Tips for My Younger Sisters: Sex, Weight, Hormones, Fertility

I’ve been blessed to grow up with two younger sisters and today I had the idea of posting some of my best tips about surfing the hormonal flux of premenopause and perimenopause for them, with the hope that it will be helpful to others as well.

One sister is 31 and lives in San Francisco. The other just turned 36 and lives in Portland.

Here you go, Lovies.

1.     Get tested. If you feel fabulous (I know the 31-year-old does!), figure out the hormonal metrics of your fabulousness: TSH, free T3, DHEAS, free and total testosterone, day 14 estradiol, day 21 progesterone. This will provide your baseline before you hit some of the rockier, erratic hormonal peaks and valleys that lie ahead. If you’re wondering about egg quality and fertility, consider a day 3 FSH (follicle stimulating hormone) and estradiol. Also, let’s throw in an anti-mullerian hormone, assuming the results about your fertility will be helpful and not create tremendous anxiety. We’re after empowerment, not more fret.

2.     Clarify your NNT. This is non-negotiable time. My NNT: meditation every morning for 30 minutes, exercise 4 days per week, write daily. Exercise in particular is a crucial habit to have. It makes all hormonal flux easier to manage and keeps your metabolism from becoming increasingly unforgiving.

3.     Be at goal weight by age 40. While there are many things you can do to prevent wrinkles, the truth is that when you lose weight after 40, your skin is more saggy. I want your outer beauty to reflect most accurately your inner beauty. I’m not advocating an unsustainable weight, but a healthy weight that feels right. Let’s do Botox prevention, shall we?

4.     Tame the beast. This is related to the previous tip: we all have weirdnesses around overeating and overdrinking. Nicole Daedone, author of Slow Sex, calls it the mantra of the modern woman: we eat too much, we drink too much, we give too much, yet we’re still hungry. More on that this Thursday! But get the bingeing under control. Seek help, perhaps from Overeaters Anonymous, particularly their H.O.W. program, or Food Addicts or Moderation Management or a skilled therapist. But please stop eating and drinking to soothe. Your one wild and precious life needs white space for authentic unfolding.

5.     Regular orgasms. I mentioned this to you when you were a teenager and you froze. You were fascinated and horrified. Still holds true today. Don’t fall into the mom-trap of putting great sex on the back burner, another item on the to-do list. Your sexual energy will fuel the rest of your vitality and propel you toward your greater purpose.

I feel so much love toward my sisters. I have a warm place in my heart for my patients who are their ages, and I often say to them, “If you were my younger sister, I would recommend ______.” Hope it’s helpful for you! If you have any younger sister/older sister questions for me, pop them in the comments section!


  1. Melissa Cassera on August 22, 2011 at 3:33 pm

    What an amazing piece and I especially love tip #3. That makes so much sense but I’ve never heard anyone say this before. Thanks Dr. Sara for your wisdom + warmth.

    • Sara Gottfried MD on August 27, 2011 at 12:22 am

      Thanks for hanging out here with us, Melissa! Love your work! — SG

  2. Cathy Jo Foust on January 13, 2012 at 9:00 pm

    Wish I had an older sister! I have so many questions…..I don’t even know where to start.

  3. Kim on March 12, 2012 at 7:09 pm

    #3 inspired me to write down (and print out) my own NNT. This is the first step to changing my lifestyle, making me a healthier, happier, and more balanced person. Thank you.