Welcome to the June 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 with real impact.

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

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

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takeaways from menopause research

The skinny fat...

"The uterus is an end organ: a preliminary study of the association between abnormal uterine bleeding and hyperinsulinemia"- published in Menopause, looked at whether abnormal uterine bleeding (AUB) might be linked to elevated insulin levels. Among over 200 premenopausal women, those with AUB were significantly more likely to have hyperinsulinemia. When BMI was included in the analysis, insulin’s independent effect became less statistically significant—likely because insulin resistance and BMI are tightly linked.

What’s clinically compelling is this: in normal-weight women, elevated insulin isn’t typically expected. So when it shows up—especially in the context of irregular cycles or heavy bleeding—it can serve as an early warning sign (the proverbial "canary in the coal mine" perhaps) that metabolic health is beginning to shift, even before more obvious symptoms appear. I’ve seen this pattern repeatedly in my own practice, and when patients recognize it early, it becomes a powerful motivator. Addressing it through a targeted, sustainable plan often leads to noticeable improvements—sometimes within weeks.

Take-home: Elevated insulin may be a hidden driver of AUB, and checking it can offer insight—especially in women who don’t “look” metabolically unhealthy. It's a reminder that we can’t rely on BMI alone when evaluating menstrual health.

Vaginas matter

For years, vaginal estrogen has been approached with an overabundance of caution in breast cancer survivors—but emerging data is finally challenging outdated assumptions in a way physicians can no longer ignore. This month at the American Society of Clinical Oncology (ASCO), a major U.S. study tracking over 18,000 postmenopausal women with breast cancer found that those who used vaginal estradiol cream had significantly better outcomes—including a 47% lower risk of death from breast cancer and a 44% lower risk of death from any cause. Even women with hormone-sensitive tumors saw meaningful improvements in overall survival. These findings echo what a 2024 meta-analysis had already made clear: local vaginal estrogen does not increase the risk of recurrence or mortality. What’s frustrating is that the evidence supporting safe and effective treatment of GSM—genitourinary syndrome of menopause—has been available for years. Yet many clinicians have clung to a paternalistic model, withholding a treatment that can dramatically improve quality of life. Vaginal dryness, painful sex, recurrent UTIs, and irritation are not minor inconveniences—they’re daily suffering. Women navigating survivorship deserve to live fully, not in fear or physical pain. It’s past time we bring nuance, compassion, and data-driven relief to this conversation.

A protective sheild from Alzheimer’s

New research from the Australian Imaging, Biomarkers and Lifestyle Study reveals that dietary nitrates from vegetables—especially leafy greens and beets—may offer brain-protective benefits for women at higher genetic risk for Alzheimer’s disease. In a decade-long study of over 500 cognitively healthy older adults, women carrying the APOE4 gene variant who consumed the most plant-based nitrates accumulated beta-amyloid, a key Alzheimer’s marker, at about half the rate of those with lower intakes. These women also showed slower shrinkage of the right hippocampus, a brain region vital for memory. The study strengthens the case for a veggie-rich diet (especially in APOE4 carriers), suggesting that natural nitrates from plants—unlike those from processed meats—could play a critical role in preserving brain health in women predisposed to Alzheimer’s.

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evidence-informed habit change

• A 10-minute walk after meals can be a game-changer for menopausal women—it not only tames post-meal blood sugar spikes but also boosts digestion, and counters the hormonal shifts that make weight gain and insulin resistance more likely during this stage of life.
• Start your day with an 8 oz glass of water—it’s a simple habit that jumpstarts hydration. Early morning hydration will  help prevent overeating, headaches, and that all-too-familiar brain fog often triggered by early morning dehydration.

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 nutrient

Magnesium 

Magnesium is central to human physiology. It serves as a cofactor in over 300 enzymatic reactions—regulating energy production, neuromuscular function, blood pressure, glucose metabolism, bone integrity, and neurotransmitter balance. Despite its broad impact, magnesium deficiency is increasingly common, even among those with diverse, nutrient-aware diets.

This paradox is largely driven by agriculture. Modern practices such as unbalanced fertilization, monocropping, and irrigation methods have depleted magnesium from soil systems, leading to substantial declines in the nutrient density of plant-based foods. As a result, foods that were once reliable sources—leafy greens, legumes, seeds, nuts—now deliver less than expected. In clinical practice, this often presents as fatigue, poor sleep, anxiety, muscle tension, headaches, or worsening insulin resistance—all with magnesium as a silent contributor.

Selecting the Appropriate Form of Magnesium: Things to Consider-

Not all magnesium supplements are equally effective. Bioavailability, target tissue impact, and tolerability differ significantly across forms:

• Magnesium Glycinate: Chelated and well-absorbed, this form is best suited for patients with anxiety, sleep disruption, or autonomic dysregulation. Glycine contributes additional calming support through GABA modulation. Minimal laxative effect makes it appropriate for long-term use.

• Magnesium L‑Threonate: Crosses the blood–brain barrier and may enhance synaptic plasticity, working memory, and cognitive clarity. Often recommended for brain fog or mental fatigue, especially in the perimenopausal transition. But, reports of strange/vivid dreams are reported by some women.

• Magnesium Citrate: A readily absorbed option with a mild osmotic effect—appropriate for patients with constipation or those needing rapid replenishment of magnesium stores. Avoid if prone to loose stools.

• Magnesium Malate: Supports mitochondrial function and is mildly energizing (so taking earlier in the day may be necessary). Commonly used in cases of chronic fatigue or muscle pain, including fibromyalgia-like symptoms.

• Magnesium Oxide: High in elemental magnesium but poorly absorbed (∼4%). Best reserved for short-term use in functional constipation. Gastrointestinal side effects are common. Cheap and available at most box stores.

Integrative Supplementation Strategy

When considering magnesium in a clinical context, the following simplistic framework is useful to discus with your physician: