Guest: Meghan Rabbitt — award-winning journalist, author of The New Rules of Women's Health Host: Elizabeth Stein, founder & CEO of Purely Elizabeth Listen: Apple Podcasts | Spotify | Amazon Music | iHeart Radio
Meghan Rabbitt spent three years interviewing 132 all-female experts to write The New Rules of Women's Health — a guide commissioned by Maria Shriver and published through her Penguin Random House imprint. The book covers everything from anatomy and gynecologic health to brain health, heart health, immune conditions, alcohol, sleep, and nutrition, all through the lens of what the research actually shows for women specifically.
In this conversation, Meghan and Elizabeth talk about why women's health has been historically under-researched (the NIH didn't even require women be included in funded research until 1993), what the latest science tells us about perimenopause and menopause, why brain health and heart health need to be on the radar in your 30s and 40s — not your 70s — and how to stop being dismissed in medical settings. They also get into hormone therapy, alcohol, sleep trackers, fiber, and why the most powerful thing any woman can do is write down her symptoms before she goes to the doctor.
Key Takeaways
Women were excluded from NIH-funded research until 1993 — which means we've been practicing medicine on women based on male data for most of modern medical history; that's finally changing
Perimenopause can start in your 30s — the hormonal shifts that make you feel "off" or "not like yourself" can begin well before the typical conversation about menopause; write it all down and bring it to your doctor
Women are two-thirds of Alzheimer's cases — the midlife menopause transition is a significant turning point for brain health; lifestyle pillars (exercise, sleep, fiber, social connection) are the most evidence-backed tools we have
Heart disease is the leading cause of death in women — more so than breast cancer; get your ApoB and talk to your doctor proactively about your cardiovascular risk before your numbers shift
80% of autoimmune disease patients are women — it often takes years to get a diagnosis; write down every symptom, even ones that feel like normal stress or aging
Alcohol hits women harder and that gets worse in midlife — hormonal changes in perimenopause affect the enzymes that break down alcohol; even moderate drinking increases breast cancer risk
Fiber in 2026 is what protein was in 2025 — it's the nutrition conversation that will define the year, and it deserves as much attention
Products Mentioned
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Episode Highlights
On why women's health research is so far behind:
The NIH didn't require women be included in NIH-funded research until 1993. Before that, the assumption was that male data applied to women. We now know we are not just small versions of men — we need research into conditions that disproportionately affect us, and in many cases we simply don't have it yet.
On perimenopause starting earlier than most women think:
Hormonal changes can begin in your 30s, not just your 40s or 50s. Symptoms are often subtle — mood shifts, unexplained weight changes, brain fog, heavier periods — and most women brush them aside, especially high-achieving women who are conditioned to push through. Meghan's advice: write everything down. Even if it feels like a small complaint, documenting symptoms over time is what gives your doctor actual data to work with.
On hormone therapy and what really happened with the Women's Health Initiative:
A major arm of the Women's Health Initiative study was stopped over concerns that hormone therapy was causing breast cancer. The reporting around that was misinterpreted — women were told hormone therapy caused breast cancer, physicians stopped prescribing it, and a generation of women went without treatment unnecessarily. We now have better data: hormone therapy started within 10 years of menopause has lower risk, and for many women without other co-factors, the benefits outweigh the risks. Have the conversation with your doctor before you need it, not after symptoms become overwhelming.
On brain health and Alzheimer's risk:
Women represent two-thirds of Alzheimer's disease cases. The brain thrives on estrogen, and as estrogen drops in perimenopause and menopause, the brain creates more estrogen receptors trying to compensate. The lifestyle factors that support brain health most: exercise (especially with other people — you get a double benefit of movement plus social connection), sleep, and fiber. Don't panic about brain fog — it's common during perimenopause and not the same as Alzheimer's — but do discuss it with your doctor so there's a baseline on record.
On heart health being underestimated:
Heart disease is the leading cause of death in women, but most women prioritize breast cancer screening over proactive heart health conversations. Elizabeth's own experience: her ApoB numbers only started rising recently, tracing back genetically to her mother. Meghan's takeaway: know your full cholesterol picture — not just total cholesterol, but the individual markers including ApoB — and have a proactive conversation with your doctor about cardiovascular risk before numbers shift.
On the breast cancer risk assessment most women have never done:
Meghan recommends every woman search for the Tyrer-Cuzick risk assessment model — a free online questionnaire that calculates your lifetime breast cancer risk. Bring that score to your doctor and ask what screening plan is right for you based on your personal risk level. Meghan did this herself and it led to her first breast MRI, catching something she would have otherwise missed.
On alcohol and midlife:
Women metabolize alcohol differently than men — fewer enzymes, less body water, higher blood alcohol levels from the same amount. That difference becomes more pronounced in perimenopause. The enzyme changes mean the glass of wine that felt fine at 30 causes a full hangover at 45. Beyond the symptom question, even moderate drinking increases breast cancer risk. The goal isn't never drink again — it's being conscious about the choice and the why behind it.
On sleep and the "revenge bedtime procrastination" phenomenon:
Many women push back bedtime because those late-night hours are the only time in the day that belongs to them. Sleep psychologist advice: don't fight it, but be mindful about what you're watching. A thriller that spikes your anxiety at 10 p.m. is worse for your sleep than the light content your algorithm feeds you. Blue light matters less than what the content is doing to your nervous system.
Frequently Asked Questions
What is The New Rules of Women's Health about?
The New Rules of Women's Health by Meghan Rabbitt is a comprehensive guide to women's health that covers anatomy, gynecologic health, breast health, perimenopause and menopause, brain health, heart health, immune conditions, gut health, skin health, alcohol, sleep, exercise, and nutrition — all through a female lens and based on interviews with 132 all-female experts. It was commissioned by Maria Shriver and published through her Penguin Random House imprint.
What are the signs of perimenopause that are often missed?
Mood changes are one of the most commonly missed signs — feeling extra ragey, tearful, or just "not like yourself" can be early perimenopause, not just stress. Other easily dismissed signs include heavier or irregular periods, brain fog, weight changes (particularly increased fat around the midsection), and sleep disruption. These symptoms can begin in a woman's 30s. Meghan recommends writing down all symptoms, even subtle ones, and bringing that list to your doctor.
What is hormone therapy and is it safe?
Hormone therapy (estrogen and/or progesterone) is used to address symptoms of the menopause transition. It fell out of favor after a widely misreported study (the Women's Health Initiative) created the perception that it caused breast cancer. Current research shows that for women without specific risk factors, hormone therapy started within 10 years of menopause generally has a favorable risk profile. It is still a medication with risks, and the conversation should be personalized with a physician who supports hormone therapy as a tool.
Why do women make up two-thirds of Alzheimer's cases?
The menopause transition is believed to be a significant factor — the brain relies heavily on estrogen, and when estrogen levels drop, the brain responds by creating more estrogen receptors trying to compensate. The mechanisms are still being studied, but researchers like Dr. Lisa Mosconi at the Cleveland Clinic (home of Maria Shriver's Women's Alzheimer's Movement) have shown that midlife is a critical window. Lifestyle factors — exercise, sleep, fiber, social connection — are the most well-supported tools for brain health in this transition.
What is ApoB and why should women know about it?
ApoB is a protein that carries LDL ("bad") cholesterol particles and is considered a more precise marker of cardiovascular risk than total cholesterol or standard LDL alone. High ApoB can be partly genetic and may not appear until midlife. Meghan recommends women have a proactive conversation with their doctor about their full cholesterol picture — including ApoB — rather than waiting until numbers shift.
What is the Tyrer-Cuzick risk assessment?
The Tyrer-Cuzick model is a free online questionnaire that calculates your lifetime risk of breast cancer based on personal and family health history. You can search for it online, complete it yourself, and bring the result to your doctor to have a more informed conversation about the right screening plan for your individual risk level. Women with dense breast tissue or other risk factors may benefit from breast MRI in addition to standard mammography.
How does perimenopause affect alcohol tolerance?
The enzymes that help metabolize alcohol change during perimenopause due to hormonal shifts, meaning women in midlife often experience stronger effects from the same amount of alcohol they handled easily in their 20s and 30s. Additionally, women's bodies have less body water than men's, meaning alcohol is more concentrated. The CDC recommends no more than one drink per day for women versus two for men. Research also shows even moderate drinking increases breast cancer risk, making it worth being mindful about the frequency and reasoning behind alcohol consumption.
Topics: Women's Health · Perimenopause & Menopause · Brain Health · Heart Health · Autoimmune Disease · Hormone Therapy · Sleep · Nutrition & Fiber · Alcohol & Midlife Health · Advocating for Yourself in Medical Settings
