Trust yourself, your body, and your intuition. Do not settle for answers that you know deep inside yourself are not meeting your needs.
– Helen Stearns, DNP
Midlife isn’t a quiet drift… it’s a dynamic biological transition that touches mood, sleep, intimacy, energy, and even how we relate to the people we love. In this candid, science‑grounded conversation with Stacey Chillemi, Helen Stearns, DNP, brings clarity and compassion to a season many women have been told to simply “tough out.” With practical language and a focus on empowerment, she reframes perimenopause and menopause as navigable phases, not mysteries you have to endure alone.
What follows is a clear roadmap built from lived clinical experience and evidence: what perimenopause actually is, why a single “normal” lab can still leave you struggling, the earliest signs to notice, and how shifts in libido, vaginal health, and urinary comfort can be addressed directly and safely. We also explore movement as longevity medicine, bone strength and fall prevention, plant‑forward nourishment for the gut‑brain axis, stress and sleep resets, female friendship as a health asset, and concrete ways to advocate for the care you deserve. Dive in, take what serves you today, and keep this on hand as your guide.
Thank you so much for joining us! Our readers would love to get to know you a bit better. Can you tell us a bit about your backstory?
I finished my doctorate as a nurse practitioner during a hiring freeze, which meant a lot of searching and uncertainty. By what felt like fate, I found an opening at a sexual medicine clinic, interviewed, and was hired immediately. Immersing myself in sexual health for both men and women, I discovered how little formal training clinicians receive on hormones, sexual pain, and midlife changes. Working closely with perimenopausal and post-menopausal women, I kept hearing life-changing feedback after treatment, and that joy fueled my dedication to this field.
Why include men and partners in this conversation?
Midlife changes influence relationships, intimacy, and daily dynamics at home, so partners matter. I often say we should have “perimenopause parties” for partners because understanding what’s happening helps them show up with empathy. When partners learn the basics, they stop taking symptoms personally and begin to support rather than react. Bringing everyone into the conversation reduces friction and builds connection.
What ultimately inspired you to specialize in midlife women’s health?
After sexual medicine, I returned to adult-geriatric primary care to keep those skills sharp. There, I saw the downstream effects of under-treating women in midlife—frailty, fractures, recurrent infections, and cognitive decline. It became clear that intervening upstream could help women age with strength and prevent so many heartbreaking outcomes. Choosing this work brought me a rare sense of peace and purpose that has only grown.
Can you define menopause vs. perimenopause, and how long can the transition last?
Menopause is defined medically as 12 full months after the final menstrual period; after that, you’re considered menopausal or post-menopausal. Perimenopause is the lead-up period, and it commonly lasts four to ten years, though it can be shorter or longer. Many women are surprised by that range, which helps explain shifting symptoms over time. Knowing the timeline eases confusion and validates what the body is doing.
Why aren’t lab tests reliable guides during perimenopause?
Hormones don’t decline in a neat line; they swing like a roller coaster. A single “normal” lab draw can be misleading, because levels may be very different the next day or even later the same day. Relying on fluctuating numbers can leave women dismissed and untreated. That’s why symptoms and clinical history are essential guides during this transition.
What are some of the earliest signs, and when can they begin?
Perimenopausal rage—intense, disproportionate anger—can appear out of nowhere, and anxiety is extremely common. Sleep often shifts first: women who once slept soundly wake at 2:30 a.m. and can’t fall back asleep. Skin may become dry or itchy (even itchy ears), and weight can redistribute to the midsection as visceral fat rises. These changes can begin in the late 30s or early 40s, which is earlier than many expect.
Would you share part of your personal journey through these changes?
I had a baby at 43, which layered postpartum and breastfeeding hormones onto perimenopause while I returned to a demanding workload. The stress and anxiety strained my relationship, and we had a hard but honest conversation that became a turning point. I sought a provider to help manage my hormones, got serious about stress reduction, and made concrete lifestyle shifts. Those steps were life-changing—for my health and for my family.
Why do mood and libido shift so much?
We have estrogen and testosterone receptors throughout the body and brain, influencing serotonin and dopamine pathways. When hormones fluctuate, you feel it—mood swings, anxiety, and changes in desire are physiologic, not character flaws. Understanding that biology reduces shame and opens the door to targeted care. It’s validating to know you’re not “just imagining it”; your chemistry is truly changing.
Can you talk about vaginal dryness, UTIs, and pain with sex?
Falling estrogen and testosterone alter vaginal pH and the epithelium, increasing dryness and the risk of urinary tract infections. Painful intercourse can understandably shut down desire—sex should never be painful unless that’s a consensual choice. Localized vaginal hormone therapy can be a simple, effective option and is appropriate for most women; used early, it protects comfort and intimacy. Women deserve more than “have a glass of wine”—they deserve treatment that restores health and confidence.
What lifestyle pillars do you emphasize first?
Exercise, nutrition, sleep, stress, and social connection form the core. If you remember only one thing, movement is longevity medicine, and I “prescribe” it as seriously as any medication. Strength training—even twice a week—along with aerobic activity supports bones, muscles, mood, and metabolism. Starting small and staying consistent beats doing everything at once.
Why is strength training so important for bones?
Muscles pulling on bone stimulate bone strength, which is crucial as we can lose a significant portion of bone mass through the transition. In older women, a hip fracture carries serious risks, and many never regain prior independence. Building both slow and fast-twitch fibers also helps with balance and fall prevention in everyday life. Progressive, safe lifting—paired with mobility—pays off for decades.
What if joint or back pain makes lifting difficult, and what about “frozen shoulder”?
Estrogen receptors live in our joints, so aches and issues—including the so-called “frozen 40 female shoulder”—are common. If you’re experiencing back pain in your 40s, asking for a DEXA scan to check bone density can be a smart baseline move. Modify loads, protect form, and build capacity with support while addressing the hormonal context. The goal is to keep you strong without aggravating symptoms.
How do you approach nutrition without overwhelm?
I focus on nurturing the gut microbiome with plant diversity, aiming for around thirty different plant foods per week, including herbs and spices. That variety supports whole-body signaling, from brain to bones. Emphasizing whole, minimally processed foods creates a foundation that’s realistic and sustaining. It’s less about perfection and more about daily patterns that your body can rely on.
What are your practical resets for sleep and stress?
Without good sleep, cortisol rises, patience falls, and weight management stalls, so sleep hygiene is non-negotiable. Think cool, dark rooms and stepping away from screens and stressful content before bed. Even brief midday walks and a couple of minutes of breathwork help recalibrate the nervous system. And don’t underestimate friendships—regular time with girlfriends truly supports well-being and longevity.
How do you reframe this season—community, purpose, and the “grandmother hypothesis”?
Human beings have always thrived in community rather than isolation. It’s empowering to view menopause as a phase that frees energy for family, creativity, and contribution. Many women find new purpose and start bold projects in these years. Shifting the story from decline to emergence changes how you experience every day.
How can women advocate for themselves with clinicians?
Trust your body and don’t settle when answers don’t fit your experience. Seek menopause-informed providers and use reputable listings and resources to guide you. Bring notes or printed studies if needed, since some clinicians still carry outdated fears around hormones. Clear, confident requests help you get the care you deserve.
For the woman who feels overwhelmed, what’s the very first step?
Move your body… TODAY. A simple walk can create more energy than it costs and build momentum for everything else. Next, protect your sleep with small, consistent habits that make nights calmer and mornings clearer. From there, choose whole foods over ultra-processed ones most of the time, and consider discussing hormone therapy with a qualified provider if you’re a good candidate.
Any final thoughts to leave with readers?
Listen to your body and don’t dismiss changes; they’re often hormone-related and very real. Education is power, and even a simple symptom checklist can connect the dots and start your plan. Seek out trustworthy educators and clinicians who truly understand hormones and midlife care. Most importantly, hold onto hope… this season can be one of profound growth, creativity, and strength.
How can our readers further follow your work online?
I’m based in Southern California and licensed for California, offering telemedicine and local mobile home visits. I’m always happy to help women in other states find reputable providers through my network. You can find me on Instagram and facebook at @helenstearnsdnp and my website at helenstearnsdnp.com. I am also active on LinkedIn. Please feel free to reach out… support and clarity are absolutely within reach when we work together.
Helen, thank you for such a candid, empowering conversation… this will help so many people.
Thank you for having me; it’s been meaningful to share, and I hope it brings relief and hope to every listener and reader.
