This episode of unPAUSED was recorded live at the Wiltern Theater in Los Angeles in front of an audience gathered to talk about perimenopause, menopause, hormones, sex, brain health, and bone health. Dr. Mary Claire Haver is joined on stage by Dr. Rena Malik, a board certified urologist, pelvic medicine specialist, and sexual health expert, for a wide ranging conversation about what is actually happening in women's bodies during the menopause transition, and what every woman navigating midlife health should know.

The conversation moves through the zone of chaos that is perimenopause, the hormonal unpredictability behind mood changes, sleep disruption, brain fog, and rising inflammation. Dr. Haver traces how estrogen loss drives increases in cholesterol, insulin resistance, and cardiovascular risk, and explains why the fastest rate of bone loss happens in perimenopause, two years before a woman's final period, making a bone density baseline in your forties, not your sixties, the smarter move against osteoporosis later in life.

They spend significant time on the legacy of the Women's Health Initiative, walking through how a small, non-significant signal in one arm of a thirty thousand person study became the number one medical news story of 2002 and set women's health back more than two decades. Dr. Haver describes her own shift from fear of prescribing hormone replacement therapy to becoming one of its most vocal advocates, and both doctors push back on the idea that women need to wait until they are fully menopausal to start the conversation with their clinician.

The two also talk candidly about sex: pain, arousal, and libido as three distinct and treatable problems, the role of vaginal estrogen and testosterone, and Dr. Haver's own experience starting testosterone for muscle mass and noticing an unexpected benefit to her libido. They close by encouraging women to look critically at where their health information is coming from, and to demand real answers from their doctors rather than accept dismissal as normal.

The episode ends with a live audience Q&A covering topics including hormone therapy after ten symptom-free years, hot flashes and night sweats, heart palpitations, GLP-1s combined with HRT, crepey skin, and how to talk with teenage daughters about what's ahead.

Guest links:

• The ‘Pause Life
  
• The ‘Pause Wellness
  
• Dr. Mary Claire Haver (Instagram)
  
• Dr. Mary Claire Haver (Facebook)
  
• Dr. Mary Claire Haver (YouTube)
  
• Dr. Mary Claire Haver (Substack)
  
• unPAUSED (Apple Podcasts)

Books:

• “The New Perimenopause: An Evidence-Based Guide to Surviving the Zone of Chaos and Feeling Like Yourself Again,” by Dr. Mary Claire Haver
  
• “The New Menopause,” by Dr. Mary Claire Haver
  
• “Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women's Well-Being and Lengthen Their Lives -- Without Raising the Risk of Breast Cancer,” by Dr. Avrum Bluming

Articles:

• Human Ovarian Reserve from Conception to the Menopause (PLOS One)
  
• Menopause and Mental Health (Journal of Midlife Health)
  
• Exploring the Feasibility of Estrogen Replacement Therapy as a Treatment for Perimenopausal Depression: A Comprehensive Literature Review (Medicina)
  
• National Use of Postmenopausal Hormone Therapy Annual Trends and Response to Recent Evidence (JAMA)
  
• Higher Serum Free Testosterone Concentration in Older Women Is Associated with Greater Bone Mineral Density, Lean Body Mass, and Total Fat Mass: The Cardiovascular Health Study Get access Arrow (JCEM)
  
• Endogenous testosterone concentrations and muscle mass, strength and performance in women, a systematic review of observational studies (Clinical Endocrinology)
  
• Effects of Resistance Exercise on Bone Health (Endocrinology and Metabolism)
  
• The Effect of Resistance Training on Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis (Healthcare)
  
• Optimal resistance training parameters for improving bone mineral density in postmenopausal women: a systematic review and meta-analysis (Journal of Orthopaedic Surgery and Research)
  
• Change in 1-year mortality after hip fracture surgery over the last decade in a European population (Archives of Orthopaedic and Trauma Surgery)
  
• Skeletal site-specific effects of jump training on bone mineral density in adults: a systematic review and meta-analysis (Journal of Sports Sciences)
  
• Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis (The BMJ)
  
• A New Hope for Woman with Vasomotor Symptoms: Neurokinin B Antagonists (Journal of Clinical Medicine)
  
• Vasomotor Symptoms During Menopause: A Practical Guide on Current Treatments and Future Perspectives (International Journal for Women’s Health)
  
• Skin, hair and beyond: the impact of menopause (Climacteric)
  
• Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use (Menopause)

Other Resources:

• Women’s Health Initiative
  
• What Women Need to Know (BHOF)
  
• The 2022 hormone therapy position statement of The North American Menopause Society
  
• Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association
  
• Dr. Corinne Menn (Instagram)
  
• Dr. Kelly Casperson (Instagram)
  
• Dr. Rachel Rubin (Instagram)
  
• Dr. Suzanne Gilberg (Instagram)
  
• Dr. Sharon Malone (Instagram)