In January 2025, InHabit Editor-in-Chief Annie Brandner sat down with Jessica Shepherd, MD, MBA, FACOG to talk menopause and midlife. Dr. Shepherd’s impressive career spans medicine, media, and entrepreneurship. A board-certified OB/GYN, wife, mother, author, and CEO, she’s a leading voice in women’s health and longevity, describing her book, “Generation M,” as “a love letter to the incredible journey of womanhood.”

‍Sharing professional insights and candid reflections from her own midlife journey, Dr. Shepherd delves into the complexities—and opportunities—of perimenopause and menopause. Her passion for helping women reclaim joy, build community, and thrive in every stage of life is unmistakable. With a deep commitment to addressing health disparities and expanding access to personalized care, Dr. Shepherd is inspiring women to live long, live well, and support each other along the way.

Reframing the conversation around menopause and aging

You’ve dedicated much of your career to shifting the narrative around menopause — challenging outdated notions and reframing it as a time of empowerment, vitality, and flourishing. What inspired you to take on this work? 

Early on in my work, I realized there was a real gap in care for midlife women going through perimenopause and entering menopause. As women age, they often feel dismissed and even confused about the changes that are going on in their body. But it really doesn’t have to be that way. 

The more I saw, the more important the work became to me. Now, as a woman in my late 40s, I want to help women look at this transition in their life boldly and comprehensively. With good understanding and better support, we can make this transition a beautiful part of our lives.
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Was there a pivotal moment or experience that shaped your perspective?  

Given the trajectory of how we teach in healthcare — which is the way it is for good reason — I knew there was something more out there that I wanted to pursue as it relates to women’s health and wellness, and who we are as whole people. It took time; I had to slowly carve out this different way of showing up and, even when it wasn’t well-accepted, I had to just stay steady to the mission, stay consistent. And eventually, you get there.
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If you could rewrite the cultural narrative around menopause in one or two sentences, what would it say? 

The becoming of our lives in menopause needs to be honoured and revered, and not ignored. There is so much beauty to be experienced as women go through menopause — we need to nurture and foster that!

For all women, I believe we should start talking about perimenopause and menopause as early as possible.

Courage, joy and steering our own ships

Let’s discuss habits. You talk about preparing for perimenopause and menopause earlier in life. What advice would you give to women in their 20s, 30s or 40s to prepare for the changes ahead?  

For all women, I believe we should start talking about perimenopause and menopause as early as possible. That means creating conversations that allow younger women to understand the transitions that will come later on in life so they can prepare adequately for them. 
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What about those women who didn’t start thinking about perimenopause and menopause until they were experiencing symptoms that disrupted their daily lives? Do you have any encouragement for those who are right in the thick of it?  

It's never too late to start. Even if you’re right in it, and there are intense symptoms, feelings, and experiences — right now is a great moment to start. I’d encourage them to look into their options, and find the help they need as far as medication, hormone replacement therapy, and other modalities that can help ease the transition of menopause. 

When it comes to habits, I would encourage women to ask, How can I make space for the things that I desire?

What about practical habits women could add into their daily lives? You know, even as I ask that, I’m mindful that many women in this phase of life feel exhausted. So the idea of adding more to their schedule may feel both unappealing and unsustainable. 

Well, I want to go to how you stated that — I agree! There is a lot on our plate. What I would challenge people to do is not necessarily add a lot of new things but instead to readjust. When it comes to habits, I would encourage women to ask, How can I make space for the things that I desire? And that will sometimes take editing or reconfiguring some things. Just like if I have a plate of food in front of me, and maybe there is a little bit too much of one thing; I can keep some, but I can pare it down to create space for something else I want. 

We look at all we’re doing, and we know it's not serving us well, but we don't always have the courage to change it.

We can ask ourselves, How can I create space or make room for something that will serve me in the best way? Because there are a lot of things on our plates that are actually not serving us in the best way, right? And I think this is where courage comes in. We look at all we’re doing, and we know it's not serving us well, but we don't always have the courage to change it. 

And what I find to be true for many women — and it’s been true for me, too — is that the reason we're so tired is that we aren’t reserving time for ourselves. Our plates are full with everyone else’s wants and needs. And once you actually ask what you’re doing to care for yourself and your own needs, you start to realize just how much of what’s on your plate is for other people. 

I’ve just come to this place in the last couple of years. And for me, it didn't mean finding a significant amount of time — it came in the form of restructuring it to include meditation, mindfulness, and journalling. Even just throughout the day, I've learned how, even in a moment of chaos, I can dial in and meditate for 5-10 minutes in my office. Even when there's noise around. You don't need the quiet room with the pillow – it really is a state of mind. Right there, in a moment of chaos, you can dial in and focus, taking time for yourself.
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I want to look at what you said about the courage it takes to change things. I think many women wake up in midlife realizing that they’ve lived so much of their lives for others that they barely know who they are — or what they want. Unpacking those big questions in midlife really does take courage, doesn’t it?

It does. Because it means coming out of certainty — what you’ve always known or done — and moving into uncertainty in order to find out who you are. And people do not want to move out of what’s certain — because it's scary. We need courage to handle the uncertainty, and to consider these parts of ourselves that need to be explored. 

We also live in a world that doesn’t encourage this kind of uncertainty, especially for women. Society wants women to stick to a template, where your job is to take care of everyone else. Say you have kids, then the kids are gone and you’re menopausal — or you don't have kids! — then you fall into this vat of uncertainty and it becomes very scary. In addition to your entire body changing, your mind changes, too — everything changes! And for most of us, no one prepared us for this transition. So what do we do? We go looking for certainty, right? It’s so tempting to stick to certainty. 
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In “Generation M,” you talk about how important laughter and joy are in this stage of our lives. With all we’ve been discussing, would you agree that in this phase of life, joy and laughter are also harder won?

Yes! And do you know why? Even as you said that, I was thinking that while different phases in our life can be really hard, I think society sends us these messages that say, “That really joyful part of your life? It’s over now.” So this goes back to what we were saying about the plate and getting to redefine and re-edit it for ourselves. 

In many ways, “Generation M” was written as a letter to all women, reminding them that they have this power within themselves to be the captain of their own ship.

In many ways, “Generation M” was written as a letter to all women, reminding them that they have this power within themselves to be the captain of their own ship. We get to say, This is a moment where I get to steer my ship. I'm going to make choices that are going to bring me the joy and laughter that I deserve. Even as I’m saying this, I think we often tell ourselves that we don't deserve those things. And I think we owe it to ourselves to say, I deserve this joy; I will choose this for myself. 
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And to stop putting it off! I think we often put off the things we want or that bring us joy, thinking we’ll get to them after we check all these other things off the list. But the list never really ends. 

And that’s why you reconfigure that plate; you redefine it to put yourself — and those moments — right into the mix right now. You say, I deserve this time and this pouring back into myself, in whatever capacity that means. 

But it is so hard to learn and to do because, a lot of times, we haven't ever done it. Or it’s been so long that we've forgotten. So it is learning a new skill. It is. And I'm in that process right now. 

The ability to feel alive and supported while going through one of the biggest transitions of your life is so important. It offers motivation and empowerment to feel better for the second half of your life.

Cultivating community 

We live in a hyperindividualistic culture without traditional rites of passage – those collective markers that help us honour and navigate major life transitions like this one. How do you think this shapes how we experience menopause today?   

Whenever there is no community — around any form of suffering or change — it can intensify the experience we’re going through. So, it’s really important that we create community for and around menopausal women — spaces where they feel seen and heard. The ability to feel alive and supported while going through one of the biggest transitions of your life is so important. It offers motivation and empowerment to feel better for the second half of your life.
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What advice would you offer to women who are longing for that kind of community? 

I always suggest that women seek spaces where they feel safe. And in the safety of their experience, they can then share their most vulnerable moments. This can help them transition into menopause with a supportive group in which they feel vibrant.

There are so many ways to find that now beyond our own friend groups. We can build networks through community groups and organizations, social media and other media platforms, professional organizations — all these can all play into creating strong networks that support the needs of women as they go through perimenopause and menopause.
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Do you have your own safe communities and spaces? 

I do. And initially it was hard to find because, you know, there's a lot of eyes on me. So I’ve also made sure to find people that are okay with challenging me.

The more we educate men throughout this process, the more support women will feel during perimenopause and menopause, and the less stigma there will be.

Men and menopause 

Can you speak for a moment to our male readers? For the partners, friends, husbands, loved ones who are eager to show up and support the women in their lives through perimenopause and menopause. What thoughts or suggestions would you offer them? 

We’ve been talking about community — men can be involved in the community by creating safe spaces. Safe spaces can include not trying to have the answer, and not being there to fix it. What a beautiful thing if, in the moment of uncertainty when a woman is navigating this new journey, she can still find safety in a partner – speaking of heterosexual relationships here — who will never go through this transition, but is still able to offer some cradle of safety, understanding and empathy.  

The more we educate men throughout this process, the more support women will feel during perimenopause and menopause, and the less stigma there will be. The more men can understand and empathize with their partners, friends, mothers, daughters as they go through this phase, the more they can help create a beautiful experience for both.
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Mental health in menopause

A lot of what we’ve been discussing are factors that would naturally support women’s well-being and mental health through this transition. What else would you say is particularly important in supporting women’s mental health? 

What I would add, I think, is the importance of simply telling women, “You're not crazy” because so many women are wondering, what the hell is going on? Studies show an increase in depression and anxiety for women in middle age; there are many reasons for this, and there is a biological component. The book touches on it, but I want to touch on it briefly here. 

When we have a decline in our reproductive hormones, it impacts how our neurotransmitters respond and interact; they’re not as in sync as they were when the reproductive hormones were in sync. This change has a very real impact on our experience. There are also many physiological changes, which can contribute to real feelings of anxiety as women are wondering, “What is happening to my body?” It all has a very real impact on how we feel and any depression and anxiety that comes. Just knowing this is helpful. 

We need to reassure women that there are reasons for what they’re experiencing. Then they can accept that and either make some changes – or not. Everyone has a choice.

When women have this information, they can lean into it and say, Okay, I know this is happening and there is a very real decline in hormones. Now, how can I navigate myself through this? Sometimes, if we don't know why something is happening, we make things up — or we try to convince ourselves it’s not happening. We need to reassure women that there are reasons for what they’re experiencing. Then they can accept that and either make some changes – or not. Everyone has a choice.
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Let’s talk symptoms

Why does menopause make it so hard to sleep, with night sweats and hot flashes? What can we do to get better sleep?

Well, the decline in estrogen contributes to changes in how our bodies regulate temperature, and that leads to night sweats, which causes a decrease in our quality of sleep. There are many different ways this can be alleviated. You can consider hormone replacement therapy, you can look into CBD gummies, which can help with getting a more restful sleep. Changing lifestyle habits can also be helpful, like decreasing food intake closer to bedtime, doing some breathwork at bedtime, and also meditation. Cognitive Behavioral Therapy has also been shown to help with sleep restoration in the menopausal phase.
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Now, brain fog. What’s the brain fog about? 

Brain fog is when there is decreased clarity, difficulty remembering certain tasks, and also in the ability to recall. This has been linked not only to estrogen decline, but also to testosterone decline, which plays a significant factor in brain clarity and executive functioning. 
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Hormone Replacement Therapy (HRT) and the evolving landscape of menopause care

Looking at menopause care today, what trends or new research excite you most? 

Research that excites me most includes the availability of testosterone therapy for women, and the different modalities in how women can receive hormone replacement therapy (HRT) now. 

While women primarily pursue hormone replacement therapy to address symptoms of menopause, research shows so many other clear benefits. It’s been shown to improve bone health, brain health, and gut health, and we’re also seeing improvement in longevity with hormone replacement therapy. 
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Are there any other areas of research that excite you or advancements that show particular promise? 

There are many advancements in treatment, including medications that are non-hormonal that can offer women relief when they have symptoms of menopause. 

Research is also growing around how to potentially delay menopause or decrease the actual transition by focusing on the health of the ovary. Dr. Piraye Beim is doing significant research, and they are looking at the longevity of the ovary in order to help women have healthier, longer lives.

In menopause, black women tend to have symptoms that are more intense and that last longer; yet they are among the least likely to have access to the care they need.

Equity and representation in menopause care

As a Black woman and a medical expert, you bring a vital perspective to a space with persistent cultural stigmas and systemic barriers. You’re working to ensure that menopause care is as inclusive and accessible as possible. 

How has the exclusion of Black women from healthcare discussions shaped the current landscape of menopause care?  

Many aspects of medicine have excluded black women from their research, which means they’ve eliminated true outcomes, experiences, and any real inclusion. As a result, there’s a real lack of understanding around the needs of black women. In menopause, black women tend to have symptoms that are more intense and that last longer; yet they are among the least likely to have access to the care they need.
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What would true equity in menopause care look like?  

True equity starts with studies that are devoted to ethnicity, since the experience of menopause is unique for women of all ethnicities. It also looks like spaces that are focused on black women in menopause so that there is a community where they feel supported, and where their voices are heard.
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On good advice and living well 

If you could go back and offer advice to your younger self, what would you say? 

If I went back to my younger self, I would definitely say not to be afraid of age and what happens in the menopausal phase. It can be the absolute most beautiful time of your life, where you value all your experiences and all your wisdom. Where you bring them into these new moments that are still to come; and where you have beautiful new beginnings.
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Is there a piece of advice that you find really valuable now, that your younger self would have laughed at? 

Oh yes. I really do. I believe that our fears really can lead us to the best parts of our exploration. And that self-awareness is imperative to our growth and transitions. 
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What does "living well" mean to you in this chapter of your life?  

Living well in this chapter of my life means being proactive and preventative, and focusing on improving the quality of life that will come over the next 40 to 50 years. We have so many modalities, beliefs, and innovations that can allow us to be the best versions of ourselves, if we truly lean into making that the path that we follow.
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Thank you so much. I’m so glad we got to do this.

You’re so welcome. Thank you!

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