Longevity as a strategic asset to women

Women's medicine is changing - away from blanket recommendations, toward a precise, life-phase-oriented health strategy. One of the voices shaping this shift is Dr. Andrea Gartenbach. In this interview, she talks about what women actually need to age well, which risks are often underestimated - and which interventions work.

Women's medicine is changing : away from blanket recommendations, toward a precise, life-phase-oriented health strategy. One of the voices shaping this shift is Dr. Andrea Gartenbach. She combines clinical experience with a modern understanding of prevention, hormonal medicine, and longevity research. In her keynote at this year's Fondsfrauen Summit, she showed clearly how female biology, social role expectations, and medical care are interconnected. It resonated strongly, so we went deeper in this interview. The conversation covers what women actually need today to age well, which risks are often underestimated , and which interventions work.

Women live longer than men - but not necessarily healthier. Why?

A key reason is that women's health was not thought of systemically for a long time. Classical medicine often treats symptoms in isolation, while the underlying biological systems - metabolism, hormones, and inflammation - are closely connected. This missing systems perspective means risks are often only recognized once they are already clinically apparent.

Healthy aging depends largely on the stability of exactly these systems. Menopause is particularly significant as a central biological turning point. As estrogen declines, an entire system changes: blood vessels lose their protective function, metabolism becomes more vulnerable, inflammation increases, and the brain becomes more sensitive to stress.

The risk profile shifts significantly - cardiovascular disease becomes the leading cause of death, while metabolic and cancer risks also rise. Importantly, these processes do not start at menopause. They often develop 10–20 years beforehand.

Which tests really matter from age 40?

If we think about health strategically, we need to focus on the biggest risks. For women, those are primarily cardiovascular disease and cancer.

The first step is cardiovascular risk assessment. Standard lipid values are not enough. Key markers include apolipoprotein B and lipoprotein(a), alongside 24-hour blood pressure monitoring and biomarkers measuring inflammation and lipid oxidation.

Cancer prevention is equally central - beyond standard screening, this means understanding different risk factors, particularly inflammation, hormonal balance, and metabolic stability.

Metabolism is not a separate topic - it is one of the central drivers of both cardiovascular disease and cancer risk. Early markers like fasting insulin, the HOMA index, or a continuous glucose monitor (CGM) help identify dysregulation in time.

Micronutrients as cofactors and precursors also play a key role - but only when interpreted functionally. What matters is not just the value, but the biological availability and use in the body.

How does menopause change the body?

Menopause is not an isolated hormone event - it is a systemic shift. As estrogen and progesterone decline, central biological processes change simultaneously. Metabolism becomes less flexible, insulin sensitivity drops, and visceral fat increases more frequently. At the same time, the loss of muscle mass accelerates, which directly affects metabolic health and performance. Cardiovascular risk also rises, as estrogen's vessel-protective effect disappears while inflammatory processes increase.

In parallel, the regulation of the nervous system changes: melatonin drops, sleep becomes less regenerative, and cortisol rhythms shift. Many women are too activated in the evenings and less rested in the mornings.

A central and often underestimated link is the close connection between stress and ovarian function. Chronic stress can act directly on hormonal regulation via the autonomic nervous system and accelerate ovarian aging. Menopause is therefore not a single symptom, but a clear system shift that affects metabolism, the brain, and long-term health risks simultaneously.

What role does hormone replacement therapy play?

The critical perception of hormone replacement therapy is largely based on a misinterpretation of the Women's Health Initiative study from the early 2000s. That study mostly examined women who were already significantly older and often many years past menopause. It also used hormone preparations and dosages that are no longer used today.

The results were applied broadly to all women, and caused significant confusion for years. Many women avoided therapy out of fear, even though they might have benefited.

Current evidence is much more nuanced. What matters is the right timing, the individual risk profile, and the choice of hormone form, application, and dosage. When therapy is started early in the menopausal transition and individually adjusted, it can play a central role for many women - particularly regarding sleep quality, bone health, quality of life, and in certain cases cardiometabolic parameters.

Today we also have far better options for individualization. Modern approaches consider not only clinical symptoms and lab values, but increasingly genetic factors, metabolic profiles, and individual risk constellations. This allows very precise, finely tuned therapy aligned with each patient's needs, symptoms, and goals.

Hormone replacement therapy is therefore not a standardized concept, but a personalized medical intervention that is individually decided and continuously adjusted.

Sleep and blood sugar - what matters?

Sleep is an active biological process. A key mechanism is blood sugar regulation. Insufficient energy intake during the day can lead to hypoglycemia at night - the body responds with a cortisol spike and waking up.

At the same time, late, heavily carbohydrate-rich meals can trigger blood sugar fluctuations. Stable energy intake throughout the day - especially in the first half - often improves sleep quality.

Which warning signs should women take seriously?

First: we are always right - when symptoms appear, the cause needs to be investigated. A clear explanation is rarely absent. No one should accept answers like "that's just how it is with age," "get used to it," or "that can't be right."

Chronic fatigue, sleep disorders, weight gain despite a stable lifestyle, and changes in the menstrual cycle are frequently misinterpreted or ignored. But they are early markers of systemic dysregulation.

What role do relationships play?

Social relationships are among the strongest - and most underestimated - influences on health and longevity. Large epidemiological studies show that the quality of social bonds can have a similar impact on mortality as classic risk factors like smoking or physical inactivity.

The underlying mechanism is primarily neurobiological. Our nervous system is built to continuously assess safety or threat - not only through physical, but also through social signals. Belonging, reliability, and emotional stability have a regulating effect on the autonomic nervous system and promote a parasympathetic state that is essential for regeneration, sleep, and repair processes.

Conversely, chronically stressful relationships act like a permanent stressor. The nervous system does not distinguish between professional and emotional stress - both activate similar physiological responses. This leads to increased activity of the stress axes, particularly the hypothalamic-pituitary-adrenal axis, with consecutively elevated cortisol levels, altered immune function, and long-term increases in inflammation. This chronic activation directly affects key health parameters: sleep quality, metabolism, hormonal regulation, and even cardiovascular risk. At the same time, social isolation or emotional dysregulation is associated with higher morbidity and mortality.

On the other side, stable and supportive relationships act as a "biological buffer." They build resilience, improve stress processing, and support the body's ability to return to a regulated state after stress. This effect is measurable - for example through heart rate variability or cortisol profiles.

An important point is the quality, not the quantity, of relationships. It is not about a large network, but about reliable, regulating connections. This is what can be called "relationship hygiene" - consciously shaping an environment that calms the nervous system rather than chronically activating it. Health is therefore not only a question of biochemistry or lifestyle, but also of connection. Or put another way: social safety is a biological signal, and a central part of longevity.

What are the three most important measures?

It is less about defining three individual measures, and more about how we start thinking about health strategically at all.

The first step is understanding your own risks. Most relevant diseases develop over years or decades - they are measurable before symptoms appear. This understanding is the foundation for every decision. It creates motivation, because you are no longer vaguely trying to "live healthy," but concretely know what you can influence.

The second step is deriving realistic, actionable measures from that. Many people make the mistake of trying to change everything at once, and fail for exactly that reason. Lasting change happens in small, consistent steps. It is not about perfection, but about direction and continuity.

When broken down to lifestyle, three central levers keep coming up: the quality of social relationships, which act directly on the nervous system and therefore on stress regulation, sleep, and long-term health. Resilience - understood both psychologically and biologically. It shows in the ability to handle stress, but also in the quality of sleep, recovery, and inner stability. And movement, especially muscle building and cardiorespiratory fitness, measured by VO₂max. These two factors are among the strongest predictors of longevity.

Longevity is therefore not a short-term optimization project. It is a process of understanding risks, prioritizing them, and influencing them step by step, over years.

Thank you for this interesting interview, Andrea!

Recording: Digital Lunch Talk

On April 28, 2026, we had our digital lunch talk with Dr. Andrea Gartenbach. As a member, you can watch the recording anytime and catch up on the key takeaways at your own pace:

 

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