Women today are living longer than ever before, but not necessarily better.
The conversation around longevity, experts say, needs to move beyond lifespan and focus on “health span”—the number of years a woman stays vibrant, mobile and mentally sharp.
Dr. Christina Enzmann, a Baltimore gynecologist with MedStar Health who also runs an online functional medicine practice, sees that shift every day in her work with women who want to live not just longer, but better. “The biggest factor influencing how long and how well women live today is cardiometabolic health,” she says. “That means the heart and metabolism—blood pressure, glucose, insulin resistance and lipids.” Movement, diet, sleep and stress all influence that system. “They’re interconnected. And that affects how women feel every day.”
Enzmann combines traditional gynecology with functional medicine, focusing on prevention and whole-body communication. “The gut, brain, immune system and hormones all talk to each other,” she says. “If one gets out of balance, it affects all the others.”
One of those systems—the gut—plays a much larger role than most women realize. “It’s our first point of contact
with the environment,” Enzmann explains. “It’s influenced by what we eat, by stress and by toxins. If the gut doesn’t work, our immune system doesn’t work. And immune health is directly linked to lifespan.”
She describes it as a chain reaction. Inflammatory foods or chronic stress can damage the gut barrier, triggering immune overactivity and inflammation throughout the body. “When that barrier breaks down, aches and pains increase, and the risk of chronic disease rises,” she says.
Muscle, she adds, is another key organ for longevity—one that’s often overlooked. “Women lose about 8 percent of muscle every 10 years after age 30,” she says. “After menopause, it can be two percent a year. Muscle isn’t just for strength—it protects bones, supports metabolism and reduces inflammation. It literally eats up extra sugar in the body.”
To maintain muscle, Enzmann raining two to three times a week, with daily movement and short bursts of higher-intensity activity if joints allow. “If you can’t do heavy exercise, walk every day for 30 minutes,” she says. “Even that has tremendous benefits for the brain and metabolism.”
Diet, she tells patients, is the foundation. But it’s not about counting calories—it’s about what food communicates to the body. “Food is information for your cells,” she says. “Whole, colorful, plant-heavy meals tell your body to turn off bad genes and turn on the good ones. You can’t mimic that effect with supplements.”
She advises an anti-inflammatory, largely unprocessed diet rich in greens, vegetables, fruits, nuts, seeds and fiber. “Thirty grams of fiber a day is ideal,” she says. “The more variety of plants you eat, the healthier your gut microbiome becomes.”
Animal protein, she adds, has its place, but balance matters. “It’s not that animal protein is bad,” she says, “but if that’s all you eat, it’s inflammatory. We need a plant-forward diet.
Focus on the dark, leafy greens and colorful vegetables. They contain the antioxidants that protect our cells.”
For midlife women, menopause often marks what Enzmann calls “a biological inflection point.” The loss of estrogen, she explains, can reveal problems that were quietly building for years. “Estrogen is like a big anti-inflammatory molecule—it’s our diplomat,” she says.
“When it goes away, everything that’s been hidden under that blanket starts to show. Joint pain, fatigue after eating, belly fat, insomnia—they’re all signs of underlying imbalance.”
But menopause doesn’t have to mean decline. “It’s a time to reflect on your health and make adjustments,” she says. Women who live in regions where people live significantly longer and healthier aren’t on hormone therapy, she says. “They move every day, eat whole foods, sleep well and have strong community ties. Those lifestyle factors are powerful.”
In perimenopause, Enzmann urges patients to focus on three pillars: metabolic health, stress and sleep. “That’s the moment to drop inflammatory foods, reduce sugar and manage stress intentionally,” she says. “The cortisol level is already elevated as we transition, so the stress we tolerated before suddenly becomes too much. It causes sleeplessness, insulin resistance, belly fat and mood changes.”
Sleep, she says, can make or break a woman’s metabolism. “One night of poor sleep can affect blood sugar for the next three days,” she says. “That’s how critical it is.” She advises women to go to bed before 11 p.m., keep bedrooms cool and dark and avoid screens. “You can’t override your internal clock. Deep, restful sleep is where the body repairs and resets.”
Her toolkit for better sleep is practical. “Make the room dark, use a sleep mask, take a hot bath before bed so your body cools afterward,” she says. “Magnesium glycinate is a good supplement—it calms the muscles and the brain. And for stress, adaptogens like ashwagandha can help protect the body from cortisol overload.”
She also believes connection and purpose are essential for health. “Relationships and meaning are longevity factors,” she says. “People who have close family, friends and purpose live longer. It’s not just emotional—it affects the brain and immune system.”
Beyond standard screenings like mammograms and colonoscopies, Enzmann recommends women over 50 monitor markers such as fasting insulin, hemoglobin A1C, thyroid function, ferritin, homocysteine and C-reactive protein, which measures inflammation. “These labs help us see what’s going on before disease develops,” she says. “Prevention is always easier than repair.”
She’s cautious about the growing use of weight-loss drugs such as GLP-1s. “They may help short-term, but they don’t change the underlying behavior,” she says. “Once you stop, the weight often comes back. We need to work with the root causes—nutrition, movement, mindset.”
In her practice, she’s seeing more women ready to do just that. “Many of my patients are coming not because something’s wrong, but because they want to understand their body better and prevent problems,” she says. “That’s a huge shift. They want to live long, but more importantly, they want to live well.”
She’s especially excited by new research on the microbiome—the ecosystem of bacteria in the gut, vagina and urinary tract—and its connection to hormones and brain health. “We used to think these systems were separate,” she says. “Now we know they influence each other. That’s the future of women’s medicine—seeing the body as one connected system.”
Asked for her advice for a long, vibrant life, Enzmann didn’t hesitate. “Protect your metabolism,” she says. “Build muscle, manage stress, feed your body real food and sleep before midnight. Those are the things that keep you young.”
“Women have more control than they think. Genetics are maybe 25 percent. Everything else is lifestyle,” she says.