The Truth About Menopause That Medicine Keeps Getting Wrong

When two board-certified OB-GYNs with decades of clinical experience sit down and speak honestly about the state of women's healthcare, you pay attention. In a recent episode of unPAUSED, Dr. Mary Claire Haver and Dr. Suzanne Gilberg did exactly that, and the conversation was equal parts validating, infuriating, and hopeful. Here are the most important lessons women (and anyone who loves one) should take away.

1. The Healthcare System Was Not Built for Women

This is not a conspiracy theory. It is a structural reality. Dr. Gilberg explained that physician reimbursement is governed by something called a Relative Value Unit, or RVU, which is determined largely by a group that has historically been composed of male surgeons. The system pays for procedures performed with hands, not for the cognitive, relational, and longitudinal work of truly knowing a patient.

The downstream effect is stark. An orthopedic surgeon who places a pin in a broken leg earns dramatically more than an OB-GYN who manages a woman's prenatal care across nine months, attends a labor that may last 50 hours, and is responsible for two (or more) lives at once. Women's health work has been structurally devalued, and that devaluation shapes who gets time, attention, and thorough care.

2. Perimenopause Is Where Menopause Was Three Years Ago

Most people now understand that menopause is a significant hormonal transition. Far fewer understand that the decade leading up to it, called perimenopause, is often where the real turbulence begins. Dr. Gilberg described it as a "low, prolonged puberty" characterized by one defining feature: a loss of resilience, on every level.

Emotional, physical, psychological, and spiritual resilience all erode during this period. Sleep fractures. Mood shifts. Joints ache. Anxiety surfaces. And because clinicians are not taught to recognize it and rarely have the time to explore it. Women are frequently handed prescriptions for sleeping pills, antidepressants, anti-anxiety medications, and treatments for conditions like fibromyalgia, which is often simply perimenopause in disguise.

The lesson: if you are in your late 30s or 40s and you feel like a different version of yourself, perimenopause deserves a place in the conversation.

3. Women Having Babies Over 40 Are Often Simultaneously in Perimenopause

One of the most underreported overlaps in women's health is the collision of late-in-life pregnancy and perimenopause. More women over 40 are having babies than ever before, yet the medical system is not connecting the dots. A 42-year-old with a newborn who cannot sleep through the night even when the baby does, who is consumed by anxiety and mood instability, may not simply be exhausted from new motherhood. She may be perimenopausal, and those two hormonal realities compound each other in ways science has barely begun to study.

For years, women in this situation were likely reassured that their exhaustion was simply the price of having a baby later in life, when the fuller picture was far more complex. The research is not there yet, but the lived experience absolutely is.

4. Moral Injury Is Different from Burnout, and It Is Driving Physicians Out of Medicine

Burnout is exhaustion. Moral injury is something deeper. It is the distress that comes from being forced to make clinical decisions that conflict with your own ethical standards, day after day, visit after visit. When a physician knows what a patient needs but the system structurally prevents her from providing it, that is moral injury.

Dr. Gilberg feels strongly that this is the main driving factor behind physicians leaving the practice of medicine.The United States is on track to face a deficit of approximately 86,000 physicians within the next decade. The solution is not telling doctors to be more resilient. It is reckoning with a system that asks them to practice medicine in ways that harm both patient and provider.

5. If You Keep Going to the Hardware Store, You Will Never Find Milk

One of the most practical pieces of advice in this conversation was this: if your clinician does not understand perimenopause or menopause, it may simply not be in their toolkit. Not because they are bad doctors, but because medical education has not prioritized it. The responsibility, frustratingly, falls on women to recognize when they have reached the limits of what a particular provider can offer and to seek someone whose expertise actually matches their needs.

Shopping for the right clinician is not complaining or being difficult. It is self-advocacy, and in this moment in healthcare, it may be the most important health skill a woman in midlife can develop.

6. Time Is Not a Luxury. It Is the Medicine.

The transformation that comes from leaving high-volume, insurance-driven practice is striking for many medical professionals. Clinicians who make that shift and begin spending 45 minutes to an hour with each patient describe it as a revelation.The clinical outcomes shift. Lab results are ordered thoughtfully and actually followed up on. Patients disclose things they have never told anyone, including histories of abuse, disordered eating, and substance use, things with enormous health consequences that simply never surface in a seven-minute appointment.

When doctors have the ability to sit back and listen, it becomes possible to get all the information you need and more. Connection is not a soft bonus in medicine. It is the mechanism through which accurate diagnosis and meaningful care actually happen.

7. Ancient Medicine and Modern Medicine Are Not Opposites

Dr. Gilberg trained in Ayurvedic medicine alongside her conventional OB-GYN career, and she made a compelling case for expanding what counts as evidence in healthcare. Over 30 percent of modern pharmaceuticals are derived from plants. Cooking herbs like rosemary and oregano have documented antimicrobial properties. Herbs like Vitex (Chaste Berry) and Siberian rhubarb have meaningful evidence supporting their use in perimenopause.

This is not an argument against pharmaceutical medicine. It is an argument for intellectual humility and a wider toolkit. The Flexner Report of 1910, which standardized American medical education, also shut down most schools that taught women, trained Black physicians, or incorporated natural medicine into their curricula. The legacy of that moment narrowed medicine in ways we are still reckoning with.

8. Women Have Always Found Ways to Heal Each Other

One of the most galvanizing topics to surface was a look back at the history of female healers. Midwives and healers in the Middle Ages were among the only women permitted to travel independently. They moved through communities, listened, shared knowledge, and quietly held the health of entire villages together, often while being marginalized or worse.

The parallel to today is not subtle. Women are gathering online, comparing notes, demanding better care, and pushing information into mainstream conversation that the medical establishment had largely ignored. That is not new. That is a very old form of collective intelligence finally finding a megaphone.

The Bottom Line

The healthcare system as it currently exists is not built to see women fully, and it is also not built to sustain the clinicians who want to care for them properly. 

Awareness is where change starts. Acknowledging that perimenopause is real and often misdiagnosed, time with your clinician, knowing that you are allowed to leave a practice that is not serving you, and believing that women's bodies and life stages deserve the same research attention as any other population, are not small things. They are the foundation of a different kind of healthcare, one that is already being built, one practice at a time.

For more of Dr. Haver’s conversation with Dr. Gilberg, listen to unPAUSED wherever you get your podcasts or watch the full episode on YouTube.