desire may work differently than many women have been taught, including why arousal can sometimes come before desire. She also breaks down the physical and psychological factors that can affect sex, from hormones, blood flow and vaginal changes to stress, sleep, body image and relationships.
Dr. Thaïs Aliabadi discusses treatment options for women experiencing painful sex, vaginal dryness and changes in libido, including vaginal moisturizers, lubricants, vaginal estrogen and testosterone.
Plus, Naomi explains why she believes menopause can be an empowering new chapter rather than the end of pleasure, intimacy or good sex.

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What You’ll Learn
Why Naomi Watts' personal experience with early menopause inspired her to help change the conversation around women's health.
The lesser-known symptoms of perimenopause and menopause, including brain fog, sleep disruption, dry eyes, vaginal dryness, and painful sex.
How hormonal changes can affect vaginal health, lubrication, and urinary symptoms.
Why sexual arousal can precede desire for many women, particularly during perimenopause and menopause.
How stress, exercise, relationship dynamics, and negative thoughts can influence sexual arousal and intimacy.
What treatment options are available for vaginal dryness and painful sex, including moisturizers, lubricants, vaginal estrogen, and other therapies.
Why open communication with your partner and a knowledgeable healthcare provider is essential to navigating changes in sexual health.
How Naomi's experiences and conversations with women inspired Stripes' sexual wellness products.
Why menopause can be a new chapter of confidence, self-advocacy, and sexual fulfillment rather than the end of a satisfying sex life.

Key Timestamps
00:00 Naomi Watts on why good sex doesn't have an age limit
04:51 The overlooked symptoms of perimenopause and menopause
07:32 Vaginal dryness, painful sex, and recurring UTIs
12:32 How arousal, body image, and negative thoughts affect intimacy
18:55 Naomi's experience navigating menopause in a new relationship
22:08 The science of arousal, exercise, and blood flow
31:42 Vaginal estrogen and long-term vaginal health
40:31 How stress, sleep, and relationship dynamics affect desire
42:00 Why women should never feel they have to tolerate painful sex
45:24 The connection between psychological arousal, physical response, and communication
51:16 Testosterone therapy and the Mona Lisa laser
56:38 Naomi's menopause tips, favorite Stripes products, and rapid-fire questions
58:05 The language around menopause that needs to change
1:00:38 Dr. Meston's advice for women navigating menopause
1:02:29 Reframing menopause as an empowering new chapter

Key Takeaways
Menopause affects more than hot flashes. Hormonal changes can influence sleep, mood, cognition, skin, eyes, vaginal health, and sexual comfort, sometimes years before menopause itself.
Female desire and arousal don't always follow a linear pattern. For many women, particularly as they age, arousal can come before desire. Understanding this can help women move away from the expectation that sexual desire must always happen spontaneously.
Sexual health involves both the mind and the body. Physical changes, stress, fatigue, body image, relationship dynamics, and distracting thoughts can all influence arousal and intimacy.
Painful sex should not be accepted as an inevitable part of aging. Vaginal moisturizers, lubricants, vaginal estrogen, and other treatment options may help, depending on individual needs and medical history. Women experiencing persistent pain should seek guidance from a qualified healthcare provider.
Communication can transform intimacy. Talking openly with a partner outside the bedroom about changing needs, comfort, and pleasure can help couples adapt and maintain connection throughout different stages of life.
Women deserve individualized, evidence-informed care. There is no single approach to sexual health during menopause. Working with a clinician knowledgeable in menopause and sexual medicine can help women understand their options.
Menopause is not the end of a fulfilling sex life. Naomi's story underscores the importance of challenging stigma, listening to women's experiences, and giving women the confidence to advocate for their health and pleasure.

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We are revisiting one of our favorite SheMD conversations with SZA.

SZA joins her longtime physician Dr. Thaïs Aliabadi and Mary Alice Haney for an intimate conversation about her health, family history and the anxiety that can come with trying to understand what is happening inside your own body.

Dr. A walks through SZA’s breast cancer risk assessment, family history, genetic testing and why a negative genetic test does not necessarily mean someone has an average lifetime risk of breast cancer.

SZA also talks candidly about health anxiety, therapy, trauma, relationships, creativity and learning to accept the parts of herself that do not fit the traditional idea of being a “nice girl.” She reflects on the drive that helped build her career, why outside validation once mattered so much to her and what she is still learning about trusting herself.

Plus, SZA talks about getting off the internet, motherhood, life beyond music and the people who have shaped who she is today.

This conversation was originally recorded before SZA went on to win three Grammys following the release of SOS.

Subscribe to SHE MD Podcast for expert tips on PCOS, endometriosis, fertility, hormonal balance, mental health, and more. Share with friends and visit SHE MD website and Ovii for research-backed resources, holistic health strategies, and expert guidance on women's health and well-being.

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What You'll Learn
Where the name SZA comes from and what each letter represents.
Why every woman should know her lifetime risk of breast cancer, even without a family history.
How factors like height, weight, breast density, family history, and genetic testing change a lifetime risk score.
Why women with a lifetime risk above 20% should start breast imaging at 30 instead of 40.
What a fibroadenoma is and why imaging catches cancers years before a lump can be felt.
How a family history of cancer can create lasting health anxiety, and why being your own advocate matters.
The story behind SOS and SZA's journey away from trying to be a "nice girl."
SZA's advice for young artists on protecting their health and creativity.

Key Takeaways
The average woman has a 12.5% lifetime risk of breast cancer, and every woman should have her personal risk calculated by her doctor.
A negative genetic test does not mean low risk, since family history, breast density, and other factors still affect a woman's lifetime risk.
Women with a lifetime risk above 20% should begin breast imaging at 30, not 40, and may be missed if risk is never calculated.
By the time a lump can be felt, it has often been there for years, which is why regular imaging is essential.
Watching loved ones go through cancer can create real health anxiety, and advocating for yourself is better than assuming something is nothing.
Integrating every part of yourself, including your edge, can be a source of strength rather than shame.

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Miranda McKeon was only 19 when she noticed a lump in her breast and was diagnosed with stage three, hormone positive, HER2 negative invasive ductal carcinoma.
In honor of Breast Cancer Awareness Month, Miranda joins SheMD to share the full story of her diagnosis, treatment and life after breast cancer. She opens up about the breast dimpling she initially dismissed, learning she carried a CHEK2 mutation despite having no family history of cancer, freezing her eggs before chemotherapy, undergoing a double mastectomy and radiation, and entering medically induced menopause in her early 20s.
Miranda also talks candidly about painful sex, vaginal dryness, low libido, dating, body image, fertility and the emotional impact of experiencing cancer during what should have been her college years.
Dr. Thaïs Aliabadi explains breast changes women should pay attention to, how genetics and breast density can affect risk, and why knowing your own baseline and speaking up when something changes can matter.
This conversation is a powerful reminder that breast cancer does not only affect older women and that knowing your body is an important part of advocating for your health.
Subscribe to SHE MD Podcast for expert tips on PCOS, endometriosis, fertility, hormonal balance, mental health, and more. Share with friends and visit SHE MD website and Ovii for research-backed resources, holistic health strategies, and expert guidance on women’s health and well-being.
Sponsors
SmileSet: Listeners get an additional 35% off clear aligners at smileset.com/shemd.
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What You'll Learn
Why breast cancer rates are rising faster in women under 50, and why young women's symptoms are so often dismissed.
The early signs of breast cancer beyond a lump, including skin dimpling, nipple changes, discharge, and persistent one-sided flaky skin.
How CHEK2 mutations and polygenic risk scores shape breast cancer risk, even without a family history.
Why a one-size-fits-all mammogram age misses individual risk, and how breast density, family history, and genetics change the picture.
How to calculate your lifetime breast cancer risk with the Tyrer-Cuzick model and when high-risk screening should begin.
How chemotherapy can affect fertility, and why egg freezing should come before treatment.
What medically induced menopause looks like for a young woman, including hot flashes, low libido, and vaginal dryness.
How vaginal estrogen and CO2 laser treatments can help with painful sex.
How to cope emotionally with a young-onset diagnosis, from therapy to gratitude lists to a trusted inner circle.

Key Takeaways
Breast cancer is more common after 50, but rates are rising faster in younger women, and one in six new invasive cases occurs before age 50.
Skin dimpling and other changes are symptoms too. A young woman may not recognize them as warning signs, which can delay diagnosis.
Most women diagnosed with breast cancer have no family history, so a lack of family history is not a guarantee of low risk.
Mammograms starting at 40 treat everyone alike. Breast density, genetics, family history, and polygenic risk can all change when screening should begin.
Every woman should know her lifetime breast cancer risk by 30. A risk of 20% or more means earlier imaging, which may include mammogram, ultrasound, and MRI.
Egg freezing should be part of the first conversation before chemotherapy, because chemo's effect on ovarian reserve is unpredictable.
Medically induced menopause can bring severe symptoms, including painful sex, and women shouldn't feel ashamed to bring them up with their doctors.
A double mastectomy leaves some residual breast tissue, so ongoing monitoring is still important.
Know what's normal for your breasts and report changes promptly.
Therapy, gratitude, and a trusted circle can help you get through a young-onset diagnosis.

Guest Bio - Miranda McKeon
Miranda McKeon is a breast cancer survivor, women’s health advocate, and content creator who was diagnosed with stage 3 hormone-positive, HER2-negative invasive ductal carcinoma at just 19 years old. After discovering a lump in her breast while home from college, Miranda underwent chemotherapy, a double mastectomy, radiation, and medically induced menopause. She later learned that she carries a CHEK2 genetic mutation associated with an increased risk of breast cancer.
Since her diagnosis, Miranda has become an outspoken advocate for young women navigating cancer, sexual health, fertility, body image, and life after treatment. She openly shares her experience with intimacy and medically induced menopause and uses her platform to encourage women to understand their bodies and advocate for their health.

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This one is a full-circle moment. Our guest isn't just one of Mary Alice's oldest friends (25 years and counting), she's also one of Dr. A's real-life patients, the doctor who actually froze her eggs. Whitney Cummings, comedian, actress, and creator of 2 Broke Girls and Whitney, has built a career saying the things women usually only whisper about. Today she says them out loud, with us.

Whitney was talking about freezing her eggs before it was a mainstream conversation (she did it at 33), and she is refreshingly, hilariously honest about getting pregnant at 40, being handed the term "geriatric pregnancy," the postpartum depression that came after her son, and the body image struggles she's carried for years. She and the hosts get into fertility, the real cost of waiting, why "biology is sexist," and the money advice she gives every young woman (skip the designer bag, save it for your eggs).

Funny, tender, and the kind of honesty that makes you feel less alone.

Subscribe to SHE MD Podcast for expert tips on PCOS, endometriosis, fertility, hormonal balance, mental health, and more. Share with friends and visit SHE MD website and Ovii for research-backed resources, holistic health strategies, and expert guidance on women's health and well-being.

Sponsors
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What You'll Learn
Why Whitney froze her eggs at 33 and how it eased her anxiety about dating and timing.
Why Dr. A tells patients never to use all of their frozen eggs to make embryos with a partner.
How egg quantity and quality decline with age, and what that means for miscarriage risk.
The lifestyle changes Whitney made before conceiving naturally at 40.
The testing and monitoring Dr. A recommends for advanced maternal age pregnancies, including preterm birth screening, low-dose aspirin, and growth ultrasounds.
Why delivery at 39 weeks is recommended for women over 40.
The difference between postpartum blues and postpartum depression, and how long the postpartum period really lasts.
Whitney's approach to co-parenting, forgiveness, and choosing a partner.

Key Takeaways
Egg freezing can reduce the pressure and anxiety around timing, and women should always keep some of their own eggs rather than using them all for embryos with a partner.
Both egg quantity and quality decline with age, but many women still have healthy pregnancies in their 40s with the right care and awareness of their personal risk factors.
Advanced maternal age pregnancies benefit from closer monitoring, including preterm birth screening, low-dose aspirin, regular growth ultrasounds, and delivery at 39 weeks.
Postpartum depression affects about one in seven women, can appear up to a year after birth, and is more likely without strong support at home.
Asking for help, leaning on your village, and letting motherhood change you are essential parts of postpartum recovery.
Choosing a partner based on respect and integrity, and co-parenting with kindness, creates a healthier environment for your child.

Guest Bio - Whitney Cummings
Whitney Cummings is a comedian, actress, director, and writer. She is the co-creator of 2 Broke Girls, the creator and star of NBC's Whitney, and the host of the podcast Good for You. Known for her disarmingly honest stand-up specials, Whitney has spoken openly about egg freezing, body image, sobriety, and her recovery from an eating disorder. She became a mom at 40 to her son Henry and has been candid about her pregnancy and postpartum journey.
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