A Deep Dive into Midlife Health, Perimenopause, and Hormone Therapy with Dr. Alicia Robbins

Meet Dr. Alicia Robbins, a specialist in women’s health and founder of The ELM in Connecticut. Dr. Robbins explains her journey into creating a practice focused on the needs of women over 40, a pivotal age for proactive health management. She shares insights into the nuances of perimenopause, hormone therapy, and the often-overlooked health shifts women experience in midlife. Through their discussion, Dr. Robbins and Amy explore how women can stay informed, empowered, and proactive about their well-being during these transformative years.

Amy Cohen Epstein:
Welcome. I’m so excited to be here today with Dr. Alicia Robbins. Alicia and I have talked before, but the podcast didn’t upload, so here we are again. Doing it in person is so much better than virtually—just reading cues, seeing when we’re talking and listening. So I’m really excited to get this opportunity. Tell us a little more about you and The ELM, what you’ve built in Connecticut, and where your passion for women’s health started.

Dr. Alicia Robbins:
Yes, so like many OB-GYNs, I was doing a lot of obstetrics, delivering babies, and seeing a lot of patients in a large group practice. I started noticing a recurring pattern with women in their late thirties and early forties who were done having kids. They’d come to their annuals and say, “I just don’t feel great. I’m fatigued, not sleeping well, having night sweats, or my period is all over the place.” And I didn’t even have all the answers at that moment. But I thought, I really want to create a practice focused on the woman who’s not actively pregnant. We focus so much on reproductive years and fertility, which is crucial, of course, but we sort of leave women hanging afterward—just “come back for your pap in a year,” and that’s it.

And we don’t give much guidance on preventing disease. Forties and fifties are such an important time because you can still have a big influence on long-term health. Many conditions women are vulnerable to—like cardiovascular disease, osteoporosis, and dementia—are influenced by lifestyle. So I thought, why not create the type of practice I’d want to go to, where we have a little more time to address lifestyle?

Amy:
Which is such an intense time in our lives. I just turned 48, and I feel like the forties have been my best decade so far. I’m actually looking forward to my fifties. I think our generation is seeing forties differently than my mom’s generation did. It’s like we’ve found our voice and are finally following our passions. But at the same time, our bodies are going through this unbelievable change that’s so slow—like molasses dripping from the ceiling. Perimenopause is this insane, lengthy stage with all sorts of bumps, twists, and turns. I know I feel strong and confident, but also, what in the world is happening in my body right now? When does it stop? And what does it mean when it stops?

Dr. Robbins:
Exactly. And so few doctors have real answers for what’s happening. They might suggest taking the pill again, but that isn’t always the best solution. Many doctors are focused on pregnancy and don’t have great solutions for women in their forties other than birth control, which isn’t ideal for everyone. That’s why I wanted to specialize in taking care of women over 40.

Amy:
How have you found discussions or more nuanced conversations around this?

Dr. Robbins:
First, I connected with an amazing group of women specializing in this. Dr. Ryn Men, who you should have on the podcast, is wonderful. I started going to conferences and reading more, especially scientific papers. It was eye-opening to learn how crucial progesterone, estrogen, and testosterone are not just for periods but also for the brain, sleep, and mood. I had good menopause training in residency, which many programs don’t have, but I didn’t fully understand these hormones’ roles in brain health.

Once I grasped that, it made sense why women would say, “I’m not sleeping well.” It’s easy to dismiss those symptoms as stress from kids or life, especially when hormone levels appear normal on paper. But you can supplement with hormone therapy during perimenopause to help with quality of life and symptoms.

Amy:
And that’s so important because sleep and mood are totally intertwined.

Dr. Robbins:
Yes, absolutely. When women come to me with symptoms—even things like weight changes—it’s often tied to sleep. If they’re not sleeping well, it’s hard to manage weight. I work to improve sleep first, which takes time but can show improvement within a few weeks if hormonal shifts are the cause. Knowing there’s a biological process can be reassuring—it’s not just “in your head.”

Amy:
There’s also this skepticism, like, “If my body’s not producing it, should I take it?” And there’s still some stigma around aging and recognizing that your body is changing.

Dr. Robbins:
Yes, and some patients wonder if they’re “too young” for hormone therapy. But perimenopause doesn’t mean menopause is imminent. This process starts years before, with symptoms that are often subtle and slow. Unfortunately, typical lab tests don’t always show these changes, and general practitioners may not specialize in this, so they recommend things like meditation or exercise.

...

I’m working with a company called Ellie Health that’s developed tech for at-home saliva testing for cortisol and, hopefully, sex hormones soon. This data could help us better tailor hormone therapy. While it’s controversial, I believe collecting daily hormonal data could reveal patterns that help us understand and support women’s health better.

Amy:
So who’s driving these changes—the doctors or the patients?

Dr. Robbins:
It’s the patients. It’s conversations like these, women asking questions and pushing for better understanding. Medicine moves slowly, but these discussions and women advocating for themselves are creating change. The more we talk about it, the more we normalize it. I’m very open about my experiences because I want women to see aging as a gift, not something to shy away from.

Amy:
How’s the reception been in your community to The ELM?

Dr. Robbins:
It’s been great; I feel so lucky. We currently have a waitlist, but we’re expanding with more providers. The good thing about perimenopause care is that much of it can be done over telehealth. Platforms like Midi Health and Alloy Health provide reliable resources for women, and I’d like to reach the younger demographic in their early-to-mid-forties to help normalize these discussions.

Amy:
And you’re not delivering babies anymore?

Dr. Robbins:
No, and honestly, obstetrics and gynecology should be separate. The focus required for each is just so different, and doctors seeing 30–35 patients daily and dealing with high-stress deliveries don’t always have the bandwidth for specialized perimenopause care.

...

Amy:
The world expects a lot from women in their forties—to be on top of everything. But it’s hard when no one addresses what’s happening to your body.

Dr. Robbins:
Right. And we focus so much on looking good, but we need to feel good too. There’s no point in looking great on the outside if you don’t feel good inside. I think it’s about meeting women where they’re at, starting with the basics of preventative care, then moving into lifestyle and hormone therapy. After that, we can explore more advanced treatments.

Amy:
Thank you so much, Dr. Robbins. I feel like we covered so much, and there are real answers and important discussions to be had.

Dr. Robbins:
Absolutely. I don’t want this to be a conversation about how awful perimenopause and menopause sound. Menopause is inevitable, but suffering isn’t. We have effective treatments and increasing resources for women, and that’s empowering. This is a medical, scientific thing—it’s not in your head—and there are solutions, both lifestyle and hormonal.

Amy:
Yes, thank you for sharing your expertise. This was fantastic.

Dr. Robbins:
Thank you, Amy! It was a pleasure to talk with you.

Editor’s Note: This interview has been edited for length and clarity