Endometriosis and Fibroids Don't Stop at Menopause with Dr. Karen Tang

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Karen Tang, a board certified gynecologist and minimally invasive gynecologic surgeon, and author of It's Not Hysteria: Everything You Need to Know About Your Reproductive Health But Were Never Told. This is part one of a two part conversation. Together they take on a question that most women entering perimenopause have never been given the tools to answer: what happens to the gynecologic conditions you have been managing for years when your hormones start to shift?

Dr. Tang opens with endometriosis, dismantling two of the most persistent myths in gynecology: that it goes away after menopause, and that it is cured by pregnancy or hysterectomy. She explains what endometriosis actually is, why it so often goes undiagnosed for an average of seven years, why imaging studies frequently miss it, and what the full range of treatment options looks like for perimenopausal women dealing with painful periods, pelvic pain, and chronic inflammation, including when surgery is the right next step.

The conversation then moves to adenomyosis, which Dr. Tang calls the most common condition no one has ever heard of. She explains how it differs from endometriosis, why C-sections and other uterine procedures increase the risk, what the heavy bleeding and pain profile looks like across the perimenopause transition, and why it is so often the hidden culprit when estrogen therapy suddenly causes unexpected bleeding.

Dr. Tang and Dr. Haver then address uterine fibroids, covering who is most affected, why location matters more than size, how perimenopause can wake up fibroids that were previously silent, and what the full surgical landscape looks like from hysteroscopy and radiofrequency ablation all the way to hysterectomy. She and Dr. Haver also address the myth that women with fibroids or endometriosis cannot take hormone therapy, and walk through how estrogen and progesterone can be managed carefully so most women can access the treatment they need without being turned away at the door.

The episode also covers the staggering gap in NIH funding for women's reproductive health conditions and the accelerated ovarian aging associated with endometriosis.

Guest links:

• Karen Tang, MD (Instagram)
  
• Karen Tang, MD (Facebook)
  
• Karen Tang, MD (YouTube)
  
• Karen Tang, MD (LinkedIn)
  
• Karen Tang, MD (TikTok)
  
• GynoMight with Karen Tang, MD (Substack)
  
• Thrive Gynecology

Books:

• “It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (but Were Never Told),” by Dr. Karen Tang
  
• “The New Perimenopause,” by Dr. Mary Claire Haver
  
• “The New Menopause,"⁠ by Dr. Mary Claire Haver

Articles:

• The impact of menstrual symptoms on everyday life: a survey among 42,879 women (American Journal of Obstetrics and Gynecology)
  
• Epidemiology of infertility in women with endometriosis (Best Practice & Research Clinical Obstetrics & Gynaecology)
  
• Perspectives From Advancing National Institutes of Health Research to Inform and Improve the Health of Women (Obstetrics & Gynecology)
  
• 2025 SWHR Women’s Health Research Agenda: Prioritizing Uterine Fibroids, Lupus, and Metabolism (Society for Women’s Health Research)
  
• The Health Disparities of Uterine Fibroids for African American Women: A Public Health Issue (American Journal of Obstetrics and Gynecology)
  
• Impacts of endometrioma on ovarian aging from basic science to clinical management (Frontiers in Endocrinology)
  
• The impact of ovarian endometrioma and endometriotic cystectomy on anti-Müllerian hormone, and antral follicle count: a contemporary critical appraisal of systematic reviews (Frontiers in Endocrinology)
  
• Preoperative Diagnosis of Symptomatic Adenomyosis: Limitations and Clinical Insights (Cureus)
  
• The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review (Fertility and Sterility)
  
• Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study (Obstetrics & Gynecology)
  
• Ovarian conservation at the time of hysterectomy for benign disease (Obstetrics & Gynecology)
  
• Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders (JAMA)

Other Resources:

• EndoRISE
  
• The McKinsey Health Institute, January, 2024
  
• Spotlight: NIH Panel Explores Endometriosis Advances, Emphasizes Awareness
  
• MIGS Information (Cedars-Sinai)
  
• The Vagina Whisperer (Sara Reardon)
  
• Access to OB-GYNs: Evaluating Workforce Supply and ACA Marketplace Networks
  
• Nowhere to Go: Maternity Care Deserts Across the US (March of Dimes)
  
• Funding for Various Research, Condition, and Disease Categories (RCDC) (NIH)