Real answers about hormones, metabolism + aging

Women’s health can feel overwhelming, especially when the conversation is often reduced to numbers on a scale or quick-fix wellness trends. But what’s really happening inside the body through your 30s, 40s, and beyond? From shifting hormones and changing metabolism to inflammation and energy levels, many women are looking for answers that actually make sense for real life.

For this edition, we spoke with Dr. Kimberly Holloway, an MDVIP-affiliated women’s health physician and gynecologist who has spent 20+ years caring for women through every stage of life.

Dr. Holloway shares insight into the health markers women should pay attention to, why belly fat becomes more stubborn with age, how hormones influence everything from cravings to energy, and the small lifestyle shifts that can support long-term wellness without extreme dieting.

Q. What health markers should women be paying attention to besides weight and cholesterol?

A. Weight and cholesterol are only two pieces of a much larger picture. In my practice, we regularly screen for pre-diabetes, looking at both hemoglobin A1C and fasting insulin, which can signal insulin resistance years before a diabetes diagnosis.

Heart disease remains the number one killer of women, yet the cardiovascular risk factors that affect women specifically are often missed in a standard lipid panel. That's why we measure inflammatory markers, which can be indicators of a woman’s risk for heart attack or stroke. We also regularly check Vitamin D levels, which play key role in bone health; Vitamin B12, which helps keep the nervous system healthy; and thyroid function, as thyroid disease is more common in women.

Q. Why does belly fat seem harder to lose in your 40s and beyond?

As estrogen levels begin to decline in perimenopause and post-menopause, a woman’s body redistributes fat. It moves away from the hips and thighs, where estrogen encouraged it to be stored, and toward the abdomen.

At the same time, lower estrogen affects how efficiently our body uses insulin, which makes it easier to store fat and harder to burn it. Cortisol, our stress hormone, also plays a role. Chronic stress causes elevated cortisol, and cortisol loves to deposit fat right around the midsection.

Q. How do hormones impact metabolism, energy, and cravings?

Hormones act as the body's messaging system, and when the messages are off, everything downstream gets disrupted. Estrogen, progesterone, thyroid hormones, insulin and cortisol all intersect in ways that directly affect how we feel day to day. When estrogen drops, serotonin tends to drop with it — which is part of why women often notice mood changes, carb cravings and disrupted sleep during perimenopause.

Poor sleep then drives up ghrelin, the hunger hormone, and lowers leptin, the hormone that signals fullness. So you're hungrier, craving sugar and starch, sleeping poorly and your metabolism has slowed — all at once.

Thyroid issues are also common in women and frequently go unrecognized. Even subtle thyroid dysfunction can cause fatigue, weight gain, brain fog, and low mood. I can't tell you how many women have come to me feeling like something is wrong with them, and a thorough hormone evaluation finally gave them an explanation.

Q. What are some subtle signs of inflammation women often overlook?

A. Inflammation can be triggered by a wide range of factors, some of which are unique to or more pronounced in women, including hormonal fluctuations, autoimmune conditions such as rheumatoid arthritis and psoriasis, chronic stress, as well as obesity and excess body fat around the abdomen.

Signs of inflammation vary so widely that it’s best to consult with your doctor about your risk for chronic inflammation and how to manage any existing conditions.

Q. What are a few realistic lifestyle changes that can improve long-term health without extreme dieting?

A. I'm not a fan of extreme approaches, as they usually lead to short-term results and long-term frustration. What I encourage patients to focus on is building sustainable habits that compound over time.

First, prioritize protein at every meal. Most women I see are not eating nearly enough protein, which directly affects muscle mass, metabolism and satiety. Aim for 1.6 grams per kilogram of body weight every day by building your plate around protein first, then vegetables, then everything else.

Second, take sleep seriously. I know we live in a culture that treats sleep as optional, but it is foundational to hormonal balance, immune function and weight regulation. Seven to eight hours is not a luxury — it's medicine.

Third, find movement you actually enjoy. Walking is genuinely one of the best things a woman can do for cardiovascular health and bone density. Strength training twice a week makes a tremendous difference in metabolic health as we age.

And finally, reduce your exposure to chronic stress wherever you can. These aren’t flashy recommendations, but they're the ones that can move the needle.