unPAUSED with Dr. Mary Claire Haver

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Natalie Crawford, double board certified obstetrician, gynecologist, and reproductive endocrinologist, and author of The Fertility Formula. In part two of this conversation, Dr. Crawford gets specific about the forces working against our hormones every day, chronic stress, disrupted sleep, inflammatory food, and the endocrine disrupting chemicals most women have never been warned about. She explains how cortisol triggers insulin resistance, how insulin resistance drives inflammation and ovarian dysfunction, and why resistance training and building skeletal muscle is one of the most direct interventions a woman can make at any age, including perimenopause. On sleep, she makes the case that it is the single most under addressed factor she sees clinically, explaining how FSH and LH are released in the early morning hours and why disrupted sleep directly interferes with ovulation, estrogen, and progesterone production. The conversation also covers anti-inflammatory nutrition and gut health, the difference between unscented and fragrance-free, why forever chemicals and phthalates are disrupting the hormone system from inside most women's homes, birth control timing and uterine lining recovery, and what egg freezing actually is and is not, and who it is most likely to benefit. Guest links Natalie Crawford, MD Natalie Crawford, MD (Instagram) Natalie Crawford, MD (TikTok) Natalie Crawford, MD (Facebook) Natalie Crawford, MD (YouTube) Natalie Crawford, MD (LinkedIn) Books “The New Perimenopause,” by Dr. Mary Claire Haver “The New Menopause,” by Dr. Mary Claire Haver “The Fertility Formula,” by Dr. Natalie Crawford To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Michelle Gordon, a board certified obesity medicine physician and diplomate of the American College of Lifestyle Medicine, with surgical fellowships from the American College of Surgeons and the American College of Osteopathic Surgeons. Through her practice Thrive Span Medical, she works with midlife women across 39 states whose metabolic and hormonal symptoms have been dismissed as normal aging. Dr. Gordon opens by dismantling the calories in, calories out framework, not as a vague wellness talking point but on a physiological level. She explains why biology determines the burn rate, why fat oxidation drops by 32% in perimenopause, why visceral fat accumulation accelerates when estrogen declines, and why insulin resistance and leptin resistance make it nearly impossible for midlife women to lose weight through willpower alone. She also covers how sleep deprivation compounds all of it, creating a cycle of cravings, brain fog, and weight gain that most women are navigating without any clinical support. Guest links: Michelle E. Gordon, DO (LinkedIn) Dr. Michelle Gordon (Instagram) Dr. Gordon, Obesity Medicine (Substack) Dr. Michelle Gordon (Facebook) Dr. Michelle Gordon Dr. Michelle Gordon (TikTok) Dr. Michelle Gordon Dr. Michelle Gordon (YouTube) 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 HaverWeightless: A Doctor's Guide to GLP-1 Medications, Sustainable Weight Loss, and the Health You Deserve,” by Dr. Rocio Salas-Whalen For full show notes, please click here. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Tony Youn, board certified plastic surgeon, bestselling author of Younger for Life, and the most followed plastic surgeon on social media. In part two of this conversation, Dr. Youn moves from skincare into devices, lifestyle, and the bigger picture of how women can think about aging and anti-aging without getting swept up in the extremes. Dr. Youn walks through the most commonly asked about in-office treatments, explaining what each one actually does and where the limitations are. He covers IPL for hyperpigmentation and sun damage, fractional CO2 lasers and how they differ from older more aggressive approaches, chemical peels and how depth determines results, and radiofrequency microneedling including what it can realistically achieve and where it falls short. He also addresses at-home devices, covering red light therapy and what the studies actually show about collagen and elastin, and what to look for in a dermal stamper. Guest links: Anthony Youn, MD Tony Youn, MD (Instagram) Doctor Youn (TikTok) Dr. Anthony Youn (Facebook) Doctor Youn (YouTube) The Doctor Youn Show (Apple Podcasts) Books “The New Perimenopause,” by Dr. Mary Claire Haver “The New Menopause"⁠ by Dr. Mary Claire Haver“Younger for Life: Unlocking the Secrets of Longevity, Nutrition and Self-Care for a Youthful Life,” by Anthony Youn ⁠"Playing God"⁠ by Anthony Youn ⁠"The Age Fix" ⁠by Anthony Youn ⁠"In Stitches"⁠ by Anthony Youn For full show notes, please click here. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

In this episode of unPAUSED, Dr. Mary Claire Haver answers your most asked questions about hormone therapy, menopause symptoms, and how to advocate for yourself when your doctor doesn't have answers. She walks through who actually qualifies for HRT, what the real contraindications are versus conditions that simply require a different delivery method, and how to think about continuing estrogen, progesterone, and testosterone therapy after 60. Dr. Haver explains the estrogen patch absorption problem, with research showing that up to 20 percent of women on transdermal therapy never reach physiologic estradiol levels regardless of dose. She breaks down SHBG, the protein that can bind your hormones and render them inactive even when your numbers look adequate on paper, and walks through what optimal estradiol levels look like for bone density and osteoporosis prevention specifically. Books: “The Complete Bone and Joint Health Plan: Help Prevent and Treat Osteoporosis and Arthritis,” by Jocelyn Wittstein“The New Perimenopause,” by Dr. Mary Claire Haver Resources: Women’s Health Initiative Estradiol (University of Rochester Medical Center) Meet Dr. Heather Hirsch Alloy Health Midi Health Menopause Quiz Lab Test Checklist Blueprint to close the women's health gap For full show notes, please click here. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Most women go through decades of marriage, menopause and midlife without ever having an honest conversation with a doctor about their sex life. Not because they don't want one — but because most physicians were never trained to have it. This week on unPaused, Dr. Mary Claire Haver sits down with Dr. James Simon, a professor of obstetrics and gynecology at George Washington University, board-certified OB-GYN, reproductive endocrinologist, and certified sexual counselor with more than 800 published papers in menopause and sexual medicine. Dr. Simon is a past president of the International Society for the Study of Women's Sexual Health (ISSWSH) and one of the most published clinicians in modern menopause care. Dr. Simon has spent his career treating what most doctors never address — the full picture of how sex, desire, pain and intimacy change for both women and men as they age. He treats couples together, and what he has witnessed across thousands of relationships is that the problems are rarely one person's fault, rarely unsolvable, and almost always rooted in something nobody warned them about. Guest links: James Simon (IntimMedicine Specialists) James Simon (Instagram) James Simon (YouTube) Articles: What if the Women’s Health Initiative had used transdermal estradiol and oral progesterone instead? (Menopause) Erectile Dysfunction (StatPearls) Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care (British Journal of General Practice) The Benefits and Harms of Systemic Testosterone Therapy in Postmenopausal Women With Normal Adrenal Function: A Systematic Review and Meta-analysis (The Journal of Clinical Endocrinology & Metabolism) Other Resources: Women’s Health Initiative The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement (NAMS) International Society for the Study of Women's Sexual Health (ISWSH) FDA panel rejects testosterone patch for women on safety grounds (The BMJ) The Saga of Testosterone for Menopausal Women at the Food and Drug Administration (FDA) (The Journal of Sexual Medicine) Sexual Medicine Society of North America (SMSNA) Books:“Restore Yourself: A Woman's Guide to Reviving her Sexual Desire and Passion for Life,” by James Simon and Victoria Houston “The New Perimenopause,”⁠ by Dr. Mary Claire Haver ⁠"The New Menopause"⁠ by Dr. Mary Claire Haver For full show notes, please click here. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

This week on unPaused, Dr. Mary Claire Haver sits down with Cindy Eckert, founder and CEO of Sprout Pharmaceuticals and creator of Addyi, the first FDA approved treatment for low libido in women. Cindy is a pharmaceutical entrepreneur who began her career at Merck before founding her first company in 2007, focusing on undermarketed FDA approved products. After successfully building and selling a male sexual health company, she became the only woman running a sexual health company and witnessed firsthand the stark contrast between how medicine treats male versus female sexual dysfunction. Her journey to bring Addyi to market became a cultural battle about whether women's sexual desire matters, leading to two FDA rejections, public hearings, and ultimately a historic approval in 2015 after a six year fight. In this conversation, Dr. Haver and Cindy explore how Addyi works differently from Viagra, targeting brain chemistry and desire rather than blood flow and arousal. Cindy explains that Addyi is a mood drug originally developed for depression that showed an unexpected effect on female libido during clinical trials. The medication works on neurotransmitters in the brain, building over approximately eight weeks to restore spontaneous thoughts, fantasies, and desire in women with hypoactive sexual desire disorder or HSDD. She walks through the massive clinical trial requirements, including 13,000 patients compared to Viagra's 4,000, and the three things they had to prove with statistical significance versus placebo: increased interest in sex, more satisfying sexual experiences, and decreased distress from the condition. ADDYI, flibanserin, is for women <65 with low sexual desire disorder who have not had problems with low sexual desire in the past, and who have low sexual desire that is troubling to them no matter the type of sexual activity, situation, or sexual partner. The low sexual desire is not due to a medical or mental health problem, problems in the relationship or medicine or other drug use. ADDYI is not for men or to enhance sexual performance. Your risk of severe low blood pressure and fainting is increased if you drink 1-2 standard alcoholic drinks close in time to your ADDYI dose. Wait at least 2 hours after one to two drinks before taking ADDYI at bedtime and skip your dose if you drink three or more drinks that evening. If you take certain prescription, OTC or herbal medications, or have liver problems, the risk of low blood pressure and fainting increases and you should not take ADDYI. Do not take if you are allergic to any of ADDYI’s ingredients. Sometimes serious sleepiness can occur. Common side effects include dizziness, nausea, tiredness, difficulty falling asleep or staying asleep and dry mouth. See PI and Boxed Warning at addyi.com/piGuest links: Cindy Eckert Cindy Eckert (Instagram) Recommended Books: “Mars and Venus in the Bedroom: A Guide to Lasting Romance and Passion,” by John Gray “The New Perimenopause,”⁠ by Dr. Mary Claire Haver ⁠"The New Menopause"⁠ by Dr. Mary Claire Haver Articles: Women with hypoactive sexual desire disorder compared to normal females: a functional magnetic resonance imaging study (Neuroscience) Sexual Dysfunction Induced by Antidepressants—A Pharmacovigilance Study Using Data from VigiBaseTM (Pharmaceuticals) Enhancing Sexual Health for Cancer Survivors (Symptom Science And Palliative Care) Flibanserin Approval: Facts or Feelings? (Sexual Medicine) Clinical trial evidence supporting FDA approval of novel therapeutic agents, 2005-2012 (JAMA) Other Resources: Addyi What is Patient-Focused Drug Development? International Society for the Study of Women's Sexual Health (ISSWSH) FDA Expands Approval of Flibanserin for Postmenopausal Women’s Sexual Health (Drug Topics) A Pill for Sexual Desire Reaches a New Group of Women (TIME Magazine)Drug Trials Snapshots Summary Report 2024 (FDA) For full show notes, please click here. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

In this episode Dr. Mary Claire Haver is joined by Dr. Rachel Rubin, a board-certified urologist and nationally recognized expert in sexual medicine, fellowship trained in both female and male sexual health. As assistant clinical professor of urology at Georgetown University and former education chair of the International Society for the Study of Women's Sexual Health, she brings unique insight into the stark disparities in how sexual dysfunction is treated across genders. Dr. Rubin founded the Sexual Medicine Research Team, and her advocacy work has been instrumental in changing FDA labeling on hormone therapy and advancing the American Urological Association Guidelines on genital urinary syndrome of menopause. During the conversation, Dr. Haver and Dr. Rubin explore the intersection of menopause, hormones and women's sexual health, revealing why most doctors, including OB-GYNs, receive virtually no training in sexual health despite sexual dysfunction affecting millions of women. Dr. Rubin explains how men's sexual health benefits from 27 fellowship programs while women's sexual health has only three, and why erectile dysfunction research receives billions while female orgasm research gets nothing from the NIH. She breaks down the complete anatomy of the clitoris that most medical professionals never learned, explaining why understanding this matters for surgical outcomes, pleasure, and treating conditions like vulvar vestibule pain that affects penetration, tampon use, and pelvic exams. Dr. Rubin discusses how the vulvar vestibule, the hormone sensitive tissue surrounding the urethra, becomes a source of pain for many women during perimenopause, on birth control pills, or postpartum due to low estrogen and testosterone. Guest links: Dr. Rachel Rubin (Instagram) Dr. Rachel Rubin (YouTube) Dr. Rachel Rubin (Website) Dr. Rachel Rubin (LinkedIn) Dr. Rachel Rubin (Facebook) Dr. Rachel Rubin (X) Books “Vagina Obscura: An Anatomical Voyage Hardcover,” by Rachel E. Gross “The New Perimenopause,”⁠ by Dr. Mary Claire Haver ⁠"The New Menopause"⁠ by Dr. Mary Claire Haver Articles Sexual function after hysterectomy according to surgical indication: a prospective cohort study (Sexual Health) The human cervix: Comprehensive review of innervation and clinical significance (Clinical Anatomy) Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves (Brain Research) The Impact of Glucagon-like Peptide-1 Receptor Agonists on Erectile Function: Friend or Foe? (Biomolecules) Effect of Saw Palmetto Extract on Erectile Dysfunction and Libido in Patients with Lower Urinary Tract Symptoms Because of Benign Prostatic Obstruction (International Journal of Applied Research on Medicinal Plants) “Not feeling like myself” in perimenopause — what does it mean? Observations from the Women Living Better survey (Menopause) Updates on Therapeutic Alternatives for Genitourinary Syndrome of Menopause: Hormonal and Non-Hormonal Managements (Journal of Menopausal Medicine) Menopausal Hormone Therapy and Cardiovascular Diseases in Women With Vasomotor Symptoms: A Secondary Analysis of the Women’s Health Initiative Randomized Clinical Trials (JAMA Internal Medicine) To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices