The Tamsen Show – Perimenopause Explained: Dr. Mary Claire Haver on Hormones, Sleep, and Mental Health

Date: October 8, 2025
Host: Tamsen Fadal
Guest: Dr. Mary Claire Haver

Episode Overview

In this episode, Tamsen Fadal sits down with Dr. Mary Claire Haver, a leading menopause specialist, to provide a comprehensive roadmap for women navigating perimenopause. The discussion dives deep into hormonal changes, sleep disruption, mental health, nutrition, bone health, sexual wellness, and effective advocacy with healthcare providers. The episode emphasizes practical solutions—from hormone therapies to lifestyle interventions—and addresses common misconceptions, empowering women to reclaim their health and well-being during this pivotal transition.

Major Discussion Points & Insights

1. Perimenopause: When to Start Thinking About It

• Key Point: Start learning immediately, even if you’re not symptomatic yet.
• "I would really focus on educating your about the process so you aren’t blindsided when this inevitable change happens to you." — Dr. Mary Claire Haver (03:18)

2. Sleep Struggles

• Hormonal Impact: Loss of estrogen leads to disrupted sleep (hot flashes, night sweats, palpitations).

• Even with perfect hormone therapy, women may experience poor sleep due to aging and lifestyle factors.

• Non-hormonal Tools: Cognitive Behavioral Therapy for Insomnia (CBTi), magnesium (preferably L-threonate or bisglycinate), L-theanine, low-dose melatonin (0.3–0.5 mg).

• "Progesterone affects GABA in our brain... helps relax things and calm us down and gives us better sleep." — Dr. Mary Claire Haver (05:45)

• Memorable Quote:
  “We still have to guard our sleep with our lives in perimenopause.” — Dr. Mary Claire Haver (03:57)

• Timestamps:

  • Role of Sleep: (03:37–06:25)
  • Supplements and Strategies for Sleep: (06:25–08:04)

3. Mental Health and Emotional Well-being

• Highest Risk: Suicide rates peak for women aged 45-55—directly overlapping with perimenopause.

• Interventions: Stabilizing hormones with transdermal estradiol is now shown to be more effective for perimenopausal depression/anxiety before jumping to antidepressants.

• Therapy and behavioral interventions are also critical.

• "The most common time for a woman to commit suicide... is between 45 and 55. And what is happening to most women in that time span? Because it’s perimenopause." — Dr. Mary Claire Haver (10:09)

• Timestamps:

  • New approaches to mental health: (09:10–11:43)

4. Nutrition, Body Composition, and Belly Fat

• Shift Focus: Away from calories/size to supporting bones and muscles with adequate protein (1.3–1.5g per kg, nearly double FDA’s minimal recommendation), micronutrients, and quality protein choices.

• Animal proteins provide complete profiles; plant-based options require thoughtful combinations.

• Dr. Haver: “Bones and muscles weigh a lot. We want big, heavy ones, big, juicy ones." — (13:04)

• Timestamps:

  • Nutrition Deep Dive: (12:02–15:38)

5. Low Libido and Sexual Wellness

• Approach: Identify root cause (relationship, pain, dryness) and address barriers first.

• Treatments:

  • Testosterone supplementation (careful dosing critical; not about reaching male levels!).
  • Non-hormonal prescription options (Addyi, Vyleesi)—both target dopamine/mood centers in the brain.

• Pellet Controversy: Overdosing with testosterone pellets can lead to irreversible side effects and is not recommended; safer alternatives (Androgel, compounded creams) exist.

• Memorable Quote:
  "We have two classes of medications that are actually really, really helpful." — Dr. Mary Claire Haver (17:21)

• Timestamps:

  • Libido solutions & testosterone: (16:53–24:53)

6. Hormone Therapy: When and What to Consider

• Birth Control vs MHT: Birth control uses higher doses of synthetic hormones; menopause hormone therapy (MHT) is a microdose and often bioidentical, safer, and more tailored to symptom management.

• Misconceptions: Many clinicians are comfortable with long-term birth control but avoid MHT without medical reason.

• Oral vs. Transdermal: Oral forms elevate clotting risks, while transdermal (patch, gel) are much safer, especially for those at higher thrombotic risk.

• Eligibility: Most women are candidates except those with hormone-sensitive tumors or active clotting risk (oral route).

• "It is a microdose compared to the birth control pill." — Dr. Mary Claire Haver (28:34)

• "Believe women. [Menopause] is diagnosed by symptoms." — Dr. Mary Claire Haver (32:23)

• Timestamps:

  • MHT and switching from birth control: (25:35–33:21)
  • Eligibility, risks, and forms of hormone therapy: (29:59–32:19)

7. Bone Health: Building and Maintaining Strength

• Critical Window: Late 20s–30s is peak bone density; menopause accelerates bone loss. Early interventions essential.

• Top 3 Changes: Lift weights, do jump training, improve balance (e.g. with weighted vests or single-leg balance during routines).

• Notable Quote:
  "Lift weights. Lift weights. Jump training." — Dr. Mary Claire Haver (34:54)

• Supplement with adequate protein, creatine, and vitamin D.

• Timestamps:

  • Protecting bones: (34:39–36:44)

8. Vaginal Estrogen and Genitourinary Syndrome of Menopause (GSM)

• Underutilized Solution: Vaginal estrogen is the number one treatment for recurrent UTIs and GSM; it’s safe even for breast cancer survivors and acts locally, not systemically.

• Lack of Knowledge: Too many clinicians recommend only lubes and dismiss symptoms.

• Dramatic Benefits: Can restore vaginal tissue, reduce infection and improve quality of life significantly.

• "100% of women will have GSM... I will grow back your vagina." — Dr. Mary Claire Haver (40:04 & 42:20)

• Timestamps:

  • Vaginal estrogen explainer: (39:26–43:19)

9. Advocating for Yourself in the Doctor’s Office

• Find a Menopause-Educated Provider: Not all OB/GYNs or PCPs are updated on current menopause care.

• Pre-visit: Track cycles, waist-hip ratio, cholesterol, vitamin D, and symptoms. Book a dedicated appointment (not just as an add-on to annual well-woman exams).

• Bring Resources: Menopause Society guidelines can help educate providers.

• Ask Directly: If your provider prescribes hormone therapy regularly but not universally (neither extreme is a good sign).

• Notable Quote:
  "You cannot just walk into any primary care doctor or OB GYN's office and, and expect them to have been able to keep up with all of the education on this." — Dr. Mary Claire Haver (33:21)

• Timestamps:

  • Advocacy tips: (43:19–46:49)

10. Exciting Developments & Future Directions

• Research Gaps: Lack of ongoing large-scale studies and political will for women’s health in the US.

• Promising Advances: Some states improving coverage, efforts to prolong natural hormone production, ongoing push for FDA-approved testosterone for women.

• Cultural Shift: More awareness, more open conversation, more women empowered to seek answers.

• Timestamps:

  • Research and future directions: (46:49–48:37)
  • Final reflections and impact: (48:22–49:04)

Notable Quotes & Moments

• On Starting Perimenopause Conversations Early:
  “Immediately.” — Dr. Mary Claire Haver, when asked when women should start caring about perimenopause (00:57, 25:35)
• On Pellets and Overmedicating:
  “You are stuck with that… you’re basically stuck with this for months until it wears off. And I just think we can do better.” — Dr. Mary Claire Haver (22:06)
• On Systemic vs. Vaginal Estrogen:
  "It's just for your vagina… We can cut rates of UTIs and therefore urosepsis by up to 50%." — Dr. Mary Claire Haver (40:46)
• On Self-Advocacy:
  “You’re giving an opportunity that you may be able to educate your clinician…” — Dr. Mary Claire Haver (44:06)

Practical Takeaways

• Sleep: Address with hormones if hot flashes are present; otherwise, CBTi, magnesium, low-dose melatonin, L-theanine.
• Mental Health: Rule out and treat hormonal imbalances first; therapy is always valuable.
• Nutrition: Prioritize sufficient protein (especially complete proteins), micronutrients, and balance for bone and muscle health.
• Sexual Health: Testosterone or non-hormonal Rx may help, but proper dosing and delivery method are critical.
• Hormones: Most women are good candidates for MHT; start thinking about it early; consider your personal risk factors and discuss with a trained provider.
• Bone Health: Strength training, jumping, balance, and adequate supplementation (vitamin D, creatine).
• GSM/Vaginal Estrogen: Ask for it sooner for prevention, not just treatment—it's underutilized and very safe for most.
• Doctor Talks: Prepare in advance; seek out or educate your provider if needed; bring symptom lists, labs, ask specifics about their menopause experience/certification.

This episode is a valuable, action-oriented discussion packed with medical expertise, personal stories, and advocacy advice—essential listening for any woman in or approaching midlife.

For free resources and guides from Tamsen: tamsenfadell.com/howtoperimenopause