Today, the field of women’s health is at the epicenter of a global transformation. Decades of silence and stigma have been replaced by scientific progress and personalized approaches. One of the most prominent events in this process was the first National Conference on Women’s Health held in Washington, D.C., which presented a new strategic vision to the global medical community.
One of the participants of this historic forum and an active advocate for the changes underway in women’s health is Ketevan Shavliashvili – a physician, entrepreneur, and doctoral candidate in Clinical and Translational Medicine. Ketevan received specialized education in functional medicine at the IFM, and in menopause and midlife women’s health at Harvard Medical School. She holds MD and MBA degrees and is the founder and CEO of the precision functional medicine platform, Medea Health.
Her scientific research focuses on critical issues such as the epigenetic aging clock, chronic inflammation, and cardiometabolic risks in perimenopause and menopause. Ketevan’s work serves to recognize the biological uniqueness of the female body and to implement data-driven, individual protocols.
In an interview with Medscriptum, Ketevan Shavliashvili speaks about the main highlights of the Washington conference, shattering the myths surrounding hormone replacement therapy, and the factors that determine a woman’s healthy aging process.
You attended the first National Conference on Women’s Health in Washington. From your perspective, what was the main message of these historic three days for the global medical community?
Currently, we are witnessing a true renaissance in the field of women’s health. For decades, topics such as menopause and the physiological transformation (transition) of the female body were shrouded in stigma and silence. However, today the reality is fundamentally changing; we are seeing an unprecedented increase in interest, scientific focus, and research toward women’s health and, specifically, menopause medicine worldwide. Menopause is no longer viewed as just a “discomfort that must be endured” or a taboo subject; modern medicine already considers it the most critical window for long-term health optimization, brain protection, and ensuring longevity.
The culmination of these global shifts and a historic event was the National Conference on Women’s Health, organized by the U.S. Department of Health and Human Services (HHS), held in Washington on March 11-13, 2026.
This was the first national-scale meeting in history where women’s health was discussed not as some narrow subfield of medicine, but as an independent, priority systemic issue. The event combined the latest scientific research with innovative approaches to prevention, diagnosis, and treatment. This conference carries immense symbolic and practical weight because, at the state level, it was officially recognized that the female body requires entirely different, specialized medical attention.
The main and clearest message of the conference, which rang out loudly from leading scientists, was the phrase: “Women are not small men.”
For decades, the absolute majority of clinical trials were conducted on men, and the obtained results were used to treat women mechanically, without any adaptation. The conference finally called this systemic and fundamental error by its name. Today, evidence-based medicine confirms that female biology, hormonal dynamics, brain metabolism, and the body’s response to pharmacological drugs differ radically from the male model. Accordingly, taking these unique biological characteristics into account in clinical practice and implementing personalized approaches is not “gender politics,” but real, precise science.
If we translate this scientific vision into practice: what type of diagnostic errors or clinical flaws has this “ignorance” of female biological uniqueness led us to?
Imagine what happens when an entire medical system is built on the biology of only one sex. For decades, most clinical trials were conducted on men, and women were simply fitted into the “male model.” In existing medical guidelines, a woman’s age, her hormonal status, or her biological uniqueness were effectively ignored, which brought very specific and deplorable results. One of the most prominent examples of this is misdiagnosis. Take, for instance, a heart attack, which manifests in women with symptoms completely different from those in men. Since specialists traditionally look for “male” signs, women’s complaints are often assessed as panic attacks or “neurosis.” In reality, cardiovascular pathologies are the leading cause of death in women, yet despite this, they often receive a delayed or completely incorrect diagnosis.
A similar trend is observed during perimenopause, when a woman suffers from insomnia, anxiety, and sharp mood swings against the background of hormonal imbalance. Instead of doctors seeing the root cause and treating the hormonal changes, these symptoms were often considered classic depression, and antidepressants were prescribed to the patient, leaving the real problem unresolved. The situation was further aggravated by bureaucratic flaws. For years, the U.S. Food and Drug Administration’s (FDA) strictest “Black Box” warning, which was imposed on systemic hormone therapy, was mechanically extended to local, vaginal estrogen as well. Even though the systemic absorption of the latter is less than 1% and its use is completely safe, millions of women refused treatment because of this error—treatment that would have protected them from the risk of recurrent urinary tract infections and sepsis.
The most problematic issue remains the flaws within the medical education system. Globally, doctors in medical universities receive only a few hours of education regarding menopause, which is why more than 75% of specialists do not have sufficient knowledge to help a woman during this period. It is the result of this educational vacuum that, for example, in America, a woman has to visit an average of six different specialists—a neurologist, cardiologist, psychiatrist, urologist, and rheumatologist—before the real cause of her complaints is determined. This is a colossal loss of time, finances, and energy, which is entirely avoidable through the correct transformation of the medical system.
In the process of re-evaluating approaches toward women’s health, the greatest resonance was caused by breaking the stigma surrounding hormone therapy. Today, when the FDA has even removed the strict “Black Box” warnings for HRT, what prompted this change in attitude toward estrogen, and generally, what role does it play in the long-term optimization of a woman’s health?
This is truly a historic moment in the field of women’s health. In July 2025, a special panel of experts from the U.S. Food and Drug Administration (FDA) re-examined the “Black Box” warnings of Hormone Replacement Therapy (HRT) objectively. As a result, on November 10, 2025, the U.S. Secretary of Health and the FDA Commissioner—my mentor, Dr. Marty Makary—officially announced a major decision. The outdated and erroneous warnings regarding the risks of cardiovascular disease, breast cancer, and dementia were removed from all estrogen-containing products, which went into effect in February 2026. As Dr. Makary noted, tens of millions of women were restricted from access to life-saving means only because medical dogma for many years relied on a completely distorted assessment of risks.
It is interesting to consider where this baseless fear came from. It all began in 2002 with the publication of the Women’s Health Initiative (WHI) study. That work had fundamental flaws that misled the entire world. First and foremost, the study was conducted in an inappropriate age group—the average age of participants was 63, which means they were long into menopause. Today we know exactly that starting therapy at this stage is radically different from treatment started in the early years of menopause. Furthermore, the study used synthetic hormones rather than bioidentical ones, specifically equine-derived estrogen and synthetic progestin, which modern medicine rarely uses.
The situation was further worsened by the fact that statistically insignificant data were presented to the public as incontrovertible evidence. Moreover, the rate of breast cancer in the control (placebo) group was unusually low, which made the risk in the hormone therapy group appear artificially exaggerated. These misinterpreted results caused global panic, leading patients and doctors to reduce the use of hormone therapy by 80% almost overnight. The most deplorable part was that these processes caused the cessation of doctor education in the direction of menopause management.
However, the reality is completely different. Especially noteworthy are the results of the 20-year follow-up of the WHI study, which completely dispel the stigma that has existed for decades. The data revealed that in women with a hysterectomy, estrogen-only therapy reduces the risk of developing breast cancer by 23% and mortality by 40%. This fact finally confirms that estrogen taken at the optimal age and with the correct formulation does not cause cancer; rather, it has a powerful oncoprotective effect. The fear rooted in society actually relied on a specific combination of synthetic hormones—estrogen and medroxyprogesterone acetate (MPA)—at only one dose.
Fortunately, today we have a much more accurate picture. We already use bioidentical hormones rather than synthetic ones, as well as a variety of doses, which gives us the possibility of full personalization of treatment. Modern evidence confirms that if a healthy woman starts hormone therapy within the first 10 years of the onset of menopause or before the age of 60, the benefits of treatment sharply outweigh any possible risk. This makes it the best investment for a healthy old age.
In preventive medicine, the so-called “Menopause Window” is often mentioned. Why is this period of time so critical, and how do decisions made during this period determine a woman’s “healthy aging”?
When we talk about menopause, most people immediately think of “hot flashes” or night sweats, but in reality, that is only the tip of the iceberg. Menopause is much more than just a symptom complex; it is a period when the risk of chronic pathologies such as cardiovascular disease, osteoporosis, or cognitive decline (e.g., Alzheimer’s) increases sharply. Estrogen receptors are localized in every organ and system of the female body. Accordingly, a deficiency of this hormone determines the stimulation of chronic inflammatory processes and the development of chronic diseases. This is where the concept of the “Critical Window” (Window of Opportunity) in preventive medicine comes in, implying that hormone replacement therapy is most effective and safe when started within the first 5-10 years of the onset of menopause, or before the age of 60. This time interval determines a woman’s healthy aging process in several key directions.
First, this issue concerns brain health and Alzheimer’s prevention. Estrogen is the main regulator of brain metabolism, and when its level drops during menopause, the neuronal system experiences a kind of “energetic crisis”—the brain can no longer utilize glucose as effectively as before. Research confirms that starting therapy specifically during this “window” period may reduce the risk of developing Alzheimer’s by 22-32%, whereas a delayed start of treatment, for example after age 65, can no longer perform a protective function for the brain and, on the contrary, can even increase the risk by 38%. Alongside this, critical changes occur in the skeletal system. Since estrogen activates the bone-forming cells, osteoblasts, bone mineral density drops at a catastrophic rate against the background of the hormonal drop in the first years of menopause. The world’s leading orthopedic surgeons and menopause specialists unanimously declare that scientific debates regarding the effectiveness of hormone therapy for maintaining bone health no longer exist; it is a scientifically proven fact.
Regarding the heart and blood vessels, the “Timing Hypothesis” applies here, which once again emphasizes the decisive importance of the time factor. If a patient starts hormone therapy in her 50s, it protects the blood vessels, hinders cholesterol accumulation, and prevents atherosclerosis—meaning it has a full cardioprotective effect. However, if we start this same process at age 70, when atherosclerotic plaques are already formed in the vessels, the therapy may prove ineffective or even carry risks. Simply put, menopause is a signal during which prevention has the greatest power. An adequately selected approach at the right time is the main investment that helps a woman spend a third of her life healthy, independent, and with a clear mind.
You mentioned that menopause is not just the “end” of the reproductive system. What does the neuroscientific view entail, which considers this period primarily as a stage of brain reorganization, and what strategies exist for strengthening cognitive reserve?
Alzheimer’s disease is found twice as often in women as in men. For a long time, it was believed that the reason for this was only women’s longevity, but modern neuroscience points us toward a completely different reality. Menopause is, first and foremost, a neurological transformation that represents a structural and functional transformation of the brain.
In this process, estrogen acts not only as a hormone but as the main “manager” that regulates the utilization of glucose—the brain’s primary fuel—by neurons. When the level of this hormone drops, the brain falls into an “energetic vacuum”; glucose metabolism decreases by 25-30%, which causes an energy starvation of the neurons. It is against this background that neuroinflammatory processes and the accumulation of those toxic amyloid proteins associated with Alzheimer’s disease are activated. It is important to realize that these changes begin 20-30 years before a clinical diagnosis is made. Accordingly, the so-called “Brain Fog” or decline in concentration during perimenopause is not just fatigue, but an early warning signal from the brain.
However, thanks to neuroplasticity, we possess numerous tools for brain protection and enhancement. As already mentioned, starting hormone replacement therapy during the “window” period (the first years of menopause) reduces the risk of developing Alzheimer’s by 22-32%. Along with this, immense importance is assigned to neuroprotective nutrition, where omega-3 fatty acids and products rich in antioxidants (especially berries and green tea) represent the main weapons against neuroinflammation. No less priority is physical activity; specifically, strength training stimulates the production of a special protein (BDNF) in the body, which is often called brain “fertilizer” because it promotes the survival and growth of neurons.
Furthermore, 7-8 hours of quality sleep is vital for brain function. It is during the deep sleep phase that the glymphatic system—the brain’s unique “cleaning service”—is activated, freeing neurons from metabolic waste accumulated during the day. Strengthening cognitive reserve is also ensured by mastering new skills, playing a musical instrument, and active social relationships. Ultimately, menopause is a period when our daily choices directly determine our cognitive health for the following decades.
Alongside brain protection, the menopausal transition is also a test for the immune system. How does modern medicine explain the fact that 80% of autoimmune patients are women, and how close is the role of hormonal dynamics here?
This issue is one of the least studied yet, at the same time, most important directions in modern medicine. According to statistical data, women make up 80-85% of patients with autoimmune pathologies. Whether it be systemic lupus erythematosus, multiple sclerosis, Hashimoto’s thyroiditis, or rheumatoid arthritis—these diseases predominantly affect women. This reality is not a matter of chance but represents an objective biological fact.
In this process, the main role is again assigned to hormones, specifically estrogen and progesterone. Our immune system is like a well-balanced army, one part of which (Th2) is responsible for antibody production and active defense, while the other—regulatory cells (T-reg)—ensures the stability and “calming” of the immune system. In the female body, estrogen stimulates exactly the “aggressive” part of immunity, which is effective for fighting infections but carries the risk of developing autoimmune processes. Progesterone acts as its counterbalance: it promotes immune tolerance and determines the dampening of inflammatory processes.
What happens during the menopause period? In the perimenopause phase, the ovaries, first and foremost, stop producing progesterone. As a result, estrogen is left alone, without a “competitor,” which causes an immune imbalance. Since the “calming” factor (progesterone) is no longer available in sufficient quantities, the immune system becomes over-activated and may attack its own tissues.
The situation is further complicated during the menopausal transition by changes in the gut microbiome and an increase in the permeability of the intestinal barrier, which is one of the strong factors in the progression of autoimmune diseases. It is precisely this hormonal and microbial imbalance that explains why many autoimmune pathologies flare up in this specific age group. Accordingly, when a woman suffers from an autoimmune problem, suppressing immunity (immunosuppression) alone is not enough; it is necessary to look at the process comprehensively and care for the optimization of the hormonal background as well.
One could say that the microbiome is a kind of “invisible ruler” of a woman’s hormonal health. What is the connection between gut biodiversity and the metabolic changes that women so often experience?
When we think about hormones, the function of the ovaries comes to mind first. However, in reality, there exists another, completely invisible ruler in our body that determines the final fate of hormones—it is our gut microbiome.
A most important part of this system is represented by the Estrobolome. This is a collection of specific bacteria localized in the gut that directly manages estrogen metabolism. The process proceeds as follows: the liver metabolizes estrogen and sends its conjugated (disposable) form to the intestines. However, the bacteria of the estrobolome produce a special enzyme—beta-glucuronidase—which “releases” this estrogen and returns it back into the bloodstream. Accordingly, if the intestinal balance is disturbed, the hormonal background in the body also becomes asynchronous and chaotic.
With the onset of menopause, as a rule, gut microbial diversity decreases significantly. Beneficial bacteria such as Akkermansia and Faecalibacterium are lost, and the activity of beta-glucuronidase also drops, which is why a smaller amount of estrogen returns to the blood. This means that the degree of hormonal deficiency is partly dependent on our gut health as well. This is why a fiber-rich diet, probiotics, and an anti-inflammatory diet are not just a “good-faith recommendation,” but a precise, scientifically substantiated hormonal intervention.
Furthermore, a completely new term has appeared in the latest 2025-2026 research—the Testobolone. Just as the estrobolome manages estrogen, there is a group of microbes in the gut that regulates the levels of testosterone and other androgens. These microbes perform structural modification of testosterone and facilitate its reabsorption. This discovery explains to us why gut health is critically important during any hormone therapy, since every drug ultimately passes through the microbiome “filter.” This is a rapidly growing research direction where the evidence base is expanding further every year.
Another important term, the Exposome, was mentioned at the conference. Perhaps you could explain to the readers what this concept entails and how it affects our health?
In functional medicine, we often use the term Exposome—it represents the combination of environmental factors and biological impacts that a person experiences throughout their entire life, from childhood to old age. It is often thought that “environmental impact” is limited only to polluted air or exhaust, but the concept of the exposome is much broader: it includes the dietary ration, household chemicals, stress levels, sleep hygiene, and even social relationships. At the same time, the exposome also studies how our body responds to these external stimuli from within—at the level of the microbiome, chronic inflammation, and epigenetics.
According to modern scientific data, approximately 70-90% of the risk for developing chronic diseases comes precisely from these exogenous (external) factors, while the share of genetic predisposition is only 10-30%. This means that a woman’s health during the menopause period is not a predetermined “fate”; it is the cumulative result of stress, dietary regime, sleep quality, and hormonal balance accumulated throughout life. Accordingly, we have the opportunity to exert a real influence on our own future if we change our environment and daily habits and make healthy choices a priority.
The main line of your activity is precision (exact) medicine, which is what the platform Medea Health is based on. What is the main idea of this project, and what does it offer women who are looking for an individual approach instead of a “standard” model?
Medea Health is a medical platform that is in an active phase of development and aims to implement the principles of precision (exact) medicine in the field of women’s health.
For a long time, a standardized model—”one size fits all”—prevailed in medicine. This approach may work for large statistical groups, but it is often ineffective regarding a specific individual. Each woman possesses a completely unique biochemistry, hormonal history, epigenetics, and lifestyle. Accordingly, using the same treatment protocol for everyone is unacceptable.
That is why the fundamental principle of Medea Health is biomarker-based management. In this way, we first perform an accurate risk assessment, after which the treatment process continues based on a model of functional medicine and systems biology. We reject template doses and unified protocols; every medical decision is based only on objective, measurable data. These data include a full spectrum of hormones, inflammatory markers, metabolic parameters, micronutrient status, microbiome analysis, and, in some cases, even the determination of epigenetic age.
When we combine these in-depth laboratory indicators with the patient’s clinical symptoms, family history, and lifestyle, we obtain a complete, individualized protocol. This plan is tailored exactly to the specific patient’s body and includes pharmaceutical and nutraceutical intervention as well as a personalized lifestyle management strategy.
Medea Health is an American platform, yet educating Georgian women is a matter of principle for you. What type of resources should we expect in the Georgian language, both for patients and for professional circles?
Providing Georgian women with evidence-based, latest, and reliable medical information is a matter of principle for me. When it comes to health, information is most perceptible and understandable in one’s mother tongue.
Our immediate plan involves the step-by-step creation of practical educational materials regarding menopause. These resources will be based on the latest standards of the world’s leading institutions (NAMS, Cleveland Clinic, IMS, FDA), so that women can distinguish myths from reality.
The next important step, the integration of which we plan on the platform in the near future, is the launch of Medea Academy. Its goal is to prepare doctors and other healthcare specialists with Medea’s precision protocols, which will be possible in both English and Georgian. This initiative will facilitate the implementation of modern, evidence-based “Midlife Medicine” standards at a professional level.
