unPAUSED with Dr. Mary Claire Haver

Episode: Menopause Masterclass: Your Complete Guide with Dr. Mary Claire Haver

Date: January 6, 2026
Host: Dr. Mary Claire Haver

Episode Overview

Dr. Mary Claire Haver kicks off a season of unfiltered menopause education with her first solo “Ask Me Anything.” This Menopause Masterclass demystifies the biology, symptoms, systemic effects, and treatments related to menopause. Through listener questions and her own story, Dr. Haver provides practical, evidence-based guidance for women navigating perimenopause, menopause, and postmenopause. The tone is candid, compassionate, and empowering, aiming to help women reclaim their healthspan.

Key Topics & Insights

1. Definitions: Menopause & Its Stages

Timestamps: 01:25–11:00

• Menopause Defined: Medically, menopause is “one year after your last menstrual period.” Issues arise when periods are irregular, absent due to interventions, or not easily trackable (e.g., with an IUD or hysterectomy).

• Why Menopause Happens: Women are born with all their eggs, which decline steadily from the womb onward via atresia (a natural “survival of the fittest” process).

• Egg Numbers Decline:

  • Birth: ~1-2 million eggs.
  • Puberty: ~120,000 eggs.
  • Age 30: ~10% of original supply.
  • Age 40: ~3% remains.

• Ovulation Mechanism: Starts in the brain (hypothalamus/pituitary) responding to estrogen levels, sending signals (FSH/LH) to the ovaries.

• Perimenopause: The ovaries grow resistant to brain signals, leading to hormonal chaos. Brain fog, mental health changes, and “just not feeling like myself” are often earlier signs than cycle changes.

  “The first sign that we see in perimenopause is not cycle dysregulation...it is brain fog, mental health changes, and sometimes just feeling, ‘I don’t feel like myself.’” (Dr. Haver, 10:45)

• Postmenopause: Everything after that one “menopause day” constitutes postmenopause—which can last decades.

2. Estrogen’s Systemic Effects & Menopause Symptoms

Timestamps: 11:50–19:30

• Estrogen Receptor Mapping: Estrogen affects more than reproductive organs—there are receptors in the brain, heart, bones, liver, joints, and beyond.
• Extensive Symptom List: Dr. Haver emphasizes that symptoms can span the body, including mental health, joint pain, cardiovascular shifts, sleep disruption, and even “heightened hearing” (“My husband chewing is absolutely intolerable to me at this point.” – 19:20).
• Timeline: Perimenopause often starts 7–10 years before periods stop—symptoms in your mid-30s or later are normal.

3. Menopause & Weight Gain: What Really Happens

Timestamps: 20:00–25:30

• Body Composition, Not Just Weight: While general weight gain may be more about aging than menopause per se, the menopause transition triggers loss of muscle and a dramatic increase in visceral (belly) fat.
• Statistics:
  • Premenopause: Visceral fat ~8% of total body fat.
  • Postmenopause: 20–23%, almost tripling without changes in diet or exercise.
• Why the Belly Fat? Loss of estrogen removes anti-inflammatory protection, leading to greater inflammation and more fat storage in the abdomen—a “negative feedback cycle.”
• Additional Risks: Increased LDL (bad cholesterol), decreased HDL (good cholesterol), and rising insulin resistance and risk of diabetes.
• Hormone Therapy Benefit:

  “A woman with prediabetes who is started on hormone therapy in perimenopause has a 50% decreased risk of developing full diabetes versus a woman not on HRT.” (Dr. Haver, 25:00)

4. Mental Health Changes: Anxiety, Mood, and Brain Fog

Timestamps: 31:00–36:00

• Hormonal Impact: Estrogen, progesterone, and testosterone regulate neurotransmitters like serotonin and dopamine. Their decline and fluctuation can trigger anxiety, depression, and cognitive changes—even in previously well-controlled individuals.

• Treatment Paradigm: Hormone therapy should be the first-line intervention for mental health changes in perimenopause, not antidepressants.

  “If you are treating depression…in perimenopause, we want to stabilize from hormones with menopause hormone therapy. First line therapy should be hormone therapy.” (Dr. Haver, 32:50)

• Provider Education Gap: Only 8% of OBGYN residents feel competent treating menopause, and most clinicians lack menopause-specific training. Patients may need to educate their own doctors.

5. Genitourinary Syndrome of Menopause (GSM): Vagina, Vulva & Bladder

Timestamps: 36:15–46:40

• Estrogen Loss Effects: The vagina and surrounding tissues become thin, dry, lose elasticity, and are prone to injury, recurrent UTIs, and decreased sexual function.

• Vaginal Estrogen:

  • “Skin care for down there.” (Dr. Kelly Casperson via Dr. Haver, 40:55)
  • Local, not systemically absorbed; safe for almost all women, including many breast cancer survivors.
  • Prevents UTIs (reduces sepsis/mortality risk) and preserves sexual function.

• Personal Story: Dr. Haver shares her own (and her “minnow bestie’s”) experience with delayed orgasm and how vaginal estrogen corrected it.

  “I myself, as a menopause expert…did not realize my delayed orgasms could be a sign of GSM. Within a month of using [vaginal estrogen], the situation had rectified itself.” (Dr. Haver, 42:40–44:00)

• Lubricants vs. Moisturizers: Lubricants (vitamin E, silicone- or oil-based) for intimacy; moisturizers (hyaluronic acid) for daily hydration and protection—especially after physical activity.

• Alternatives:

  • Prasterone: Converts to estrogen/testosterone locally in the vagina.
  • Ospemifene: Oral SERM (selective estrogen receptor modulator), acts as estrogen in vaginal tissue but not in breast.

• Safety: No studies have shown increased breast cancer recurrence risk with vaginal estrogen; data even suggest greater longevity in survivors who use it.

6. Hormone Therapy: Myths, Methods, and Best Practices

Timestamps: 48:10–67:45

• Provider Discrepancies: Get guidance from menopause-trained clinicians, not those selling alternative therapies (e.g., chiropractors pushing supplements).
• Many Hormone Therapy Types: Not a “one size fits all” approach; beware of clinics offering only pellets (expensive, higher risk, invasive, and may involve misleading claims).

  “You can get bioidentical, FDA-approved, tested, excellent hormone therapy at Walgreens for $25 a month.” (Dr. Haver, 50:10)

• Do You Have to Do Hormone Therapy? No. Women on hormone therapy tend to live 2–3 years longer and have better bone/cardiovascular health, but, “You absolutely can be healthy without it. But it does get harder.” (Dr. Haver, 51:40)

a. Estrogen

• Main form given is estradiol (chemically identical).
• Other forms: estrone (from peripheral tissue), estriol (from placenta, mostly in pregnancy).

b. Progesterone

• Given if you have a uterus (protects from thickening/cancer when using estrogen).
• Also improves sleep and anxiety for many. Some forms may cause anxiety in 10–15% of women; alternatives available.

c. Testosterone

• Historically overlooked as a “male hormone” but vital for libido, muscle mass, and well-being in women.
• Dosing in the US typically uses men’s testosterone gels at much smaller doses for women (no FDA-approved female product yet).
• Personal story: Testosterone restored Dr. Haver’s interest in sex (“within a month, my husband got cuter…” 63:00–64:10), even though she didn’t meet the formal criteria for treatment.

7. Age, Safety, and Duration of Hormone Therapy

Timestamps: 68:00–75:20

• Bone Protection: Estrogen protects bones as long as you use it; stopping eliminates that benefit.

• Cardiovascular Disease: Estrogen is protective against new heart disease if started within 10 years of menopause or before age 60.

  “If you start [hormone therapy] close to menopause, within 10 years or before the age of 60, you’ll decrease the risk of a first heart attack as much or more than a statin.” (Dr. Haver, 70:50)

• No Expiry Date: No age is “too late” to start or continue; safe as long as benefits outweigh risks.

  “There is no end date. There is no date at which you have a shelf life and you must stop hormone therapy. That is a misnomer and it is fully supported by the Menopause Society.” (Dr. Haver, 74:20)

• Lifestyle Still Matters: Hormone therapy is one tool. Diet, exercise, sleep, and stress management remain essential for optimal health.

Notable Quotes

• On Menopause Education Gaps:

  “We’re doing a terrible job educating our clinicians about menopause and mental health. Actually, we’re doing a terrible job educating them about menopause and anything.” (Dr. Haver, 34:15)

• On Safe Use of Vaginal Estrogen:

  “Let me just stop that nonsense right here and now. There is no elevated risk of recurrence for a patient to use vaginal estrogen—even in active breast cancer patients, even in survivors.” (Dr. Haver, 45:40)

• On Hormone Therapy Mindset:

  “The goal is not to make women younger. This is not a ‘get your wife back’ moment… this is medication meant to restore a balance that your body is missing.” (Dr. Haver, 50:55)

• On Personal Hormone Preference:

  “My choice, my decision, based on my knowledge, is I will continue to enjoy the benefits of hormone therapy for as long as possible—and as long as I don’t develop a contraindication. I may die with an estradiol patch on.” (Dr. Haver, 75:10)

Segment Timestamps at a Glance

• Definitions & Physiology: 01:25–11:00
• Estrogen’s Systemic Effects: 11:50–19:30
• Weight Gain & Body Composition: 20:00–25:30
• Mental Health Changes: 31:00–36:00
• Genitourinary Syndrome of Menopause: 36:15–46:40
• Hormone Therapy (Overview & Options): 48:10–67:45
• Age, Safety, and Duration: 68:00–75:20

Summary Takeaways

• Menopause is a life phase affecting nearly every organ system—not just the reproductive tract.
• Symptoms are diverse, often starting with mental health/cognitive changes well before periods stop.
• Estrogen’s protective effects wane with menopause, increasing risks for cardiovascular disease, diabetes, osteoporosis, and quality-of-life symptoms.
• Hormone therapy is safe and effective for many women, especially if started near menopause; local vaginal estrogen should be considered by almost everyone, and it is critically underused.
• Myths about hormone therapy and menopause care are rampant—even among clinicians. Find a provider with true expertise.
• Lifestyle and mindset remain crucial pillars in thriving through midlife and beyond.

For more information, research citations, and individualized care, visit Dr. Mary Claire Haver on Instagram (@rmaryclair) or at thepAUSelife.com.

(This masterclass is educational. For personal medical advice, consult a qualified provider.)