The 'Pause Life by Dr. Mary Claire Haver - The unPaused Podcast

en us RSS Website Apple YouTube
Listen to Audacy | Mary Claire Haver, MD's unPAUSED with Dr. Mary Claire Haver podcast with Dr. Mary Claire Haver on Apple Podcasts.
Website Apple YouTube RSS
Episodes
50
Transcripts
0
0% coverage
Missing Transcripts
50
With Chapters
0

Episodes

Published 2026-07-28

Menopause Masterclass: When "Normal Labs" Are Lying to You

Open

In this episode of unPAUSED, Dr. Mary Claire Haver delivers a solo masterclass on the lab work every woman in perimenopause, menopause, and post menopause should understand and request from her doctor. Dr. Haver explains why standard annual labs, built for a general population, routinely miss the specific hormonal, metabolic, cardiovascular, and bone related changes that happen during the menopause transition, and she walks through seven categories of testing that give a far more complete picture of a woman's health.

She starts with an advanced lipid panel, explaining why LDL alone is not enough and why ApoB, Lp(a), and small dense LDL particles matter for women whose cardiovascular risk shifts as estrogen declines. She covers fasting glucose and fasting insulin together, showing how the HOMA IR score can reveal insulin resistance long before a diabetes diagnosis. She addresses bone health in depth, arguing that waiting until age 65 for a baseline DEXA scan is far too late given how much bone density can be lost in the years surrounding menopause, and she details safe vitamin D supplementation ranges and optimal target levels.

Dr. Haver also explains why thyroid dysfunction so closely mimics perimenopause symptoms and why TSH alone can miss the full picture, why ferritin testing catches iron depletion long before anemia develops, and how heavy or irregular bleeding in perimenopause contributes to that iron loss. She discusses when and why to check estradiol and testosterone levels, and why one time hormone tests are not reliable for diagnosing perimenopause itself. The seventh lab category is high sensitivity C reactive protein, a marker of chronic inflammation tied to declining estrogen.

The second half of the episode is devoted to twelve common ways women feel dismissed by their doctors, from being told they are too young for perimenopause to being offered an antidepressant without any hormonal discussion. For each scenario, Dr. Haver gives specific language women can use to advocate for themselves, along with pointers to the Menopause Society guidelines, the validated Menopause Quiz, and a clinician directory available at thepauselife.com. She ends with a personal reflection on her own post menopausal life, encouraging listeners to seek out informed care rather than accept dismissal as the final word.

Guest links:

Books

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-07-21

The Ovary’s Job Doesn’t End at Menopause: A Top Neuroscientist Explains

Open

In this episode of unPAUSED, Dr. Mary Claire Haver talks with Dr. Jennifer Garrison, a neuroscientist and founder of the Global Consortium for Reproductive Longevity and Equality, about why the ovary should never have been labeled a purely reproductive organ. Dr. Garrison explains that ovaries function like a second brain in the body, sending and receiving chemical signals to nearly every tissue system including the heart, bones, brain, immune system, and metabolism. She walks through her research on the hypothalamus and the brain ovary signaling network, describing how inflammation in this part of the brain may be one of the earliest drivers of aging across the whole body.

The conversation covers why the ovary ages roughly two and a half times faster than the rest of the body, a gap that helps explain the health span difference between women and men. Dr. Garrison and Dr. Haver discuss how poor ovarian function shows up across a woman's life, not only at menopause, contributing to conditions like polycystic ovarian syndrome, infertility, early menopause, depression, metabolic disease, and autoimmune disease. They also unpack why autoimmune conditions rise sharply after menopause and why women's immune systems respond differently to viruses than men's.

Dr. Garrison shares striking numbers on how little biomedical research funding has gone toward understanding female physiology outside of pregnancy and cancer, including how recently the NIH began requiring female inclusion in preclinical studies. She and Dr. Haver compare research volume on menopause and perimenopause to the vast body of research on pregnancy, illustrating just how far behind the science remains.

Dr. Haver and Dr. Garrison get practical too, discussing why every woman should have a full cardiovascular workup by 40, why DEXA scans and body composition tracking matter for bone and muscle health, and why hormone therapy still relies on tools largely unchanged since the 1940s. Ovarian health, Dr. Garrison argues, is foundational to understanding aging and deserves far greater research investment beyond fertility, with real implications for how women navigate perimenopause, menopause, and midlife.

Guest links:

Recommended Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-07-17

Lift Heavy, Protect Your Brain: Strength, Creatine, and Sauna for Women with Dr. Stacy Sims

Open

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with exercise physiologist and nutrition scientist Dr. Stacy Sims, moving from what does not work to what actually does for women in perimenopause and menopause. They cover why strength training, not endless cardio, is one of the most powerful tools women have for protecting muscle, bone, and brain health at midlife, and Dr. Sims walks through exactly how to structure a 20 minute strength session for maximum benefit.

The conversation turns to creatine, including why women between 18 and 65 see some of the strongest benefits for brain and heart health, proper dosing, and why timing and mixing matter for bioavailability. Dr. Sims and Dr. Haver also discuss why distance runners can still develop osteoporosis despite years of training, and how chronic under fueling and calcium loss play a role.

They separate marketing from evidence on some of the biggest wellness trends right now, including GLP-1 medications, gray market peptides, cold plunging, and sauna use, and explain why women often respond differently than men to cold and heat exposure. The episode also covers why sit-ups are not necessary for a strong core, why cardio remodels the female heart differently than the male heart, and why women are more fatigue resistant than men from a biological standpoint. Dr. Sims closes with practical guidance for women just starting a strength training journey, along with her top priorities for circadian rhythm alignment, movement, and building sustainable habits for long term health.

Guest links:

Books:

Articles:

Episode Page Apple Extract Knowledge
Published 2026-07-14

Why Women Gain Weight on the Same Diet as Men: Fueling, Fasting, and Biology with Dr. Stacy Sims

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with exercise physiologist and nutrition scientist Dr. Stacy Sims to unpack why so much fitness and diet advice built on male physiology leaves women confused about why the scale will not move, and why weight loss can feel so much harder for women than for men on the exact same plan. Dr. Sims, author of Roar and Next Level, a former professional cyclist who has taught and coached at Stanford, breaks down why women following the same diet and training program as their male partners often end up tired and stuck rather than leaner and fitter.

The conversation covers the biological reasons women conserve fat in a calorie deficit, how female circadian rhythm differs from male circadian rhythm, and why eating within an hour of waking helps regulate cortisol and appetite hormones like ghrelin and peptide YY. Dr. Sims explains why fasted workouts can backfire for women, why front loading calories earlier in the day supports better metabolic outcomes, and why time restricted eating works with a woman's biology in ways that intermittent fasting often does not.

Dr. Haver and Dr. Sims also dig into strength training for women in perimenopause and menopause, including why lifting heavier weights helps preserve fast twitch muscle fibers, power, and proprioception, all of which decline earlier in women than in men. They discuss the connection between high intensity exercise and lactate production, and why lactate is a preferred fuel for brain metabolism that may help protect against cognitive decline and dementia risk. The episode also touches on bone density and osteoporosis risk after menopause, the difference between calories in versus food quality and timing, and practical guidance on microdosing melatonin for better sleep.

Throughout the conversation, Dr. Sims makes the case that women's health depends on training and eating in ways that reflect female biology at every life stage, and that building muscle and bone during midlife matters more than chasing thinness.

Guest links:

Books:

Articles:

Episode Page Apple Extract Knowledge
Published 2026-07-10

Vanishing Vulvas & Menopause: What's Really Happening with Dr. Karen Tang

Open

In part two of this conversation, Dr. Mary Claire Haver continues 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 episode begins with one of the most common complaints women bring into midlife and one of the least discussed: pain, itching, burning, and changes in the vulva and vagina.

Dr. Tang opens by explaining why the vulva is among the most sensitive skin on the body, why menopause accelerates changes that most women are never warned about, and why so much vulvovaginal itching and pain gets dismissed as a yeast infection when it is often something else entirely. She walks through the conditions that frequently go undiagnosed, including lichen sclerosus, vulvodynia, lichen simplex, psoriasis of the vulva, and genitourinary syndrome of menopause, and explains what each one actually is and how it is treated.

The conversation then moves to painful sex, which Dr. Tang is clear is never normal and never something women should have to accept. She explains how to describe pain with sex in a way that helps a clinician pinpoint the cause, why pelvic floor physical therapy is something she recommends to nearly everyone, and why vaginal estrogen remains the most underused and underappreciated tool in menopause care. She and Dr. Haver also discuss vaginal DHEA and why the combination of estrogen and testosterone it delivers is gaining attention in sexual medicine.

Dr. Tang and Dr. Haver also cover what changes in surgical decision-making as women move through perimenopause and into menopause, how to think about ovary preservation at the time of hysterectomy, and why a doctor who offers only one option is a red flag regardless of the condition being treated. The episode closes with a practical guide to advocating for yourself at a medical appointment, including how to prepare, what to bring, and what answers to refuse to accept.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-07-07

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

Open

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:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-06-30

Gut, Brain, and Hormones: The Menopause Connection with Dr. Amy Shah

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Amy Shah, a physician trained in internal medicine and immunology with a nutrition background from Cornell, and author of the new book Hormone Havoc.

Dr. Haver and Dr. Shah begin the conversation with the gut-hormone-brain connection, explaining how 40% of estrogen is recirculated through the gut, how the estrobolome, the collection of gut bacteria responsible for metabolizing estrogen, determines how much the body retains, and why declining estrogen in perimenopause and menopause triggers a cascade that loosens the tight junctions meant to keep food particles, toxins, and viruses from entering the bloodstream. This leaky gut drives inflammation that accelerates every symptom women are already experiencing, from weight gain and mood changes to sleep disruption and brain health decline. The gut-brain axis, the constant two-way communication between the gut and the brain, means that what is happening in the gut is directly shaping cognitive function, motivation, and emotional resilience in menopause. She also covers how 95% of serotonin is made in the gut, why chronic inflammation reroutes tryptophan away from serotonin and melatonin, and what that means for mood, sleep, and appetite in midlife.

The conversation moves into dysbiosis, what it is, why it is so difficult to diagnose, and why the food sensitivity tests and gut health panels many women are spending thousands of dollars on are currently no more reliable than a coin flip. From there Dr. Shah explains what women can actually do about it through nutrition, which is the foundation of her 30-30-3 framework: 30 grams of protein at the first meal of the day, 30 grams of fiber throughout the day, and three servings of probiotic fermented foods. She covers what each piece does, why most women are falling short on all three, how to read a label to identify genuinely probiotic foods, and why the gut microbiome can shift meaningfully in as little as three days.

Dr. Shah and Dr. Haver also cover cortisol dysregulation and insulin resistance in perimenopause, circadian fasting and why aggressive fasting can backfire for women under stress, and Dr. Shah's 4-3-2-1 exercise framework covering movement, resistance training, heat therapy, and sprints. They also cover the emerging data on fiber intake and Alzheimer's prevention, the anti-inflammatory diet principles that support hormonal and brain health in midlife, and why hormone therapy and nutrition are not competing approaches but complementary ones.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-06-23

Train Your Brain To Thrive Through Menopause

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Sue Varma, a board certified psychiatrist, distinguished fellow of the American Psychiatric Association, and author of Practical Optimism. They open by taking on a question that sits at the intersection of psychiatry and menopause medicine: why do some women thrive through the most difficult biological transition of their lives, and what can the rest of us learn from them?

Early in the conversation, Dr. Varma shares a finding that reframes everything: only 25% of people are born optimistic, and there is actually a gene for it. The other 75% have to learn it. Dr. Varma explains why optimism is not toxic positivity, what practical optimism actually means, and why both extreme optimists and extreme pessimists end up paralyzed into inaction in different ways. She also addresses what happens when depression, anxiety, and brain fog layer on top of the hormonal changes of menopause and perimenopause, and why so many women are being undertreated as a result.

Dr. Varma walks through the practical applications of her framework, explaining why waiting for motivation to strike is a losing strategy, how chronic stress and cortisol keep women stuck in survival mode, how to move healthy behaviors out of the prefrontal cortex and into the basal ganglia where they become automatic, and why lowering the entry barrier rather than overcommitting is the key to building habits that stick. She also covers the U-shaped happiness curve, why 47 to 48 is statistically the lowest point of midlife happiness and coincides with peak perimenopause, and why that nadir is actually an opportunity for rebuilding.

Dr. Varma and Dr. Haver also dig into shame and the failure cycle many women experience in midlife, the default mode network and how rumination takes hold, the four steps of emotional processing, and what the four Ms of mental health, movement, mastery, meaningful engagement, and mindfulness, look like in daily practice. They also cover loneliness in midlife, the sandwich generation, sleep disruption and the 3:00 AM wake-up cycle, and why a worry journal works better than most people expect.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-06-16

Menopause Masterclass: My Menopause Toolkit – HRT and more

Open

In this solo episode of unPAUSED, Dr. Mary Claire Haver answers one of the most asked questions she receives: what hormones do you actually take, and why? Rather than a general overview of menopause hormone therapy, this is a fully transparent, clinically grounded walk through her personal protocol, including every formulation she uses, why she chose it, and what the FDA-approved alternatives are for women whose needs or circumstances differ.

Dr. Haver opens with systemic estrogen, explaining why she uses a transdermal patch as her primary delivery method, why she added a small dose of oral estradiol for bone protection after finding her serum levels were not reaching the threshold needed to preserve bone density, and why she believes routine estradiol level testing should become standard of care even though current guidelines do not yet reflect the latest absorption data. She walks through the key FDA-approved transdermal and oral estrogen options, including patches, gels, sprays, and oral formulations, covering the differences in delivery, cost, clotting risk, and SHBG implications.

On progesterone, she explains why she takes oral micronized progesterone every night without fail, how it converts to allopregnanolone and binds to the GABA receptor to support deep sleep, and what the alternatives are for women who cannot tolerate it, including vaginal administration, the Combi Patch, progestin IUDs, and Duavee.

She covers testosterone, including why she started it for muscle and bone preservation rather than libido, how she doses and applies the men's formulation off-label, what monitoring looks like, and why she is cautious about pellets. She also walks through the main vaginal and vulvar options for GSM, including estrogen cream, tablets, rings, suppositories, DHEA, and topical estriol for the face, explaining why she considers vaginal estrogen one of the most undertreated and underappreciated tools in menopause care.

The episode closes with a full supplement review covering omega-3s, vitamin D, vitamin K, methylated B vitamins, CoQ10, genistein, collagen, creatine, fiber, magnesium L-threonate, and her sleep supplement formulation, and ends with a discussion of oral minoxidil for hair loss, including dose, cost, and why she switched from topical.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-06-12

Toxins, Stress, and What They're Doing to Your Hormones with a Top Reproductive Endocrinologist

Open

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Natalie Crawford, double board certified obstetrician, gynecologist, and reproductive endocrinologist, and author of The Fertility Formula. In part two of this conversation, Dr. Crawford gets specific about the forces working against our hormones every day, chronic stress, disrupted sleep, inflammatory food, and the endocrine disrupting chemicals most women have never been warned about.

She explains how cortisol triggers insulin resistance, how insulin resistance drives inflammation and ovarian dysfunction, and why resistance training and building skeletal muscle is one of the most direct interventions a woman can make at any age, including perimenopause. On sleep, she makes the case that it is the single most under addressed factor she sees clinically, explaining how FSH and LH are released in the early morning hours and why disrupted sleep directly interferes with ovulation, estrogen, and progesterone production.

The conversation also covers anti-inflammatory nutrition and gut health, the difference between unscented and fragrance-free, why forever chemicals and phthalates are disrupting the hormone system from inside most women's homes, birth control timing and uterine lining recovery, and what egg freezing actually is and is not, and who it is most likely to benefit.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-06-09

The Truth About Your Biological Clock: Egg Quality, AMH and Fertility with Dr. Natalie Crawford

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Natalie Crawford, a double board certified obstetrician, gynecologist, and reproductive endocrinologist, and author of the new book The Fertility Formula. Both physicians open by sharing their own fertility journeys, including pregnancy losses and dismissal from the medical system, before turning to the science that most women are never given access to.

Dr. Crawford challenges one of the most persistent myths in women's health: that the biological clock is about running out of eggs. It is not. It is about egg quality, and those are completely different problems with completely different solutions. She explains how inflammation damages the chromosomes and mitochondria inside eggs, how chronic inflammation can actually deplete the ovarian reserve by penetrating the ovarian vault, and why the standard message to women, hurry up or give up, is not supported by the science.

The conversation moves into a clear explanation of the reproductive health system, how the brain, ovaries, and uterus communicate, where chronic inflammation and insulin resistance create static interference in that system, and why the same biology that shapes fertility in your 30s directly shapes perimenopause, metabolic health, brain health, and bone density in your 40s and 50s. The fertility story and the menopause story, Dr. Crawford argues, are the same story.

Dr. Crawford also takes on the AMH test and why ACOG's recommendation against routine testing is, in her view, taking agency away from women by deciding in advance that they cannot handle the data. She explains what AMH actually measures, why a low result at 30 should change how a woman thinks about her family planning, her perimenopause timeline, and her long term bone and cardiovascular health, and why at $79 out of pocket, withholding it is indefensible. She also shares her own diagnosis of celiac disease and how it connected to unexplained pregnancy loss, osteopenia at 41, and years of dismissed symptoms.

The episode also covers what a healthy menstrual cycle actually looks like as a vital sign, how to track ovulation beyond what most apps are offering, what a short luteal phase or shortening cycles can signal before symptoms appear, why infertility is 50% a male factor issue, and what trimester zero, the three months before trying to conceive, could mean for egg and sperm quality.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-06-02

GLP-1s, Hormones, and Why You Can't Calorie-Count Your Way Out of Menopause with Dr. Michelle Gordon

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Michelle Gordon, a board certified obesity medicine physician and diplomate of the American College of Lifestyle Medicine, with surgical fellowships from the American College of Surgeons and the American College of Osteopathic Surgeons. Through her practice Thrive Span Medical, she works with midlife women across 39 states whose metabolic and hormonal symptoms have been dismissed as normal aging.

Dr. Gordon opens by dismantling the calories in, calories out framework, not as a vague wellness talking point but on a physiological level. She explains why biology determines the burn rate, why fat oxidation drops by 32% in perimenopause, why visceral fat accumulation accelerates when estrogen declines, and why insulin resistance and leptin resistance make it nearly impossible for midlife women to lose weight through willpower alone. She also covers how sleep deprivation compounds all of it, creating a cycle of cravings, brain fog, and weight gain that most women are navigating without any clinical support.

The conversation then moves into GLP-1 therapy, covering who is and is not a good candidate, the differences between semaglutide and tirzepatide and why women tend to tolerate tirzepatide better, how to dose safely and slowly, what informed consent should actually include, and why Dr. Gordon treats obesity as a chronic relapsing disease that requires long term management rather than a temporary fix. She also addresses weight regain after stopping GLP-1s, the SELECT trial and its cardiovascular findings, the anhedonia some patients experience on higher doses, and what the data actually shows about muscle loss.

Dr. Gordon and Dr. Haver also discuss the combination of GLP-1 therapy and hormone replacement therapy, including the studies showing women on HRT lose more weight on GLP-1s than on medication alone, and why the two together may represent the future of midlife metabolic care. They also cover protein intake, fiber, resistance training, and why these remain non-negotiable regardless of what medications a woman is taking.

Dr. Gordon closes the episode with a direct message to the women who have been dismissed, gaslit, and told to try harder: midlife weight gain is physiological and predictable, you are not broken, and help is available.

Guest links:

Recommended Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-05-26

Menopause Is a Portal: Reclaiming the Body, the Story, and the Second Half with Dr. Hillary McBride

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Hillary McBride, a psychologist, researcher, and author whose work focuses on women's lived experience of embodiment across the lifespan, and particularly what happens during the perimenopausal and menopausal transition. She brings a feminist, biopsychosocial lens to the work, looking at the intersection of biology and culture and how the stories we are handed about aging as women can shape what we actually feel, right down to measurable health outcomes.

Dr. McBride opens by naming what the research literature has gotten wrong. Women's voices have been largely absent from the empirical conversation about perimenopause and menopause, and what women are actually saying when asked about their experience is strikingly different from what the medical literature reflects. They are describing not just difficulty but clarity, not just loss but a deepening sense of self, not just symptoms but a portal.

The conversation explores what Dr. McBride's research found when she asked newly postmenopausal women to reflect on the menopause transition: women describing a renewed sense of identity, freedom from roles that no longer fit, liberation from self-objectification, and a feeling that everything before this moment was a dress rehearsal. She also addresses the concept of found freedom, what women are actually freeing themselves from during the aging process, and why the challenge of the transition is not a barrier to growth but often the pathway through it.

Dr. McBride and Dr. Haver dig into the social scripts women have been handed about aging bodies, where they come from, who benefits from them, and how to begin rewriting them. They discuss why women silence themselves around thriving, the phenomenon of fat talk and its role in female social bonding, and what it would look like to build friendships that can hold both struggle and flourishing at the same time.

The episode also covers the connection between anticipating a difficult menopause and actually experiencing more symptoms including anxiety, sleep disturbances, and joint pain, the role of intergenerational connection in navigating the transition, and what it means for women's wellbeing when they are finally given permission to tell the full story of this season of life. Dr. McBride also shares findings from her group therapy research with perimenopausal women, including a medically supervised psychedelic therapy component, which showed that when women process the menopause transition in community, not only do symptoms decrease but their distress about those symptoms decreases as well.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-05-21

The Holistic Plastic Surgeon: Devices, Ozempic Face, and What Your Habits Do to Aging Skin

Open

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Tony Youn, board certified plastic surgeon, bestselling author of Younger for Life, and the most followed plastic surgeon on social media. In part two of this conversation, Dr. Youn moves from skincare into devices, lifestyle, and the bigger picture of how women can think about aging and anti-aging without getting swept up in the extremes.

Dr. Youn walks through the most commonly asked about in-office treatments, explaining what each one actually does and where the limitations are. He covers IPL for hyperpigmentation and sun damage, fractional CO2 lasers and how they differ from older more aggressive approaches, chemical peels and how depth determines results, and radiofrequency microneedling including what it can realistically achieve and where it falls short. He also addresses at-home devices, covering red light therapy and what the studies actually show about collagen and elastin, and what to look for in a dermal stamper.

The conversation then turns to surgery, with Dr. Youn drawing a clear line between what lasers, Botox, and other non-invasive skincare treatments can and cannot do, and explaining the real trade-offs of a facelift in language most patients never hear from their surgeons. He also reflects on the social pressure women face around aging and offers a framework for thinking about cosmetic procedures that starts with doing the least necessary to feel good.

Dr. Youn and Dr. Haver then turn to the habits that shape how skin ages over time, covering sleep, stress, sugar and glycation, inflammation, gut health, fiber, and protein.

The episode also covers Ozempic face, what is actually happening to skin during rapid weight loss on GLP-1 medications, and what the early data suggests about collagen loss and quality. The conversation closes with a look at the supplement evidence, including what the studies actually show about hydrolyzed collagen, and where the science stands on NAD, NMN, and IV drip treatments.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-05-19

What Estrogen Does to Your Skin (And What Actually Works)

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Tony Youn, a board certified plastic surgeon nationally recognized as one of the top plastic surgeons in the United States, bestselling author of Younger for Life, and the most followed plastic surgeon on social media with more than five million YouTube subscribers and eight million TikTok followers. In part one of this two part conversation, they take on a question that sits at the intersection of hormones and skin health that most doctors have never connected for their patients: what estrogen is actually doing to the skin, and what women can do about it.

Dr. Youn opens with a statistic that women lose 30% of the thickness of their collagen in the first five years after menopause, and then continue losing collagen at twice the rate of men for every year that follows. He explains exactly why this happens, how estrogen interacts with the fibroblasts that produce collagen and elastin, what declining estrogen does to hyaluronic acid and skin hydration, and why women are not imagining it when their skincare suddenly stops working.

From there the conversation becomes a practical guide. Dr. Youn walks through his morning and evening skincare framework, covering vitamin C serums and why stabilization matters, retinoids and tretinoin and how to choose between them based on skin type, peptides, growth factors, exfoliation, and where women are spending money on products that do nothing. He also addresses sunscreen, the debate between mineral and chemical formulas, and why the FDA has not approved a new sunscreen filter since the 1990s.

The episode then moves into procedures, with Dr. Youn covering neurotoxins including Botox, Dysport, and Daxxify, what they do, when to start, and what baby Botox actually means. He explains hyaluronic acid fillers, how much is too much, which areas carry the most risk, and why he only recommends fillers that can be dissolved. He also covers fat transfer, what makes it appealing and what makes it unpredictable, and how to vet whoever is doing your injections.

Dr. Youn also addresses the data on hormone replacement therapy and skin, including the evidence for systemic estrogen improving collagen thickness, what the studies do and do not show, and where topical estrogen fits into the conversation.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-05-12

Mast Cells, Histamine, and Perimenopause Explained: MCAS, Anxiety, Estrogen

Open

In this bonus episode of unPAUSED, Dr. Mary Claire Haver is joined by Dr. Zachary Rubin, double board certified allergist and immunologist and New York Times bestselling author of All About Allergies, to dig into the connection between histamine, mast cells, and women's hormonal health.

Dr. Rubin breaks down what mast cells are, how histamine works across multiple organ systems, and why women are disproportionately affected by mast cell related conditions including mast cell activation syndrome (MCAS). The two dig into the estrogen and histamine connection, why perimenopause can trigger or worsen symptoms like anxiety, brain fog, and histamine intolerance, and what MCAS actually is and how it is diagnosed. Dr. Rubin also addresses the viral H1 and H2 blocker combination that has been circulating online, explaining the real science behind why it may be helping some women with PMDD, endometriosis, and perimenopausal symptoms, while being honest about what we still do not know.

They also cover quercetin, DAO supplements, low histamine diets, and how to think about self experimentation safely. If you have been wondering whether histamine could be a piece of your hormonal health puzzle, this conversation is a great place to start.

To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy

Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Episode Page Apple YouTube Extract Knowledge
Published 2026-05-12

Menopause Masterclass: HRT Safety, Patch Absorption, Progesterone Intolerance, and Bone Density

Open

In this episode of unPAUSED, Dr. Mary Claire Haver answers your most asked questions about hormone therapy, menopause symptoms, and how to advocate for yourself when your doctor doesn't have answers. She walks through who actually qualifies for HRT, what the real contraindications are versus conditions that simply require a different delivery method, and how to think about continuing estrogen, progesterone, and testosterone therapy after 60.

Dr. Haver explains the estrogen patch absorption problem, with research showing that up to 20 percent of women on transdermal therapy never reach physiologic estradiol levels regardless of dose. She breaks down SHBG, the protein that can bind your hormones and render them inactive even when your numbers look adequate on paper, and walks through what optimal estradiol levels look like for bone density and osteoporosis prevention specifically.

She tackles unscheduled bleeding on HRT, explaining that 50 percent of women will experience it when starting hormone replacement therapy and why it almost never requires a biopsy or workup in the first six months. Dr. Haver explains progesterone intolerance and the alternatives available, including vaginal administration, the Mirena IUD, and Duavee. She also walks through when to add testosterone to a menopause treatment protocol, what hypoactive sexual desire disorder means, and why monitoring testosterone levels matters. Dr. Haver covers persistent menopause symptoms despite HRT, the role of thyroid function and inflammation in overlapping presentations, and the difference between stress incontinence and urge incontinence including how each is treated.

On supplements, Dr. Haver breaks down what the evidence actually supports for women in perimenopause and menopause: vitamin D, omega-3 fatty acids, creatine, fiber, and CoQ10, with clear reasoning for each and an honest assessment of where the data is strong and where it is not. She makes the case for pelvic floor physical therapy and why she believes it should be standard care for every woman.

The episode closes with something the longevity conversation rarely addresses. Dr. Haver makes the case that unresolved trauma and a history of childhood sexual assault carry measurable cardiovascular consequences that approach those of smoking, and that any serious discussion of women's health and longevity has to include ACE scores and access to mental health support.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-05-05

Estrogen, Progesterone, and Testosterone: The Science of Hormones, Sexual Function, and Menopause

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Tami Rowen, an obstetrician, gynecologist, and leading gynecologic surgeon at the University of California San Francisco, and an internationally recognized expert in sexual health and sexual medicine. Together they get precise about some of the most misunderstood terrain in women's health: estrogen, progesterone, progestins, and testosterone for women, what they actually do in the body, how the confusion around them began, and what becomes possible for women when care is evidence-based and not fear-based.

Dr. Rowen opens with something most women have never been told: that contraceptive estrogen and menopausal estrogen are fundamentally different molecules with different goals, different mechanisms, and different effects on the body. She walks through why ethinyl estradiol, the synthetic estrogen in most birth control pills, binds to the estrogen receptor 300 times more strongly than natural estradiol, why that matters for everything from blood clotting to testosterone levels to bone density, and why modern contraception is still valuable and worth defending even as we get more precise about how it works.

Progesterone and progestins come next, with Dr. Rowen unpacking what they are, how they differ, why they are not interchangeable, and why the progestin component of birth control is actually the primary driver of ovulation suppression, not the estrogen. She explains progesterone intolerance, who is most at risk, how it connects to PMDD, postpartum depression, and perimenopausal symptoms, and what the alternatives are for women who cannot tolerate micronized progesterone. She also addresses how progesterone sensitivity shows up differently across perimenopause and menopause, and why hormone therapy is rarely one size fits all.

On testosterone, Dr. Rowen covers what the evidence actually supports, where the data is strong and where it is not, why dosing matters and what the risks are when testosterone levels are pushed far beyond a woman's natural range, why pellets carry absorption risks, why packets should never be used for women, and what options exist when no FDA approved product for women is available. She also addresses low libido and sexual desire, the FDA approved libido medications Addyi and Vyleesi, how they work in the brain, and who they are most likely to help.

Dr. Rowen also explains why orgasm changes in midlife, how sexual pain, vaginal health, and GSM and genitourinary syndrome of menopause affect sexual function, why recurrent bacterial vaginosis may have a hormonal root, and why the Dutch test, often marketed as a comprehensive hormone assessment, does not measure what many people believe it does.

Guest links:

Recommended Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-04-28

The Holderness Family Gets Real About Perimenopause

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Kim and Penn Holderness, the husband and wife content creators behind the widely popular Holderness Family, bestselling authors, and winners of The Amazing Race Season 33. Together they built an audience of millions by finding the humor in real life, and in this conversation they turn that same lens on perimenopause, ADHD, marriage, and the particular chaos of midlife.

Kim opens up about the perimenopausal symptoms that arrived before she had any name for them: the anxiety that made everything feel like being chased by a bear, the panic attacks triggered by nothing she could identify, and the growing sense that something was fundamentally wrong with her. She describes walking out of her doctor's office with no treatment after being told her symptoms were normal, the financial reality of having to seek out a functional medicine doctor to finally get the estrogen and progesterone support she needed, and the combination of hormonal and psychiatric care that eventually helped her feel like herself again. She also speaks with real honesty about her postpartum anxiety, perimenopause and depression, and her OCD diagnosis, and how all of it left her desperate for a voice that would simply say: this is hard.

Penn offers a perspective that is rare in this space, the partner who is paying attention, confused, trying to help, and sometimes getting it wrong. He reflects on watching Kim's emotional resilience shift, how his love language of physical touch collided directly with her need for space, and the fears, including the subconscious ones, that surface when intimacy changes in a marriage. His advice for husbands navigating the menopause transition is worth the listen on its own.

Together they dig into the overlap between perimenopause and ADHD: both underdiagnosed in women, both stigmatized, both historically understudied in female patients. Penn shares his own adult ADHD diagnosis and the long journey toward understanding his brain. Kim reflects on how their willingness to laugh at their own lives led Penn to create "Perry," the character that gave them both a way to process what was happening without shame. Kim also reflects on her daughter leaving for college and how empty nesting hits differently when your hormones are already in flux.

Dr. Haver brings clinical grounding to everything Kim and Penn share, connecting their lived experience to the neuroscience of why perimenopause starts in the brain, why brain fog and mental health symptoms so often arrive before the physical ones, and why the women's health system has so consistently failed women at exactly the moment they needed support most. She also speaks personally, reflecting on her own experience as a mother of two daughters with ADHD and what it took to finally get them the help they needed.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-04-23

The Testosterone Conversation with Dr. Kelly Casperson: Beyond Libido

Open

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Kelly Casperson, urologist, author, and host of the podcast "You Are Not Broken." Part 2 goes deep on testosterone therapy for women, the most misunderstood hormone in women's health, and covers the full range of what it actually does in the female body, why every woman will experience declining levels over time, and why there are still zero FDA approved testosterone products for women while men have more than a dozen.

Dr. Casperson opens with the basics: ovaries make testosterone, the hormone pathway runs one way from cholesterol through progesterone to testosterone to estradiol, and women in normal cycling years carry four times more testosterone than estrogen in their bodies. She explains where testosterone receptors are found, which is everywhere from the brain to bone to muscle to the clitoris to the tear ducts, and why reducing testosterone in women to a libido drug misses the full picture entirely.

The conversation covers what testosterone actually helps with across every domain of female sexual health including desire, arousal, orgasm, and blood flow to the clitoris, as well as its role in energy, motivation, mood, nerve function, and mitochondrial health. Dr. Casperson explains why women and testosterone research is lagging decades behind male data, why women on estrogen who add testosterone are able to reduce antidepressant use at significantly higher rates, and why she describes it not as a libido medication but as a motivation medication that supports the dopamine and serotonin pathways.

They address the safety data directly. Decades of data exist on testosterone use in trans men at ten times the female physiologic dose with no increased risk of death, cancer, or breast cancer over 50 years. Dr. Casperson also walks through the emerging research on testosterone and breast cancer risk reduction, the cadaver data showing higher brain testosterone levels correlating with lower rates of dementia, and why she would spend a blank check on a randomized placebo controlled trial studying testosterone and dementia prevention.

Dr. Casperson walks through how to prescribe testosterone responsibly without FDA approved products, why pellets tend to run supraphysiologic and what that means for hair loss and side effects, and how to evaluate whether a patient is a candidate. Dr. Casperson also walks through what labs she runs on every woman who presents with hypoactive sexual desire disorder or who simply does not feel like herself, from a full thyroid panel to fasting insulin to B12 to omega-3 levels.

The episode also covers genital urinary syndrome of menopause, the Medicare data showing only 7% of women who received a GSM diagnosis were given vaginal estrogen within 18 months, how to apply vaginal estrogen cream correctly and why a loading dose is often counterproductive, and the data showing vaginal estrogen decreases urinary tract infections, reduces ICU admissions and death from sepsis, does not increase breast cancer recurrence, and may be associated with decreased risk of rectal cancer.

Also covered are vaginismus, pelvic floor dysfunction, the role of vibration and blood flow in restoring sexual function, the sexual side effects of birth control pills, antidepressants, and GLP one medications, and why moisture during sex is not a reliable indicator of desire or arousal.

The episode closes with Dr. Casperson's message to every woman listening: you are not broken.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-04-23

The Testosterone Conversation with Dr. Kelly Casperson: Beyond Libido Description

Open

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Kelly Casperson, urologist, author, and host of the podcast "You Are Not Broken." Part 2 goes deep on testosterone therapy for women, the most misunderstood hormone in women's health, and covers the full range of what it actually does in the female body, why every woman will experience declining levels over time, and why there are still zero FDA approved testosterone products for women while men have more than a dozen.

Dr. Casperson opens with the basics: ovaries make testosterone, the hormone pathway runs one way from cholesterol through progesterone to testosterone to estradiol, and women in normal cycling years carry four times more testosterone than estrogen in their bodies. She explains where testosterone receptors are found, which is everywhere from the brain to bone to muscle to the clitoris to the tear ducts, and why reducing testosterone in women to a libido drug misses the full picture entirely.

The conversation covers what testosterone actually helps with across every domain of female sexual health including desire, arousal, orgasm, and blood flow to the clitoris, as well as its role in energy, motivation, mood, nerve function, and mitochondrial health. Dr. Casperson explains why women and testosterone research is lagging decades behind male data, why women on estrogen who add testosterone are able to reduce antidepressant use at significantly higher rates, and why she describes it not as a libido medication but as a motivation medication that supports the dopamine and serotonin pathways.

They address the safety data directly. Decades of data exist on testosterone use in trans men at ten times the female physiologic dose with no increased risk of death, cancer, or breast cancer over 50 years. Dr. Casperson also walks through the emerging research on testosterone and breast cancer risk reduction, the cadaver data showing higher brain testosterone levels correlating with lower rates of dementia, and why she would spend a blank check on a randomized placebo controlled trial studying testosterone and dementia prevention.

Dr. Casperson walks through how to prescribe testosterone responsibly without FDA approved products, why pellets tend to run supraphysiologic and what that means for hair loss and side effects, and how to evaluate whether a patient is a candidate. Dr. Casperson also walks through what labs she runs on every woman who presents with hypoactive sexual desire disorder or who simply does not feel like herself, from a full thyroid panel to fasting insulin to B12 to omega-3 levels.

The episode also covers genital urinary syndrome of menopause, the Medicare data showing only 7% of women who received a GSM diagnosis were given vaginal estrogen within 18 months, how to apply vaginal estrogen cream correctly and why a loading dose is often counterproductive, and the data showing vaginal estrogen decreases urinary tract infections, reduces ICU admissions and death from sepsis, does not increase breast cancer recurrence, and may be associated with decreased risk of rectal cancer.

Also covered are vaginismus, pelvic floor dysfunction, the role of vibration and blood flow in restoring sexual function, the sexual side effects of birth control pills, antidepressants, and GLP one medications, and why moisture during sex is not a reliable indicator of desire or arousal.

The episode closes with Dr. Casperson's message to every woman listening: you are not broken.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Extract Knowledge
Published 2026-04-21

Sexual Health, Libido, and Orgasm: What Medicine Missed with Dr. Kelly Casperson

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Kelly Casperson, a urologist, author, and host of the podcast “You Are Not Broken”. Dr. Casperson trained in a specialty that treats both men and women, which gave her an early and clear view of the gender gap in sexual healthcare. That disparity became the driving force behind her work, her two books You Are Not Broken and The Menopause Moment, and her clinic, the Casperson Clinic. Together they cover the full landscape of what women were never taught, what medicine has missed, and what actually works for female sexual health, libido, desire, and sexual dysfunction in midlife.

The conversation gets straight to what most women were never told: that the orgasm gap between heterosexual men and women has not improved in decades, and that the silence around female sexual health has never been about a lack of science. It has been about a lack of priority.

Dr. Casperson walks through the female sexual response cycle and why the linear model built from 1950s research has left generations of women believing they are broken. She explains the difference between spontaneous and responsive desire, why dopamine is released in pursuit of something rewarding and what that means for women who have spent years having sex that was not worth desiring, and why the orgasm gap between heterosexual couples remains one of the most underdiscussed issues in women's healthcare.

The episode covers what arousal actually is physiologically, why blood flow to the female pelvis matters as much as it does to the male pelvis, and how new research on vibration and clitoral stimulation may support tissue health beyond pleasure. Dr. Casperson addresses what happens to orgasm with age as hormones decline and pelvic floor strength decreases, the role of estrogen and testosterone in clitoral blood flow, and why six weeks postpartum is not a medically supported return to sexual activity.

They discuss the two FDA approved medications for hypoactive sexual desire disorder, flibanserin (Addyi) and bremelanotide (Vyleesi), how they work on the dopamine pathway, and why 10% of Addyi prescriptions are taken by men despite the pink box. Dr. Casperson also addresses the large and often vocal group of women who have no desire for sex and are unbothered by it, why that experience deserves as much clinical attention as low desire with distress, and what it means for long term relationships when one partner has quietly exited the sexual agreement.

The episode closes with a conversation about the naturalistic fallacy, the assumption that because something is natural it is therefore better, and how it is used to discourage women from treating menopause symptoms. Dr. Casperson's position is clear: her work is dedicated to making sure every woman has the education she needs to make her own informed decision.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-04-14

Plant Medicine for Menopause: What Science and Ancient Healing Say Actually Works

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Suzanne Gilberg, a board-certified OB-GYN, integrative medicine expert, and author with nearly 30 years of clinical experience, including training in Ayurvedic medicine spanning almost two decades. Dr. Gilberg is the Chief Clinical Officer of Monarch, a membership-based healthcare practice built to restore what modern medicine has nearly eliminated: time, relationship, and trust between women and their clinicians.

Dr. Haver and Dr. Gilberg open with a question that sits at the heart of women's midlife health: why does the current healthcare system consistently fail to see women clearly? Dr. Gilberg explains why the system is not built for humans but for shareholders, reimbursement structures, and productivity metrics that reward procedures over listening. She breaks down the difference between burnout and moral injury, why physicians are leaving traditional medicine in record numbers, and what it actually costs women when their doctors are structurally prevented from knowing them. The conversation traces how the 1910 Flexner Report reshaped American medicine, shutting down Black medical colleges, eliminating part-time schools where women trained, and marginalizing plant-based and indigenous healing traditions in ways that still define clinical practice today.

The episode goes deep on perimenopause as a distinct and frequently missed phase of hormonal transition, why women in perimenopause are being handed antidepressants, sleeping pills, and fibromyalgia diagnoses instead of hormonal evaluations, and what happens when postpartum and perimenopause overlap in women having babies after 40. Dr. Gilberg also speaks candidly about her own breast cancer diagnosis at 47 and her decision, as a survivor, to go on hormone therapy, reframing what it means to build health span rather than simply extend lifespan.

The conversation turns to plant medicine, where Dr. Gilberg draws on Ayurvedic training and the emerging science of botanical treatments to walk through what actually works for perimenopause and menopause symptoms. She discusses chasteberry and its role in supporting progesterone production during perimenopause, Siberian rhubarb as a potential selective estrogen receptor modulator for hot flashes, and the evidence behind black cohosh, including why its bad reputation is largely undeserved. She offers concrete guidance on how to evaluate supplement quality, why third-party testing is non-negotiable, and how to integrate botanical medicine responsibly alongside conventional care. She also previews her forthcoming book on plant medicine, covering both the science and the history of how humans have always turned to plants to heal.

This episode is equal parts systems critique and practical toolkit, a conversation about why women deserve more time and a much wider lens on what medicine can be.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-04-07

The Missing Piece in Longevity: The Top Gerontologist on Aging, Joy, and the Science of Thriving

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Kerry Burnight, a gerontologist and national leader in aging research who spent 18 years teaching geriatric medicine at the University of California Irvine School of Medicine and is the author of Joyspan: The Art and Science of Thriving in Life's Second Half. Dr. Burnight brings a framework that is especially relevant for women navigating menopause and midlife: the key to good longevity is not how long you live. It is how much you love the life you are living.

Dr. Haver and Dr. Burnight begin with the concept of joyspan itself, a term Dr. Burnight coined to name the missing piece between lifespan and healthspan. Drawing on the American Psychological Association's definition of joy as wellbeing and life satisfaction, they explore why joy is not a luxury add-on to healthy aging but a measurable, cultivatable vital sign. Dr. Burnight explains the distinction between joy and happiness, why happiness is circumstantial while joy is an inside job, and how Viktor Frankl's research on finding meaning under extreme suffering forms the scientific and philosophical foundation of her framework. They also discuss Yale University research showing that aging beliefs alone can impact longevity by up to seven and a half years, influence inflammation levels, and affect disease expression, making the way women think about getting older one of the most powerful health interventions available.

The conversation goes deep on internalized ageism and how cultural messaging that frames growing older as shameful gets embedded in women's psychology from a lifetime of exposure. Dr. Haver and Dr. Burnight speak honestly about the shame women carry around the physical changes of menopause and aging, the experience of invisibility in midlife, and how the billion-dollar anti-aging industry profits from keeping that shame in place. Dr. Burnight also addresses the safety versus autonomy tension adult daughters navigate when caring for aging parents, why going in hot rarely works, and how to have more productive conversations about home modifications, caregiving, and end-of-life planning. She shares the real cost of caregiving on women's cognitive health, including research showing that becoming the primary caregiver of a dementia patient doubles a woman's own risk of developing dementia.

Dr. Burnight offers a practical framework for building joyspan across four domains: adaptation, connection, growth, and the balance between self and others. She explains why social connection functions like a vital medication for women's health in midlife, why social portfolios need to be actively diversified across generations, and why continuing to do hard things is not optional at any age. The episode concludes with three concrete tools for moving the needle on longevity, a candid assessment of popular longevity trends, and a compelling case for why the best possible version of you is ahead, not behind.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-03-31

The Perimenopause Masterclass: Anxiety, Brain Fog, Broken Sleep, Weight Gain & GLP-1s

Open

In this episode of unPAUSED, Dr. Mary Claire Haver answers the questions she gets asked most, sitting down solo to address what perimenopause actually is, why it starts in the brain before it ever shows up in bloodwork, and why so many women experiencing anxiety, brain fog, broken sleep, and unexplained weight gain are dismissed, misdiagnosed, or handed prescriptions for symptoms that have a hormonal root.

Perimenopause is not a waiting room. It is its own distinct biological phase, a seven to ten year hormonal transition that begins long before periods stop and touches every organ system in the body. And yet most women are never taught to recognize it.

Dr. Haver breaks down the hormonal chaos of perimenopause, revealing why estrogen does not simply decline but surges and crashes erratically as the brain floods the ovaries with luteinizing hormone (LH) and follicle stimulating hormone (FSH) in a desperate attempt to produce more, and why a single blood draw will almost never tell the full story. She answers the metabolic questions she hears constantly, explaining how visceral fat can double or triple during the transition with no changes in diet or exercise, why LDL cholesterol rises an average of 20%, and how cardiovascular risk, insulin resistance, bone density loss, and inflammation are all woven into the same story medicine has largely failed to tell women.

She also takes on the questions women bring her after being handed antidepressants for anxiety and mood changes, sleeping pills for night sweats and broken sleep, and statins with no one ever evaluating them for hormonal changes. Hot flashes, irregular periods, cognitive decline, and weight gain are not separate problems to be treated in isolation. Dr. Haver addresses the male default in medical research, the absence of perimenopause from clinical training, and the systemic underfunding of women's health, while making clear this is not about individual doctors failing their patients. It is about a healthcare system that was never built to see women clearly after reproduction ends.

Dr. Haver walks through the five lab tests every woman in midlife should know: fasting insulin and glucose, ferritin, vitamin D, Lp(a), and high sensitivity CRP. She shares what the data actually reveals about muscle mass, resistance training, and GLP-1 therapy, and explains why building a lifestyle that protects the next 30 to 40 years is not optional and why hormone therapy alone will not get you there.

This is not a conversation about surviving perimenopause. It is a roadmap for using it as a window of opportunity to test early, act early, and build the foundation for the best third of your life.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-03-24

Brain Fog, Memory Loss, and Alzheimer’s Risk During Menopause with Dr. Lisa Mosconi

Open

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Lisa Mosconi, neuroscientist and associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine, New York Presbyterian Hospital. Dr. Mosconi directs the Alzheimer's Prevention Program, including the NIH-funded Women's Brain Initiative and the Alzheimer's Prevention Clinic, and was recently named director of the $50 million Program in Women's Health, Cutting Alzheimer's Risk Through Endocrinology. She is also the author of the bestselling book The Menopause Brain.

Dr. Mosconi and Dr. Haver go deeper into why brain fog, memory lapses, and cognitive changes in midlife are not just frustrating. They are biologically significant, and for some women, they may signal an inflection point for Alzheimer's risk. The conversation covers the statistics women are rarely given starting at age 45, a woman has twice the risk of Alzheimer's as a man of the same age. Women are also twice as likely to be diagnosed with anxiety or depression, three times more likely to develop an autoimmune disorder affecting the brain, four times more likely to suffer from migraines, and more likely to be killed by a stroke after menopause.

Dr. Mosconi explains why Alzheimer's is not a disease of old age but a disease of midlife, with amyloid plaques and neurofibrillary tangles beginning to form decades before symptoms appear. She walks through the critical distinction between Alzheimer's disease, the biology, and Alzheimer's dementia, the symptoms, and why that gap represents the most important window for prevention. Importantly, having plaques does not mean a woman will develop dementia, and understanding what determines that difference is at the heart of her research.

The episode covers the finding that went viral when Dr. Robbie Brinton testified before the FDA: when the brain can no longer access adequate energy from glucose during the hormonal transition, it shifts to burning amino acids and then fat, including in animal models the white matter that insulates neurons. Dr. Mosconi explains why this is an adaptive response and not a pathology, and why the human brain appears to compensate in ways that rodent models cannot fully replicate.

Dr. Mosconi also shares one of the most surprising findings from her lab: rather than downregulating estrogen receptors after menopause as animal models predicted, the human brain actually increases receptor density for up to 15 years after the final menstrual period. Her team is the only one currently FDA-authorized to use a PET imaging tracer to measure estrogen binding directly in the brain.  The episode also covers maternal inheritance of Alzheimer's risk through mitochondrial DNA, why menopause does not cause Alzheimer's but can unmask underlying vulnerabilities, and the importance of the distinction between endogenous estradiol and hormone therapy when evaluating neuroprotection.

The conversation closes with Dr. Mosconi's CARE program, a $50 million global initiative spanning 17 research sites, more than 70 scientists across six continents, and a projected dataset of 100 million women. The goal is to cut Alzheimer's risk in half for women by 2050, develop hormone therapy protocols guided by brain imaging, and build the first Alzheimer's risk calculator for women that can be integrated directly into clinical practice through Epic.

Coop Sleep Goods - Get 20% off your first order and try Coop risk-free with a 100-night sleep-better guarantee at coopsleepgoods.com/UNPAUSED

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-03-17

The Alzheimer's Prevention Plan for Women: Hormones, Sleep, and Nutrition with Dr. Lisa Mosconi

Open

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Lisa Mosconi, a neuroscientist and associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine, New York Presbyterian Hospital. Dr. Mosconi directs the Alzheimer's Prevention Program, including the NIH-funded Women's Brain Initiative and the Alzheimer's Prevention Clinic, and was recently named director of the $50 million Program in Women's Health, Cutting Alzheimer's Risk Through Endocrinology. She is also the author of the bestselling book The Menopause Brain.

This conversation is about prevention. Dr. Mosconi has spent decades building the science that shows Alzheimer's risk in women is neither inevitable nor untreatable and that the choices women make in midlife around hormones, sleep, and nutrition have a direct, and measurable, impact on the brain's long-term health.  Together, they explore why two thirds of all Alzheimer's patients are women and what role menopause plays in that disparity. Dr. Mosconi explains the difference between the rare genetic mutations that directly cause Alzheimer's, found in roughly 2% of patients, and the risk factors that shape outcomes for the other 98%, including the distinction between early and late onset disease and between sporadic and familial Alzheimer's. Both share their own family histories with dementia and what that means for their personal risk.

The conversation covers what brain fog is neurologically, why it can be severe enough to trigger fears of early onset dementia, and how to tell the difference between cognitive fatigue from the hormonal transition and something requiring clinical evaluation. Dr. Mosconi explains the concept of subjective cognitive decline, when a woman feels a real change in her cognitive performance, but standard testing still shows she is within normal range, and why that distinction matters. Her framework for when to seek evaluation: forgetting where you put your keys is not Alzheimer's. Not knowing what your keys are for is a different conversation. The episode also addresses creatine, why women have lower creatine reserves than men, and whether supplementation could support brain energy and reduce brain fog, an area Dr. Mosconi sees as genuinely worth studying.

Dr. Mosconi explains what brain imaging shows as women move through perimenopause and into postmenopause, including a surprising U-shaped pattern of brain connectivity that reorganizes into something stronger on the other side. She details why estrogen receptors in the hippocampus, amygdala, frontal cortex, and brainstem help explain the rage, anxiety, memory lapses, and sleep disruption so many women experience, not as character flaws, but as neuroscience.

On sleep, Dr. Mosconi breaks down the glymphatic system, he brain's overnight clearing mechanism, and why protecting deep sleep is one of the most powerful tools available for Alzheimer's prevention. She explains how chronic stress depletes pregnenolone, suppresses melatonin, and worsens menopause symptoms through the cortisol pathway, and why magnesium glycinate may help interrupt that cycle.

On nutrition, she walks through what the brain actually requires: omega-3 fatty acids, antioxidants including vitamin C, B vitamins especially B12, and adequate glucose, not just for energy, but for the synthesis of glutamate and GABA, the brain's most abundant neurotransmitters. She also explains why ultra-processed foods drive neuroinflammation and oxidative stress, and why what is bad for the heart is equally bad for the brain.

The episode also covers the 14 modifiable risk factors that account for over 40% of all Alzheimer's cases globally, the discovery of irisin and how muscle contraction directly supports brain health, and a candid breakdown of the Women's Health Initiative Memory Study — what it actually showed, what it did not show, and why the absence of the right research is not the same as evidence that hormone therapy doesn't work.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-03-10

The Sleep Crisis in Menopause: Insomnia, Sleep Apnea & Solutions

Open

Poor sleep during perimenopause and menopause isn't just exhausting—it's linked to increased cardiovascular disease risk, depression, anxiety, weight gain, cognitive decline, and reduced quality of life. Yet for decades, women's sleep complaints have been minimized, dismissed, or blamed on just getting older.

In this episode, Dr. Mary Claire Haver sits down with board-certified sleep medicine specialist Dr. Andrea Matsumura to unpack what's really happening to women's sleep during the menopause transition and what we can actually do about it. Dr. Matsumura completed her medical degree at the University of Texas Health Science Center San Antonio and her internal medicine residency in Portland, Oregon before returning to Oregon Health & Science University for a fellowship in sleep medicine, where she discovered the critical connection between women's hormones and sleep disorders.

Up to 50% of menopausal women have undiagnosed sleep apnea, and women present so differently than men that they're consistently missed by gender-biased screening tools like the STOP-BANG questionnaire, which actually gives women a lower risk score simply for being female. The conversation explores the role of estrogen, progesterone, and testosterone in sleep regulation, from thermal control to airway support to deep sleep maintenance, and why even women on hormone therapy can still struggle with insomnia. It also reveals why 30% of postmenopausal women battle restless leg syndrome and the connection to ferritin levels that most doctors miss.

Dr. Matsumura breaks down what Cognitive Behavioral Therapy for Insomnia actually involves, describing it as behavioral retraining that's like building muscle rather than a quick fix. She introduces her Dream Sleep Method, an acronym covering daytime activity, resting environment, emotions, archetype or chronotype, and medical conditions, providing a comprehensive framework for addressing root causes of sleep disruption rather than just masking symptoms. The discussion covers why melatonin production drops by 50% by age 50, why the pineal gland is the first gland in the body to calcify, and what that means for sleep quality in midlife.

Dr. Matsumura explains how to build the perfect sleep environment with three key elements: dark, cool, and quiet. She covers why sleep restriction or the accordion effect can help retrain the brain, and how sleep trackers can be both helpful and harmful depending on how you use them. This episode provides women with the knowledge that their sleep struggles are treatable medical conditions, not inevitable consequences of aging, and that small improvements in sleep quality can yield significant health benefits for women in perimenopause and menopause.

Guest links:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-03-03

Katie Couric on Truth, Trust, and Women's Health

Open

From her groundbreaking televised colonoscopy to her breast cancer journey, Katie Couric has turned personal experience into powerful advocacy for the health issues medicine has overlooked. This week on unPaused, Dr. Mary Claire Haver sits down with Katie Couric, award-winning journalist, founder of Katie Couric Media, co-founder of Stand Up To Cancer, and author of the New York Times bestseller Going There. Katie spent 15 years co-hosting the Today Show, served as the first solo female anchor of CBS Evening News, and has interviewed nearly every president, world leader and cultural voice of the last four decades.

Together, they explore Katie's journey from growing up in Arlington, Virginia, where her parents instilled the importance of education and financial independence, to breaking barriers in network news while navigating profound personal loss. Katie opens up about losing her husband Jay to stage four colon cancer when her daughters were six and two, how that tragedy launched her into cancer advocacy, and why she made the decision to have a colonoscopy on live television — a moment that changed screening rates across America and took the stigma out of a life-saving procedure.

The conversation dives into the Women's Health Initiative and its lasting aftermath. Katie and Dr. Haver unpack how flawed research and sensationalized reporting created decades of fear around hormone replacement therapy, leaving an entire generation of women without adequate treatment for menopause symptoms. They discuss emerging therapies for breast cancer survivors experiencing severe menopausal symptoms, including selective estrogen receptor modulators like bazedoxifene combined with conjugated estrogens (Duavee), which allows estrogen to reach the brain, bones, joints and skin while blocking estrogen receptors in the breast tissue.

Katie reveals she is producing a new documentary that will expose the stark disparities in medical research between men and women. She shares the statistics that drove her to make this film: women were not required to be included in clinical trials until 1993, female crash test dummies with anatomically correct bodies were only recently developed, women take an average of four years longer to be diagnosed with diseases, and while two out of three Alzheimer's patients are female, only 12% of Alzheimer's research funding focuses on women. The film will connect the dots on systemic sexism in medicine, from the dismissal of women's pain in emergency rooms to the 40 FDA approved treatments for erectile dysfunction versus the lack of approved testosterone therapy for women.

They explore postpartum depression and psychosis, with Katie recounting her reporting on the Andrea Yates tragedy in Texas, where a mother suffering from untreated postpartum psychosis drowned her five children. Both women discuss their own experiences with intrusive thoughts after childbirth and how mandatory screening protocols emerged from that tragedy, though gaps in maternal mental healthcare remain.

Katie explains why she continues working, driven by a sense of purpose and the responsibility to use her platform for public service during a time when science and journalism are under attack. She discusses the crisis in media literacy, the erosion of trust in institutions, and how consumers are getting affirmation rather than information from news sources that confirm their preexisting biases. The episode examines what it means to stay engaged and visible in midlife, the importance of purpose beyond motherhood, and why women living longer but not living well is one of the defining health challenges of our time.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-02-24

The Sex Life Nobody Warned You About: What a Top Sexual Medicine Expert Wants You To Know

Open

Most women go through decades of marriage, menopause and midlife without ever having an honest conversation with a doctor about their sex life. Not because they don't want one — but because most physicians were never trained to have it. This week on unPaused, Dr. Mary Claire Haver sits down with Dr. James Simon, a professor of obstetrics and gynecology at George Washington University, board-certified OB-GYN, reproductive endocrinologist, and certified sexual counselor with more than 800 published papers in menopause and sexual medicine. Dr. Simon is a past president of the International Society for the Study of Women's Sexual Health (ISSWSH) and one of the most published clinicians in modern menopause care.

Dr. Simon has spent his career treating what most doctors never address — the full picture of how sex, desire, pain and intimacy change for both women and men as they age. He treats couples together, and what he has witnessed across thousands of relationships is that the problems are rarely one person's fault, rarely unsolvable, and almost always rooted in something nobody warned them about.

In this conversation, Dr. Simon explains why long-term couples develop a "sexual script" that quietly kills desire, and what it actually takes to break out of it. He breaks down the shift from spontaneous to responsive desire in perimenopause and menopause — why so many women find themselves feeling indifferent to sex, why a diagnosis of hypoactive sexual desire disorder (HSDD) is more common than most realize, and why that is normal, not broken. The conversation covers testosterone therapy for women, including what it genuinely helps with, why accurate measurement matters, the difference between physiologic and supraphysiologic dosing, and the ongoing push for an FDA-approved testosterone product for women.

Dr. Simon also addresses erectile dysfunction in aging men, how it ripples through relationships when female partners blame themselves, and what women need to understand about male sexual aging. The episode covers genitourinary syndrome of menopause, vaginal estrogen, DHEA, sex hormone binding globulin, and why it is always easier to maintain vaginal health than to restore it. Dr. Simon explains the full spectrum of pelvic floor dysfunction and why pelvic floor physical therapy remains one of the most underutilized tools in women's sexual health. And he closes with his concept of "outercourse" — a framework for aging couples who can no longer rely on penetrative sex, and a practical approach to helping partners finally say what they need using "I language" outside the bedroom.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-02-17

Building a Menopause Brand: Naomi Watts on HRT, Hot Flashes & Hollywood

Open

This week on unPaused, Dr. Mary Claire Haver sits down with Naomi Watts, Academy Award nominated actress, entrepreneur, and New York Times bestselling author of Dare I Say It: Everything I Wish I'd Known About Menopause. Naomi's career spans decades in Hollywood, from her breakthrough role in David Lynch's Mulholland Drive to recent work with directors like Ryan Murphy and Lena Dunham. After receiving a shocking early menopause diagnosis at 36 while struggling with fertility, Naomi spent years navigating untreated symptoms in silence before becoming an unexpected advocate for millions of women facing midlife transitions. In 2021, she founded Stripes Beauty, a menopause focused skincare and wellness brand built on community, education, and celebrating womens earned wisdom rather than promising to reverse time.

In this conversation, Dr. Haver and Naomi explore the reality of growing up across continents after losing her father at eight years old, the decade long struggle to break into Hollywood, and the moment at 30 when her acting career finally launched. Naomi opens up about the devastating news from her doctor that she was approaching menopause at 36, the desperate fertility journey that followed including traveling to China for herbal remedies and extreme dietary changes, and the perimenopause symptoms she dismissed as allergies or stress in her late twenties including night sweats, migraines, brain fog, and sleep disruption.

Naomi reveals the shame she carried about being menopausal while building her career in an industry that tells women their value expires at 40, the moment with her now husband, actor Billy Crudup, when she had to explain her estrogen patch, and the panic of experiencing hot flashes on airplanes and in public spaces before finding proper treatment. She discusses successfully managing her symptoms with hormone replacement therapy since 2013, the changes to her skin and vaginal health she didn't expect frozen shoulder and UTIs that surprised her, and the pushback from friends and industry peers when she considered building a menopause brand.

Dr. Haver and Naomi discuss the shifting Hollywood narrative with older actresses like Pamela Anderson, Nicole Kidman, and Demi Moore landing sexually driven age appropriate roles, the statistics showing one in five to one in 10 women quit jobs at career peaks due to untreated menopause symptoms like brain fog and anxiety, and why being cast in roles specifically because directors know she'll authentically portray perimenopause and menopause feels meaningful. Naomi shares her experience writing her New York Times bestseller with contributions from medical experts, cold pitching her menopause brand concept during COVID, the importance of connection through in person events and community building and looking ahead to longevity and living a functional independent life like her grandmothers who lived past 99 and 101. This conversation provides both personal vulnerability and practical wisdom about transforming shame into purpose, managing symptoms from hot flashes to sleep issues to sexual health changes, challenging ageism in entertainment, and building a second act focused on empowering women to feel seen and celebrated during the second half of life.

Guest links:

Books:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-02-10

Female Libido in Menopause: Desire Loss, Biology & Solutions with Cindy Eckert

Open

This week on unPAUSED, Dr. Mary Claire Haver sits down with Cindy Eckert, founder and CEO of Sprout Pharmaceuticals and creator of Addyi, the first FDA approved treatment for low libido in women. Cindy is a pharmaceutical entrepreneur who began her career at Merck before founding her first company in 2007, focusing on under marketed FDA approved products. After successfully building and selling a male sexual health company, she became the only woman running a sexual health company and witnessed firsthand the stark contrast between how medicine treats male versus female sexual dysfunction. Her journey to bring Addyi to market became a cultural battle about whether women's sexual desire matters, leading to two FDA rejections, public hearings, and ultimately a historic approval in 2015 after a six year fight.

In this conversation, Dr. Haver and Cindy explore how Addyi works differently from Viagra, targeting brain chemistry and desire rather than blood flow and arousal. Cindy explains that Addyi is a mood drug originally developed for depression that showed an unexpected effect on female libido during clinical trials. The medication works on neurotransmitters in the brain, building over approximately eight weeks to restore spontaneous thoughts, fantasies, and desire in women with hypoactive sexual desire disorder or HSDD. She walks through the massive clinical trial requirements, including 13,000 patients compared to Viagra's 4,000, and the three things they had to prove with statistical significance versus placebo: increased interest in sex, more satisfying sexual experiences, and decreased distress from the condition.

The conversation reveals the shocking disparities in how sexual health is funded, researched, and approved across genders. Cindy shares how venture capitalists laughed her out of rooms despite her previous success, how the FDA fast tracked Viagra approval in six months while Addyi took six years with two rejections, and why the statement that Addyi provides only modest benefit reveals the underlying assumption that women's sexual pleasure has no value. She discusses the brain scan imaging research from neuroscience that showed women struggling with low libido have measurably different brain responses to sexual stimuli, proving this is a biological condition rather than purely psychological. Cindy explains why no medical specialty truly owns female sexual health the way urology owns male sexual health, leaving women bounced between OBGYN, psychiatry, and dismissive platitudes.

Dr. Haver and Cindy address the barriers women still face accessing Addyi, from insurance companies requiring patients to fail marriage counseling before approving coverage to pharmacists questioning whether husbands know their wives are taking the medication. They discuss how breast cancer survivors who have an 85 to 90 percent chance of experiencing HSDD receive almost no information about treatment options, while men with erectile dysfunction after prostate cancer receive immediate intervention programs. Cindy shares her decision to fight to get Addyi back after the pharmaceutical company that acquired it shelved the product without ever launching it, and how she has used the proceeds to fund other female health disruptors working on innovations from infant formula to date rape drug detection.

The episode concludes with discussion of the new documentary The Pink Pill: Sex, Drugs and Who Has Control, which chronicles Cindy's battle with the FDA and features the brave women who testified at public hearings about their struggles with HSDD despite being mocked and ridiculed. This conversation provides both the science and the cultural context behind one woman's mission to change how medicine values female pleasure and desire.

ADDYI, flibanserin, is for women <65 with low sexual desire disorder who have not had problems with low sexual desire in the past, and who have low sexual desire that is troubling to them no matter the type of sexual activity, situation, or sexual partner. The low sexual desire is not due to a medical or mental health problem, problems in the relationship or medicine or other drug use. ADDYI is not for men or to enhance sexual performance.

Your risk of severe low blood pressure and fainting is increased if you drink 1-2 standard alcoholic drinks close in time to your ADDYI dose. Wait at least 2 hours after one to two drinks before taking ADDYI at bedtime and skip your dose if you drink three or more drinks that evening. If you take certain prescription, OTC or herbal medications, or have liver problems, the risk of low blood pressure and fainting increases and you should not take ADDYI.   Do not take if you are allergic to any of ADDYI’s ingredients. Sometimes serious sleepiness can occur. Common side effects include dizziness, nausea, tiredness, difficulty falling asleep or staying asleep and dry mouth. See PI and Boxed Warning at addyi.com/pi

Guest links:

Recommended Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-02-03

Understanding Your Brain Through Perimenopause and Menopause with Dr. Louisa Nicola

Open

An estimated 7.2 million Americans age 65 and older are currently living with Alzheimer's dementia. The part that should alarm every woman listening is this: almost two thirds of them are women.

In this episode, Dr. Mary Claire Haver sits down with neurophysiologist and Alzheimer's researcher Dr. Louisa Nicola to unpack what's really happening to women's brains during perimenopause and menopause and what we can do about it. Louisa Nicola is a neurophysiologist, human performance coach, and founder of Neuro Athletics, a consulting firm that works with elite athletes and high-level professionals to optimize brain health and performance. A former world class triathlete, she transitioned into neuroscience and earned her Master of Medicine in neurophysiology from the University of Sydney. Dr. Nicola is currently pursuing her doctorate studying the effects of resistance exercise on brain health. She focuses on optimizing brain function and longevity, particularly in women, through sleep, nutrition, and exercise interventions.

Dr. Nicola reveals how Alzheimer's disease doesn't suddenly appear at 70 but starts quietly in our thirties and forties, building up over a 30-year progression. She explains what's happening in the brain as amyloid beta proteins and tau tangles accumulate, why the hippocampus is the first area to go, and the critical role that sleep plays in clearing these proteins through the glymphatic system. The conversation explores why women are more predisposed to tau protein accumulation than men and how estrogen, progesterone, and prolactin inhibit the enzyme that causes tau proteins to become hyperphosphorylated and toxic. Dr. Nicola explains the connection between declining estrogen during perimenopause and increased Alzheimer's risk, including how estrogen helps mediate glucose metabolism in the brain, supports synaptic connections, and why the loss of this hormonal scaffolding leaves women vulnerable to cognitive decline.

Dr. Nicola breaks down the difference between brain fog and dementia, explaining that brain fog is a symptom that can be caused by hormonal changes, stress, or sleep deprivation, while dementia is a medical diagnosis that includes multiple forms including Alzheimer's disease, vascular dementia, and Parkinson's dementia. She discusses the window of opportunity for hormone replacement therapy, referencing Scandinavian studies showing that women with one copy of the APOE4 gene have a two-to-four-fold increase in Alzheimer's risk but can lower that risk with early estrogen replacement. The discussion covers why one night of sleep deprivation can raise amyloid beta levels in the brain, why sleep regularity matters more than sleep duration, and how hot flashes and night sweats disrupt the critical deep sleep stages needed for brain waste clearance through the glymphatic system.

Dr. Nicola explains why exercise is the single best thing women can do for brain health, revealing that women with high cardiovascular fitness measured by VO2 max can lower their dementia risk by 80%. She breaks down aerobic exercise that releases BDNF and grows the hippocampus by 2%, resistance training and strength training that releases myokines and improves frontal lobe function, and high intensity interval training that produces lactate as fuel for the brain. The conversation explores why muscle health and bone health matter for longevity, why larger leg muscles correlate with larger brains, and how exercise can reverse age-related heart decline. Dr. Nicola shares her supplement recommendations including omega 3 fatty acids, EPA and DHA for brain health, creatine for cell energy metabolism and recovery from sleep deprivation, and why most women have omega indexes below 4% when they should be at 8% or higher for cardiovascular health and reduced mortality risk.

The conversation explores nutrition for brain health including the Mediterranean diet and MIND diet, managing LDL cholesterol and APOB, and the importance of adequate protein, green leafy vegetables for magnesium, and omega fatty acids. Dr. Nicola explains how glucose metabolism affects cognitive function and memory, how cortisol and chronic stress impact sleep quality and brain health, and why social connection and self-compassion matter for longevity and mortality risk. This episode provides women with evidence-based strategies for protecting their brains during perimenopause, menopause, and midlife, emphasizing that Alzheimer's disease and dementia are not inevitable parts of aging and that lifestyle interventions can make a profound difference in long term brain health and quality of life.

Guest links:

Recommended Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-01-27

Menopause, Hormones and Women’s Sexual Health with Dr. Rachel Rubin

Open

In this episode Dr. Mary Claire Haver is joined by Dr. Rachel Rubin, a board-certified urologist and nationally recognized expert in sexual medicine, fellowship trained in both female and male sexual health. As assistant clinical professor of urology at Georgetown University and former education chair of the International Society for the Study of Women's Sexual Health, she brings unique insight into the stark disparities in how sexual dysfunction is treated across genders. Dr. Rubin founded the Sexual Medicine Research Team, and her advocacy work has been instrumental in changing FDA labeling on hormone therapy and advancing the American Urological Association Guidelines on genital urinary syndrome of menopause.

During the conversation, Dr. Haver and Dr. Rubin explore the intersection of menopause, hormones and women's sexual health, revealing why most doctors, including OB-GYNs, receive virtually no training in sexual health despite sexual dysfunction affecting millions of women. Dr. Rubin explains how men's sexual health benefits from 27 fellowship programs while women's sexual health has only three, and why erectile dysfunction research receives billions while female orgasm research gets nothing from the NIH. She breaks down the complete anatomy of the clitoris that most medical professionals never learned, explaining why understanding this matters for surgical outcomes, pleasure, and treating conditions like vulvar vestibule pain that affects penetration, tampon use, and pelvic exams. Dr. Rubin discusses how the vulvar vestibule, the hormone sensitive tissue surrounding the urethra, becomes a source of pain for many women during perimenopause, on birth control pills, or postpartum due to low estrogen and testosterone.

Dr. Haver and Dr. Rubin also address genital urinary syndrome of menopause, or GSM, and why vaginal estrogen is critical not just for sexual function but for preventing urinary tract infections and sepsis. Dr. Rubin explains how vaginal estrogen could save Medicare up to 22 billion dollars annually yet remains dramatically underutilized because doctors dismiss vaginal and urinary symptoms as normal aging. She introduces vaginal DHEA as another FDA approved option that provides both estrogen and testosterone benefits locally, particularly helpful for women on aromatase inhibitors or those who need additional androgen support for the genital tissue. Dr. Rubin walks through the five-ingredient menu of hormone therapy, including systemic estrogen, progesterone, and testosterone, plus local vaginal hormones and targeted vestibule treatment when needed. She discusses the role of pelvic floor physical therapy in addressing painful sex and bladder health concerns.

Dr. Rubin discusses medications and their sexual side effects, from SSRIs causing delayed orgasm and genital numbness to birth control pills potentially lowering libido and causing vestibule pain by suppressing testosterone. She explains how spironolactone, finasteride, and even GLP-1 medications can impact sexual function in ways patients are rarely counseled about, while men routinely receive detailed discussions about sexual side effects. The conversation covers FDA approved medications for low libido in women, including Addyi and Vyleesi, that work on dopamine pathways in the brain and genitals to improve not just desire but arousal, orgasm, and lubrication. Dr. Rubin shares why these medications remain unknown to most women despite being available for years, and how insurance companies create barriers by requiring women to fail marriage counseling before approving treatment.

The episode concludes with a discussion of how relentless advocacy finally removed misleading black box warnings from hormone therapy labels after 20 years. Dr. Rubin explains why the label never should have existed in the first place, how the FDA required no advisory panel to add the warning but extensive bureaucracy to remove it, and what changed when advocates got loud enough. Whether you're experiencing painful sex, low libido, recurrent UTIs, or simply want to understand how hormones, medications, and life stages affect sexual function and menopause symptoms, this conversation provides the evidence-based information and validation that women deserve. 

Guest links:

Recommended Books:

Articles:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2026-01-22

Strong Bones, Strong Body, Stronger Second Half with Dr Jocelyn Wittstein - Part 2

Open

In this continuation of their conversation, Dr. Jocelyn Wittstein and Dr. Mary Claire Haver shift from understanding why menopause affects bones and joints to what actually works for building stronger bones and preventing fractures. If you've been told your bone density is declining, or you're worried about falls and fractures, this episode delivers the practical protocols you need.

Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor at Duke University specializing in sports medicine and the female athlete across the lifespan. She's also a former collegiate gymnast and mother of five. Her research focuses on frozen shoulder, ACL injuries in female athletes, and the musculoskeletal syndrome of menopause. As president of the Forum for Women in Sports Medicine, Dr. Wittstein is changing how we understand the intersection of hormones, movement, and independence in women's bodies.

They tackle the questions women ask most. How much exercise is enough? What types build bone? Is jumping necessary? They discuss the LIFT More trial and EFOPS trial, research showing women in structured exercise programs had a fifty percent reduction in fracture risk, even as bone density eventually declined. This reveals something crucial: preventing fractures goes beyond bone density numbers alone.

The conversation addresses estrogen levels and bone protection. Dr. Wittstein explains why there's confusion about dosing, discussing how different amounts of transdermal estrogen affect bone density and what this means during perimenopause and menopause. She shares her personal protocol including strength training, jumping exercises, balance work, and nutrition with fiber, anti-inflammatory eating, and supplements like creatine monohydrate.

The discussion addresses a risk factor many women don't know: the connection between urinary tract infections, genitourinary syndrome of menopause, and hip fractures. Dr. Wittstein explains how untreated GSM leads to recurrent UTIs, causing confusion at night and falls. Up to forty percent of hip fracture patients have UTIs before or after surgery, contributing to serious complications. Vaginal estrogen could be preventive, and the box warning has just been removed.

Dr. Wittstein emphasizes self-advocacy, discussing why women's musculoskeletal pain often isn't taken seriously when imaging looks normal. She shares how she's training orthopedic surgeons to ask about menopausal symptoms and refer to women's health providers, breaking down silos between specialties.

Whether you're concerned about osteoporosis, dealing with joint pain, or want to maintain strength and independence, this episode provides evidence-based strategies for a stronger second half of life.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-01-20

Menopause, Frozen Shoulder and the Joint Pain Wake Up Call with Dr. Jocelyn Wittstein - Part 1

Open

If you've ever struggled to put on a bra, reach behind your back, or lift your arm without searing pain in your shoulder, you're not alone. Frozen shoulder strikes women in midlife at alarming rates, yet for decades, medicine dismissed it as a mystery condition with no known cause. Orthopedic surgeon Dr. Jocelyn Wittstein saw what others missed: her patients with frozen shoulder were almost all women between forty and sixty, experiencing hot flashes, night sweats, and other symptoms of perimenopause and menopause. What she discovered is changing how we understand the impact of declining estrogen on women's joints, bones, and muscles.

Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor at Duke University, specializing in sports medicine and the female athlete across the lifespan. She's also a former collegiate gymnast and mother of five. Her research focuses on frozen shoulder, ACL injuries in female athletes, and the musculoskeletal syndrome of menopause. As president of the Forum for Women in Sports Medicine, Dr. Wittstein is changing how we understand the intersection of hormones, movement, and independence in women's bodies.

In this conversation, Dr. Mary Claire Haver and Dr. Wittstein explore how declining estrogen during perimenopause and menopause impacts joints, bones, muscles, and connective tissue. They discuss why frozen shoulder disproportionately affects women in midlife, with some Asian cultures having their own term for it that translates to fifty year shoulder. Dr. Wittstein explains the critical window for treatment, why early intervention can be transformative, and how hormone replacement therapy may prevent it, with preliminary data suggesting women using systemic estradiol have half the risk of developing frozen shoulder. She shares why physical therapy during the inflammatory phase can worsen it and how to recognize the early warning signs.

The conversation expands beyond frozen shoulder to address broader musculoskeletal changes during menopause. Dr. Wittstein discusses why women are eight times more likely than men to tear their ACL, her research using real-time hormone measurements and advanced imaging to understand this disparity, and what oral contraceptives might have to do with injury risk. She explains why women over fifty are thirty-five percent more likely to have arthritis than men, a difference that doesn't equalize until age eighty, suggesting these are hormonally influenced processes driven by estrogen loss.

Dr. Wittstein and Dr. Haver dive deep into bone health and osteoporosis prevention. Dr. Wittstein explains why impact matters for bone density, sharing research on jumping exercises and how mechanical load stimulates bone formation. She discusses evidence for strength training, particularly the LIFT More trial that demonstrated significant bone density gains in menopausal women who performed back squats, deadlifts, and overhead presses.

The conversation addresses practical prevention strategies women can implement now. Dr. Wittstein discusses wrist fractures that often happen when women in their fifties fall as an early warning sign of bone health issues and why catching these cases early could prevent hip fractures decades later. They discuss balance training, agility work, and why standing on one leg while brushing your teeth can reduce fall risk. Dr. Wittstein shares her evidence-based perspective on weighted vests.

For women experiencing joint pain, stiffness, or loss of range of motion during perimenopause or menopause, this episode validates that these symptoms aren't in their heads and aren't simply aging. Dr. Wittstein explains why joints hurt more, why injuries take longer to heal, and why frozen shoulder appears out of nowhere during midlife. She emphasizes that while HRT can be one prevention tool, lifestyle interventions like strength training, impact exercise, and balance work are crucial for all women, regardless of whether they choose hormone replacement therapy. 

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-01-17

Sally Wainwright on Riot Women, Identity Theft of Menopause, and Writing Real Female Characters

Open

Award-winning British television creator Sally Wainwright joins Dr. Mary Claire Haver to discuss her groundbreaking new BBC series Riot Women, a drama about five midlife women who form a punk rock band while navigating menopause, aging parents, and the complexities of life after 50. Sally, the creative force behind acclaimed series including Happy Valley, Gentlemen Jack, and Last Tango in Halifax, shares how her own experience with perimenopause and menopause inspired the show and why she calls this life stage "identity theft."

The conversation explores Sally's journey from bus driver to one of British television's most celebrated showrunners, her commitment to portraying authentic female characters who carry grief, desire, sexuality, rage, and resilience in bodies that reflect actual lived experience, and how brain fog, joylessness, and depression led her to finally try hormone replacement therapy after initially believing outdated myths about breast cancer risk, and how that decision transformed her wellbeing.

Dr. Haver and Sally discuss the critical importance of naming menopause symptoms, from the devastating loss of motivation and confidence that can accompany hormonal changes to the sandwich generation pressures of dementia care for aging parents while raising teenagers. The episode examines why female stories, particularly those featuring women over 50, face funding challenges in entertainment, how male writers have historically constructed female characters through the male gaze, and why Sally believes women are more heroic and emotionally articulate than men.

They explore the revolutionary aspects of Riot Women, including its honest portrayal of sexual health, libido changes, medical gaslighting, and the transformative power of HRT, rarely if ever depicted on screen with such nuance and optimism. Sally discusses audience response to the series, including an unprecedented volume of thank-you letters to the BBC from viewers who felt seen for the first time, men's surprising embrace of the show despite its focus on female experience, and a handful of critics who complained about the absence of "nice men" despite the show's ensemble of complex, flawed characters of all genders. This conversation offers validation for anyone navigating the physical and emotional challenges of perimenopause and menopause, inspiration for creative midlife reinvention, and hope that entertainment is finally beginning to tell the truth about women's lives with the honesty, ferocity, humor, tenderness, and rage they deserve.

Guest links:

Articles:

Other Resources:

Clips from Riot Women:

Episode Page Apple Extract Knowledge
Published 2026-01-13

From Hysteria to Medical Gaslighting and the Path Forward with Dr. Elizabeth Comen

Open

Dr. Elizabeth Comen is a board-certified oncologist at NYU Langone Health, co-director of the Mignoni Women's Health Collaborative, and author of the groundbreaking book "All In Her Head: The Truth and Lies Early Medicine Taught Us About Women's Bodies and Why It Matters Today." In this powerful conversation about medical gaslighting and women's healthcare, she and Dr. Mary Claire Haver trace the deep roots of medical misogyny and reveal why the healthcare system still dismisses women's symptoms today.

Dr. Comen shares the story of a breast cancer patient on her deathbed who, hours from death, apologized for sweating during a hug. It's a moment that captures what nearly every woman experiences in a doctor's office, the reflexive apology for being in a normal human body. Whether it's apologizing for leg hair in stirrups or hiding underwear during an exam, women have internalized tremendous shame about their bodies. Dr. Comen explains this isn't random. It's the legacy of a medical system built by men who dismissed women's pain and symptoms as hysteria, neurosis, or anxiety.

Through meticulous research into medical history, Dr. Comen reveals how this medical gaslighting became embedded in healthcare. She discusses William Osler, one of cardiology's founding fathers, who described women's chest pain as "neurotic angina" and wrote that "these women do not die." Yet heart disease is the number one killer of women. She explains how women are twice as likely to call an ambulance for their husband's heart attack than for themselves, and when they do seek help for chest pain, they're far more likely to be misdiagnosed with a panic attack instead of receiving proper cardiac care.

Dr. Haver and Dr. Comen discuss the systemic healthcare gaps across medical specialties: why 80% of autoimmune diseases affect women yet it's not considered a women's health field, why female specific surgeries are reimbursed at significantly lower rates than comparable male procedures, why Alzheimer's disease is twice as common in women but received almost no research funding, and how the legacy of dismissing women's sexual health continues in breast cancer and oncology care today. They explore bizarre historical medical fears like "bicycle face," the myth that women would become ugly and infertile from exercise, and how plastic surgery evolved to make women "marriage material" rather than serve their actual health needs.

Despite the sobering history of medical misogyny, this conversation ends with hope. Dr. Comen shares why she's optimistic about the cultural shift happening in women's healthcare now, the importance of women advocating for themselves in medical settings, and how the next generation doesn't have to wait for menopause to stop apologizing and start demanding better healthcare.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2026-01-06

Menopause Masterclass: Hormones, Brain Fog, Weight & Mental Health with Dr. Mary Claire Haver

Open

Dr. Mary Claire Haver breaks down everything you need to know about perimenopause, menopause, and postmenopause in this solo episode, answering critical questions about hormones, symptoms, and treatment with the medical expertise and personal experience that's made her a trusted voice for millions of women.

Most women don't realize perimenopause can begin at 35-36 years old, a full seven to ten years before periods stop. Dr. Haver explains why the first signs are often brain-related: fog, anxiety, feeling like "something's not right," rather than physical changes. Menopause itself is just one day (one year after your last period), but postmenopause represents 30-50 years of life without ovarian hormones. Understanding these three phases changes everything about how women can navigate this transition.

In this episode, Dr. Haver answers questions like: What is menopause, and when does it really start? Why am I gaining weight around my middle even though my diet hasn't changed? Why am I suddenly experiencing anxiety and depression? What changes happen to the vagina and bladder? What are my hormone therapy options? And what about testosterone, do I need it?

With estrogen receptors mapped throughout the body, Dr. Haver reveals how declining hormones affect nearly every system. She lists over 40 potential symptoms beyond hot flashes: frozen shoulder, elevated cholesterol, insulin resistance, joint pain, kidney stones, and even heightened hearing. Understanding the biology of how your hypothalamus frantically signals ovaries that can't respond explains why menopause impacts so much more than your cycle. She also explains why visceral belly fat triples during this transition, regardless of diet and exercise changes, and what that means for long-term health.

Dr. Haver shares a revealing statistic: only 8% of OB-GYN residents feel competent treating menopause, and 77% receive zero menopause training. She explains what doctors should know but often don't: hormone therapy as first-line treatment for mental health changes in perimenopause, prophylactic vaginal estrogen for all perimenopausal women (considered safe even for many breast cancer patients), no mandatory stop date for hormone therapy when benefits outweigh risks, and affordable bioidentical options that exist beyond expensive pellets.

This episode equips you with the knowledge to find menopause-educated clinicians, recognize quality care, and demand treatment that actually works. As Dr. Haver emphasizes throughout the episode, no woman should suffer unnecessarily when safe, effective options exist.

Guest links:

Books:

Other Resources:

Episode Page Apple Extract Knowledge
Published 2025-12-30

Midlife Divorce: The Facts, The Finances, and The Fallout with Jenny Hutt

Open

Divorce rates for people over 50 have doubled since the 1990s, and women are initiating the majority of them. What's really driving this shift? In this episode of unPAUSED, Dr. Mary Claire Haver sits down with family law attorney and broadcaster Jenny Hutt to discuss the facts, finances, and fallout of midlife divorce.

Jenny Hutt is a family law attorney specializing in divorce and mediation in New York, and she spent two decades as a broadcaster on SiriusXM. She's one of Dr. Haver's earliest supporters, and she brings both personal experience and professional insight to this conversation about a controversial topic relating to women's health: the connection between menopause and divorce.

Dr. Haver and Jenny start with the facts: the statistics behind gray divorce, why women are initiating most of them, and what's really happening beyond the oversimplification of "dry vagina" causing divorces. They discuss feeling unsupported, undervalued, and reaching a breaking point after years of caregiving. They also dive into finances: what every woman should know about her money, whether she's thinking about divorce or not, the three things to do if you're considering divorce, the difference between mediation and legal representation, how to protect inheritance, and the details around a postnuptial agreement. They also address the financial reality that women's household income drops 41% on average after divorce, compared to 23% for men. Finally, they explore the fallout: the stress on the sandwich generation of caring for aging parents while raising children, how trauma strains marriages, rebuilding identity after a long marriage, the shame women feel, and why the other side of divorce can bring unexpected peace and freedom.

Guest links:

Recommended Books:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2025-12-23

Leaving Her Dream Job for Menopause Advocacy: Tamsen Fadal on HRT & Purpose After 50

Open

What happens when a news anchor loses her words on live television and discovers it's not stress, but menopause? Emmy Award-winning journalist Tamsen Fadal joins Dr. Mary Claire Haver to share why she walked away from her dream job in pursuit of changing the conversation around women's health, the powerful story behind her New York Times bestselling book How to Menopause, and her groundbreaking PBS documentary The M Factor.

Tamsen spent 30 years in broadcast journalism without saying the word "menopause" on air—not once. Then perimenopause hit. Brain fog made her skip words on the teleprompter. A hot flash so severe during a live newscast left her sweating and pale, eventually forcing her off the set entirely. Despite erratic bleeding, insomnia, and mounting symptoms, doctor after doctor missed the diagnosis.

But once she understood what was happening, she couldn't stop talking about it. She co-produced The M Factor: Shredding the Silence on Menopause with three other women, self-funding the documentary after she was told there was no audience. The trailer went viral. PBS picked it up. Over 1,000 community screenings followed in 43 countries.

Dr. Haver and Tamsen reflect on their first meeting at a menopause conference, the moment they both realized how little training doctors receive, and why this work feels like a calling.

Guest links:

Books:

Articles:

Other Resources:

Episode Page Apple YouTube Extract Knowledge
Published 2025-12-18

Orgasm After Menopause: Vibrators, Testosterone & Solutions with Dr. Lauren Streicher (Pt. 2)

Open

In our last episode of unPAUSED, we began a conversation with Dr. Lauren Streicher about orgasm, sexual function, and why these topics are still so taboo. Because there was so much to talk about, we decided to make this a two-part episode. So today, Dr. Mary Claire Haver continues this conversation. 

Dr. Streicher is a professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, the host of Dr. Streicher's Inside Information Podcast, and the creator of Come Again, a 30-episode audio series on sexuality and sexual function. She's been at the forefront of sexual medicine for decades, pushing conversations forward that most clinicians still avoid.

In this episode, we're diving into why vibrators work when nothing else does and what the research shows about vibration versus other types of stimulation. Dr. Streicher explains non-hormonal arousal creams, CBD oil for the clitoris, and whether these products actually help. We discuss the role of neurotransmitters in orgasm and walk through the FDA-approved libido drugs Addyi and Vyleesi, including why testosterone is often the preferred option for women and why pellets are problematic. Dr. Streicher breaks down the orgasm gap between men and women and explains why it actually narrows with age. She walks us through her clinical approach when a patient comes in struggling with orgasm, why pain must always be addressed first, and how to find a sexual medicine expert. We also talk about what gives her hope for the future of this field and why not every woman needs to have an orgasm for sex to be pleasurable and successful.

Guest links:

Books:

    Subscribe to COME AGAIN: Sexuality and Orgasm DrStreicher.com/comeagain         
    Use code UNPAUSED20 for 20% off (This code expires Dec 23)

    Gyne Hacks! (Including how to How to Get a Hands-free Free Vulvar View)

    Other Resources:

    Articles:

    Episode Page Apple YouTube Extract Knowledge
    Published 2025-12-16

    Where Did My Orgasm Go? Menopause, SSRIs, and the Science of Pleasure with Dr. Lauren Streicher

    Open

    What happens to your orgasm after menopause? It's something that nearly half of women experience during midlife, but so few are talking about it. In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Lauren Streicher to discuss exactly what changes to orgasm, libido, and sex, why it happens, and what you need to know if you're struggling.

    Dr. Streicher is a professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, the host of Dr. Streicher's Inside Information Podcast, and the creator of Come Again, a 30-episode audio series on sexuality and sexual function. She's a senior researcher at the Kinsey Institute and one of the true pioneers of sexual medicine, helping to define and legitimize a specialty that for decades simply didn't exist.

    Dr. Haver and Dr. Streicher start with the basics: what an orgasm actually is, the anatomy of the clitoris, and why most women cannot have an orgasm from penetrative sex alone. Dr. Streicher explains vaginal orgasms, cervical orgasms, the G spot, and the historical research of Princess Marie Bonaparte, who measured the distance between the clitoris and vaginal opening in 240 women in an effort to understand why she couldn't orgasm during intercourse. They discuss what happens to orgasm and sex post menopause, including the role of blood flow, nerve health, clitoral atrophy, cardiovascular disease, diabetes, and medications, especially SSRIs that can affect both libido and orgasm. Dr. Streicher walks through how genitourinary syndrome of menopause affects the clitoris, why the pelvic floor matters for orgasm, and why so many women have never even seen their own anatomy. They also talk about anorgasmia, the inability to have an orgasm, both primary and acquired, and why this is almost never discussed in medical training.

    Guest links:

    Books:

    Subscribe to COME AGAIN: Sexuality and Orgasm DrStreicher.com/comeagain         
    Use code UNPAUSED20 for 20% off (This code expires Dec 23)

    Gyne Hacks! (Including how to How to Get a Hands-free Free Vulvar View)

    Other Resources:

    Articles:

    Episode Page Apple YouTube Extract Knowledge
    Published 2025-12-09

    Menopause, Misogyny and the Medical System: Dr Sharon Malone Sets the Record Straight

    Open

    Dr. Sharon Malone has spent decades fighting for women to get the healthcare they deserve, and she's not slowing down. As Chief Medical Advisor at Alloy Women's Health, host of "The Second Opinion" podcast, and author of the New York Times bestseller "Grown Woman Talk," Dr. Malone joins Dr. Mary Claire Haver in this episode to talk about reshaping how we think about menopause, aging, and women's health advocacy.

    For too long, women have been told to accept suffering as normal. Hot flashes, brain fog, joint pain, sleep problems, the complete unraveling of quality of life during perimenopause and menopause? Dr. Malone talks about being done with that narrative. In this conversation, she explains how the medical system has systematically failed women, from keeping them out of research studies to applying male-centric data to female bodies, from dismissing their menopause symptoms to perpetuating dangerous myths about estrogen and hormone therapy that have left an entire generation undertreated.

    She breaks down the Women's Health Initiative, the deeply flawed study that scared women away from hormone replacement therapy (HRT). She explains exactly what went wrong, why the study enrolled women who were too old to answer the questions it claimed to address, and why doctors are still getting it wrong today, decades after the original findings were walked back. The cost? A generation of women suffering unnecessarily while billions in research dollars went elsewhere.

    Dr. Malone also tackles the intersection of gender and racial bias in medicine, explaining why your zip code matters more than your genetic code when it comes to health outcomes. From her own journey navigating medical school as a Black woman in the 1980s to losing her mother to cancer at just 12, she points out the healthcare disparities from both sides of the exam table.

    At 66, Dr. Malone is proof that midlife isn't about decline. It's about stepping into your power. And she shares a clear message that women have accepted suffering for far too long, and it's time to demand better.

    Guest links:

    Books:

    Articles:

    Other Resources:

    Episode Page Apple Extract Knowledge
    Published 2025-12-02

    Can't Take Estrogen? Dr. Corinne Menn on Who Can, Who Can't & What's Changed

    Open

    In this episode, Dr. Mary Claire Haver sits down with Dr. corinne Menn to tackle one of the most common questions in women's health: "Can I take estrogen?" As a board-certified OB-GYN, certified menopause practitioner, and 24-year breast cancer survivor, Dr. Menn brings both professional expertise and lived experience to this conversation about who can take hormone therapy, who can't, and what's changed in recent years.

    Dr. Menn's own story provides powerful context for this discussion. At just 28 years old, during her second year of medical residency, she discovered a lump in her breast just one week before learning her mother had recurrent ovarian cancer. Within days of her mother's sudden death, Dr. Menn received her own devastating diagnosis: breast cancer. What followed was a grueling journey through mastectomy, chemotherapy, and induced menopause while simultaneously completing one of medicine's most demanding training programs.

    Throughout this conversation, Dr. Menn shares the profound gaps in survivorship care that she experienced firsthand and continues to witness in her patients today. The medical system, she explains, is focused on treating cancer but often fails to prepare women for the marathon of side effects that follow, particularly the devastating impact of estrogen deprivation on sexual health, mental health, bone density, and cardiovascular risk.

    Guest links:

    Recommended Books:

    Articles:

    Other Resources:

    Episode Page Apple Extract Knowledge
    Published 2025-11-25

    Still Bobbi: Bobbi Brown on Reinvention, Midlife Entrepreneurship & Finding Purpose After 60

    Open

    What does it look like to begin again at 62 and thrive? Beauty industry pioneer Bobbi Brown joins Dr. Mary Claire Haver for an intimate conversation about her new memoir, Still Bobbi, building Jones Road Beauty in her sixties, leaving behind the company that bore her name for 25 years, and redefining what success, purpose, and aging mean in the second half of life.

    Bobbi Brown revolutionized the beauty industry with her "no makeup makeup" philosophy in the 1990s, sold her company to Estée Lauder, and spent decades as creative director before exiting in her late fifties. But instead of retiring, she launched Jones Road Beauty at 62 during a pandemic, proving that passion and entrepreneurship don't disappear with age; they evolve. In this personal conversation, Bobbi shares her journey from Chicago to building a global beauty empire, the emotional reality of leaving the company with her name on it, and why she refuses to use the term "anti-aging." She opens up about growing up with a mother who struggled with mental illness, losing her brother to HIV, and how weighted vest training and strength over skinny became her midlife mantras.

    Dr. Haver and Bobbi connect over shared experiences of menopause, hormone therapy, and the relentless pressure of being a founder. They discuss what it means to perform when exhausted, learning to say no, and why the maintenance phase of any transformation, whether weight loss or career pivot, is often the hardest part.

    Bobbi's memoir, Still Bobbi, is a story of resilience, grit, and determination for anyone who thought their best work was behind them.

    Guest links:

    Books

    Articles

    Other Resources

    Episode Page Apple Extract Knowledge
    Published 2025-11-18

    GLP-1s and Midlife Metabolism Part 2: Dr. Rocio Salas Whalen Breaks Down the Science of Weight Loss and Menopause

    Open

    What happens after you lose the weight? Few are focused on this important question about GLP-1 medications. In Part 2 of this conversation on GLP-1s and Midlife Metabolism, triple board-certified endocrinologist Dr. Rocio Salas-Whalen continues her discussion with Dr. Mary Claire Haver, going deeper into what happens after weight loss, including the physical and emotional changes no one prepares you for, and what the future of these medications looks like.

    Dr. Salas-Whalen, founder of New York Endocrinology and author of the upcoming book Weightless, tackles the questions women are actually asking: How do I know if I'm getting good care? What about compounding pharmacies? Will I need therapy? And what comes next in obesity medication?

    The conversation addresses the psychological shifts that happen when you reach your goal weight for the first time in your life. Dr. Salas-Whalen shares what she's learned from following patients long-term and why the maintenance phase is actually the most important part of treatment.

    Dr. Salas-Whalen also addresses the cost and accessibility crisis around Ozempic, Wegovy, and Mounjaro, the environmental impact of single-use injection pens, and why direct-from-manufacturer vials (like Eli Lilly's Zepbound vials) are making treatment more affordable. She shares her standard of care for obesity treatment and explains exactly what questions to ask before starting GLP-1 therapy.

    For women experiencing perimenopause and menopause weight gain, this episode provides useful information about what to expect beyond initial weight loss, how to maintain results long-term, and why proper medical supervision with body composition monitoring is essential for protecting muscle mass and metabolic health.

    Guest links:

    Books:

    This episode covers:

    • The emotional reality of rapid weight loss and body image adaptation after GLP-1 treatment
    • Why some patients need mental health support alongside GLP-1 medications
    • How weight loss affects relationships and marriages as well as the "Ozempic divorce" phenomenon
    • The truth about compounding pharmacies: safety concerns, FDA regulations, and red flags to watch for
    • Why GLP-1 medications combined with menopause hormone therapy show superior weight loss results
    • Green flags and red flags when choosing a provider for GLP-1 treatment
    • The future of obesity medication: triple incretin drugs (retatrutide), oral GLP-1 options, and monthly injections
    • Protein requirements to preserve muscle mass during weight loss: why 100 grams daily matters
    • Physical changes after significant weight loss: cold intolerance, excess skin, and medical considerations
    • How to support a loved one on GLP-1 medications without triggering guilt or shame
    • Who should NOT take GLP-1 medications: contraindications and safety considerations
    • Finding an obesity medicine specialist: how to locate qualified providers

    Articles:

    Other Resources:

    Episode Page Apple Extract Knowledge
    Published 2025-11-11

    GLP-1s and Midlife Metabolism: Dr. Rocio Salas-Whalen Breaks Down the Science of Weight Loss and Menopause: Part 1

    Open

    Are GLP-1 medications a game-changer for women in midlife—or just another quick fix? In this conversation, triple board-certified endocrinologist Dr. Rocio Salas-Whalen joins Dr. Mary Claire Haver to cut through the hype and share what women really need to know about Ozempic, Wegovy, Mounjaro, and the science behind sustainable weight loss.

    Dr. Salas-Whalen, founder of New York Endocrinology and author of the upcoming book Weightless, explains why GLP-1 receptor agonists represent a fundamental shift in how we understand and treat obesity—not as a willpower problem, but as a chronic medical condition with biological drivers including hormones, genetics, and metabolism.

    For women navigating perimenopause and menopause, the conversation gets even more specific. Dr. Salas-Whalen breaks down why estrogen decline drives fat redistribution to the abdomen, increases visceral fat, and makes it nearly impossible to lose weight using the same strategies that worked before. She reveals how GLP-1 medications can address the metabolic changes of midlife while protecting what matters most: muscle mass.

    This episode covers:

    • How GLP-1 medications work: mimicking gut hormones to regulate appetite, blood sugar, and metabolism
    • Why 80% of women experience unexplained weight gain during perimenopause and menopause
    • The difference between subcutaneous fat and visceral fat—and why it matters for heart health
    • Dr. Salas-Whalen's GPS protocol: GLP-1 + Protein + Strength training to prevent muscle loss
    • Why body composition matters more than BMI or the number on the scale
    • How much muscle loss is acceptable during weight loss (and how to minimize it)
    • The truth about "Ozempic face"
    • Who should consider GLP-1 medications—and who shouldn't
    • Common side effects, how to manage them, and what proper medical supervision looks like
    • Why these medications may need to be long-term treatment for chronic obesity

    Dr. Salas-Whalen shares her clinical experience treating thousands of patients and addresses the viral misinformation circulating online. She explains why obesity is a transgenerational disease influenced by genetics, environment, food accessibility, and even childhood trauma—not personal failure.

    Guest links:

    Articles

    Other Resources

    Books

    Episode Page Apple Extract Knowledge
    Published 2025-11-04

    Build Strength, Live Longer: The Menopause Longevity Blueprint with Dr. Vonda Wright

    Open

    What if weak bones and muscle loss aren't just "normal aging" but the result of decades of misinformation? In this episode, double board-certified orthopedic surgeon Dr. Vonda Wright joins Dr. Mary Claire Haver to shatter the myth that frailty, fractures, and decline are inevitable for women in midlife.

    Dr. Wright explains why women can lose up to 20% of their bone mass in just five years after menopause—and more importantly, what we can do to prevent it. She reveals how stress, inadequate nutrition, and neglecting strength training and hormonal health create the very outcomes we've been taught to accept as unavoidable.

    From the "musculoskeletal syndrome of menopause" that affects 70-80% of women (yet most doctors never discuss) to the science of building bones through strategic lifting, Dr. Wright provides the blueprint for aging with power instead of resignation.

    This episode also covers:

    • Why your bones are master communicators affecting your brain, metabolism, and more
    • The real story behind frozen shoulder and why it happens to women in perimenopause
    • How to lift weights for longevity
    • Why many women are diagnosed with osteoporosis only after they break something, when it's already too late
    • How estrogen loss drives chronic inflammation
    • Why nutrition, specifically foods that are rich in calcium, are better than calcium supplements to help strengthen bones

    Dr. Wright also shares her personal journey through perimenopause as an athlete and surgeon, and why she wrote her latest New York Times bestselling book Unbreakable.

    Guest links:

    Articles

    Other Resources

    Books

     

    Episode Page Apple YouTube Extract Knowledge
    Published 2025-10-28

    Menopause and Heart Disease: What Every Woman Needs to Know with Dr. Jayne Morgan

    Open

    What if your hot flashes are actually warning signs about your cardiovascular health? Dr. Mary Claire Haver sits down with research cardiologist Dr. Jayne Morgan to talk about the intersection of menopause and heart disease. Dr. Morgan explains why women present with different heart attack symptoms than men, how menopause accelerates cardiovascular risk, and why the medical system still isn't recognizing the connection. You'll learn what hot flashes reveal about stroke and heart disease risk, how arterial stiffening and blood pressure changes happen during the menopause transition, and why hormone therapy started early may be protective for your heart. Dr. Morgan shares which lab tests women should be getting, when to start screening for cardiovascular disease, and what lifestyle changes actually make a difference. She also discusses the role of statins, GLP-1s, and why research done primarily on men has led to treatments that may harm women. This conversation covers what every woman needs to know about protecting her heart through midlife and beyond.

    Guest links:

    Articles

    Other Resources

    Episode Page Apple Extract Knowledge