The focus has shifted from lifespan to healthspan — from simply adding years to adding vitality, clarity, and independence well into later life. Doctors who specialize in women’s midlife health say the key to longevity isn’t a supplement or a trendy diet but a consistent investment in sleep, movement, nutrition, and stress management.
“It’s about the quality of life, not just the numbers,” said Dr. Gerti Tashko, an endocrinologist based in Rockville who runs GT Health. “Are we happier? Are we living more meaningful lives? What’s the end goal?” For him, true longevity isn’t counting birthdays — it’s what he calls “the bigger area under the curve,” the stretch of life lived in good health, purpose, and connection.
Tashko treats women who want to stay energetic, clear-minded, and strong into their 70s and 80s. “When I talk with patients, I try to shift the focus from lifespan to healthspan,” he said. “It’s not the years — it’s the quality of those years.”
He builds care around four pillars: sleep, exercise, nutrition, and stress control. Sleep, he said, is often the first to falter but the easiest to improve. “Ideally, you should go to bed by 10 p.m., the latest 11 p.m.,” he said. “If you miss that window, even if you sleep eight hours, the quality is poorer.” When sleep suffers, stress hormones such as cortisol stay elevated, raising blood pressure, insulin resistance, and anxiety.
Tashko defines metabolism simply: how efficiently the body processes energy. When metabolism slows — as it often does during and after menopause — weight creeps up, cholesterol climbs, and fatigue sets in. “After menopause, metabolism slows and body weight goes up, and that spills over to higher cholesterol, blood pressure, even sleep apnea,” he said. “I’ve seen women whose cholesterol jumps 50 to 100 points. I have a much deeper appreciation now of what that means physically, mentally, emotionally.”
The solution, he tells patients, is to be proactive. “If you maintained your weight in your 30s with 30 minutes of exercise a day, that may not be enough after menopause,” he said. “You might need more movement to keep up with natural changes.” Strength training, daily walking, and light aerobic activity help preserve lean muscle, which keeps metabolism high.
Women often ask how to separate real science from hype. “Look at the source,” Tashko said. “Is the person board-certified? Are they referencing clinical trials? The source has to be evidence-based.” He urges patients to focus on what’s proven: movement, restorative sleep, balanced nutrition, and managing stress.
When lifestyle changes fall short, he digs deeper.
“Lifestyle addresses more than 90% of issues,” he said. “But if we’re still not seeing full results, that’s when I order more detailed labs — checking hormones, nutrients, inflammatory markers—and decide with the patient whether to add a supplement or medication.”
For women who think it’s too late to change, Tashko offers reassurance. “From my experience, it’s never too late,” he said. “You could be in your 20s, 50s, or 80s — every little bit helps. Within a couple of weeks you can see meaningful changes, and these changes are cumulative.”
The holistic view matters most. “Nothing is in isolation. Cardiovascular, kidney, fatty liver disease, sleep apnea, insulin resistance — they appear separate, but they’re all intertwined,” he said. “There are no quick fixes. It’s total commitment to wellness, which is hard at the beginning, but over time it becomes second nature.”
“It’s like brushing your teeth,” he said. “At first you think about it, then it just becomes what you do. And that’s the real key to living longer — and better.”
Gynecologist and functional medicine physician Dr. Christina Enzmann agrees that longevity begins with daily choices. “Cardiometabolic health is really super important,” she said. “And the other one is really movement and stress.” She sees women in midlife facing a common set of challenges: fatigue, belly fat, inflammation, and insomnia — all intensified when estrogen declines. “Most of our organs have estrogen receptors,” she said. “So once that goes away, all the underlying issues start to show.”
Enzmann calls menopause a “biological inflection point,” but also an opportunity. “It’s not that you start getting sick when estrogen goes away,” she said. “It’s that everything that’s been underlying starts to show. It’s the time to make changes.” About 70% of her patients in perimenopause, she said, use that moment to overhaul their routines — focusing on anti-inflammatory foods, movement, stress reduction, and sleep.
Her nutritional approach is simple: fill the plate with mostly plants. “Every plate should be 80% greens and veggies, nuts and seeds,” she said. “Quit the sugar. Stay away from inflammatory foods.” Whole, colorful meals are “information for your cells,” she added — signals that help the body “turn off the bad genes and turn on the good ones.”
She also stresses maintaining muscle. Women lose about 8% every 10 years after age 30, she said, and muscle is what “gobbles up all that extra sugar.” Daily walking, light strength training, and outdoor movement are crucial for both metabolic and mental health.
For both physicians, longevity isn’t about chasing numbers or new gadgets — it’s about steady, cumulative habits that protect the body’s interconnected systems. “Women have more control than they think,” Enzmann said. “Genetics are maybe 25%. Everything else is lifestyle.”
Ellen Braunstein is a freelance writer.
