Sara Szal

Directions Website Contact the practice

Women's hormonal health has been understudied and misunderstood for decades. I am correcting that. Harvard, MIT, UCSF-trained OB/GYN. NYT bestselling author.
(213)

Science-backed protocols for pregnancy, postpartum, perimenopause, and menopause. Want guidance? Sara Gottfried MD is the three-time New York Times bestselling author of The Hormone Cure, The Hormone Reset Diet, and Younger. Her latest book, Women, Food, and Hormones is available for preorder now. No medical advice. Comments and posts come from Dr. Gottfried and her team.

11/02/2026

My cholesterol has always looked good.

This year, my LDL was 93. Well within the normal range.

But another number, called ApoB, was telling a different story.

And here's why every woman, especially around menopause, should know about it.

Your LDL tells you how much cholesterol is in your blood.

Your ApoB gives us a better idea of how many particles are carrying that cholesterol through your bloodstream. And those particles can contribute to plaque buildup in your arteries.

Here's what surprised me: ⚡Your LDL can look perfectly normal while your ApoB tells a different story. ⚡

That's exactly what happened to me around menopause.

And research shows that these numbers can change as our hormones shift, even when we're doing everything right.

So the next time your doctor tells you your cholesterol looks good, ask whether it's worth checking your ApoB and Lp(a), another marker of inherited heart risk.

Because "normal" cholesterol doesn't always tell the whole story.

❤️ Comment HEART and I'll send you my FREE ACCESS article, including what I recommend asking your doctor.

Have you had your ApoB checked?⬇⬇

10/30/2026

⚡The point of a GLP-1 is not to disappear. It's to become metabolically resilient.

Muscle is your metabolic reserve. It helps regulate blood sugar, supports your bones, and protects your strength and balance as you age.

But when weight drops rapidly, you may be losing muscle along with fat.

And for women in perimenopause and menopause, this matters even more.

That's why I focus on three things with my patients taking GLP-1s:

▪ adequate protein,
▪ progressive resistance training
▪ and a medication dose that doesn't leave them chronically underfed.

Because the goal isn't simply weight loss. It's better metabolic health, with your strength intact.

Want to know what else I monitor in my patients taking GLP-1s?

👉👉Comment GLP1 and I'll send you my free GLP-1 guide.

The guide covers the lab tests, body composition measurements, side effects, and monitoring strategies I use with my patients.

10/29/2026

GLP-1 medications are changing the way we treat obesity and metabolic health. And for many women, the benefits are significant.

But after 30+ years of caring for women, I have a question:

Are we paying enough attention to what happens beyond the number on the scale?

We know that substantial weight loss can include loss of lean mass. Some studies have also found changes in heart rate and HRV.

And in my practice, I'm hearing something else: women reporting changes in s*xual desire, sensation, and even how their pelvic floor feels.

Does that mean GLP-1 medications are causing these changes?

Not necessarily. The research on female s*xual function and pelvic floor health is still remarkably limited.

But these are questions we should be asking.

Because successful weight loss should mean more than becoming smaller. It should also mean protecting your strength, recovery, energy, and quality of life.

Here are my top 5 questions every woman taking a GLP-1 should be asking.

And in my latest article on The Female Edge on Substack, I go deeper into what the research tells us, what we still don't know, and what I believe needs more attention.

👉👉Comment PEPTIDES and I'll send you the free article link.

10/27/2026

Shopping with another person in the dressing room has always felt mildly traumatic for me. Someone else as a witness to my private suffering: the body dysmorphia, belly fat, and constant negotiation with the mirror.

Yesterday, elysewalker healed that wound. She’s the Esther Perel of getting dressed.

Elyse, CEO and founder of elysewalker, is exactly my age, and she gave little old nerdy me six hours of her time. Six hours?!

She did her homework. She knew about my sneaker closet, my t-shirt habit, my chunky boots, and my (way too many) backpacks.

Then she hand-picked everything from power suits to a leopard coat, a gorgeous new purse, and a sweater with feathers.

Frugal me spent a small fortune. More important, I gained a new soul sister.

Elyse has flagship stores in NYC, the Palisades, and St. Helena, and she’s helping rebuild the Palisades community after the fire. Please shop her stores and online. This is a woman worth supporting.

My daughter was dying to see the looks, so Elyse made her a video. Now I need your vote too.

Which OOTD should I make sure I buy? Vote in the comments 👇

1️⃣ Chloé black jacket, silk satin Dorothy blouse, and the insane “superwoman” suede elastic waistband pants. Whaaat?
2️⃣ Feather sweater with cream MOTHER Lemon Twist jeans
3️⃣ Double-breasted blazer, jeans, + teddy bear tiny purse (!)
4️⃣ Leopard jacket and YSL purse

I may need to go back today and reconsider a few treasures I left behind!

xo, Dr. Sara

10/26/2026

Did you know that menopause can change the bacteria living in your va**na?

And those changes may affect everything from va**nal dryness to recurrent infections.

Here's what I want more women to understand.

A healthy va**nal microbiome is usually dominated by protective bacteria called Lactobacillus crispatus.

These bacteria help maintain the acidic environment that protects against bacterial vaginosis, urinary tract infections, and some s*xually transmitted diseases.

After menopause, crispatus often disappears along with estrogen.

Less estrogen means less glycogen, the substance that feeds these beneficial bacteria. As their numbers decline, va**nal pH can rise, making it easier for less desirable bacteria to thrive.

This is why treating va**nal health isn't always as simple as using a lubricant or taking a probiotic.

In a randomized clinical trial my colleagues and I published in 2025, we studied a va**nal tablet containing three strains of L. crispatus.

Among women who started with a less-than-optimal microbiome:

▪ 90% of those using the va**nal tablet developed a L. crispatus-dominant microbiome by day 21.

▪ Only 11% of women receiving a placebo experienced the same shift.

But there's an important distinction: these women were still menstruating. We need more research to understand how well this approach works after menopause.

In my practice, I look at the va**nal environment as a whole, including estrogen levels, protective bacteria, and tissue health.

Your va**nal microbiome deserves as much attention as your gut microbiome.

Have you ever had your va**nal microbiome tested, or even discussed it with your doctor?⬇⬇

👉Comment TRIFECTA for my va**nal health protocol made up of three interconnected pieces.

10/24/2026

What happens when one partner wants s*x more often than the other?

I wrote an article last week called The S*x You Have So They’ll Stop Asking… and it blew up on Substack.

Clearly, I touched on something many couples are experiencing but aren't talking about.

It's easy to fall into a pattern where one person feels rejected, the other feels pressured, and neither feels particularly close.

Sometimes, the partner with less desire says yes simply to avoid disappointment or tension.

There's a name for this: mercy s*x.

But here's what the research tells us: when people have s*x to avoid disappointing their partner, desire and satisfaction tend to be lower for both partners.

One person is trying to protect the relationship. The other is hoping to feel wanted. Yet neither is getting the connection they need.

After 30 years of listening to women talk about desire, I believe we need to stop treating differences in desire as one person's problem.

So what can couples do together?

❤️ Talk about it outside the bedroom, when neither person feels pressured or rejected.

❤️ Make time for affection without the expectation of s*x.

❤️ Instead of asking “Why don't you want to?” try “What would make you want to?”

❤️ Talk openly about pleasure, changing needs, and any physical discomfort.

❤️ Consider couples or s*x therapy if you're struggling to find your way forward.

Both partners deserve to feel wanted, safe saying no, and genuinely connected.

My full article is free to read on Substack. I hope you'll share it with your partner and use it to start a conversation.
https://saraszalmd.substack.com/p/the-s*x-you-have-so-theyll-stop-asking

10/22/2026

You're waking at 4 AM with your heart racing, dragging yourself through the afternoon on caffeine, and staring at the ceiling at bedtime.

Your bloodwork comes back normal🤷‍♀️

But here's something that may not have been measured:

👉👉what your cortisol is doing throughout the day.

Cortisol is supposed to follow a rhythm. Generally higher in the morning, gradually declining throughout the day, and lower at night.

Chronic stress and disrupted sleep can alter that pattern.

And the implications may go beyond fatigue, sleep, and desire.

A 2024 brain-imaging study found that higher cortisol was associated with greater amyloid accumulation and reduced glucose metabolism in certain brain regions in women. The association with reduced brain glucose metabolism was stronger after menopause.

These are associations, not proof that cortisol causes Alzheimer's disease. But they raise important questions about the relationship between stress physiology, menopause, and brain health.

The question isn't always whether your cortisol is high.

👉👉It's whether your cortisol is following the rhythm it should.

In my article on cortisol, I explore the research, why standard bloodwork may not answer these questions, and what we're learning about cortisol and women's brain health.

Comment CORTISOL and I'll send you the article.

▪️▪️▪️▪️
Women's hormonal health has been understudied and misunderstood for decades. I am correcting that.
Harvard, MIT, UCSF-trained OB/GYN. NYT bestselling author.
FOLLOW for science-backed protocols for pregnancy, postpartum, perimenopause, and menopause 🫶

10/21/2026

There is a particular exhaustion in being the woman everyone trusts to hold them together while wondering who will hold you when you come undone.

I know that woman. I have been her.

As a physician, oldest sister, and mother, I’ve spent decades caring for others. I know how to show up, solve problems, and keep carrying what needs carrying. But life has a way of asking us harder questions.

What happens when being needed becomes your identity? When you become so skilled at caring for everyone else that you forget you are a living, breathing human being who needs care, too?

I’ve come to call the answer self-stewardship. My friend Elena Brower taught me about this concept.

Self-stewardship is the ongoing practice of taking responsibility for the conditions that allow you to remain fully alive. Tending to your body. Protecting your energy. Honoring your limits. Making room for pleasure, creativity, intimacy, rest, and belonging.

Not as another item on your to-do list but as a way of living.

My body tells me when I’m overriding a no. The ocean reminds me that not every wave requires resistance. Bradly Jacobs has taught me about this for of nervous system regulation. It feels like a miracle.

I am learning that devotion without self stewardship becomes martyrdom, that loving others deeply does not require abandoning myself, that receiving fully requires its own kind of courage.

I don’t want to spend the rest of my life becoming more resilient so I can carry more. I want a life that makes room for awakening and aliveness.

You don’t have to become the ocean’s lifeguard. I can be in the water, too.

Where are you being asked to stop holding everything together and start caring for the woman doing the holding?

10/21/2026

Women are taught to worry about breast cancer, heart disease, and osteoporosis.

But what about the brain? 🧠

⚡Nearly two-thirds of Americans living with Alzheimer's are women. ⚡

And the changes that influence our cognitive health can begin long before we notice significant memory problems.

I know this because I've watched women around me lose words, sleep, and the thread of who they were.

I've experienced my own perimenopausal brain fog, too.

And for years, like many physicians, I underestimated what was happening.

We now have brain imaging research showing that glucose metabolism changes across the menopause transition.

Estradiol plays an important role in how the brain produces and uses energy.

This is why I believe midlife, particularly ages 40 to 60, deserves much more attention when we're talking about women's brain health.

I've put together a list of things YOU can do NOW, from building muscle and protecting sleep to understanding hormones, cardiovascular risk, and ApoE4.

Some are simple changes you can start making.

Others deserve a more individualized conversation with your clinician.

Comment MEMORY and I'll send you my new article:

Your Brain Is Already Changing After 40. Here Are 7 Things to Do About It.

The first three recommendations are available to everyone, with the more detailed clinical protocols for paid Substack subscribers.

10/19/2026

Your va**na doesn't have an expiration date.

Yet more than half of women after menopause experience va**nal dryness, burning, painful s*x, or recurring urinary problems.

And far too many are told it's simply part of getting older.

In my practice, I look at three interconnected pieces of va**nal health. I call it The Va**na Trifecta.

1️⃣Hormones help rebuild and maintain va**nal tissue.

2️⃣Bacteria help protect the va**nal ecosystem.

3️⃣Light is an emerging approach being studied for tissue health, blood flow, and repair.

The evidence isn't equal across all three.

Va**nal estrogen is an established treatment. The research on microbiome restoration and red light therapy is still developing, particularly in postmenopausal women.

But I believe we need to be looking at the whole picture, especially when women have been suffering for years without effective treatment.

I've just published The Va**na Protocol: Hormones, Bacteria, and Light, sharing the 12-week approach I use with patients and in my own body, including what the research supports and where the evidence is still young.

⚡⚡Comment TRIFECTA and I'll send you the article. ⚡⚡

🫶🫶And SHARE this post with all those in your circle. So many women are experiencing these symptoms but are reluctant to talk about it - or have tried and been dismissed by their doctor. That needs to change.

Address

Moraga, CA

Website

https://saraszalmd.com/links/, https://bit.ly/TheFemaleEdge

Alerts

Be the first to know and let us send you an email when Sara Szal posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.