Midlife and menopause can bring real physical and psychological changes that affect libido, arousal, and pleasure—but that doesn’t mean desire or a satisfying sex life are destined to disappear. This week we sat down with registered nurse and Permission for Pleasure author Cindy Scharkey to unpack what actually happens to desire, arousal, pleasure, and our bodies as we move through perimenopause, menopause, and beyond. We explore why so many women stop wanting sex in midlife, how hormones, stress, body image, and long-term relationships play a role, and why waiting to be “in the mood” often doesn’t work anymore (and more importantly, what does).

Cindy Scharkey, RN, BSN, PHN, is a healthcare professional with almost 4 decades of experience. Throughout her career as a Certified Childbirth Educator, OB/GYN nurse and speaker, she has been consistently exposed to the taboos and silence surrounding women’s sexuality. Cindy is passionate about providing women with the content and self-confidence they need to find freedom on their own sexual wellness journey. As the author of Permission for Pleasure: Tending Your Sexual Garden, and Host of the Permission for Pleasure podcast, Cindy offers education and conversations about expressing, experiencing and enjoying your sexuality. You can learn more about her, her book, and her work at www.cindyscharkey.com

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This week we welcome back our resident reproductive endocrinologist and menopause specialist, Dr. Carla DiGirolamo, for another candid conversation. We pull back the curtain on Carla’s own menopause experience—how she navigates her symptoms, what she’s learned, and what she practices herself. We also dig into the hard conversations so many of us are having as we navigate this ever-evolving space, and how years of working closely with active midlife women have shaped her thinking on hormone therapy, GLP-1 medications, testosterone, hormone testing, and what actually moves the needle for athletic women in the transition.

Carla DiGirolamo, MD, PhD, is a Double Board Certified Reproductive Endocrinologist and Obstetrician/Gynecologist specializing in women’s performance and menopausal medicine. She is also a Crossfit Level 1 trainer, Certified Nutrition Coach, and member of CrossFit Medical Society. She is a MedFit Care provider and provides weekly workouts and medical updates at her Substack Athletic Aging. She is an Endocrine Consultant for Wild Health and Women’s Health Director at Eternal Health. Most recently, she has launched her own private practice specializing in helping active and high-performing women reach their performance potential from puberty through menopause. Dr. DiGirolamo is now seeing patients for virtual consultations for menopausal care and performance optimization. Visit her website www.drcarlad.com to learn more about her services and schedule an appointment.

Resources

Athletic Aging with Dr. Carla DiGirolamo on Substack

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In this special episode, your Feisty Women's Performance podcast host Dr. Erin Ayala brings together a group of experts on mental health to talk about the science and psychology of stress and collective trauma.

Along with being a sports psychologist & therapist in her own right, Erin also lives in Minneapolis, Minnesota — which has been at the center of the news over the last month since it became the target of the largest immigration enforcement action to date in the U.S. Thousands of federal agents have patrolled the streets and detained residents, and, over this past weekend, shot and killed a second bystander — leading to hundreds of thousands of people protesting in Minneapolis and around the country.

In this tense environment, how do we show up as athletes, as members of our community, as our best and healthiest selves?

Join Dr. Tess Kilwein, Dr. Quincy Guinadi, and Christine Bright as they discuss how these experiences shape mental health and performance, and how you can respond to stress and trauma — whether you're going through it right now with the news or you're dealing with your challenges.

Key Takeaways:

• What is collective trauma? Learn how collective trauma impacts communities and individuals, and why this understanding is crucial for athletes and coaches.

• Recognize that intentional rest in times of stress can be essential for long-term sustainability.

• Know that movement and sport can be powerful tools in community healing.

• Get tips on how to navigate the complexities of wanting to help without feeling performative or overwhelmed, and how to effectively engage in difficult conversations without shame or guilt.

Don't be perfect. Be brave.

Guest Introductions:

• Dr. Tess Kilwein: A board-certified clinical, health, and sport psychologist with expertise in mental performance and athlete wellness.

• Dr. Quincy Guinadi: A postdoctoral resident specializing in identity, mental health, and the experiences of marginalized communities.

• Christine Bright: Lead consultant at the Center for Healing and Justice through Sport, focusing on trauma-informed coaching and community support.

Resources Mentioned:

• Center for Healing and Justice through Sport

• Nothing Heals like Sport Playbook

• "What Happened to You" by Dr. Bruce Perry and Oprah

• Beyond Ally by Dr. Maysa Akbar

• Find ways to help at standwithminnesota.com

Exercise is supposed to be healthy—but when does dedication cross into compulsion? In this episode, we sat down with sports psychologist and new host of the Feisty Women’s Performance Podcast, Dr. Erin Ayala to explore the murky, often misunderstood concept of exercise addiction. We unpack why it’s not an official diagnosis, how it overlaps with perfectionism, anxiety, body image, and control, and why endurance athletes—especially midlife women—can be uniquely vulnerable. We also dive into identity, boundaries, training culture, and how to tell whether exercise is supporting your life—or quietly running it.

Erin Ayala, PhD, LP, CMPC is a Licensed Psychologist and Certified Mental Performance Consultant (CMPC) offering virtual mental health therapy for athletes aged 14 and above. She provides one-on-one performance coaching, CMPC mentorship, clinical supervision, and group workshops for teams and sport organizations. She supports athletes in injury recovery, managing performance anxiety, depression, pre-competition stress, confidence, and self-criticism. Located in Minnesota, she is licensed to work with athletes in 40 states. You can learn more about Dr. Ayala and her work at www.skadisportpsychology.com.

Follow the newly launched The Feisty Women’s Performance Podcast here.

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This week we welcome back protein and fat-loss researcher Dr. Bill Campbell to unpack early findings from what may be the largest menopause fitness survey to date, designed to finally study women who actively train. We dive into what thousands of fit midlife women report about calorie and protein intake, hormone therapy use, and the widely felt—but poorly studied—experience of weight-loss resistance during peri- and postmenopause. The conversation also explores why hormone therapy use appears far higher in fitness-engaged women than in national estimates, how muscle quality and power may decline even before we notice muscle loss, and why high-intensity interval work appears especially promising for reducing visceral fat.

Bill Campbell, PhD is a Professor of Exercise Science and Director of the Performance and Physique Enhancement Laboratory at the University of South Florida. He is also a Certified Strength & Conditioning Specialist from the National Strength & Conditioning Association and former president of the International Society of Sports Nutrition (where he is also 1 of 35 individuals to be recognized as a ‘Fellow’ of the organization—an honor reserved for those individuals who have outstanding contributions to the field of sports nutrition). He has published over 200 scientific papers and abstracts, three textbooks, and 20 book chapters in areas related to physique enhancement, sports nutrition, resistance training, and dietary supplementation. You can learn more about him and his work at www.billcampbellphd.com

Resources

Investigating weight loss resistance across the menopausal transition: a preliminary quantitative survey of resistance-trained women here

Insufficient sleep undermines dietary efforts to reduce adiposity here

Why the Calories In/Calories Out Equation Can Fail Women with Jody Dushay, MD here

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When the first signs of menopause hit, the temptation can be strong to throw everything we have at it–all the supplements, all the hacks, all the hormones. But not everything is right for everyone, and doing too much at once can backfire, leaving you feeling worse, lighter in the wallet, or both. This week, we take a more measured, targeted approach with pharmacist, nutritionist, and certified menopause lifestyle practitioner Sarah Gray, author of It’s Not You, It’s Perimenopause. A marathon runner herself, Sarah explains how incremental, sustainable changes—matched to your body, goals, and real life—can help you feel better now while protecting your health for the long run.

Sarah Gray is one of Australia’s few dual-qualified health professionals in pharmacy and nutrition, and a Certified Menopause Lifestyle Practitioner. She takes a practical, science-based, whole-person approach to helping women thrive through perimenopause and beyond—blending nutrition, movement, mindset, and the smart use of supplements and medications. A trusted Australian health expert and social media thought leader, Sarah has appeared on Channel 10’s My Market Kitchen for four seasons and regularly contributes across radio, print, online media, and podcasts. In her debut book, The Australian Perimenopause Action Plan, she draws on 25+ years across pharmacy, private practice, public health, and the supplements industry to give women a clear, actionable roadmap for midlife. You can learn more about her and her work at thenutritionpharmacist.com

Resources

Book: It's Not You, It’s Perimenopause

Collagen studies:

Specific collagen peptides benefit the biosynthesis of matrix molecules of tendons and ligaments

Collagen supplementation augments changes in patellar tendon properties in female soccer players

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“Carbs are evil.” As we usher in 2026, and as endurance athletes around the globe are stuffing down as many carbohydrates per hour as humanly possible to supercharge their performance, this week’s guest, sports dietitian Kristen Arnold, still manages misconceptions, especially from her midlife clients, that carbohydrates are something to be cut from the diet. Nothing could be further from the truth. This week we kick off the new year with a show all about the life and performance-boosting benefits of carbs. We cover carbohydrate timing, processed carbs versus unprocessed carbs, carbohydrate’s impact on blood sugar, brain function, mood, inflammation, general health, and much, much more.

Kristen Arnold, MS, RDN, CSSD is a board-certified sports dietitian, cycling coach, and retired professional athlete with over 10 years of experience in sports dietetics. She has worked with a wide range of professional sports teams, athlete-centered healthcare initiatives, and Olympic organizations. Kristen owns a thriving private practice dedicated to empowering active women across the lifespan through evidence-based sports nutrition coaching and education. She is a first-author, peer-reviewed researcher on improving postmenopausal women’s health through targeted nutrition strategies and counseling, and she regularly speaks on podcasts and contributes to publications on sports nutrition topics. Learn more at sportsnutritionforwomen.com.

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This episode originally dropped on: March 19, 2025

Many of us have spent a lifetime trying to shrink ourselves. We grew up being told you could never be too thin. As athletes, especially in endurance sports, smaller, lighter, faster was the ethos of the day. That is changing as we see athletes, especially women, discover that being fueled and strong yields even better performance–and longevity. This week’s guest, trainer and nutrition coach Steph Gaudreau embodies that journey through both her personal and professional life. She shares how, for 40+ women especially, growing muscles is the key to better energy and performance in sport and life, and how strength training is the gateway to midlife self-acceptance.

Steph Gaudreau, CISSN, CPT, helps athletic women over 40 fuel themselves better, get stronger, increase their energy, and perform better in the gym. She’s a sports nutritionist and strength coach with multiple certifications including USA Weightlifting coach, Menopause Health & Fitness Specialist, Girls Gone Strong Women’s Coaching Specialist, and Intuitive Eating Counselor. She shares her advice on building strength, proper fueling, and much more as the host of the Fuel Your Strength Podcast. You can learn more about Steph and her work at www.stephgaudreau.com

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