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E216
November 03, 2026
Menopause Masterclass: Recurrent UTIs and the Genitourinary Syndrome of Menopause (GSM)
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In this episode of unPAUSED, Dr. Mary Claire Haver delivers a solo masterclass on recurrent UTIs and genitourinary syndrome of menopause, or GSM, the condition once called atrophic vaginitis. Up to 80% of postmenopausal women experience it. Yet it remains the most undertreated condition of midlife, even though the treatment is inexpensive, safe, and highly effective.

Dr. Haver explains why GSM is far more than vaginal dryness. She walks through how declining estrogen and testosterone affect the vulva, vagina, clitoris, urethra, and bladder, and how that leads to painful sex, loss of arousal, delayed orgasm, urinary urgency, waking at night to urinate, and recurrent urinary tract infections. She also shares how she missed GSM in herself until a colleague asked her one simple question.

She breaks down how the Women’s Health Initiative, and a boxed warning that never belonged on low dose vaginal estrogen, kept generations of women from treatment. She explains what changed when the FDA moved to remove that warning in November 2025. She also makes the case that vaginal estrogen, not antibiotics, should be the first line approach to preventing recurrent UTIs after menopause.

She covers every treatment option, including vaginal estrogen cream, tablets, inserts, and rings and how to apply them correctly. She also discusses vaginal DHEA, an oral option for women who cannot use a vaginal product, and pelvic floor physical therapy. She explains why many women on systemic hormone therapy still need vaginal estrogen, how lubricants and moisturizers differ from true treatment, and why laser treatments should never come first.

The episode closes with answers to the questions patients ask most, including whether vaginal estrogen affects a partner, whether it is ever too late to start, and exactly what to say to a doctor to get a prescription. As Dr. Haver emphasizes throughout, common does not mean normal, and no woman has to just live with this.

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Chapters

00:00:00 – Why GSM can be more dangerous than you think
00:00:53 – The most undertreated condition in menopause
00:01:50 – What is genitourinary syndrome of menopause?
00:04:23 – The GSM symptoms even doctors can miss
00:07:07 – Vaginal, sexual, and urinary symptoms explained
00:09:28 – Why GSM isn't just a menopause problem
00:11:14 – How decades of estrogen fear affected treatment
00:14:23 – The FDA's vaginal estrogen warning reversal
00:18:47 – What hormone loss does to vaginal tissues
00:21:21 – Clitoral atrophy and changes in orgasm
00:22:37 – The overlooked cause of painful penetration
00:23:56 – Why GSM increases urinary problems and UTIs
00:26:18 – Vaginal estrogen as a frontline treatment
00:29:26 – How to apply vaginal estrogen correctly
00:31:28 – How long treatment takes to work
00:32:44 – Vaginal DHEA and other hormone treatment options
00:36:13 – Treating vestibular pain and pelvic floor dysfunction
00:38:19 – Why lubricants and moisturizers aren't enough
00:44:18 – Why so few women receive treatment
00:48:00 – Vaginal estrogen safety and common questions
00:49:14 – Do you need vaginal estrogen if you're on HRT?
00:50:10 – Is it ever too late to start treatment?
00:51:06 – How to ask your doctor for vaginal estrogen

About the guest

Dr. Mary Claire Haver

Dr. Mary Claire Haver, MD, FACOG, MSCP, is a board-certified OB-GYN and Menopause Society Certified Practitioner. She is the #1 New York Times bestselling author of The New Menopause, a book written to empower women with evidence-based menopause care, and the newly released New York Times Bestseller, The New Perimenopause: An Evidence-Based Guide to Surviving the Zone of Chaos and Feeling Like Yourself Again. She earned her medical degree from Louisiana State University Medical Center and completed her residency in Obstetrics and Gynecology at the University of Texas Medical Branch (UTMB), where she is now an Adjunct Associate Professor. 

In 2021, she founded The ‘Pause Wellness, a clinic committed to providing comprehensive menopause care. In 2023, she launched ThePauseLife.com, a trusted resource for women navigating menopause. She is also the host of the podcast unPAUSED with Dr. Mary Claire Haver, where she continues the conversation on women’s health, empowerment, and evidence-based care. 

A sought-after speaker and educator, Dr. Haver is a regular contributor to national media and has been featured in The New York Times , Forbes , The Today Show , CBS Mornings , and Oprah’s Menopause Revolution, and the 2025 TIME100 Creators List . Her social media presence has grown to more than 7 million followers, where she continues to demystify menopause with relatable, science-backed content.