Advanced Strategies for Management of Midlife Maladies
Emily Sadri is a board-certified Women's Health Nurse Practitioner, and hormone expert with a gift for making complex functional and lifestyle medicine interventions accessible and doable. Her mission is to help women understand their beautiful and intricate body systems, so they know exactly how to care for themselves and so that they feel amazing. Emily believes that great health starts with happy hormones and a balanced stress response. She's helped hundreds of women figure out the root causes of their fatigue, anxiety, weight gain, and hormonal issues. Emily owns and operates a boutique telehealth practice helping women in Ohio, Florida, New York, Colorado, New Mexico, and Minnesota live more balanced, healthier lives.
Leslie: Can you tell us about your background and how you became focused on perimenopause and menopause care?
Emily: I’ve worked for many years as a nurse practitioner and certified nurse midwife, primarily in the traditional healthcare system. During the pandemic, I shifted my approach toward functional medicine and opened my own practice. Interestingly, I didn’t initially set out to focus on perimenopause and menopause. But as I transitioned, most of the women seeking my care were in their 40s and 50s. I realized that the functional medicine approach wasn’t enough; the hormonal issues women face at this stage require a hormone-first approach. That’s where my focus has been for the past several years—helping women in perimenopause and menopause navigate their health.
Leslie: Hormone Replacement Therapy (HRT) is often seen as controversial. Can you explain why that is?
Emily: You’re right—it’s a hot-button topic. Much of the fear around HRT stems from the early 2000s when results from a study called The Women’s Health Initiative were prematurely released. The media latched onto findings that suggested HRT increased the risk of breast cancer, causing a lot of fear. They didn’t take into account the complexities of the data. For instance, the study used Premarin, an estrogen derived from horse urine, which is different from human estrogen. Additionally, they used synthetic progestin rather than bioidentical progesterone. Over time, we’ve learned that the increased risk of breast cancer was mainly tied to synthetic progestin, not estrogen itself. In fact, estrogen, especially when taken without synthetic progestin, may lower the risk of breast cancer. Now, with decades of follow-up, the data show that the benefits of HRT, like reducing the risk of cardiovascular disease and osteoporosis, far outweigh the risks for most women.
Leslie: What options are available today for hormone replacement therapy?
Emily: There are several options today, and it’s important to know that you don’t have to rely on outdated forms like Premarin. Many women are prescribed estradiol, which is bioidentical to human estrogen, either as a patch or an oral tablet. Progesterone, when needed, is also available in bioidentical forms, which are safer than synthetic progestin. In my practice, I use a more customized approach, often prescribing hormones separately rather than combined. We offer both static dosing, where women take the same dose daily, and phasic HRT, which mimics the natural hormonal fluctuations of a menstrual cycle. This flexibility allows us to tailor treatment to the individual needs of each woman.
Leslie: Weight gain and metabolic changes are common concerns during menopause. Can you explain why this happens?
Emily: The hormonal changes of perimenopause and menopause, particularly the decline in estrogen, play a significant role in metabolic health. Estrogen is critical for maintaining insulin sensitivity. As estrogen levels drop, insulin resistance increases, which makes it harder for your body to move glucose into cells. This leads to higher circulating insulin levels, which promotes fat storage—especially around the belly. This insulin resistance also causes an increase in cholesterol and triglycerides because estrogen influences how the body processes and excretes cholesterol. That’s why many women notice a rise in cholesterol levels during midlife, even if their diet and lifestyle haven’t changed. Estrogen is a key modulator in maintaining metabolic balance, so replacing it can help with both weight and cholesterol management.
Leslie: What role do inflammation and aging play in weight gain during menopause?
Emily: Aging itself brings increased inflammation, which contributes to weight gain and metabolic changes. Inflammation and hormone imbalances often go hand in hand, making it harder for women to manage their weight as they age. For many women, focusing on reducing inflammation is crucial. This might involve dietary changes, supplements, and lifestyle adjustments, but addressing the hormonal shifts—particularly the decline in estrogen—is often the key to regaining metabolic control. In my practice, we aim to decrease inflammation and work on anti-inflammation techniques, but we also treat the elephant in the room: hormone decline. It’s about tackling the whole picture to help women feel their best.
Leslie: What about women who are doing everything right—eating well, exercising—but still can’t lose weight?
Emily: This is a common scenario, and it’s incredibly frustrating for many women. These women are eating a low-inflammatory diet, exercising, and doing all the “right” things, but they’re still stuck. In many cases, insulin resistance is the culprit. Even if they’re not overeating, their bodies are still producing too much insulin, which causes fat storage. For these women, we sometimes use medications like GLP-1 agonists, such as semaglutide or tirzepatide. These medications help regulate blood sugar and reduce insulin levels, which can break the cycle of weight gain. They’re not a magic bullet, but they can be a great tool when used as part of a comprehensive weight loss plan that includes diet, exercise, and hormone optimization.
Leslie: What nutritional strategies do you recommend for women in perimenopause and menopause?
Emily: Nutrition is key, especially when it comes to stabilizing blood sugar and supporting hormone balance. First and foremost, women need adequate protein—around 100 grams per day. Most women don’t get nearly enough protein, and this can lead to muscle loss, which is especially concerning as we age. Muscle mass helps protect our bones and supports a healthy metabolism. I also recommend focusing on low-glycemic, high-protein breakfasts. We’re most insulin-resistant in the morning, so starting the day with a high-carb breakfast can spike blood sugar. Instead, prioritize protein and healthy fats, and save your carbohydrates for later in the day when your body can handle them better. Minerals are another important factor. Magnesium, chromium, and manganese are great for balancing blood sugar. I often use supplements like berberine, which works similarly to metformin by improving insulin sensitivity at the cellular level. These tools can help women regain control over their metabolism.
Leslie: Where can women find you and learn more about your work?
Emily: I’m quite active on Instagram at @emilysadri_np, and you can also find more information on my website. I’m launching a new telemedicine company in the fall, where we’ll offer comprehensive hormone replacement therapy and weight loss programs for women in six states. If you’re in one of those states, we’d love to help support your health journey!
Leslie: What’s your final advice for women going through perimenopause and menopause?
Emily: My biggest advice is to stay informed and proactive about your health. Menopause doesn’t mean you have to accept weight gain, fatigue, or feeling “off.” There are so many tools available—from HRT to functional medicine to lifestyle changes—that can help you thrive during this stage of life. Don’t be afraid to seek out the help you need, and remember that you don’t have to go through this transition alone.
