Five tips for great sex in midlife

In this episode of SHE MD, Mary Alice Haney and Dr. Thaïs Aliabadi welcome back Dr. Kelly Casperson to discuss perimenopause, menopause, and hormone therapy with clarity and science instead of fear.

Dr. Casperson explains why perimenopause is a clinical diagnosis, not simply a lab result, and why so many women are dismissed as “too young” or “too old” when their symptoms are real. She addresses the biggest myth about hormone replacement therapy and reframes the conversation around individualized, science-backed risk-benefit decisions.

The discussion dives into testosterone for women, including its impact on libido, motivation, muscle mass, and mood, along with the risks of high-dose hormone pellets. They explore progesterone for sleep, the hysterectomy myth, and why vaginal estrogen is one of the safest and most effective treatments for dryness, painful sex, bladder urgency, and recurrent UTIs.

The episode also tackles the midlife brain, brain fog, and how estrogen influences glucose metabolism. From restoring desire in long-term relationships to navigating alcohol, supplements, and exercise, this conversation reinforces one powerful truth: women are not broken. With the right knowledge and support, midlife can be a season of clarity, strength, and transformation.

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What You’ll Learn:

What perimenopause actually is and why labs are not required for diagnosis

The biggest myth about hormone therapy and how fear shaped menopause care

How testosterone supports libido, motivation, and muscle strength in women

Why vaginal estrogen is safe and essential for preventing dryness and UTIs

What happens to the brain in midlife and why brain fog occurs

Key Timestamps:

(01:30) Introduction and why Dr. Casperson wrote The Menopause Moment

(04:10) The biggest myth about hormone therapy and why fear still shapes menopause care

(09:25) Meet the hormones: testosterone, estrogen, and progesterone in midlife

(11:50) Testosterone for women: libido, motivation, muscle, and dosing concerns

(14:45) Hormone pellets explained: side effects, hair loss, and why removal is difficult

(17:15) Progesterone for sleep and the hysterectomy myth clarified

(24:25) Symptoms of too much estrogen

(26:00) “Senile Vagina” - the “use it or lose it” myth

(33:05) Vaginal atrophy, bladder symptoms, UTIs, and why vaginal estrogen matters

(34:00) How to properly apply vaginal estrogen and why cream can be more effective

(41:20) Great sex in midlife: lube and honest communication

(50:30) Responsive vs spontaneous desire and bringing novelty back to long-term relationships

(56:15) The midlife brain: estrogen, glucose metabolism, and brain fog

(01:02:50) Alcohol, supplements, exercise, and non-hormonal tools for cognitive health

(01:05:00) Final advice for women entering midlife and why you are not broken

Key Takeaways:

Hormone therapy decisions should be individualized and based on science, not fear

Perimenopause is common, real, and often underdiagnosed

Testosterone plays a significant role in women’s well-being beyond libido

Vaginal estrogen is one of the safest and most effective preventive treatments in menopause

Midlife can be a powerful reset when women prioritize their health and mindset

Guest Bio:

Dr. Kelly Casperson is a urologist, educator, and top international podcaster whose mission is empowering women to live their best love lives. In her podcast, You Are Not Broken, she combines science, humor, and candor to dismantle the myths women have learned about sex, intimacy, midlife, and hormones.

Dr. Casperson earned her medical degree from the University of Minnesota and completed her surgical training and residency at the University of Colorado. She is a proud member of the American Urological Association, International Society for the Study of Women’s Sexual Health, and the Society of Women in Urology.

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