Podcast Summary: unPAUSED with Dr. Mary Claire Haver

Episode: Can't Take Estrogen? Dr. Corinne Menn on Who Can, Who Can't & What's Changed
Date: December 2, 2025
Host: Dr. Mary Claire Haver
Guest: Dr. Corinne Menn

Overview:

This deeply personal and practical episode centers on the real-life complexities of managing menopause—especially for women who are breast cancer survivors, previvors, or have been labeled "high risk" and told they can’t take estrogen. Dr. Corinne Menn, herself a young breast cancer survivor and now an acclaimed menopause specialist, shares her journey from abrupt menopause in her twenties to national advocacy, mentorship, and pioneering telehealth collaborations. Together with Dr. Haver, she unpacks the evolving answers around hormone therapy, patient rights, the dangers of oversimplified medicine, survivorship quality, and the need for individualized, empathetic care.

Key Discussion Points & Insights

Dr. Menn’s Backstory and Medical Journey

• (05:47) Dr. Menn grew up in rural upstate New York, not initially drawn to science ("I was not the science girly…"). After several shifts in college, she opted for pre-med, driven by a desire for stability and independence.
• (08:48) She chose OB/GYN, feeling an early affinity for women's health.
• (09:30–15:54) Her mother’s ovarian cancer diagnosis and death—while Dr. Menn was in residency—shaped her personally and professionally. Just days before her mother’s death, Dr. Menn herself found a lump in her breast, which was later diagnosed as cancer.
• (16:37–20:41) She navigated options for breast surgery as a young patient, ultimately choosing a double mastectomy for peace of mind—despite initial advice against it. This experience underscored how young women’s needs are often overlooked or misunderstood.
• (21:09–33:04) Grappling with sudden menopause from chemotherapy, the emotional fallout, and a desire for motherhood, Dr. Menn pushed for and preserved embryos—groundbreaking at the time. She later was able to conceive and deliver her daughter, Ava, naturally.

Notable Quote:
"The very, very first thought was not that I was going to die, nothing. It was that I might never be a mom." — Dr. Corinne Menn [15:25]

The Survivor/Previvor Experience & Menopause in Young Women

• (37:08–38:45) Dr. Menn describes feeling “left in the dust” as a young cancer patient, both in terms of peer support and as a menopausal woman after treatments. She credits the Young Survival Coalition with giving her a community and lifeline.
• Many women report being told, “You can’t take estrogen,” then receive virtually no support for profound menopausal symptoms—ranging from hot flashes to sexual dysfunction to mental health struggles.
• (39:22–42:55) Oncologists, despite good intentions, often can’t provide individualized menopause or sexual health care due to system constraints and lack of training.

Notable Quote:
"My whole thing is: I want women to have their cake and eat it too. I want you to be treated for your breast cancer... but we need to find a way to make those treatments tolerable, to improve your quality of life." — Dr. Corinne Menn [42:00]

Patient Advocacy, Vaginal Estrogen & Quality of Life

• (43:42–45:45) Dr. Menn recounts a shocking real-life story where a patient was denied vaginal estrogen despite severe symptoms, demonstrating ongoing gaps and under-education among providers.
• Local vaginal estrogen for survivors is highlighted as a critical, low-risk intervention, with stories of patients unable to tolerate even basic exams due to atrophy.
• Addressing mental health, sexual functioning, and cognitive impacts of menopause is essential—these should be expected, predictable, and proactively managed.

Notable Quote:
“If you just take one or two of the bricks off that woman’s back, she could stand a little straighter and feel more like herself." — Dr. Corinne Menn [41:30]

Evolving Guidelines: Who Can and Who Can't Take Estrogen

• (55:25–56:31) Dr. Menn and Dr. Haver discuss absolute contraindications for estrogen therapy: unexplained vaginal bleeding, current estrogen-dependent breast cancer, recent blood clots, or active significant liver disease.
• Family history of breast cancer, hypertension, or high cholesterol are NOT contraindications for menopausal hormone therapy.
• Individualization matters: Many conditions (e.g., Factor V Leiden, history of blood clots) can be addressed with non-oral estrogen.
• (58:03–59:25) The “Weird Barbie” analogy: Medicine needs to move beyond treating only the “ideal” patient and recognize everyone is a “weird Barbie”—unique and deserving of tailored care.

Notable Quote:
“The biggest barrier we get is family history of breast cancer. That is not a contraindication.” — Dr. Corinne Menn [56:31]

The Hidden Toll: Early and Premature Menopause

• (59:32–60:56) 1 in 8 women lose ovarian function before natural menopause (under age 51), either surgically or due to treatment.
• Early loss of hormones dramatically increases risks of osteoporosis, cardiovascular disease, and is often poorly addressed.
• (61:00–62:45) Updated genetic testing is vital: Many women tested before 2013 may have mutations missed by older tests; Dr. Menn herself discovered a BRCA2 mutation years after her initial negative result.

Notable Quote:
"It is medical malpractice to remove somebody's ovaries prematurely and not have pre-op counseling, a pre-op plan." — Dr. Corinne Menn [60:32]

Changing the System: Communication, Education, and Shared Decision-Making

• (69:46–73:57) Medical communication has shifted: social media now plays a massive role in patient education. Dr. Menn encourages doctors to embrace this, see themselves as “medical communicators,” and help patients sort quality information.
• Collaboration with organizations (Menopause Society, ASCO) is improving, but medical training still lags behind patient needs.
• (74:26–75:14) Key resources for survivors & previvors:
  • menopauseandcancer.com
  • Young Survival Coalition
  • British Menopause Society’s guidelines
  • Emphasis on patient self-education and proactive advocacy

When Hormones Are Not an Option: What Else Helps?

• (76:30–79:24) Non-hormonal treatments (medications for hot flashes, sleep, mood) are available and important. Proactive management, using medications even temporarily, can dramatically improve quality of life.
• Lifestyle "pillars"—sleep, exercise, nutrition, social connection—are essential (sometimes women only realize this after being forced off HRT).
• New research and clinical trials (like MENOABC) aim to collect real-world data and broaden safe, individualized treatments for survivors.

Memorable Quotes & Moments

• "Menopause made me do it." — Dr. Corinne Menn [84:25]
• “Every woman, at some point in her life, is going to have to deal with something difficult within her health.” — Dr. Corinne Menn [83:13]
• “We’re all weird Barbies. We’re all unique.” — Dr. Corinne Menn [58:51]
• "Doctors make the worst patients.” — Dr. Mary Claire Haver [67:40]

Segment Timestamps (Topic Highlights)

• 02:45 — Dr. Menn’s patient-centered approach and philosophy
• 09:30–15:54 — Family history, personal cancer diagnosis, and emotional fallout
• 16:37 — Navigating surgery options and the meaning of survivorship
• 21:09 — Fertility preservation and the experience of chemo-induced menopause
• 23:22 — Mental health and menopausal symptoms during treatment
• 37:08 — Young Survival Coalition and needs of young survivors
• 42:00 — Advocating for quality of life, not just survival
• 43:42 — Local estrogen, GSM, and patient anecdotes
• 55:25 — Who can and cannot take estrogen: real contraindications
• 58:03 — "Weird Barbie" and the myth of the “perfect candidate”
• 59:32 — Early menopause and its underestimated prevalence
• 62:45 — Hormone replacement after risk-reducing surgery in BRCA carriers
• 64:26 — Study: sexual dysfunction and dissatisfaction with survivor care
• 69:46–73:57 — Push for better medical communication and patient empowerment
• 74:26–75:14 — Key survivor/previvor resources
• 76:30 — Non-hormonal strategies and lifestyle pillars
• 83:13 — Dr. Menn on “unpausing” her life and focusing on leadership

Resources & Recommendations

• For Survivors/Previvors:

  • Menopause and Cancer (comprehensive info and support)
  • Young Survival Coalition (community and advocacy)

• Guidelines:

  • British Menopause Society’s “Management of Estrogen Deficiency in Breast Cancer Survivors” (checklist for holistic management)
  • Menopause Society, ASCO, and NCCN position statements

• Books:

  • You Are Not Broken
  • The New Menopause Manifesto (recommended for hormonal education and self-advocacy)

• Further information and CME:

  • Dr. Menn’s website: drmenn.com
  • CME course: “Managing Menopause and Breast Cancer” at HeatherHirshAcademy.com
  • Dr. Haver’s resources: ThePauseLife.com, social handles, and The New Perimenopause (book)

Tone & Takeaways

Real, unfiltered, and empathetic—this is a conversation by survivors for women facing medical complexity, fear, and frustration with the status quo. Dr. Menn and Dr. Haver are frank about the brokenness of the system, the necessity of patient-empowerment, and the need for more up-to-date, compassionate, and personalized care—especially for those previously dismissed as "too complicated" for hormonal therapies.

Final Words:
“Every woman is dealing with their own challenge...I’m excited to empower women to not have to face the barriers that we all had to.”—Dr. Corinne Menn [83:13]

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