An estimated 7.2 million Americans age 65 and older are currently living with Alzheimer's dementia. The part that should alarm every woman listening is this: almost two thirds of them are women. In this episode, Dr. Mary Claire Haver sits down with neurophysiologist and Alzheimer's researcher Dr. Louisa Nicola to unpack what's really happening to women's brains during perimenopause and menopause and what we can do about it. Louisa Nicola is a neurophysiologist, human performance coach, and founder of Neuro Athletics, a consulting firm that works with elite athletes and high-level professionals to optimize brain health and performance. A former world class triathlete, she transitioned into neuroscience and earned her Master of Medicine in neurophysiology from the University of Sydney. Dr. Nicola is currently pursuing her doctorate studying the effects of resistance exercise on brain health. She focuses on optimizing brain function and longevity, particularly in women, through sleep, nutrition, and exercise interventions. Dr. Nicola reveals how Alzheimer's disease doesn't suddenly appear at 70 but starts quietly in our thirties and forties, building up over a 30-year progression. She explains what's happening in the brain as amyloid beta proteins and tau tangles accumulate, why the hippocampus is the first area to go, and the critical role that sleep plays in clearing these proteins through the glymphatic system. The conversation explores why women are more predisposed to tau protein accumulation than men and how estrogen, progesterone, and prolactin inhibit the enzyme that causes tau proteins to become hyperphosphorylated and toxic. Dr. Nicola explains the connection between declining estrogen during perimenopause and increased Alzheimer's risk, including how estrogen helps mediate glucose metabolism in the brain, supports synaptic connections, and why the loss of this hormonal scaffolding leaves women vulnerable to cognitive decline. Guest links: Louisa Nicola (Instagram) Louisa Nicola (Facebook) Louisa Nicola, MMed, PhD(c) (LinkedIn) Louisa Nicola (YouTube) Louisa Nicola (X) Neuro Athletics The Neuro Experience Podcast (Apple Podcasts) The Brain Code Books “Joyspan,” by Dr. Kerry Burnight To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

In this episode Dr. Mary Claire Haver is joined by Dr. Rachel Rubin, a board-certified urologist and nationally recognized expert in sexual medicine, fellowship trained in both female and male sexual health. As assistant clinical professor of urology at Georgetown University and former education chair of the International Society for the Study of Women's Sexual Health, she brings unique insight into the stark disparities in how sexual dysfunction is treated across genders. Dr. Rubin founded the Sexual Medicine Research Team, and her advocacy work has been instrumental in changing FDA labeling on hormone therapy and advancing the American Urological Association Guidelines on genital urinary syndrome of menopause. During the conversation, Dr. Haver and Dr. Rubin explore the intersection of menopause, hormones and women's sexual health, revealing why most doctors, including OB-GYNs, receive virtually no training in sexual health despite sexual dysfunction affecting millions of women. Dr. Rubin explains how men's sexual health benefits from 27 fellowship programs while women's sexual health has only three, and why erectile dysfunction research receives billions while female orgasm research gets nothing from the NIH. She breaks down the complete anatomy of the clitoris that most medical professionals never learned, explaining why understanding this matters for surgical outcomes, pleasure, and treating conditions like vulvar vestibule pain that affects penetration, tampon use, and pelvic exams. Dr. Rubin discusses how the vulvar vestibule, the hormone sensitive tissue surrounding the urethra, becomes a source of pain for many women during perimenopause, on birth control pills, or postpartum due to low estrogen and testosterone. Guest links: Dr. Rachel Rubin (Instagram) Dr. Rachel Rubin (YouTube) Dr. Rachel Rubin (Website) Dr. Rachel Rubin (LinkedIn) Dr. Rachel Rubin (Facebook) Dr. Rachel Rubin (X) Books “Vagina Obscura: An Anatomical Voyage Hardcover,” by Rachel E. Gross Articles Sexual function after hysterectomy according to surgical indication: a prospective cohort study (Sexual Health) The human cervix: Comprehensive review of innervation and clinical significance (Clinical Anatomy) Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves (Brain Research) The Impact of Glucagon-like Peptide-1 Receptor Agonists on Erectile Function: Friend or Foe? (Biomolecules) Effect of Saw Palmetto Extract on Erectile Dysfunction and Libido in Patients with Lower Urinary Tract Symptoms Because of Benign Prostatic Obstruction (International Journal of Applied Research on Medicinal Plants) “Not feeling like myself” in perimenopause — what does it mean? Observations from the Women Living Better survey (Menopause) Updates on Therapeutic Alternatives for Genitourinary Syndrome of Menopause: Hormonal and Non-Hormonal Managements (Journal of Menopausal Medicine) Menopausal Hormone Therapy and Cardiovascular Diseases in Women With Vasomotor Symptoms: A Secondary Analysis of the Women’s Health Initiative Randomized Clinical Trials (JAMA Internal Medicine) To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

In this continuation of their conversation, Dr. Jocelyn Wittstein and Dr. Mary Claire Haver shift from understanding why menopause affects bones and joints to what actually works for building stronger bones and preventing fractures. If you've been told your bone density is declining, or you're worried about falls and fractures, this episode delivers the practical protocols you need. Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor at Duke University specializing in sports medicine and the female athlete across the lifespan. She's also a former collegiate gymnast and mother of five. Her research focuses on frozen shoulder, ACL injuries in female athletes, and the musculoskeletal syndrome of menopause. As president of the Forum for Women in Sports Medicine, Dr. Wittstein is changing how we understand the intersection of hormones, movement, and independence in women's bodies. They tackle the questions women ask most. How much exercise is enough? What types build bone? Is jumping necessary? They discuss the LIFT More trial and EFOPS trial, research showing women in structured exercise programs had fifty percent reduction in fracture risk, even as bone density eventually declined. This reveals something crucial: preventing fractures goes beyond bone density numbers alone. Guest links: Jocelyn Ross Wittstein, MD (Duke Health) Jocelyn Wittstein, MD (Instagram) Duke Female Athlete Program Milken Institute Women’s Health Initiative Books:“The Complete Bone and Joint Health Plan: Help Prevent and Treat Osteoporosis and Arthritis,” by Dr. Jocelyn Wittstein and Sydney Nitzkorski, MS, RD To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

If you've ever struggled to put on a bra, reach behind your back, or lift your arm without searing pain in your shoulder, you're not alone. Frozen shoulder strikes women in midlife at alarming rates, yet for decades, medicine dismissed it as a mystery condition with no known cause. Orthopedic surgeon Dr. Jocelyn Wittstein saw what others missed: her patients with frozen shoulder were almost all women between forty and sixty, experiencing hot flashes, night sweats, and other symptoms of perimenopause and menopause. What she discovered is changing how we understand the impact of declining estrogen on women's joints, bones, and muscles. Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor at Duke University, specializing in sports medicine and the female athlete across the lifespan. She's also a former collegiate gymnast and mother of five. Her research focuses on frozen shoulder, ACL injuries in female athletes, and the musculoskeletal syndrome of menopause. As president of the Forum for Women in Sports Medicine, Dr. Wittstein is changing how we understand the intersection of hormones, movement, and independence in women's bodies. In this conversation, Dr. Mary Claire Haver and Dr. Wittstein explore how declining estrogen during perimenopause and menopause impacts joints, bones, muscles, and connective tissue. They discuss why frozen shoulder disproportionately affects women in midlife, with some Asian cultures having their own term for it that translates to fifty year shoulder. Dr. Wittstein explains the critical window for treatment, why early intervention can be transformative, and how hormone replacement therapy may prevent it, with preliminary data suggesting women using systemic estradiol have half the risk of developing frozen shoulder. She shares why physical therapy during the inflammatory phase can worsen it and how to recognize the early warning signs. Guest links: Jocelyn Ross Wittstein, MD (Duke Health) Jocelyn Wittstein, MD (Instagram) Duke Female Athlete Program Milken Institute Women’s Health Initiative Books“The Complete Bone and Joint Health Plan: Help Prevent and Treat Osteoporosis and Arthritis,” by Dr. Jocelyn Wittstein and Sydney Nitzkorski, MS, RD To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Award-winning British television creator Sally Wainwright joins Dr. Mary Claire Haver to discuss her groundbreaking new BBC series Riot Women, a drama about five midlife women who form a punk rock band while navigating menopause, aging parents, and the complexities of life after 50. Sally, the creative force behind acclaimed series including Happy Valley, Gentlemen Jack, and Last Tango in Halifax, shares how her own experience with perimenopause and menopause inspired the show and why she calls this life stage "identity theft." The conversation explores Sally's journey from bus driver to one of British television's most celebrated showrunners, her commitment to portraying authentic female characters who carry grief, desire, sexuality, rage, and resilience in bodies that reflect actual lived experience, and how brain fog, joylessness, and depression led her to finally try hormone replacement therapy after initially believing outdated myths about breast cancer risk, and how that decision transformed her wellbeing. Dr. Haver and Sally discuss the critical importance of naming menopause symptoms, from the devastating loss of motivation and confidence that can accompany hormonal changes to the sandwich generation pressures of dementia care for aging parents while raising teenagers. The episode examines why female stories, particularly those featuring women over 50, face funding challenges in entertainment, how male writers have historically constructed female characters through the male gaze, and why Sally believes women are more heroic and emotionally articulate than men. They explore the revolutionary aspects of Riot Women, including its honest portrayal of sexual health, libido changes, medical gaslighting, and the transformative power of HRT, rarely if ever depicted on screen with such nuance and optimism. Sally discusses audience response to the series, including an unprecedented volume of thank-you letters to the BBC from viewers who felt seen for the first time, men's surprising embrace of the show despite its focus on female experience, and a handful of critics who complained about the absence of "nice men" despite the show's ensemble of complex, flawed characters of all genders. This conversation offers validation for anyone navigating the physical and emotional challenges of perimenopause and menopause, inspiration for creative midlife reinvention, and hope that entertainment is finally beginning to tell the truth about women's lives with the honesty, ferocity, humor, tenderness, and rage they deserve. Guest links: Sally Wainwright (Instagram) Sally Wainwright (IMDB) Articles Menopausal Hormone Therapy and the Breast: A Review of Clinical Studies (Breast Care) Anhedonia: A Concept Analysis (Archives of Psychiatric Nursing) Other Resources Primary Ovarian Insufficiency in Adolescents and Young Women (American College of Obstetricians and Gynecologists) Riot Women (BBC) Clips from Riot Women: 251105_RiotWomen_Ep1_Clip_Satisfaction_Bug.mp4 251105_RiotWomen_Ep1_Clip_WithAttitude_Bug.mp4 251105_RiotWomen_Ep1_Clip_RiotWomen_Bug.mp4 251105_RiotWomen_Ep1_Clip_OneMenopausalWomanToAnother_Bug.mp4 251105_RiotWomen_Ep1_Clip_ForTheRefugees_Bug.mp4 To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Dr. Elizabeth Comen is a board certified oncologist at NYU Langone Health, co-director of the Mignoni Women's Health Collaborative, and author of the groundbreaking book "It's All In Her Head: What It Reveals About Medicine's Past and Present." In this powerful conversation about medical gaslighting and women's healthcare, she and Dr. Mary Claire Haver trace the deep roots of medical misogyny and reveal why the healthcare system still dismisses women's symptoms today. Dr. Comen shares the story of a breast cancer patient on her deathbed who, hours from death, apologized for sweating during a hug. It's a moment that captures what nearly every woman experiences in a doctor's office, the reflexive apology for being in a normal human body. Whether it's apologizing for leg hair in stirrups or hiding underwear during an exam, women have internalized tremendous shame about their bodies. Dr. Comen explains this isn't random. It's the legacy of a medical system built by men who dismissed women's pain and symptoms as hysteria, neurosis, or anxiety. Through meticulous research into medical history, Dr. Comen reveals how this medical gaslighting became embedded in healthcare. She discusses William Osler, one of cardiology's founding fathers, who described women's chest pain as "neurotic angina" and wrote that "these women do not die." Yet heart disease is the number one killer of women. She explains how women are twice as likely to call an ambulance for their husband's heart attack than for themselves, and when they do seek help for chest pain, they're far more likely to be misdiagnosed with a panic attack instead of receiving proper cardiac care. Dr. Haver and Dr. Comen discuss the systemic healthcare gaps across medical specialties: why 80% of autoimmune diseases affect women yet it's not considered a women's health field, why female specific surgeries are reimbursed at significantly lower rates than comparable male procedures, why Alzheimer's disease is twice as common in women but received almost no research funding, and how the legacy of dismissing women's sexual health continues in breast cancer and oncology care today. They explore bizarre historical medical fears like "bicycle face," the myth that women would become ugly and infertile from exercise, and how plastic surgery evolved to make women "marriage material" rather than serve their actual health needs. Despite the sobering history of medical misogyny, this conversation ends with hope. Dr. Comen shares why she's optimistic about the cultural shift happening in women's healthcare now, the importance of women advocating for themselves in medical settings, and how the next generation doesn't have to wait for menopause to stop apologizing and start demanding better healthcare. Guest links: Dr. Elizabeth Comen Dr. Elizabeth Comen (Instagram) Dr. Elizabeth Comen (LinkedIn) Dr. Elizabeth Comen, MD (NYU) Books “All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today,” by Dr. Elizabeth Comen “The New Menopause,” by Dr. Mary Claire Haver“The New Perimenopause: An Evidence-Based Guide to Surviving the Zone of Chaos and Feeling Like Yourself Again,” by Dr. Mary Claire Haver To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Dr. Mary Claire Haver breaks down everything you need to know about perimenopause, menopause, and postmenopause in this solo episode, answering critical questions about hormones, symptoms, and treatment with the medical expertise and personal experience that's made her a trusted voice for millions of women. Most women don't realize perimenopause can begin at 35-36 years old, a full seven to ten years before periods stop. Dr. Haver explains why the first signs are often brain-related: fog, anxiety, feeling like "something's not right," rather than physical changes. Menopause itself is just one day (one year after your last period), but postmenopause represents 30-50 years of life without ovarian hormones. Understanding these three phases changes everything about how women can navigate this transition. In this episode, Dr. Haver answers questions like: What is menopause and when does it really start? Why am I gaining weight around my middle even though my diet hasn't changed? Why am I suddenly experiencing anxiety and depression? What changes happen to the vagina and bladder? What are my hormone therapy options? And what about testosterone, do I need it? With estrogen receptors mapped throughout the body, Dr. Haver reveals how declining hormones affect nearly every system. She lists over 40 potential symptoms beyond hot flashes: frozen shoulder, elevated cholesterol, insulin resistance, joint pain, kidney stones, even heightened hearing. Understanding the biology of how your hypothalamus frantically signals ovaries that can't respond explains why menopause impacts so much more than your cycle. She also explains why visceral belly fat triples during this transition regardless of diet and exercise changes, and what that means for long-term health. Dr. Haver shares a revealing statistic: only 8% of OB-GYN residents feel competent treating menopause, and 77% receive zero menopause training. She explains what doctors should know but often don't: hormone therapy as first-line treatment for mental health changes in perimenopause, prophylactic vaginal estrogen for all perimenopausal women (considered safe even for many breast cancer patients), no mandatory stop date for hormone therapy when benefits outweigh risks, and affordable bioidentical options that exist beyond expensive pellets. This episode arms you with knowledge to find menopause-educated clinicians, recognize quality care, and demand treatment that actually works. As Dr. Haver emphasizes throughout the episode, no woman should suffer unnecessarily when safe, effective options exist. Articles: When zero doesn’t mean zero: the limits of coronary calcium in women (Dr. Peter Attia) Guest links: Mary Claire Wellness The ‘Pause Life Dr. Mary Claire Haver (Instagram) Dr. Mary Claire Haver (YouTube) Books “The New Menopause,” by Dr. Mary Claire Haver Other Resources The Menopause Society The Women’s Health Initiative Dr. Kelly Casperson Dr. Corinne Menn To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Divorce rates for people over 50 have doubled since the 1990s, and women are initiating the majority of them. What's really driving this shift? In this episode of unPAUSED, Dr. Mary Claire Haver sits down with family law attorney and broadcaster Jenny Hutt to discuss the facts, finances, and fallout of midlife divorce. Jenny Hutt is a family law attorney specializing in divorce and mediation in New York, and she spent two decades as a broadcaster on SiriusXM. She's one of Dr. Haver's earliest supporters, and she brings both personal experience and professional insight to this conversation about a controversial topic relating to women's health: the connection between menopause and divorce. Dr. Haver and Jenny start with the facts: the statistics behind gray divorce, why women are initiating most of them, and what's really happening beyond the oversimplification of "dry vagina" causing divorces. They discuss feeling unsupported, undervalued, and reaching a breaking point after years of caregiving. They also dive into finances: what every woman should know about her money whether she's thinking about divorce or not, the three things to do if you're considering divorce, the difference between mediation and legal representation, how to protect inheritance, and the details around a postnuptial agreement. They also address the financial reality that women's household income drops 41% on average after divorce compared to 23% for men. Finally, they explore the fallout: the stress on the sandwich generation of caring for aging parents while raising children, how trauma strains marriages, rebuilding identity after a long marriage, the shame women feel, and why the other side of divorce can bring unexpected peace and freedom. Guest links: Jennifer Hutt  Just Jenny Podcast (Apple Podcasts) Jennifer Koppleman Hutt (Wisselman Harounian Family Law) Jenny Hutt (e-mail) Jenny Hutt (Instagram) Other Resources U.S. Divorce Rates Down, Marriage Rates Stagnant From 2012-2022 (U.S. Census Bureau) Women More Likely Than Men to Initiate Divorces, But Not Non-Marital Breakups (American Sociological Association) Books“The Galveston Diet: The Doctor-Developed, Patient-Proven Plan to Burn Fat and Tame Your Hormonal Symptoms,” by Dr. Mary Claire Haver To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

What happens when a news anchor loses her words on live television and discovers it's not stress, but menopause? Emmy Award-winning journalist Tamsen Fadal joins Dr. Mary Claire Haver to share why she walked away from her dream job in pursuit of changing the conversation around women's health, the powerful story behind her New York Times bestselling book How to Menopause, and her groundbreaking PBS documentary The M Factor. Tamsen spent 30 years in broadcast journalism without saying the word "menopause" on air—not once. Then perimenopause hit. Brain fog made her skip words on the teleprompter. A hot flash so severe during a live newscast left her sweating and pale, eventually forcing her off the set entirely. Despite erratic bleeding, insomnia, and mounting symptoms, doctor after doctor missed the diagnosis. But once she understood what was happening, she couldn't stop talking about it. She co-produced The M Factor: Shredding the Silence on Menopause with three other women, self-funding the documentary after she was told there was no audience. The trailer went viral. PBS picked it up. Over 1,000 community screenings followed in 43 countries. Dr. Haver and Tamsen reflect on meeting at their first menopause conference, the moment they both realized how little training doctors receive, and why this work feels like a calling. Guest links: Tamsen Fadal The Tamsen Show “The (M) Factor” Documentary Tamsen Fadal (Facebook) Tamsen Fadal (YouTube) Tamsen Fadal (LinkedIn) Tamsen Fadal (Instagram) Tamsen Fadal (TikTok) Books “How to Menopause,” by Tamsen Fadal “The New Menopause,” by Dr. Mary Claire Haver “The Galveston Diet,” by Dr. Mary Claire Haver “The Wisdom of Menopause,” by Dr. Christiane Northrup “The Menopause Manifesto,” by Dr. Jen Gunter This episode covers: Why many women are prescribed antidepressants for hot flashes instead of hormone therapy Growing up with a mother who suffered through surgical menopause in silence The fear of HRT and what finally changed Tamsen's mind Writing a book publishers said had "no audience" and then hitting the New York Times bestseller list Why the Women's Health Initiative headlines continue to harm women decades later Walking away from a 30-year career as a primetime news anchor to focus on menopause advocacy The "shelf life" for women in journalism and ageism in media Her new documentary Before the Pause focusing on perimenopause Why millennials are approaching menopause differently than Gen X Finding community, purpose, and a second act in midlife Articles The North American Menopause Society recommendations for clinical care of midlife women (Menopause)The Estrogen Dilemma (Time Magazine) To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

In our last episode of unPAUSED, we began a conversation with Dr. Lauren Streicher about orgasm, sexual function, and why these topics are still so taboo. Because there was so much to talk about, we decided to make this a two part episode. So today, Dr. Mary Claire Haver continues this conversation. Dr. Streicher is a professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, the host of Dr. Streicher's Inside Information Podcast, and the creator of Come Again, a 30 episode audio series on sexuality and sexual function. She's been at the forefront of sexual medicine for decades, pushing conversations forward that most clinicians still avoid. In this episode, we're diving into why vibrators work when nothing else does and what the research shows about vibration versus other types of stimulation. Dr. Streicher explains non-hormonal arousal creams, CBD oil for the clitoris, and whether these products actually help. We discuss the role of neurotransmitters in orgasm and walk through the FDA-approved libido drugs Addyi and Vyleesi, including why testosterone is often the preferred option for women and why pellets are problematic. Dr. Streicher breaks down the orgasm gap between men and women and explains why it actually narrows with age. She walks us through her clinical approach when a patient comes in struggling with orgasm, why pain must always be addressed first, and how to find a sexual medicine expert. We also talk about what gives her hope for the future of this field and why not every woman needs to have an orgasm for sex to be pleasurable and successful. Guest links: Dr. Streicher Dr. Streicher (Instagram) Dr. Streicher’s Inside Information: Menopause, Midlife, and More (Apple Podcasts) Lauren Streicher - Faculty Profile (Northwestern Medicine) Dr. Streicher (YouTube) Subscribe to COME AGAIN: Sexuality and Orgasm DrStreicher.com/comeagain Use code UNPAUSED20  for 20% off (This code expires Dec 23)  Dr. Streicher's  Podcast Dr. Streicher’s  Inside Information: Menopause, Midlife and More DrStreicher’s Substack https://drstreicher.substack.com/ Gyne Hacks! (Including how to How to Get a Hands-free Free Vulvar View) Books: “Slip Sliding Away: Turning Back the Clock on Your Vagina,” by Dr. Lauren Streicher “Hot Flash Hell-A Gynecologist's Guide to Turning Down the Heat (Dr. Streicher's Inside Information),” by Dr. Lauren Streicher “The Essential Guide to Hysterectomy: Advice from a Gynecologist on Your Choices Before, During, and After Surgery,” by Dr. Lauren Streicher “Sex Rx: Hormones, Health, and Your Best Sex Ever,” by Dr. Lauren Streicher “She Comes First: The Thinking Man's Guide to Pleasuring a Woman,” by Dr. Ian Kerner “The New Perimenopause,” by Dr. Mary Claire Haver To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices