The first time I met Dr. Jila Senemar, I had no idea who I was about to have dinner with. My lawyer had invited me to an intimate dinner at a woman's home in South Miami, and I came in totally blind to who I would be dining amongst. Around the table sat seven women, most a decade ahead of me in age and experience, though likely with a younger biological age, considering their devotion to the Tracy Anderson Method. Every one of them so incredibly accomplished, personally and professionally. What transpired was a night not to be forgotten. I left feeling inspired and enthusiastic about what growing older means in the fullest sense.

I have been thinking about that night ever since, because I'm 36, which means I'm sitting in the in-between. I'm not done having babies, and I'm not anywhere near menopause. But I can feel that something is shifting, and frankly, nobody warned me about it. My friends in their late 20s come to me with questions about their bodies. My friends in their 40s tell me what nobody told them. And the women in their 50s all say some version of the same thing: I wish someone had explained this to me sooner.

So for our latest practitioner POV, I went back to one of the women from that dinner. Dr. Jila Senemar is a board certified OB-GYN, certified menopause specialist, and founder of JilaMD in Miami, and she sat down with me  for an all encompassing conversation on perimenopause, postpartum, and everything the standard fifteen minute appointment never gets to. What follows are the highlights. The full episode is worth every single minute, and you can watch it 

First, a map: the four seasons of a woman's hormonal life

Dr. Jila walks through it quickly, and it is clarifying to see it all laid out. Puberty starts anywhere from nine to twelve. Your 20s and 30s are the reproductive years, when cycles are regular and hormones are humming. Her analogy: your Wi-Fi is on par. From the mid 30s into the 40s, some women start noticing shifts. Early perimenopause brings cycle irregularities, though reproduction is still very much on the table. Late perimenopause is when the hot flashes, sleep disturbances, anxiety, mood changes, and libido shifts tend to show up. And menopause itself is technically one single day: the day you have gone twelve full months without a period. Every day after that is postmenopause, for the rest of your life.

If you are somewhere in the first half of that map and thinking this conversation is not for you yet, that is exactly the mindset Dr. Jila wants to change.

Your 20s and 30s are quietly writing the script

One of my favorite parts of this conversation was her answer to what a 25 year old should be doing right now to shape how she feels at 45. It comes back to what she calls the five pillars: optimized sleep, real nutrition from actual food, movement, stress management, and community. Not a peptide stack. Not a $400 supplement routine. The boring stuff, dialed in consistently.

The pillar she pushes hardest for women our age is muscle. Not cardio, cardio, cardio, but lifting weights two to three times a week with progressive overload, meaning once a weight gets comfortable, you go heavier. Muscle is bone preservation. Muscle improves insulin sensitivity. Muscle is what lets you sit on the floor with your grandkids at 70. And building it requires real protein intake, from any source, plant based included. Her numbers surprised me, and I will let her walk you through them in the full episode.

She also makes the case that ovarian reserve testing, a simple blood panel any lab can run, should be far more routine at younger ages than it currently is. Because there are lifestyle changes a 25 year old can make today that actually improve those biomarkers over time.

The early signs are not what you think

Real early signs are subtler and much easier to dismiss. Sleep disturbances that become a pattern instead of a one-off. A new kind of anxiety you never had before. Mood shifts your friends notice before you do. And for women with ADHD or a history of postpartum depression, symptoms that were well managed suddenly getting louder on the exact same medication.

Here is the part that stopped me: your cycles can be perfectly regular and your labs can be perfectly normal while all of this is happening. She also flags two impostors worth ruling out, thyroid dysfunction and iron deficiency, because they can mimic the same picture. If disrupted sleep is your loudest symptom right now, our deep dive on night sweats pairs well with this section of the episode.

When postpartum runs straight into perimenopause

This is the crossroads so many of us are standing at, because we are having babies later. Dr. Jila shared her own story of delivering her first son as a chief resident and being told that taking a single day beyond six weeks would cost her after graduation. Her question about that six week timeline has stayed with me: who set it? Nobody. But nobody questioned it either.

Postpartum is the lowest estrogen state a woman experiences, a steep drop from the highest state of pregnancy. For women who are also approaching perimenopause, the two can blur together. That low estrogen environment is behind symptoms most new moms are never told to expect, from vaginal dryness and irritation to brand new UTIs, and for women who breastfeed long term without a period, even bone density deserves attention.

It is also exactly why we talk about postpartum the way we do at Mamala. The research on postpartum depletion, including the work of Dr. Oscar Serrallach that shaped how we built Support Snacks™, treats postpartum as a nutrient critical stage that can stretch on for years, not something that wraps at the six week visit. Dr. Jila's nutrition guidance for this window lines up: protein first, fresh produce, and attention to calcium, magnesium, and vitamin D3 with K2, ideally checked and dosed with someone who actually knows your levels rather than guessed at.

"Your labs are normal" is not the end of the conversation 

I asked her to speak directly to the woman who has sat in an office, said I am falling apart, and been told her labs are fine so she must be too. Her answer is the reason this episode exists. She told me it happens tens of thousands of times a day in this country, and that what every one of those women should hear instead is this: I hear you. You are not wrong. And you are not broken.

Two myths she dismantles along the way. You do not have to wait for menopause to consider hormone therapy; it can be started in perimenopause if symptoms are affecting your quality of life. And in perimenopause she does not wait on lab work to act, because hormones fluctuate so much that a single normal result means very little. She treats symptoms, not printouts.

The fear that set women back a generation

If you have ever heard a woman whisper, "but will it give me breast cancer...," this section is required viewing. Dr. Jila unpacks the 2002 Women's Health Initiative press release, the study behind the fear: older participants, synthetic hormones that are no longer the standard, and a relative risk presented to the public as if it were an absolute one. Prescriptions collapsed almost overnight, and an entire generation of women went without options.

The tide is finally turning. In late 2025, the FDA removed the black box warning from hormone therapy packaging. But as she points out, the correction never gets the press conference the fear did, so the catching up falls to conversations like this one.

Version 2.0

I asked her whether perimenopause might be less of a decline and more of a recalibration, and her answer reframed the whole thing for me. She does not want women white knuckling their way through to the other side. She wants them to arrive at a version of themselves that is better than the one they keep trying to get back to. One of her patients described starting treatment as going from seeing in black and white to seeing in color.

And when I asked her to finish the sentence, a woman in her 40s is finally allowed to, she did not hesitate: take care of herself, make herself the priority, and make the next 40 years her best.

Watch the full conversation

We covered so much more than fits here. In the full episode, Dr. Jila gets into the one supplement she says is genuinely worth your money, the lie women tell themselves most often, her refreshingly honest take on peptides in your 30s, perimenopause rage and the biology behind it, and what is actually happening to the brain when the fog rolls in.

Watch the full episode with Dr. Jila Senemar on YouTube  and if this conversation hits home, send it to the friend who keeps being told her labs are normal.