About half the women who come into my pharmacy tell me some version of the same story. They're tired. Not "I stayed up too late" tired, but tired no matter how much they sleep or how much coffee they drink. They've been to their doctor, and they were told it's just aging, or just menopause. If you're dealing with menopause fatigue and you've heard that too, I want you to know there's more to it. I got into this on this episode of The Trusted Pharmacist.
Now, hormones matter a lot here. When you lose estrogen and progesterone, you feel it. But there's something else going on inside your cells that almost never comes up in a regular office visit, and it has a lot to do with your energy.
My guest was Jennifer Scheinman, a dietitian who works with Timeline, the company that makes the urolithin supplement Mitopure. Jen went through a long fight with Lyme disease before she finally found a practitioner who believed her. So she knows what it's like to get brushed off. We spent most of our time talking about your mitochondria and what happens when your body stops cleaning them up like it used to.
Why "It's Just Aging" Isn't the Whole Answer
Look, aging is part of this. I'm not going to pretend it isn't. But "you're getting older" shouldn't be where the conversation stops.
Jen compares your mitochondria to little factories that make energy for your cells. Even a well-run factory wears down over time. So your body has a cleanup system called mitophagy. It clears out the damaged mitochondria so new ones can replace them.
The part that surprises people is how early this starts. Jen says things begin slowing down at the cellular level in your 30s. Most women don't really notice until their 40s. And as you get older, that cleanup crew basically starts retiring. The broken mitochondria stick around, take up space, and damage the healthy ones next to them.
So what does that feel like? Mostly a heavy, dragging fatigue that sleep and coffee don't fix. A lot of women get brain fog along with it. Some notice they just don't bounce back from a workout like they used to.
There's also a practical reason this gets overlooked. Right now, there's no good test your doctor can order to check how your mitochondria are working. Jen said some tests are starting to come out, but her company's science team thinks they're still pretty early. So for now, how you feel is the best clue you've got. Don't ignore it.
What Menopause Fatigue Has to Do With Your Mitochondria
Your Hormones and Mitochondria Work Together
As a pharmacist, this was the part I found most interesting. The very first step in making your sex hormones, including estrogen, happens inside your mitochondria. Your mitochondria also have estrogen receptors on them. A lot of this still comes from preclinical research, so it hasn't been proven in people yet. But the biology lines up.
The way I see it, estrogen is kind of like a signal telling your mitochondria to keep running well. When estrogen drops in perimenopause and menopause, that signal gets weaker. Jen agreed, and she said it goes both ways. If your mitochondria aren't healthy, they don't support hormone production as well either.
She was also upfront that no amount of mitochondrial support is going to stop menopause. HRT by itself won't fix everything. Mitochondrial support by itself won't either. So if you're on hormones and you're still dragging, it doesn't automatically mean the hormones aren't working. It might just mean something else still needs attention.
Your Gut Makes Urolithin A, Not Your Plate
You can't just eat urolithin A. It's what's called a postbiotic, which means your gut bacteria make it for you. When you eat foods with polyphenols, like pomegranates and walnuts, the right bacteria turn those into urolithin A.
Problem is, according to Jen, only about a third of people make it at all, and a lot of them don't make much. Nobody knows yet exactly which bacteria do the job. People with lots of healthy, diverse gut bacteria tend to be the ones who make it. Even whether you were born by C-section or breastfed can shape your gut bacteria.
And even if your gut is in great shape, it's hard to get enough from food. Jen said you'd have to drink about six cups of pomegranate juice a day to get what's in the supplement. She's a dietitian and she'd never tell anybody to do that. I wouldn't either. This is also a big reason I keep telling people to start with their gut. When your gut's off, it affects a lot more than digestion.
How It's Different From CoQ10 or NAD Boosters
I'll be honest, I went into this part a little skeptical. The energy supplement aisle is full of hype. But Jen's explanation made sense to me.
Think back to the factory. CoQ10 is like the workers on the floor. NAD boosters help healthy mitochondria keep going. Both can help, but if the factory itself is falling apart, the workers can only do so much. Urolithin A is more like the demolition crew. It clears out the broken mitochondria and helps your body build new ones. Jen said it's the only molecule she knows of that's been shown in human studies to trigger mitophagy, and it works in a similar way to exercise.
One of their first human studies took muscle biopsies over a month. Compared to placebo, the genes that control how mitochondria work and get replaced were significantly improved. And Jen still takes CoQ10 herself. She just sees urolithin A as the first layer, and the other stuff works better once that's in place.
The Dose That Has Data Behind It
At 250 mg, they didn't see any benefit. They tested up to 2,000 mg, and it was safe, but the benefits leveled off at 1,000 mg. Most of the data is at 1,000 mg once a day, though 500 mg still showed real benefit.
For women in midlife who are really struggling, Jen would start at 1,000 mg. Once you're feeling better, you could drop to 500 mg, especially if cost or taking too many pills is a concern.
And give it time. Your mitochondria didn't get this way overnight, and they won't bounce back overnight either. Jen says plan on at least two months, maybe four. She compared it to a dimmer switch, not a light switch. The first thing she noticed was that she stopped getting sore after the gym.
I had the same kind of experience. I took it for a couple months and honestly didn't think I noticed much, so I stopped. Then I started feeling that tiredness come on quicker. That's when I thought, okay, maybe it was doing something after all.
Where People Actually See Results
Muscle has the strongest research, which makes sense because your muscles use a ton of energy. In middle-aged adults who didn't exercise, 500 mg improved muscle strength. In older adults, 1,000 mg improved endurance. Neither group changed how they ate or exercised, and most of the people in both studies were women. There were also studies in athletes that showed better recovery.
Now, Jen was clear that this isn't a replacement for exercise. But if you're so worn out you can't make it to the gym, it might help you get over that hump.
The skin research surprised me. When urolithin A was used on the skin, people saw fewer visible signs of aging in two weeks. By eight weeks, wrinkle depth and volume were significantly better. Redness from the sun also went away faster. And unlike tretinoin, it's gentle and you can use it in the sun. You still need sunscreen, though.
Where to Start This Week
Jen said something I agree with completely. The basics aren't exciting, but they matter the most. Sleep and stress come first, then how you eat and how you move. You can't make up for those with supplements, and even HRT works better when they're dialed in. That's always where I start with people too.
If I were in your shoes, I'd do two things.
Start with one small change. Take a walk outside. Add some protein or fiber to one meal. Jen made the point that little steps add up, and they tend to stick better than trying to change everything at once.
If you've got the basics down and you're still exhausted, look at urolithin A at 1,000 mg once a day. Stick with it for two to four months before you decide if it's working. Pay attention to the small stuff, like being less sore after a workout or not needing a nap at 3 in the afternoon. Jen thinks it pairs well with HRT, even though nobody's studied that combination directly yet.
When You're Ready to Connect the Dots
Menopause fatigue gets brushed off all the time. A lot of that is because people treat it like one problem with one fix, when really it's several things in your body affecting each other.
Honestly, that's true for most of your health.
Most women end up trying to sort it out on their own, scrolling through social media and conflicting advice, trying to figure out what actually applies to them.
The Magnolia Inner Circle is for exactly that.
It's a place where you can ask a pharmacist your questions and get a straight answer. You'll start to see how your hormones and your gut tie into your energy, so you can follow a real plan instead of jumping to the next thing.
Members also get challenges, deeper trainings, support from people going through the same thing, supplement discounts, and resources to help you feel like yourself again.
