The Tamsen Show

Host: Tamsen Fadal
Guest: Dr. Mary Claire Haver
Episode: Dr. Mary Claire Haver: The Perimenopause Symptoms No One Warned You About
Date: September 10, 2025

Episode Overview

In this compelling episode, Tamsen Fadal sits down with renowned OB/GYN and menopause specialist Dr. Mary Claire Haver to dissect perimenopause—the often misunderstood, under-researched precursor to menopause that affects every woman who lives long enough. Dr. Haver draws from her clinical expertise, personal journey, and new book, The New Perimenopause, to deliver the roadmap she wishes she’d had herself. She and Tamsen candidly explore why perimenopause remains a "zone of chaos," unrecognized by the medical community and rarely discussed openly, and urge listeners to recognize and address symptoms early. Raw, real, and packed with both empathy and actionable advice, this is essential listening for any woman approaching midlife.

Key Discussion Points & Insights

What Is Perimenopause? The Hormonal “Zone of Chaos”

• Defining Menopause and Perimenopause (06:36):
  • Medically, menopause is one year after your final period. Perimenopause is the unpredictable 4-10 year transition leading up to menopause.
  • During perimenopause, the hormonal system shifts from rhythm to chaos due to dwindling eggs and erratic brain-ovary communication.
  • Dr. Haver:

    "This system goes down fighting and these hormones go cattywampus… It’s the hormonal zone of chaos." (07:09)

Why Women Don’t Know About It

• Monumental Knowledge Gap in Medicine (11:14):

  • Vast disparity between the research focus on pregnancy vs. menopause; even less for perimenopause.
    • "If I type in the word ‘pregnancy’… 1.2 million articles… Menopause? About 98,000. Perimenopause? 6,800." — Dr. Haver (11:14)
  • Perimenopause wasn’t even recognized in medical literature until the 1980s.

• Systematic Dismissal and Gaslighting (16:52):

  • Dr. Haver reflects on the ingrained bias in medicine to psychologize women’s symptoms:

    “When you can’t figure it out and it’s a female, it’s most likely in her head.” (16:52)

    • She admits to once being part of the problem and is now dedicated to breaking the cycle.

When to Think About Perimenopause

• Timelines & Statistics (15:09):

  • Average menopause onset: Age 51; transition can begin in the late 30s to early 40s.
  • "It is completely reasonable for someone in their late 30s, certainly early 40s, almost statistically impossible by their late 40s that something in their body isn’t changing because of this hormonal chaos." — Dr. Haver (15:55)
  • Many women in active cycles with regular periods are still experiencing perimenopausal changes.

• Symptoms: More Than Hot Flashes (38:24):

  • Top symptoms (from Dr. Haver’s survey of thousands):
    1. Hot flashes/night sweats (85.9%)
    2. Weight gain/redistribution (82.4%)
    3. Anxiety/depression/panic attacks (82.3%)
    4. Sleep disturbances (81.7%)
    5. Fatigue (80.6%)
  • More: sexual dysfunction, bloating, digestion issues, brain fog, migraines, joint pain, palpitations, skin/hair/nail changes, dry eyes/mouth, urinary and allergy changes.
  • “This is perimenopause. We’re not even through the transition yet.” — Dr. Haver (39:19)

Why Doctors Miss It

• No Simple Test & Diagnosis of Exclusion (19:15):

  • "We don’t have a one time blood, urine or saliva test. Save your money." — Dr. Haver (19:17)
  • Diagnosis is clinical, after ruling out other causes.

• Training Gaps (20:42, 24:42):

  • Less than 8% of new graduates feel competent to manage menopause care.
  • “We are doing a disservice to women’s health… we’re really stopping female-specific medical education after reproduction.” — Dr. Haver (20:42)

Real-Life Impact of Dismissal

• Stories of Struggle (28:44):

  • Dr. Haver shares her own perimenopausal struggles:

    "I remember slamming on the brakes in the car...I’m not okay. What is wrong with me?" (28:44)

  • Validation: “It’s not your fault. Let’s get you some help… I’m trying to be the doctor I needed.” (31:24)

• Long-Term Consequences (39:34):

  • Unaddressed, perimenopause can contribute to osteoporosis, increased dementia risk, and even suicide.
  • “Fastest rate of bone loss in osteoporosis begins in perimenopause…We’re not checking you for bone loss until 20 years later.” — Dr. Haver (41:11)

Perimenopause and the Body — Key Physical Changes

• Uterine & Bleeding Patterns (43:42):
  • 90% experience dysfunctional uterine bleeding: “Only 10% skate through…” (44:01)
• Musculoskeletal Pain and Skin/Mucous Changes (44:28):
• Heart Palpitations (45:34):
  • 43% prevalence; often misattributed, leading to needless ER visits.
  • “No one…was taught to connect the dots that all of these things are perimenopause.” (45:34)
• Belly Fat & Metabolism (46:00):
  • Estrogen reduction increases inflammation, insulin resistance, and intra-abdominal fat even without lifestyle changes.
  • “We start driving fat to the intra-abdominal cavity with not a single change in diet or exercise.” — Dr. Haver (47:01)
• Eating Disorders Link (47:43):
  • Increase in binge eating during perimenopause due to physiological and mental health changes.

Cognitive & Mental Health Effects

• Brain Fog & Word Loss (31:40):

  • “We see shrinkage in the area of the brain where memory is stored...it’s the verbal memory that dips in perimenopause.” — Dr. Haver (31:47)
  • Symptoms can be mistaken for dementia or ADHD.

• Mental Health: More Than A Mood (34:19):

  • 40% increase in new-onset anxiety and depression.
  • Hormone therapy is often more effective than antidepressants for perimenopausal mood disruption:

    “They respond better to stabilizing their hormones…than they do with increasing their SSRI.” (34:19)

• “I Don’t Feel Like Myself” (36:05):

  • The most common, yet hardest for doctors to interpret, symptom.
  • An actual study calls this symptom “Not Feeling Like Myself” (NFL)—and recognizing it is a key diagnostic clue.

Perimenopause with Endometriosis & PCOS (51:39)

• Endometriosis: May experience symptom worsening or improvement; treatment must be nuanced due to tissue sensitivity.
• PCOS: Baseline hormonal dysfunction worsens with perimenopause, making symptoms and metabolic risks more complicated.

Sexual Function and Confidence (53:49)

• Libido changes are common, begin in midlife, and are multifactorial (pain, arousal, orgasmic disorders, desire).
• Treatment options now include two FDA-approved medications (Addyi, Vyleesi); testosterone may help but lacks FDA-approved female formulation.

Notable Quotes & Memorable Moments

• On the State of Research:

  "Is my life after I was done having children less, like 90% less important than it was when I was able to bear children?" — Dr. Haver (12:07)

• On Perimenopause Onset:

  "It is completely reasonable for someone in their late 30s, certainly early 40s, almost statistically impossible by their late 40s that something in their body is changing because of this hormonal chaos." — Dr. Haver (15:55)

• On Being Dismissed:

  "In medicine, when you can't figure it out and it's a female, it's most likely in her head." — Dr. Haver (16:52)

• On the Real Impact:

  "By the time they get to me, they're at their wit's end...These are women who had managed their lives...then all of a sudden they can't." — Dr. Haver (28:44)

• On Systemic Change:

  “I’m trying to be the doctor I needed.” — Dr. Haver (31:24)

• On Brain Symptoms:

  “Specifically, when they looked at different cognitive testing, it’s the verbal memory that dips in perimenopause with the hormonal chaos.” — Dr. Haver (31:47)

• On Dismissing Symptoms:

  “Pat her on the knee, take a vacation, get more sleep, lose weight, drink water, all the platitudes.” — Tamsen Fadal (37:19)

Timestamps of Key Segments

• 00:55 List of common symptoms – What perimenopause really feels like
• 06:36 What is perimenopause? Why do we have it?
• 11:14 The research gap and why women don’t know more
• 15:09 When does perimenopause start? Age ranges and signs
• 19:15 Why there’s no magic test for perimenopause
• 24:42 The problem with medical training and why clinicians miss the signs
• 28:44 Dr. Haver's raw personal account of perimenopause struggles
• 31:40 Brain fog and cognitive issues
• 34:19 Mental health consequences and hormone therapy vs. antidepressants
• 36:05 The “I don’t feel like myself” phenomenon
• 38:24 The five most common perimenopause symptoms
• 41:11 Osteoporosis risk and bone loss during perimenopause
• 43:42 Physical changes: Bleeding, pain, palpitations, belly fat, eating patterns
• 51:39 Perimenopause with endometriosis and PCOS
• 53:49 Sexual effects and new treatments
• 57:12 Tease for Part 2: Solutions and practical help

Tone & Language

The conversation is direct, empathetic, personal, and often humorous. Both Tamsen and Dr. Haver speak candidly—validating the lived experience, expressing frustration at systemic gaps, and maintaining an energetic, solution-focused outlook.

Takeaways

• Perimenopause is a universal, disruptive, under-recognized hormonal transition requiring far more research, education, and validation.
• Its symptoms are vast—well beyond hot flashes—and can begin in the late 30s.
• Most doctors are not trained to address it, and no simple lab test exists.
• Dismissal poses real health risks: mental health crises, osteoporosis, cardiovascular disease, and more.
• Recognizing "not feeling like yourself" can be the crucial cue to seek help.
• Solutions exist, and more are arriving with increased awareness and advocacy (to be covered in Part 2).

"We are gaslighting and dismissing these women. And I was part of the problem. And I’m done." — Dr. Mary Claire Haver (17:53)