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E145
July 07, 2026
Endometriosis and Fibroids Don't Stop at Menopause with Dr. Karen Tang
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In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Karen Tang, a board certified gynecologist and minimally invasive gynecologic surgeon, and author of It's Not Hysteria: Everything You Need to Know About Your Reproductive Health But Were Never Told. This is part one of a two part conversation. Together they take on a question that most women entering perimenopause have never been given the tools to answer: what happens to the gynecologic conditions you have been managing for years when your hormones start to shift?

Dr. Tang opens with endometriosis, dismantling two of the most persistent myths in gynecology: that it goes away after menopause, and that it is cured by pregnancy or hysterectomy. She explains what endometriosis actually is, why it so often goes undiagnosed for an average of seven years, why imaging studies frequently miss it, and what the full range of treatment options looks like for perimenopausal women dealing with painful periods, pelvic pain, and chronic inflammation, including when surgery is the right next step.

The conversation then moves to adenomyosis, which Dr. Tang calls the most common condition no one has ever heard of. She explains how it differs from endometriosis, why C-sections and other uterine procedures increase the risk, what the heavy bleeding and pain profile looks like across the perimenopause transition, and why it is so often the hidden culprit when estrogen therapy suddenly causes unexpected bleeding.

Dr. Tang and Dr. Haver then address uterine fibroids, covering who is most affected, why location matters more than size, how perimenopause can wake up fibroids that were previously silent, and what the full surgical landscape looks like from hysteroscopy and radiofrequency ablation all the way to hysterectomy. She and Dr. Haver also address the myth that women with fibroids or endometriosis cannot take hormone therapy, and walk through how estrogen and progesterone can be managed carefully so most women can access the treatment they need without being turned away at the door.

The episode also covers the staggering gap in NIH funding for women's reproductive health conditions and the accelerated ovarian aging associated with endometriosis.

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Chapters

00:00:00 – Why Endometriosis Is So Often Missed
00:02:02 – Meet Dr. Karen Tang
00:07:38 – Understanding Endometriosis
00:15:32 – Endometriosis Myths Debunked
00:22:14 – Adenomyosis Explained
00:29:08 – Endometriosis Treatments & HRT
00:42:08 – Surgical Menopause & Ovary Removal
00:47:28 – Everything You Need to Know About Fibroids
01:00:15 – Fibroid Treatment Options
01:11:00 – Final Takeaways

About the guest

Dr. Karen Tang

Dr. Karen Tang, MD, MPH, is a Columbia and Harvard-trained gynecologist and minimally invasive gynecologic surgeon who is an internationally recognized leader in reproductive health. As @KarenTangMD, she reaches millions of viewers with her educational videos about periods, pelvic pain, sex, and reproductive rights. She's the author of It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (but Were Never Told). Dr. Tang is a consultant for the WHO, and has been featured in the New York Times, the Washington Post, NPR, Forbes, Nightline, NBC News, among other media outlets. She lives in the Philadelphia area with her husband and three children.