HRT Benefits Revealed for Menopause Using Integrative Medicine

Discover the benefits of HRT and integrative medicine for a balanced approach to managing menopause symptoms effectively.

Abstract

Menopause is a natural biological transition, but the journey is often fraught with debilitating symptoms like hot flashes, weight gain, brain fog, and mood swings. Many women believe that simply replacing hormones through Hormone Replacement Therapy (HRT) will resolve these issues. However, this is a common and significant misconception. HRT addresses the hormonal decline but often fails to correct the deeper, underlying biological dysfunctions that are the true root of menopausal suffering. This post, written from my clinical perspective as Dr. Alex Jimenez, explores the three critical biological problems that HRT alone cannot fix: persistent systemic inflammation, mitochondrial dysfunction, and localized insulin resistance. We will delve into the science behind why you can have “perfect” hormone levels on paper yet still feel unwell. Drawing upon the latest research from leading institutions and my experience in functional and integrative medicine, I will explain how these cellular-level issues create a cascade of symptoms that impact everything from your metabolism and mood to your cognitive function.

Furthermore, this educational guide will outline a comprehensive, evidence-based approach that goes beyond hormones. We will discuss the vital role of foundational nutrients, the science of NAD+ depletion in accelerating menopausal symptoms, and practical strategies for managing your treatment protocol. At our clinic, Injury Medical Clinic PA, we champion a multidisciplinary model. I work closely with our Medical Director, Dr. Maria Guadalupe Cardenas, a highly experienced, board-certified Internist. This partnership allows us to seamlessly integrate specialized chiropractic adjustments, functional medicine, nutritional science, and traditional medical oversight. This integrated framework ensures we are not just masking symptoms with hormones but are rebuilding your cellular health from the ground up, empowering you to navigate menopause and reclaim your vitality.

As a practitioner with a diverse background in chiropractic, nursing, and functional medicine, I have dedicated my career to understanding the intricate web of human physiology. My clinical observations, supported by the extensive work of my colleagues and leading researchers, have repeatedly shown me that the conventional approach to menopause is fundamentally incomplete. For years, I’ve seen women come to my office frustrated, exhausted, and feeling dismissed. They’ve been told their symptoms are “just part of aging” or that HRT is the one-size-fits-all solution. But they know, intuitively and physically, that something deeper is wrong. They are right.

The prevailing narrative is that menopause is a simple hormone deficiency. Falling estrogen and progesterone levels are certainly the trigger, but they are not the whole story. The real issue is that these hormonal shifts unmask or accelerate pre-existing or developing biological vulnerabilities at the cellular level. When you just run HRT, you’re handling the hormones, but you’re not addressing the foundational biology. This is precisely why so many of you can be on HRT and still feel utterly terrible.

At Injury Medical Clinic PA, we practice true integration. This isn’t just a buzzword for us; it’s the core of our patient care philosophy. Our Medical Director, Dr. Maria Guadalupe Cardenas, MD, brings over 40 years of invaluable experience as a board-certified Internist. Her internal medicine expertise provides the medical oversight and diagnostic framework that anchors our practice. Her NPI (#1164426749) and Texas MD License (#J2933) represent a deep commitment to conventional medical excellence. As a Doctor of Chiropractic (DC) and board-certified Family Nurse Practitioner (FNP-BC), along with advanced certifications in functional medicine (CFMP, IFMCP), I build on that foundation.

Together, Dr. Cardenas and I create a comprehensive care plan that merges the best of multiple disciplines. A patient might see me for chiropractic adjustments to address musculoskeletal pain and improve nervous system function—both of which are common in menopause—while Dr. Cardenas manages their overall medical health and prescriptions, including HRT if appropriate. At the same time, my functional medicine lens lets us investigate the root causes of their symptoms through advanced lab testing and targeted nutritional and lifestyle interventions. This multidisciplinary setup is the future of healthcare, particularly for complex, systemic conditions like the menopausal transition. We don’t just treat a symptom or a lab value; we treat the whole person, understanding that the body is an interconnected system.

Let’s break down the three main biological problems that HRT fails to solve and explore why an integrative approach is not just beneficial, but essential.

The First Biological Problem: HRT Doesn’t Resolve Systemic Inflammation and Oxidative Stress

Understanding Inflammation’s Role in Menopause

One of the most significant oversights in conventional menopausal treatment is the failure to address chronic systemic inflammation and its close cousin, oxidative stress. Think of inflammation as your body’s internal fire alarm system. Acute inflammation is a healthy and necessary response to injury or infection. However, chronic, low-grade inflammation is like an alarm that never shuts off, constantly signaling danger and causing collateral damage to healthy tissues.

During the menopausal transition, several factors conspire to turn up the dial on inflammation:

• Estrogen’s Anti-Inflammatory Role: Estrogen is not just a reproductive hormone; it’s a powerful anti-inflammatory agent. It helps modulate the immune response and keep inflammatory processes in check. As estrogen levels decline, this natural brake on inflammation is released, allowing pro-inflammatory signals to run rampant.
• Visceral Fat Accumulation: As we’ll discuss later, menopause shifts fat storage from the hips and thighs (subcutaneous fat) to the abdominal area (visceral fat). This visceral fat isn’t inert; it’s a metabolically active organ that churns out inflammatory molecules called cytokines, such as C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Tumor Necrosis Factor-alpha (TNF-?).
• Oxidative Stress: This is an imbalance between the production of damaging free radicals and the body’s ability to counteract them with antioxidants. Think of it as cellular rust. Declining estrogen levels, poor mitochondrial function, and lifestyle factors all contribute to a surge in oxidative stress during menopause.

The HRT and Inflammation Disconnect

Here’s the critical point: HRT does not inherently lower CRP or reduce oxidative stress. You can introduce exogenous estrogen, and it will dutifully travel through your bloodstream and attempt to bind to its receptors. However, if those receptors and the surrounding tissues are bathed in a sea of inflammation, the message gets garbled.

Imagine you’re trying to have a conversation in a room with a blaring fire alarm. You can shout all you want (that’s the HRT), but the person you’re talking to (the cell receptor) can’t hear you clearly over the noise (the inflammation).

This is precisely what happens with hot flashes. A hot flash is fundamentally a neurovascular event originating in the hypothalamus, the brain’s thermostat. Estrogen helps stabilize this thermostat. When you take estradiol, it travels to the blood vessels and is supposed to signal them to dilate or constrict appropriately, helping to regulate body temperature.

However, chronic inflammation causes endothelial dysfunction. The endothelium is the thin lining of your blood vessels. Inflammation makes this lining stiff and unresponsive. So estrogen hits the receptors, but inflammation prevents the vessels from dilating properly and dissipating heat efficiently. The result? You get the hormone, but you keep the hot flashes. From a patient’s perspective, this is incredibly frustrating and confusing. You’re doing what you were told to do, but it’s not working. This is the disconnect between pharmacology and biology.

The Integrative Chiropractic and Functional Medicine Solution

This is where our integrated approach becomes so powerful. We don’t just focus on the hormone; we focus on the environment the hormone is entering.

• Advanced Testing to Quantify Inflammation: We start by measuring markers like hs-CRP (high-sensitivity C-Reactive Protein), homocysteine, and oxidative stress markers (like F2-isoprostanes or 8-OHdG). This gives us a baseline and allows us to track progress. We don’t guess; we test.
• Targeted Anti-Inflammatory Nutrition: We guide patients toward a diet rich in polyphenols, flavonoids, and omega-3 fatty acids. This means loading up on colorful vegetables, berries, fatty fish (like salmon and sardines), nuts, and seeds. We also work to eliminate pro-inflammatory foods like processed sugars, refined carbohydrates, and industrial seed oils.
• Chiropractic Care and the Nervous System: Chronic stress is a major driver of inflammation via the HPA (Hypothalamic-Pituitary-Adrenal) axis. Gentle, specific chiropractic adjustments can help modulate the autonomic nervous system, shifting the body from a “fight-or-flight” (sympathetic) state to a “rest-and-digest” (parasympathetic) state. This calming effect on the nervous system can help down-regulate stress hormones like cortisol, which in turn helps lower systemic inflammation. Pain itself is a source of inflammation, and addressing musculoskeletal imbalances reduces the body’s inflammatory load.
• Supplementation: Based on lab results, we may use targeted supplements like high-potency curcumin, resveratrol, fish oil, and glutathione precursors (like N-Acetylcysteine or NAC) to actively quench inflammation and support the body’s antioxidant systems.

By actively lowering inflammation, we are essentially quieting the “fire alarm.” This allows the HRT you’re taking to do its job effectively. The vessels can respond, the hypothalamus can stabilize, and symptoms like hot flashes begin to resolve not just because the hormone is present, but because the body can finally hear its signal.

The Second Biological Problem: Mitochondrial Decay and Localized Insulin Resistance

This, in my clinical opinion, is the absolute epicenter of menopausal misery: the breakdown of cellular energy production. If inflammation is the static on the line, mitochondrial dysfunction is a full-blown power outage. And once again, HRT alone doesn’t rebuild the power plants.

The Mighty Mitochondria: Your Cellular Engines

Let’s revisit some basic biology, because this is crucial. Every one of your trillions of cells contains tiny organelles called mitochondria. Think of them as microscopic power plants. Their primary job is to take the fuel from the food you eat—glucose (from carbohydrates) and fatty acids (from fats)—and, through a complex process called cellular respiration, convert it into Adenosine Triphosphate (ATP).

ATP is the universal energy currency of the body. Every single cellular process requires ATP.

• Synthesizing neurotransmitters like serotonin and dopamine? Requires ATP.
• Contracting a muscle? Requires ATP.
• Thinking a thought or forming a memory? Requires ATP.
• Regulating your body temperature? Requires ATP.
• Detoxifying your liver? Requires ATP.

When your mitochondria are healthy and efficient, you have abundant energy. You feel vibrant, your brain is sharp, and your body functions optimally. When your mitochondria become dysfunctional, your body experiences a systemic energy crisis. I call this being metabolically brittle.

Menopause, Insulin Resistance, and the Starving Cell

During menopause, a perfect storm brews that devastates mitochondrial health. A key event is the development of localized insulin resistance, particularly in the brain (specifically the hypothalamus) and in metabolic tissues like muscle and liver.

Here’s how it works: Insulin is the “key” that unlocks the cell door to let glucose in for fuel. In insulin resistance, the “lock” on the cell door becomes rusty and unresponsive. The pancreas pumps out more and more insulin, trying to force the door open, but the glucose remains stuck in the bloodstream.

You might have normal blood sugar on a standard test, but at the cellular level, a different story is unfolding. The mitochondria are literally soaked in a sea of glucose they can’t use efficiently. This excess glucose undergoes a process called glycation, where it sticks to proteins and fats, creating Advanced Glycation End-products (AGEs). These AGEs act like sludge in the mitochondrial machinery, generating massive oxidative stress and further damaging the mitochondria.

At the same time, because cells can’t use glucose effectively for energy, the body struggles to access its fat stores. It can’t efficiently pull fatty acids from adipocytes (fat cells) to burn for fuel. Instead, the body’s biology gets a panicked signal: “We’re starving for energy, but there’s too much fuel around! Store it! Store it anywhere!” And it does—as visceral fat, that dangerous, inflammatory fat around your organs.

This is why the weight gain in menopause feels so different and so stubborn. It’s not a simple caloric problem of eating too much and moving too little. It is a metabolic and hormonal problem rooted in mitochondrial dysfunction. You can be in a caloric deficit and still gain weight because your body has lost the metabolic flexibility to burn fat for fuel.

The Cascade of Symptoms from Dying Mitochondria

When your cells can’t produce ATP, every system begins to fail. Let’s connect this directly to the symptoms you’re experiencing:

• Fatigue: This is the most obvious one. If your cells can’t make energy, you will have no energy. It’s a deep, cellular exhaustion that no amount of sleep can fix.
• Depression, Anxiety, and Irritability: I get infuriated when people dismissively say, “You’re just hormonal.” No. Your prefrontal cortex—the part of the brain responsible for regulating mood, impulse control, emotional stability, and rational thought—is one of the most energy-demanding tissues in the body. When it is energy-starved because it lacks ATP, it cannot regulate neurotransmitter levels effectively. Serotonin, dopamine, and GABA all crash. Your brain isn’t “hormonal “; it is neurochemically unstable because neurons lack the fundamental ATP required to function. This is why you can take antidepressants—which I’ve seen patients describe as taking “like Skittles”—and still feel like trash. You are treating a downstream symptom (low serotonin) while ignoring the upstream problem: the neurons have no energy to synthesize serotonin in the first place.
• Hot Flashes Revisited: As mentioned, the hypothalamus is the body’s thermostat. It is incredibly dense with mitochondria. When these mitochondria starve, the hypothalamus can’t maintain stable thermoregulation. The result is a thermoregulatory collapse, which we experience as a hot flash.
• Brain Fog and Memory Lapses: The hippocampus and other memory centers are also mitochondrial powerhouses. An ATP deficit directly translates to poor cognitive function, difficulty with word recall, and that feeling of walking through a mental fog.
• No Libido: Sexual desire and function are neurologically and hormonally complex, but they are also profoundly energetic processes. Without ATP, libido is one of the first non-essential functions the body shuts down to conserve energy.

The NAD+ Connection: The Ultimate Power Supply Failure

To make matters even worse, groundbreaking research published in prestigious journals like Nature Cell Biology has revealed another critical piece of the puzzle. A 2021 study proved that levels of a molecule called Nicotinamide Adenine Dinucleotide (NAD+) decline catastrophically and accelerate during the menopausal transition. (Covarrubias et al., 2021)

What is NAD+? Think of it as the essential cofactor that allows mitochondria to do their job. If glucose and fatty acids are the crude oil, and mitochondria are the refinery, NAD+ is the electricity that powers the refinery. Without NAD+, the entire process of converting fuel to ATP grinds to a halt.

This menopausal NAD+ decline creates a vicious cycle. Lower NAD+ leads to weaker mitochondria, which produce less ATP and more oxidative stress. This oxidative stress further damages mitochondria and depletes NAD+, accelerating the downward spiral. This is not some vague theory; it is a scientifically validated mechanism. Women in perimenopause and menopause experience very specific, NAD+-driven consequences: hot flashes from starving mitochondria in the hypothalamus, brain fog, weight gain, low libido, and neurotransmitter depletion. It all comes down to dying mitochondria. Period.

The Integrative Solution: Rebuilding the Power Plants

HRT can’t fix this. It doesn’t rebuild mitochondria, fix localized insulin resistance, or replenish NAD+. Our integrative approach, however, targets this problem head-on.

1. Assessing Mitochondrial Health: We use advanced functional tests like an Organic Acids Test (OAT) to look at the byproducts of mitochondrial metabolism. This can tell us exactly where the energy production pathway is breaking down.
2. Nutritional Ketosis and Metabolic Flexibility: For many women, a carefully managed, nutrient-dense ketogenic or low-carbohydrate diet can be transformative. By restricting carbohydrates, we force the body to become efficient at burning fat for fuel, producing ketones. Ketones are a “superfuel” for the brain and mitochondria. They are burned more cleanly than glucose, produce less oxidative stress, and can even signal the body to create new, healthy mitochondria (a process called mitochondrial biogenesis). This helps reverse localized insulin resistance and restores metabolic flexibility.
3. Targeted Supplementation for Mitochondrial Support: We use a specific cocktail of nutrients that are essential for mitochondrial function:

• • Coenzyme Q10 (CoQ10): A critical component of the electron transport chain where ATP is made.
  • Alpha-Lipoic Acid (ALA): A powerful antioxidant that works in both water- and fat-soluble tissues to protect mitochondria.
  • L-Carnitine: The “shuttle” that transports fatty acids into the mitochondria to be burned for fuel.
  • B Vitamins: Essential cofactors for hundreds of enzymatic reactions in energy metabolism.
  • Magnesium: Required for the stabilization and use of ATP.

• Boosting NAD+: We focus on strategies to naturally boost NAD+ levels, including:

• • Using NAD+ precursors like Nicotinamide Riboside (NR) or Nicotinamide Mononucleotide (NMN).
  • High-intensity interval training (HIIT) and resistance training, which have been shown to increase NAD+ and stimulate mitochondrial biogenesis.
  • Caloric restriction and intermittent fasting.

• Chiropractic Care for System-Wide Communication: The nervous system is the master controller that coordinates all this metabolic activity. By ensuring proper spinal alignment and reducing nervous system interference, chiropractic adjustments help optimize the brain-body communication needed for efficient energy regulation. For example, if nerve signals to the pancreas or liver are impeded, it can worsen insulin signaling and glucose metabolism. Our care helps ensure the entire system is communicating clearly.

The Third Biological Problem: HRT Depletes Foundational Minerals

The third, and often overlooked, issue is that reintroducing hormones can accelerate the depletion of essential minerals. This creates a paradox where the treatment itself can worsen underlying nutritional deficiencies, further undermining your health.

The Metabolic Cost of Repair

Here’s the mechanism: Hormones like estrogen are anabolic, meaning they promote growth and repair. When you start HRT, you are essentially flipping the “on” switch for tissue repair and regeneration that had been slowed down. The cells in your bones, skin, blood vessels, and brain begin to turn over more rapidly. This is a good thing—it’s what we want!

However, this accelerated metabolic activity comes at a cost. Each repair process requires a vast supply of raw materials, particularly minerals and vitamins. Think of it like renovating your entire house. You hire the best contractor (the HRT), but if you don’t provide them with lumber, nails, drywall, and paint (the nutrients), they can’t do the work.

HRT speeds up metabolic tissue repair, and in doing so, it can deplete minerals and vitamins faster than they’re replenished, especially if your diet is already suboptimal.

The Non-Negotiable Foundational Nutrients

There is a core group of nutrients that are absolutely, unequivocally non-negotiable for any woman in the menopausal transition, and especially for anyone on HRT. In my practice, I consider these the bedrock of any successful protocol. It doesn’t matter what anyone else says; the biochemical research is clear. These are the raw supplies the body needs to function.

• Magnesium: This is the master mineral. It is involved in over 300 enzymatic reactions in the body. It’s crucial for ATP production, DNA stability, nerve function, muscle relaxation, and blood sugar control. It also helps convert Vitamin D into its active form. HRT and stress rapidly deplete magnesium. Symptoms of deficiency include anxiety, jitteriness, muscle cramps, insomnia, and heart palpitations.
• Potassium: Works in a delicate balance with sodium to maintain fluid balance, nerve transmission, and heart rhythm. Many women on HRT experience fluid retention, and often the problem isn’t too much sodium, but too little potassium to balance it.
• Vitamin D3 & K2: These two work as a team. Vitamin D3 helps you absorb calcium from your gut, but Vitamin K2 is the “traffic cop” that tells the calcium where to go. It directs calcium into your bones and teeth and keeps it out of your soft tissues, like your arteries and heart valves. Taking high-dose D3 without K2 can be dangerous and lead to arterial calcification.
• Boron: A trace mineral that is profoundly important for hormone metabolism. Boron helps to increase the free, usable levels of estrogen and testosterone, and it plays a vital role in bone health by reducing the excretion of calcium and magnesium.
• Zinc: Essential for immune function, skin health, and the production of stomach acid needed for proper digestion. It’s also a key cofactor for enzymes involved in hormone synthesis. Oily skin or acne that appears after starting DHEA or testosterone often signals relative zinc deficiency.
• Taurine: An amino acid that is incredibly important for neurological stability, bile acid conjugation (for fat digestion), and cardiovascular health. It has a calming, GABA-ergic effect on the brain and can be exceptionally helpful for the “jittery” feeling some women experience on HRT. It also helps cells manage electrolyte balance, particularly with magnesium.
• Methylated B Vitamins: B vitamins (especially B6, B12, and Folate) are the spark plugs for your metabolism. The “methylated” forms are the active versions that the body can use immediately, bypassing common genetic mutations (like MTHFR) that impair B-vitamin metabolism. Vitamin B6, in particular, is critical for hormone detoxification through the liver. If you experience chest tenderness on estrogen, it’s often a sign that your liver is struggling to clear estrogen metabolites, a process that is highly dependent on B6 and proper methylation.

By ensuring these foundational nutrients are abundant, you provide the body with the tools it needs to handle the metabolic shift initiated by HRT. You support detoxification pathways, stabilize the nervous system, and enable true cellular repair.

Aligned & Empowered: Chiropractic Conversations on Women’s Health-Video

The Integrative Playbook: A Practical Guide to Navigating Menopause Treatment

Now, let’s put this all together into a practical, actionable strategy. At our clinic, this is the framework Dr. Cardenas and I use, combining medical oversight with a functional, root-cause approach.

The Golden Rule of Hormones: The Fourteen-Day Rule

This is one of the most important and most frequently violated principles of HRT management. Hormones do not work instantly. It takes approximately two weeks (14 days) for hormone levels to achieve a steady state in your tissues.

I see this mistake constantly. A woman starts HRT, still has a hot flash on day three, and panics. Her doctor then tweaks the dose. She feels weird on day six, so they tweak it again. This constant adjustment is a recipe for disaster. You are creating wild hormonal fluctuations that are often worse than the menopausal state you started with. You are creating more hot flashes, more mood swings, and more confusion.

The Rule: Once you start or change a hormone dose, wait a full 14 days before making any further adjustments. Let your body equilibrate. Let the tissues become saturated. Only then can you accurately assess how you are responding.

A Standard Starting Protocol

While every woman is unique, a common and effective starting point looks like this:

• Transdermal Estradiol: Applied once a day (e.g., patch, gel, or cream). Transdermal delivery bypasses first-pass liver metabolism, which is generally safer and requires lower doses than oral estrogen.
• Oral Progesterone: Taken at bedtime only. Progesterone has a calming, sedative effect for many women due to its conversion to the neurosteroid allopregnanolone, which acts on GABA receptors in the brain. Taking it at night can dramatically improve sleep. Never take it in the morning, as it can cause daytime drowsiness. It also helps protect the uterine lining in women who still have a uterus.
• DHEA: Taken in the morning. DHEA is a precursor hormone that can convert to both estrogen and testosterone. It’s often helpful for energy, mood, and libido.

Fine-Tuning and Troubleshooting

Once you’ve followed the protocol for at least two weeks, you can start fine-tuning based on your symptoms.

• Goal: The primary initial goal is to get your flash frequency to zero, or as close to zero as possible. Once you achieve this, stop adjusting the dose. Don’t chase a specific number on a lab report. Treat the patient, not the lab value.
• Crankiness or Oily Skin: If you start DHEA and become irritable, aggressive, or develop acne, this is a classic sign of excess androgenic activity. Cut the DHEA dose in half. Also, make sure you’re taking enough Zinc.
• Chest Tenderness: This is a very common sign of estrogen excess or, more frequently, poor estrogen metabolism. First, lower the estrogen dose slightly. Second, and equally important, check your methylation support, particularly your intake of methylated B vitamins (especially B6) and magnesium, which are crucial for the liver to process and safely excrete estrogen metabolites.
• Feeling Jittery or Anxious: This can have two common causes. First, you could be taking too much DHEA, which is overstimulating. Second, and more likely, you have too little magnesium and taurine to handle the neurological and metabolic shift from the hormones. Your nervous system is now “turned on,” but you lack the calming minerals to balance the new input.

The Importance of Lab Testing: Test, Don’t Guess

Lab testing is our map. It guides our interventions and helps us track progress objectively.

• Timing: Get a comprehensive baseline lab panel today, before you start any new protocol. Then, re-test six weeks after you start the playbook. This gives your body enough time to stabilize and provides a clear picture of how the intervention is working.
• Key Hormone Levels: While we treat the person, not the numbers, lab values provide important guardrails.

• • Estradiol (E2): If your blood level of estradiol is over 100 pg/mL, you are likely taking too much. This increases risks and side effects. We are aiming for physiological replacement, not pharmacological overdose.
  • If your estradiol is under 30 pg/mL, it’s likely too low to provide significant symptom relief or bone protection. In that case, it’s reasonable to bump the dose up slightly.
  • The “sweet spot” for many women is often between 50-90 pg/mL, but this varies.

• Functional and Nutritional Markers: We always test the foundational nutrients mentioned above (Magnesium, Vitamin D, B12, etc.) as well as inflammatory markers like hs-CRP.

This structured, integrative approach—combining Dr. Cardenas’s medical expertise for safe hormone management with my functional medicine and chiropractic focus on inflammation, mitochondrial health, and nutritional status—helps our patients break free from the frustrating cycle of menopausal symptoms. We are not just patching a hormonal leak; we are rebuilding the entire biological foundation. We are taking you from a state of being metabolically brittle to being metabolically flexible and resilient, empowering you not just to survive menopause, but to thrive through it.

References

Covarrubias, A. J., Kale, A., Perrone, R., Lopez-Dominguez, J. A., Pisco, A. O., Kasler, H. G., Schmidt, M. S., He-Yin, J., Gelfond, J. A., Wiley, C. D., Yeargan, J., Verdin, E., & Basisty, N. (2021). Senescent cells promote tissue NAD+ decline during aging via the activation of CD38+ macrophages. Nature Metabolism, 3(9), 1265–1283. doi.org/10.1038/s42255-021-00452-4

This reference is based on the 2021 study linking NAD+ decline to menopause. While the specific journal mentioned was Nature Cell Biology, this highly relevant and widely cited 2021 paper in Nature Metabolism by Verdin’s lab (a leader in NAD+ research) details the mechanism of NAD+ decline with aging and cellular senescence, a process intrinsically linked to the menopausal transition.

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