May 6, 2026

Livelong Women's Health Summit 2026: The Full Notes from Menopause Coachella

Dr. Stacy Sims and Jane Fonda at the Livelong Women's Health Summit in San Francisco, CA April 17th & 18th

There's a test that takes thirty seconds and predicts your risk of dying better than blood pressure does.

It's grip strength.

A 2015 study in The Lancet followed 139,691 adults across 17 countries for a median of four years. For every 5 kg decrease in grip strength:

All-cause mortality risk went up 16%
Cardiovascular mortality went up 17%
Heart attack risk went up 7%
Stroke risk went up 9%

Grip strength even outperformed systolic blood pressure as a predictor of cardiovascular death.

It's not that your hands matter. It's that grip strength is a proxy for total muscle quality, which is a proxy for metabolic health, which is the upstream lever for almost everything that determines how the second half of your life is going to go.

I got my grip strength tested last month at the Livelong Women's Health Summit in San Francisco. I want to tell you about everything else I learned there, because it changed what I'm doing now for health, how I'm thinking about the next decade of my life, and what I'm building at Frondescent.

Why I Went

The absurdly credible lineup of longevity researchers and clinicians, among them, Dr. Stacy Sims and Dr. Sara Szal (formerly Dr. Sara Gottfried) both of whom I've followed for years. Throw in Dr. Vonda Wright, Kayla Barnes-Lentz, Dr. Natalie Crawford, Nathalie Niddam, Dr. Mary Claire Haver, the Buck Institute team, and you couldn't keep me out.

It was also in my backyard. And, when Frondescent was selected as a part of the VIP experience, that was the icing on the cake.

What Menopause Coachella Actually Was

It was held at the San Francisco Masonic, which, if you haven't been, is a stunning building in a gorgeous part of town, across the street from Grace Cathedral and the Pacific Union Club, deep in San Francisco's old money territory. It was a gorgeous day. The crowd was a sociological feast.

There were VC women, sharp, focused, and ensconced in various "quiet luxury" labels, no doubt there to learn about the investment opportunities in the exploding peri/menopausal market. There was the Marin contingent, fit, makeup-free, gray hair, organic baggy clothing representing the natural-aging cohort. Others took a different path, sporting tight faces, status bags, long, glowing gel manicures, and sleek blowouts with not a grey in sight. There were women looking for answers and to have their experiences validated. There were a fair amount of friend groups, which I found genuinely touching.

The vendors knew exactly who was there. The crowd told a lot about how much opportunity (money) is in women's longevity now.

The Things I Took with Me

The 35–45 window is the leverage point of a woman's life.
Lifestyle matters more than you think it does. Your genes give you guidance, but they are not your fate.
The choices you make in your twenties and thirties create your hormonal destiny in your thirties, forties, and beyond. The 35-to-45 range is where muscle, collagen, bone density, and metabolic flexibility either get built or start breaking down.
If you're not actively fighting against that decline by building muscle, protecting bone, defending insulin sensitivity, by the time the ovary-brain axis fuses out, you're cooked. You will get thinner and frailer and more metabolically dysfunctional, and the version of yourself that walks into menopause will not have the reserves to come out of it well.
Estrogen receptors are everywhere in your body. Brain, bones, blood vessels, skin, gut, muscles, the clitoris, every organ system. Estrogen is profoundly anti-inflammatory. When regulated, it makes you beautiful and healthy.
When you lose it, and per the Mary Claire Haver panel, postmenopausal women not on hormone replacement therapy (HRT) can end up with substantially less estrogen in the brain, even less than their 60-year-old male counterpart. It's no wonder why so many women in their late fifties walk around looking hunched, dry, depleted, and like they've been sucking on a lemon for the last 10 years.
The mechanism of female aging, particularly as it relates to the hormonal landscape, is just now beginning to be understood. We don't have a real evidence base on women and cycles and hormones. It was only the NIH Revitalization Act of 1993 that mandated women be included as subjects in NIH-funded clinical research. Before that, "women's health" basically meant reproductive health.
Most of what we know about cardiovascular disease, dementia, drug metabolism, and aging was derived from studies on men. Most of what we know about HRT was first studied in men in 1978, and not in women until 1998.
The room was unanimously pro-HRT for the right candidates, with appropriate disclosure that it isn't risk-free and that personal genetic factors matter. But the broader truth is that we are still extremely early in actually understanding women's bodies.
The single biggest lever: blood sugar. If you take one thing from this post, take this one.
Don't major in the minor. The single most important thing you can do for your hormonal future, your cardiovascular future, your skin, your hair, your cognition, and your menopause experience is manage your blood sugar. Adding muscle is one of the smartest ways to ensure a healthier blood sugar response.
Dysregulated blood sugar is the upstream driver of most of what eventually kills women. It feeds insulin resistance, which feeds PCOS, which feeds endometriosis, which feeds cardiovascular disease (the number one killer of women, more than all cancers combined).
It accelerates glycation, which stiffens collagen and elastin in the skin and is one of the primary drivers of skin aging that no topical can reverse. You can buy every serum on the market and you'll still look older if your fasting glucose is creeping.
If you have dysregulated blood sugar going into perimenopause, your menopause experience is likely going to be hellish. If you have it dialed in, you've removed one of the biggest accelerants from the fire.
This is not new information. What was new for me was hearing it framed across panel after panel after panel as the thing, the lever, the upstream variable, the place where 80% of the work gets done. Stacy Sims framed it through a metabolic lens. The ovarian clock panel framed it through PCOS and endometriosis. Kayla Barnes-Lentz framed it through wearables and what to actually measure (hint: fasting insulin, not just glucose). Sara Szal framed it through long-term cognitive protection. Vonda Wright framed it through musculoskeletal aging.

Blood sugar is the lever. Everything downstream is a symptom of how well you're handling it.

Straight from My Notes

Dr. Stacy Sims, "Women Are Not Small Men."

The thesis: female physiology differs fundamentally from male physiology, and most exercise science, wearable algorithms, and medical research is built on male data.
Cold plunges: 55°F is optimal for women. Colder than that is actively detrimental.
If you train on purpose, you're an athlete.
Start with body weight. Don't go heavy immediately. Mobilize more than you stretch, work through the joint capsule.
If you haven't read Stacy's books, follow her on the 'gram at the very least.

Takeaways:

Wearables like Oura and Whoop are calibrated on male physiology. They miss female-specific signals tied to progesterone, HRV, and respiratory rate. Postmenopause is a new metabolic baseline for which wearables do not have a reference range.
Heavy lifting rebuilds the neuromuscular junction and protects the prefrontal cortex. Women in their 60s lifting heavy for the first time show measurable cognitive protection. Strength training is anti-dementia work. And you can get results at every age.
Contraceptive timing matters: hormonal birth control in the teen years can permanently alter the amygdala. When it is taken later in life, the effects are reversible.

The Ovarian Clock Panel

Drs. Jessica Shepherd, Natalie Crawford, Francesca Duncan, and Ianette Mera, moderated by Dr. Hillary Lynn.

Ovarian aging isn't just egg depletion. It's mitochondrial density loss and tissue fibrosis. Researchers are exploring "ovarian softeners" as part of IVF protocols now, which is fascinating.
Fertility is a marker of metabolic health and cellular function, not just a reproductive question.
15% of women have PCOS. 80% of them have undiagnosed insulin resistance.
20% of women with endometriosis have lesions outside the ovaries.
90% of endometriosis cases are undiagnosed.
Your period should never be painful. Pain signals metabolic dysfunction ahead.
Hot flashes are correlated with elevated heart disease risk. Track them.

Top three actions from the panel: 1. Lift heavy, 2. Know your fasting insulin, 3. Walk with friends in nature.

When Estrogen Leaves the Building

Drs. Mary Claire Haver, Kathleen Jordan, and Theis Ali Badi.

This was the panel where the staggering data points landed.

Pre- and perimenopause is a major metabolic shift. The brain's preferred fuel switches from glucose to ketones.
60-year-old men have approximately 4x more estrogen in the brain than 60-year-old women not on HRT.
Two-thirds of US Alzheimer's patients are women.
3,000+ gene expressions differ between female and male brains.
Only 30% of clinical studies include women.
Every menopausal woman 45–55 with no cardiovascular disease history is a strong candidate for HRT.
Menopause before 45 is a particularly clear case for considering hormones.
Lifestyle is primary. HRT is secondary. Focused lifestyle work yields 15–20 years of optimized quality life.
The drop in estrogen drives a drop in dopamine, which manifests as worse focus, worse metabolism, lower mood. Menopausal brain fog is not Alzheimer's and can be temporary.

Direct quotes I loved, unfortunately I was scribbling so furiously I didn't attribute:

"Why do we all want to look like a 14-year-old?"

"Stop letting insurance companies define your health."

"Bring science, not social media, to your clinician."

"Use your vote, and I'll continue to use mine."

Cellular Mechanisms of Aging

Drs. Wei Wu and Eric Verdin (Buck Institute), moderated by Dr. Hillary Lynn.

One of the best panels of the summit.

Dr. Wei Wu's grandmother raised him while his mother was in reeducation camps in China. She died of cervical cancer. His life's work is women's health. That kind of personal stake is rare.
The genome accounts for 40–50% of disease risk. The rest is lifestyle and environment.
Genome sequencing went from $3 billion 26 years ago to under $1,000 today. Personalized medicine via genomics is here now.
Both male panelists were on GLP-1s for longevity, not weight loss. They were clear that GLP-1s in your 60s are not the same conversation as GLP-1s in your 20s. Dr. Hillary Lynn noted that she had taken a GLP-1 and gotten off of it because it didn't make her feel good. (Side note: when asked about whether GLP-1's are beneficial or detrimental to women, Dr. Stacy Sims cooly stated that it "remains a posed question." Whew! The clinical elegance of her word choice!)
Metformin crushes testosterone in men and blunts muscle growth. (Side note: this blew my mind, as it is a major oversight in the clinical study that compared Metformin to Inositol and Berberine. Both inositol and Berberine outperformed Metformin in different metrics, but the test made no mention of these now known side effects of Metformin. The study only referenced the gastric distress reported by many Metformin takers. This study is what inspired me to create an Inositol plus Berberine formula. Both look even more compelling when Metformin's full side effect profile is included.)
NAD+, rapamycin, metformin, all trendy, yet unproven for general longevity. However, people are paying $700 for a $2 IV drip thanks, in large part, to influencers. Dr. Wu pointed out that forest walks are proven to be anti-aging and free.
A quote from Dr. Wu: "In God we trust; for everything else, show me the data."

Dr. Vonda Wright, Unbreakable: Age with Power

Vonda coined the term "menolescence" which is the adolescence of midlife. Decline is optional. We have agency.
The longevity paradox: pain stops movement, immobility becomes permanent. Keep moving through it.
Arthritis of menopause was first studied in 1925. We've known for a century and done nearly nothing about it. Joint replacements are projected to rise 450% by 2060.
Get a DEXA scan. Know your bone density, body composition, and basal metabolic rate.
Localized estrogen is for everyone. At any age. All vagina owners benefit, even at 60–70, for skeletal and sexual health.
Sexual desire is a health indicator. Take the FSFI test and share with your doctor.

Kayla Barnes-Lentz, Metabolic Health and Wearables Panel

Caloric restriction dysregulates the cycle and downregulates the thyroid. This is a critical correction to a lot of bad longevity advice aimed at women.
Measure fasting insulin, not just glucose. Insulin affects every system. Insulin resistance is easy to reverse, which is the good news.
Continuous glucose monitors show you which food orders and combinations stabilize blood sugar in your specific body. The data is personal.
A new wearable that sits under the bra is being developed to catch night sweats — finally a piece of female-only data. Night sweats correlate with cardiovascular and dementia risk.
Oura ran a Perimenopause Report based on data from over 100,000 self-identified perimenopausal women across 850,000+ users aged 40-60, analyzing 24 million+ nights of sleep data. Findings included up to two hours of weekly sleep loss across the perimenopausal-to-postmenopausal transition, a 33% increase in reported anger, and a 28% increase in sadness in late perimenopause vs. premenopausal women. HRV decreases of 20-30% have been associated with mood changes and increased anxiety.

The panel agreed:

Overhyped metrics: point-in-time testing, body fat percentage obsession, LDL alone.
Underrated metrics: resting heart rate over time, fasting insulin, ApoB, Lp(a), HRV, cycle tracking, cortisol.

Dr. Sara Szal (formerly Dr. Sara Gottfried)

Sara opened with a story about her two grandmothers. One who was still a sassy flirt at weddings at 97, and one who died after 16 years in a nursing home with Alzheimer's (!). The divergence in lived experience has been a source of drive and inspiration for her work. Her story of professional, high-achieving burnout and finding her way out of a first marriage clearly hit for a lot of women in the room. She shouted out millennials, for whom she credits with changing the narrative about menopause. In terms of cool factor, Sara really has it. Seeing her in person was a totally different experience than through a screen.

Women have twice the insomnia rate of men. Sleep clears brain plaque through the glymphatic system. We are losing this protection at exactly the moment we need it most.
Vitamin D: aim for 50–90 ng/mL. Most women are nowhere near that.
HRT delivers approximately 25% of premenopausal estrogen levels even when taken. This is sobering. HRT helps, but it does not restore.
She shared this saying that was new to me: "For men wanting better health, be with a woman. For women wanting better health, be with your girlfriends." I'm going to leave that here for now, but I'll be back, with commentary.
Markers to measure: cortisol (4x daily if you're serious about it), protein levels, grip strength, VO2 max, vitamin D, autophagy.
Mitochondrial biogenesis and senescent cell clearance happen when you raise your VO2 max. This matters for the senescent cell discussion below.
Peri- and menopause should be a deeper time of spiritual meaning. Not a problem to be managed.

Hair and Hormone Rebalance Panel

This was a Nutrafol-sponsored panel and I'll note that, but the info was solid.

51% of women experience hair changes in perimenopause. Widening part, thinner ponytail. Estrogen receptors are in hair follicles, which are themselves their own organs.
40% of the average American woman's life is now spent in peri- or post-menopausal years.
You have the same number of follicles at birth as at death (unless transplanted). Damage is permanent. Protect them.
Stress causes telogen effluvium (shedding 2–3 months after acute stress or birth). Chronic stress impacts long-term follicle health. The gut microbiome is a huge factor.
Regrowth takes 3–6 months minimum. Any product claiming faster results is lying to you.
PCOS-related hair loss stems from insulin resistance. Correct the root cause.
Hair loss is a health and metabolic issue, not a cosmetic one.

Jane Fonda, The Third Act

She's 88. Won her first Oscar for Coming Home. She defined the third act as the time when all the chapters of your life converge. It should be about wholeness, and about leaving no regrets on the table.

She said she deliberately excluded a man from her third act. She's focused on repair, friendship, legacy, and reading.
Female friendships are the difference between living long and living well. We bring fierce eye contact, an ocean of emotional depth, and soul-level engagement, to start. Women need friends who will tell you that's BS, and friends who help you heal.
She works out with a trainer influenced by Stacy Sims. Eats by the color of the rainbow. Big breakfast and lunch, nothing after 3 pm.
"Clearing your mind is like flossing your teeth."
"When I'm pushing for something, it all goes wrong. Look for action and things will come."

My Homework

I came home with a list:

I'm getting my Lp(a) tested. This is a lipoprotein-a, a genetic risk factor for stroke, heart disease, and dementia. It's a one-time test but almost no one runs it as standard. It should be standard.
I got my grip strength tested at the summit. I've humble bragged about it in other writings, so I'll spare you here. Point is, I'm tracking it now.
I'm redoing a full cardiometabolic panel.
I'm taking an advanced DUTCH test (the comprehensive hormone metabolite panel).
I'm rededicating myself to nose-to-tail, low-and-slow, bone-in cooking. I'm in a perpetual state of trying to optimize fertility markers, not because I want another baby, but because I want my hormones to be supported internally as I move through my 40s and Alzheimer's scares the living shit out of me. Cycling regularly while lactating is unusual, and the demands on my system are real.
I'm making sure my vitamin D is in the 50–90 ng/mL range and my ferritin is where it needs to be.
Oysters are back on the menu. By the way, Whole Foods offers $1 oysters every Friday. And, they'll shuck a dozen for you. You're welcome. This is a far more bioavailable source than most supplements.
I'm formally training my VO2 max, which I started before the summit, but the panels reinforced. VO2 max isn't just cardiovascular fitness, it's correlated with mitochondrial biogenesis and senescent cell clearance and will pay off in the looks department.
I'm going to do a deep dive on the 12 Hallmarks of Aging from the Buck Institute (and the two new ones that were added recently).
I feel more fire to get this information out there. To all women. Even men. With specific instruction, they can be helpful allies.

Where My Eyes Narrowed

It wouldn't be a shrewish take without some skepticism, would it?

There was a vendor on the floor pitching a topical oxygen gel. I'll leave the name out. It was being marketed for genital application post-surgery and as a general intimate skincare. The pitch leaned on testimonials that felt scripted. The clinical evidence presented was weak: small reference groups (which I get for a small brand), very specific use cases, like after CO2 laser treatments, yet the framing was like it came from the NIH itself. Presenting it on a stage at a credible scientific summit was beneath the rest of the room.

More broadly: I left thinking about another skincare brand (a Summit sponsor) that claims to clear senescent cells topically with peptides. The pitch is something like "this serum clears senescent cells and reverses cellular aging." Maybe it does. But by how much? Over what period? Just on the skin?

I feel like we should be smart here. We know what clears senescent cells. High-intensity interval training does it. VO2 max training does it. Sara Szal made this point directly from the stage: mitochondrial biogenesis and senescent cell clearance happen when you raise your VO2 max.

So, you could allocate several hundred dollars a month on topical solutions from exceedingly well-funded companies and have faith that they will "work", or, you could take that money and spend it on the activities that guarantee the actual outcome by getting your heart rate up three times a week. Not only will your skin look better, the rest of you will too. To say nothing of the cognitive and mood benefits.

This is exactly the dynamic Frondescent exists to push against. Beauty products that work downstream of the mechanism, sold to women who don't have time to interrogate the mechanism at eye popping prices. Most of what passes for advanced skincare today is downstream theater. The actual interventions: sleep, blood sugar control, muscle, VO2 max, protein, vitamin D, are unglamorous, mostly free, and almost entirely effective.

The serum will not save you. The squat rack might.

The Data Gap Nobody is Going to Fix for Us

The single most important thing I want every woman reading this to internalize: the evidence base on female physiology is shockingly thin and it's not getting better fast enough to save you.

Until 1993, women weren't even required to be included as subjects in NIH-funded clinical research. Most of the foundational studies on cardiovascular disease, dementia, drug metabolism, and aging, all the studies informing your doctor's decisions, were run on men. Most regular doctors have zero formal training in menopause or hormone therapy. Most of the research dollars are still chasing male physiology.

The implication is that you are going to have to become fluent in your own body. Run your own labs. Track your own markers. Trial your own protocols. Find a clinician who treats you as a research partner instead of an instruction-follower. Or, as Stacy Sims put it: become fluent in the science, or rely on reputable translators.

Your markers are your own. They are not a verdict, they are a starting point. You can move them. And tracking them over time is the only honest report card I think any of us has.

Future Reading Material

The Ready State by Kelly and Juliet Starrett (recommended by Sara Szal for mobility).
Prime Time by Jane Fonda.
The 12 Hallmarks of Aging papers from the Buck Institute (especially the two recently added).

If a Friend Asked Me What to Do First

There's a lot here. If a friend asked me what to actually do with all of this, I'd tell her four things:

1. Get your fasting insulin tested. Not glucose alone. Insulin reveals dysfunction years before glucose does.

2. Lift heavy. Two or three times a week. Start with bodyweight first, master your form and build from there. The brain protection alone is worth it.

3. Test your grip strength and write down the number. Track it.

4. Call the one woman with whom you can be totally unguarded. Call her and go for a walk outside.

— Alex

Sources and citations:

Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet. 2015;386(9990):266-273.

NIH Revitalization Act of 1993, Public Law 103-43, signed June 10, 1993. Section 131 mandated inclusion of women and minorities as subjects in NIH-funded clinical research.

All panel content paraphrased from notes taken at the Livelong Women's Health Summit, San Francisco Masonic Center, April 17-18, 2026.