The Tamsen Show

Episode: The Men's Guide To Menopause
Host: Tamsen Fadal
Date: October 10, 2025

Overview

In "The Men's Guide To Menopause," Tamsen Fadal, Emmy-winning journalist and best-selling author, delivers a direct, compassionate, and information-rich roadmap for men seeking to understand menopause and perimenopause, particularly as these transitions impact the women in their lives. Drawing on leading research and candid interviews with top doctors, neuroscientists, and menopause specialists, the episode breaks down the physical, emotional, neurological, and relational changes of menopause. Tamsen aims to equip men with the context, language, and empathy needed to support their partners, family members, and colleagues during this critical stage.

Key Discussion Points & Insights

Why This Matters: Setting the Stage

• Menopause affects everyone: Any man with a partner, mother, sister, or friend in their mid-30s to mid-50s is likely close to someone experiencing perimenopause or menopause.
• "Most men never get this far—not because they don’t care, but because no one’s ever told them that this matters. But it does." (Tamsen, [01:44])
• Menopause/perimenopause affects every aspect of a woman's health and well-being, with symptoms that are often invisible and misunderstood.

The Basics: What Men Were Never Taught

The Menopause Timeline

• Menopause is one day: the 12-month anniversary of a woman's last period.
• The major impact is in the years before—perimenopause—which can start as early as age 35 and last 4-10 years.
• Metaphor: Hormones are like a thermostat gone haywire—unpredictable surges and crashes impact brain, sleep, metabolism, mood, sex life, and confidence.

Women’s Experiences, in Their Words

• "The woman you know...suddenly seems overwhelmed by things that never used to bother her." (Tamsen, [01:44])
• “It can make her feel like she’s coming literally undone. That’s how I felt. And it came without warning.” (Tamsen, [05:43])

Symptom Deep-Dive: What Perimenopause Feels Like

Interview with Dr. Mary Claire Haver ([06:25])

• Most common symptoms (from a testimonial survey):
  • Hot flashes & night sweats (85.9%)
  • Weight gain/redistribution (82.4%)
  • Anxiety, depression, panic attacks (82.3%)
  • Sleep disturbances (81.7%)
  • Fatigue (80.6%)
• Lesser-known symptoms: sexual dysfunction, GI problems, brain fog, migraines, heart palpitations, changes in skin/hair/nails.
• Memorable quote:

  “This is perimenopause. We’re not even through the transition yet.” — Dr. Mary Claire Haver, ([07:16])

Systemic Misunderstanding & Medical Dismissal

Why Perimenopause Is So Confusing

Interview with Dr. Sharon Malone ([08:51])

• Perimenopause is a moving target—characterized by physical and emotional symptoms, often before periods stop.
• “Imagine it’s like having PMS every day...That is sort of what perimenopause is like.” — Dr. Sharon Malone, ([09:59])
• Menopause defined: When a year has passed without a period, but treatment should be based on symptoms, not just the calendar.
• There’s no definitive test—“Perimenopause is defined when you say it is when you are having symptoms and you are between the ages of 35 and 45.” ([11:21])
• Key message:

  “Menopause is inevitable. Suffering is not.” — Dr. Sharon Malone, ([12:44])

The Knowledge Gap in Medicine

Interview with Dr. Heather Hirsch ([16:45])

• Most doctors, even OB/GYNs, receive only about an hour of menopause education.
• Perimenopause/menopause is relevant for multiple specialties (urology, psychiatry), but little required training.
• "The pyramid’s completely upside down." — Tamsen, ([19:23])
• Takeaway: The system often fails women; men can help advocate for better care.

The Neurological Impact: Menopause and the Brain

Interview with Dr. Lisa Mosconi

• Up to 62% of peri- and post-menopausal women report decline in memory, attention, and language.
• “It’s the number one statement: ‘I don’t feel like myself’.” — Tamsen, ([24:28])
• Brain scans show a 30% drop in energy in the temporal cortex, linked to memory and cognition, as estrogen levels fall ([27:14]).
• Metaphor:

  "Estrogen is almost to the brain what fuel is to a car." — Dr. Lisa Mosconi, ([29:14])

• Brain fog often improves over time, but can be deeply unsettling and misunderstood.

Emotional & Relationship Toll

• Mood shifts, anxiety, and loss of confidence are common—sometimes mistaken for personal or relationship issues.
• “When she needs your support the most—not to be fixed, not to be avoided—just seen, understood, and met with care.” — Tamsen, ([31:27])

Sex & Intimacy: The Hidden Story

Interview with Dr. Kelly Casperson ([33:35])

• Physical changes: estrogen drop can thin and dry vaginal tissue, impacting pleasure and even anatomy.

  “Our labia minora...can literally vanish, absorbed, gone, because of hormone loss.” — Dr. Kelly Casperson, ([33:35])

• Painful sex is common but not ‘normal’; vaginal estrogen can help, even for many breast cancer survivors, but isn't widely discussed or offered.

  “We don’t have enough research? We have plenty of research. We have so much research. We have guidelines now.” — Dr. Kelly Casperson, ([37:10])

• Testosterone helps some women, but libido is complex—also connected to stress, safety, emotional connection.

Notable Candid Conversation

• Tamsen and guests share firsthand that libido and pleasure can return with the right treatment and support—not a simple fix and not only about hormones.

How to Support Her: Practical Steps for Partners

• Start by listening, not fixing—ask how you can support her, emotionally and physically.
• “When she feels off...she’s probably wondering if she’s still lovable inside of it.” — Tamsen, ([41:36])
• Sleep hygiene: critical for women’s wellbeing during menopause; support routines that improve rest.
  Dr. Shelby Harris ([42:24]) suggests:
  • Keep sleep/wake times consistent.
  • Don't over-focus on ‘perfect’ routines.
  • Seek evaluation if sleep remains poor after trying basics.

Simple Ways to Show Support ([43:23])

• Ask sincere, open questions: “Is there anything you’ve been dealing with lately that I haven’t noticed?”
• If in doubt, educate yourself first—download resources, watch documentaries, read the book “How to Menopause.”
• Don’t minimize her experience; acknowledge and validate her symptoms.

Notable Quotes & Memorable Moments

| Timestamp | Speaker | Quote | |-----------|---------|-------| | [01:44] | Tamsen | "Most men never get this far—not because they don’t care, but because no one’s ever told them that this matters. But it does." | | [05:43] | Tamsen | “It can make her feel like she’s coming literally undone. That’s how I felt. And it came without warning.” | | [07:16] | Dr. Haver | "This is perimenopause. We’re not even through the transition yet." | | [09:59] | Dr. Malone | “Imagine it’s like having PMS every day...That is sort of what perimenopause is like.” | | [12:44] | Dr. Malone | “Menopause is inevitable. Suffering is not.” | | [19:23] | Tamsen | "The pyramid’s completely upside down." (on how menopause is taught in med school) | | [24:28] | Tamsen | “It’s the number one statement: ‘I don’t feel like myself’.” | | [29:14] | Dr. Mosconi | "Estrogen is almost to the brain what fuel is to a car." | | [33:35] | Dr. Casperson | “Our labia minora...can literally vanish, absorbed, gone, because of hormone loss.” | | [37:10] | Dr. Casperson | “We have so much research. We have guidelines now.” (on safety of vaginal estrogen) | | [41:36] | Tamsen | “When she feels off...she’s probably wondering if she’s still lovable inside of it.” |

Action Items & Further Resources

• Listen without judgment or rushing to solutions
• Educate yourself: Download the free Men’s Guide to Menopause (linked in episode description)
• Start with sleep: Help her get better rest
• Show up: Let her know you care enough to learn, using practical, caring language
• Seek additional help: If symptoms are severe or persistent, support her in seeking specialized medical advice
• Explore further: Watch related episodes on hormone therapy, brain health, and navigating perimenopause

Important Timestamps

• [01:44] — Tamsen’s welcome and statement on why this matters
• [06:25] — Dr. Haver outlines common symptoms
• [08:51] — Dr. Malone explains perimenopause confusion
• [12:44] — Dr. Malone’s “inevitable, but not suffering” philosophy
• [16:45] — Dr. Hirsch on medical education gaps
• [22:24] — Dr. Mosconi discusses menopause and brain fog
• [33:35] — Dr. Casperson on anatomy and intimacy
• [42:24] — Dr. Harris on sleep strategies
• [43:23] — Tamsen’s practical guidance for men
• [Closing] — Tamsen’s encouragement to keep learning and be present

Tone and Style

The episode is pragmatic, empathetic, candid, and unwaveringly supportive. Tamsen Fadal and her guests blend medical expertise with personal anecdotes, always striving to validate both women's and men's experiences, offer real-world solutions, and remove stigma from this universal transition.

For More:

• Download the Men’s Guide to Menopause (see episode description)
• Explore related episodes (on hormone therapy, brain health, relationships)
• Follow The Tamsen Show for weekly, in-depth conversations on women’s health and midlife