In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Fran Haydanek, a board certified OB/GYN and host of the podcast I Did My Own Research, to sort out when brain fog, anxiety, and fatigue point to perimenopause and when they point to something else. A big part of the answer lies in a woman’s history. Women whose mood shifted with earlier hormone changes, from severe PMS and PMDD to depression after pregnancy, face a much higher risk of depression during the menopause transition. The issue is not abnormal hormone levels but how the brain responds to fluctuating hormones, a pattern called reproductive hormone sensitivity, and knowing that history means mood swings in midlife never have to catch a woman off guard. These changes can also appear with no prior history at all, and hormone therapy and antidepressants can be used together.

Dr. Haver and Dr. Fran explain why no single blood test can diagnose perimenopause, why irregular periods, hot flashes, and night sweats are often the first clues, and why booking a separate problem visit, rather than raising concerns at the annual well woman exam, gets you the time you need. They walk through the Zone of Chaos, when follicles dwindle and estrogen swings unpredictably, then go head to toe through perimenopause symptoms like hair loss, insomnia, heat intolerance, palpitations, and joint pain, along with the conditions that can mimic them, including low iron, thyroid disease, sleep apnea, and burnout.

Other topics include why a ferritin test matters for women with heavy periods or fatigue, why a history of gestational diabetes or preeclampsia should shape heart and metabolic screening in midlife, and what it means when symptoms persist despite treatment. They close with practical ways to find a menopause trained clinician and a case for every clinician who cares for women being ready to treat menopause and prescribe vaginal estrogen.

Guest links:

• Dr. Fran Haydanek
  
• Dr. Fran Haydanek (YouTube)
  
• Dr. Fran Haydanek (Threads)
  
• Dr. Fran Haydanek (Facebook)
  
• Dr. Fran Haydanek (TikTok)
  
• Dr. Fran Haydanek (Instagram)
  
• I Did My Own Research (Apple Podcasts)

Recommended Books:

• “The New Perimenopause,” by Dr. Mary Claire Haver
  
• “The New Menopause"⁠ by Dr. Mary Claire Haver

Articles:

• Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018 (CDC, Morbidity and Mortality Weekly Report)
  
• The association between postpartum depression and perimenopausal depression: A nationwide register-based cohort study (Maturitas)
  
• Major Depression During and After the Menopausal Transition: Study of Women’s Health Across the Nation (SWAN) (Psychological Medicine)
  
• The risk of depression in the menopausal stages: A systematic review and meta-analysis (Journal of Affective Disorders)
  
• Effects of Hormone Therapy on Cognition and Mood in Recently Postmenopausal Women: Findings from the Randomized, Controlled KEEPS–Cognitive and Affective Study (PLOS Medicine)
  
• Effectiveness of electro-press needle for menopause-associated hot flashes: Protocol of a randomized controlled trial (Medicine)
  
• Prevalence of Iron Deficiency and Iron-Deficiency Anemia in US Females Aged 12–21 Years, 2003–2020 (JAMA)
  
• Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis (The BMJ)
  
• Hypertension in Pregnancy and Postpartum: Current Standards and Opportunities to Improve Care (Circulation)
  
• Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women: A Scientific Statement From the American Heart Association (Circulation)

Other Resources:

• Women’s Health Initiative
  
• Study of Women’s Health Across the Nation (SWAN)
  
• Surprising Signs & Symptoms Of Menopause (The ’Pause Life)