Unbreakable: A Woman’s Guide to Aging with Power

For generations, the narrative surrounding women’s aging has been one of quiet decline—a slow, inevitable slide toward frailty. But that narrative is changing. Dr. Vonda Wright, a pioneering orthopedic surgeon and longevity expert, argues that aging is not a slippery slope you simply have to accept. Instead, with the right strategy, midlife can be the beginning of the most powerful years of your life.

In a recent discussion at the Aspen Institute, Dr. Wright introduced the concept of "Menolescence"—a comprehensive reframing of the physical, psychological, and hormonal transition women experience. By combining cutting-edge science with actionable lifestyle changes, women can pivot from merely surviving menopause to thriving with "unbreakable" vitality. This guide explores the essential pillars of aging with power, from dispelling hormone myths to mastering the specific exercise protocols that midlife bodies demand.

Key Takeaways

• The "Menolescence" is holistic: The transition out of fertility is not just about ovaries; it affects the brain, heart, bones, and metabolic health due to estrogen receptors located throughout the body.
• Exercise as medicine (The F.A.C.E. Protocol): Midlife fitness requires a specific balance of Flexibility, Aerobics, Carrying a load (heavy lifting), and Equilibrium to prevent frailty.
• Protein is non-negotiable: To prevent muscle loss, women should aim for approximately one gram of protein per pound of ideal body weight daily.
• Fact over fear regarding HRT: Modern data suggests that for many women, the cardiovascular and bone-protecting benefits of hormone therapy outweigh the risks when prescribed correctly.
• Microvascular heart health: Women’s heart disease often presents differently than men’s, requiring specific diagnostic approaches beyond standard stress tests.

The Data Gap: Why You Must Be Your Own Advocate

To understand why women struggle to find answers during midlife, we have to look at the medical system itself. Despite women making 80% of healthcare decisions in the United States and controlling trillions in consumer spending, women’s health research has historically been underfunded and overlooked.

Until 1993, it was not required for women to be included in medical research. Consequently, decades of medical protocols were designed based on male physiology and applied to women. This gap persists in education as well.

"Less than 7% of all medical students... are taught about women's health past fertility. So it goes fertility, disease, and dead. What happens to the 40 years in between?"

Dr. Wright emphasizes that women must realize they are the majority—51% of the population. This demographic power means women have the agency to demand better care, better research, and better answers regarding the physiological changes occurring in their 40s, 50s, and beyond.

The Physiology of Aging: It’s Not Just "The Change"

Men and women age differently. While men typically experience a slow, steady hormonal decline of about 1% per year, women face a precipitous drop. This is largely due to the retirement of the ovaries. Because estrogen is not merely a sex hormone but a master regulator with receptors on almost every tissue—including the brain, heart, gut, muscles, and bones—its withdrawal creates systemic upheaval.

The Cardiovascular Connection

Heart disease is the number one killer of women, yet it often goes undiagnosed because women develop heart disease differently than men. Men typically suffer from obstructive disease (major blockages), while women are more prone to microvascular disease (dysfunction in the tiny arteries). Symptoms can be subtle, such as extreme fatigue or a general sense of not feeling "right," rather than the crushing chest pain often depicted in media.

Dr. Wright notes that the loss of estrogen can lead to a 40–60% increase in heart disease risk, as estrogen plays a vital role in vascular health. This makes proactive cardiovascular screening, specifically looking for microvascular issues, essential for women in midlife.

Rethinking the WHI Study

Much of the fear surrounding Hormone Replacement Therapy (HRT) stems from the 2002 Women's Health Initiative (WHI) study. Dr. Wright advocates for making decisions based on "fact, not fear." She points out that the study primarily looked at older women (average age 63) using synthetic hormones, yet the results were generalized to apply to all women. For many, the risk of osteoporosis and hip fractures—which carry a significant mortality rate—may outweigh the risks associated with modern, bioidentical hormone therapy.

The F.A.C.E. Protocol: Training for Longevity

What worked for your body at 20 will not work at 50. Midlife bodies require a strategic approach to exercise to maintain structural integrity. Dr. Wright utilizes the acronym F.A.C.E. to outline the necessary components of a longevity-focused fitness routine.

F - Flexibility

You must invest in joint range of motion daily. If soft tissues become stiff, you lose mobility, which leads to the "shuffle" seen in older populations. Incorporate dynamic stretching, yoga, or Pilates to ensure every joint moves through its full range of motion.

A - Aerobics

Cardiovascular health is critical, but the method matters. Dr. Wright advises against staying in the "middle zone" of intensity where you are working hard but not recovering.

• Zone 2 (Base Training): Spend roughly 80% of your cardio time here (e.g., 3 hours a week). This is a lower heart rate zone that builds mitochondria and burns fat without causing excessive fatigue.
• High Intensity (Sprints): Twice a week, push your intensity to the max for short bursts (e.g., 30 seconds on, fully recover). This stimulates stem cells and improves VO2 max in as little as 20 minutes.

C - Carry a Load

To remain "unbreakable," you must lift heavy weights. The goal in midlife is to build power—the ability to react quickly and forcefully (like catching yourself when you trip).

• Heavy is relative: "Heavy" is whatever feels challenging for you within a 6-10 rep range.
• Focus on failure: You should lift to the point where you cannot complete another rep with good form.
• Bone density: Lifting heavy is one of the few ways to signal bone growth and prevent osteoporosis.

E - Equilibrium

Falls are a leading cause of injury and death in older women. Train your balance daily to keep the neural pathways between your brain and muscles sharp. Simple habits, like standing on one leg (Tree Pose) while brushing your teeth, can pay huge dividends in stability.

Nutrition and Supplementation for the Midlife Woman

One of the most common mistakes women make is under-eating, particularly regarding protein. As we age, our bodies become less efficient at processing protein, meaning we need more of it, not less, to maintain muscle mass.

The Protein Prescription

Dr. Wright recommends aiming for 1 gram of protein per pound of ideal body weight. If you are under-fueled, your body will catabolize (eat) your own muscle and bone for energy. This leads to a condition known as "skinny fat" (sarcopenia)—looking thin but having dangerously low muscle mass and high visceral fat.

A Sample "High-Protein" Day:

• Breakfast 1: Greek yogurt with berries (approx. 20g protein).
• Breakfast 2: Egg white omelet (approx. 25g protein).
• Lunch: Chicken breast or substantial plant protein (approx. 40g protein).
• Dinner: Lean protein source to close the gap.

Strategic Supplementation

While food comes first, specific supplements can support the aging body:

• Creatine Monohydrate (or HCL): Vital for both muscle power and brain energy.
• Vitamin D & Magnesium: Essential for bone health, immune function, and sleep.
• Omega-3s: Critical for reducing inflammation, particularly in the brain.
• NAD+ Precursors (NMN or NR): Supports mitochondrial function and cellular energy (avoid IV NAD+, as it must work intracellularly).

Hormones and Brain Health

Brain fog is a hallmark symptom of the menolescence, often described by women as losing their nouns or feeling like their processor is slow. This is directly linked to the brain’s dependency on estrogen for energy metabolism.

"When we don't have estrogen, our entire brain chemistry changes and we start to catabolize the myelin of your nerves as a fuel source."

For women considering Hormone Replacement Therapy, Dr. Wright outlines a hierarchy of options:

1. Vaginal Estrogen: Safe for nearly everyone (including breast cancer survivors) to prevent urinary tract infections and pelvic floor dysfunction. It is not absorbed systemically.
2. Transdermal Estradiol: Patches, creams, or gels that bypass the liver (unlike oral estrogen), reducing clot risk.
3. Micronized Progesterone: Essential for women with a uterus to protect the uterine lining; also acts as a sleep aid.
4. Testosterone: Often overlooked in women, it supports muscle maintenance and brain function ("the technicolor dreamcoat" of hormones).

Conclusion

Aging is inevitable, but how we age is largely a choice. By understanding the data, prioritizing protein and heavy lifting, and making informed, fearless decisions about hormone health, women can protect their future selves. The goal isn't just to live longer—it is to maintain the mobility, cognitive sharpness, and vitality required to live a life that is truly unbreakable.