Welcome to the July 2025 Edition of 3-2-1…Menopause!
Exclusively for the Pause and Flourish Collective

This is your curated guide to what’s happening in the world of menopause science right now. Each month, you’ll find three evidence-based highlights from the latest research, two practical shifts you can apply today, and one deep dive into a nutrient, supplement or lab test with real impact.

Here, you’ll learn what’s new, what matters, and what you can actually do—with clarity.

Let’s explore what July has to offer—and why your personal health and habits deserve a little more attention.

3 

takeaways from menopause research

Perimenopause—earlier than you think…

More than half of women, 30-35 years old,  now report moderate to severe perimenopausal symptoms—55.4%, to be exact—according to a new UVA Health study in partnership with the Flo women’s health app. By age 36 to 40, that figure climbs to 64.3%. Yet, despite experiencing these early-onset symptoms, most women delay seeking treatment until their mid-50s or beyond. Drawing on self-reported data from over 4,400 American women over age 30.   The study employed a  Menopause Rating Scale to capture physical and emotional symptoms. Echoing my clinical observations, the psychological manifestations of perimenopause—anxiety, depression and irritability—tend to emerge first.  These symptoms peak between ages 41 and 45, before tapering off. In contrast, physical issues such as sexual dysfunction, bladder changes and vaginal dryness are most prevalent in the 51-plus cohort, while the classic hot flashes and night sweats reach their zenith around ages 51–55 and are least frequent in the youngest cohort.

By mapping this symptom trajectory and uncovering high symptom burdens in women traditionally considered too young for perimenopause, this study underscores “an alarming gap” in both research and clinical care. We can only hope that more of this type of data will encourage earlier recognition, education and intervention—ensuring that no woman need suffer in silence.

https://www.nature.com/articles/s44294-025-00061-3

SSRI’s may be easier to stop than we thought!

Antidepressants like Zoloft, Lexapro and Celexa are among the most commonly prescribed drugs in the United States. Recent estimates indicate that 24 percent of women are currently being treated for depression—more than double the rate in men. Concerns about discontinuing these medications often arise in clinical settings particularly regarding withdrawal symptoms. A new systematic review and meta-analysis led by Imperial College London pooled data from 50 randomized controlled trials (17,828 participants, 67 percent female, mean age 44 years) to quantify the incidence and nature of discontinuation symptoms using the Discontinuation Emergent Signs and Symptoms (DESS) scale. Compared with those who continued antidepressants or stopped placebo, patients who discontinued antidepressants were about 70 percent more likely to report roughly one additional symptom on the DESS. Specific symptoms with higher odds after stopping antidepressants included dizziness, nausea, vertigo, and nervousness

Importantly, the average number of discontinuation symptoms at one week fell below the threshold for clinically significant discontinuation syndrome, and stopping antidepressants was not associated with a worsening of depressive symptoms, suggesting that later mood changes more likely reflect true relapse rather than withdrawal. For women navigating menopause—often a time of hormonal shifts, mood changes, and the need to adjust multiple medications—these findings offer reassurance that, under medical supervision and with appropriate tapering, discontinuing an antidepressant may involve only mild (one additional symptom) and transient (one week) effects. As always, decisions about medication changes should be individualized, but this high-quality evidence can help reduce unnecessary fear around stopping antidepressants.

Study link: Michail Kalfas et al. “Incidence and Nature of Antidepressant Discontinuation Symptoms: A Systematic Review and Meta‑Analysis.” JAMA Psychiatry. Published online July 9, 2025. doi: 10.1001/jamapsychiatry.2025.1362.
https://doi.org/10.1001/jamapsychiatry.2025.1362

Tee Time?

During menopause, our built‑in detox systems and mitochondrial stamina decline, making us more vulnerable to modern chemical onslaughts. A striking new JAMA Network Open study reports that living within one mile of a golf course spikes your Parkinson’s disease risk by 126% compared with living over six miles away—and sharing that same groundwater with the course nearly doubles the risk again.  Given how heavily U.S. golf courses rely on mitochondrial‑disrupting pesticides like paraquat and rotenone, it’s surprising the “green golf” movement hasn’t gained real traction. This isn’t about ditching tee times, but rather a vivid reminder that “evolutionary novel” corporate chemicals can seep into our water and our brains, contributing to the classic tragedy of the commons.

But knowledge is power. Think of your home as a mini‑bio‑dome: install a reverse‑osmosis filter (Berkeys don’t cut it), swap to non‑toxic cookware, and monitor air quality with HEPA units indoors—and even in your car (if you spend a lot of time in traffic) with filters from IQAir. Opt for organic produce (start with the Dirty Dozen) to slash dietary pesticide loads, and fill your plate with foods that activate Nrf2 pathways (cruciferous vegetables like broccoli, cabbage and kale, as well as herbs and spices like turmeric, garlic and ginger) —boosting your native detox machinery.  Nrf2 is a master regulator protein that, when triggered by these compounds, turns on a suite of genes responsible for antioxidant production and phase II detoxification enzymes. By gradually curating your environment—from water to cookware to air—you’re not panicking, you’re taking control. These simple, actionable steps help empower you to do what you can to protect your hormones, your brain health, and your overall well‑being through the menopause transition and beyond.

Read the full study here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833716

2

evidence-informed habit changes

Since we were speaking of organic and NRF2 activation…

🍓 Dirty Dozen (Most Pesticide-Contaminated Produce)

These fruits and vegetables tested highest for pesticide residues, even after washing:

1. Strawberries
2. Spinach
3. Kale, Collard & Mustard Greens
4. Grapes
5. Peaches
6. Pears
7. Nectarines
8. Apples
9. Bell & Hot Peppers
10. Cherries
11. Blueberries
12. Green Beans

⚠️ Note: Green beans were added in 2023 and remain due to multiple pesticide residues, including some banned in other countries.

🥑 Clean Fifteen (Lowest Pesticide Residues)

These items had the fewest pesticide residues, and are considered safer to buy non-organic:

1. Avocados
2. Sweet Corn
3. Pineapple
4. Onions
5. Papaya
6. Sweet Peas (Frozen)
7. Asparagus
8. Honeydew Melon
9. Kiwi
10. Cabbage
11. Watermelon
12. Mushrooms
13. Mangoes
14. Sweet Potatoes
15. Carrots

     1

    nutrient

    Vitamin B₁₂ plays a pivotal role in maintaining neurological function, energy metabolism, and DNA synthesis—processes that become increasingly important for women navigating the hormonal fluctuations of menopause. As estrogen levels decline, many women suffer from fatigue, brain fog, and mood disturbances; B₁₂ serves as a cofactor for mitochondrial energy production and neurotransmitter synthesis, helping to counteract these common complaints. Moreover, adequate B₁₂ supports red blood cell formation, which can offset the mild anemia sometimes seen during perimenopause and beyond.

    One of the key biochemical pathways in which B₁₂ participates is methylation—the transfer of methyl groups (–CH₃) to DNA, proteins, and lipids. In particular, methylcobalamin (the active form of B₁₂) partners with folate to convert homocysteine into methionine, thereby lowering homocysteine levels that, when elevated, are associated with increased cardiovascular risk. Methionine then gives rise to S‑adenosylmethionine (SAMe), the body’s principal methyl donor, which supports neurotransmitter balance and cellular health.

    Menopausal women may be at higher risk for B₁₂ deficiency due to age‑related decreases in gastric acid and intrinsic factor, both essential for B₁₂ absorption. In addition, common medications—such as proton‑pump inhibitors or metformin—can further impair absorption. Typical dietary sources (red meat, dairy, fortified cereals) may not suffice, especially in plant‑forward diets. For this reason, many practitioners recommend measuring serum B₁₂ or methylmalonic acid levels and considering supplemental methylcobalamin, which is well absorbed and directly supports methylation reactions.

    Supplementation strategies often range from 500 to 1,000 µg of methylcobalamin daily, either orally or via sublingual preparations, although higher doses may be used in cases of documented deficiency. Regular monitoring every 6–12 months can guide adjustments and ensure optimal status. By prioritizing vitamin B₁₂—particularly its methylated form—women in menopause can bolster energy levels, cognitive clarity, and cardiovascular health through robust support of their methylation pathways.