Woman's World

Tired of Menopause Symptoms? A Probiotic May Increase Estrogen Naturally

Rachel Cosma — Mon, 04 May 2026 17:00:19 +0000

If menopause has left you dealing with achy joints, a fuzzy memory and vaginal dryness, you’re not imagining things. Many of the most frustrating midlife shifts trace back to declining estrogen. For some women, prescription hormone replacement therapy (HRT)—now called menopausal hormone therapy)—offers welcome relief. But it isn’t the right fit for everyone, whether due to medical history, personal preference or simply wanting to try a gentler path first. The good news? Exciting new research suggests that probiotic supplements help increase estrogen levels naturally. Here’s what menopausal women need to know.

What the latest research shows

A recent review published in Frontiers in Aging assessed natural alternatives for supporting healthy estrogen levels in women whose bodies are producing less of the hormone. The reviewers weighed a range of options women have long turned to during midlife, looking at how each might gently nudge estrogen back toward more comfortable territory.

Out of all the contenders evaluated, one stood out as the most potent: a simple probiotic supplement that helps increase estrogen naturally.

The supplement that’s most helpful for increasing estrogen

According to the review, a daily probiotic blend featuring the L. brevis strain raised circulating estrogen by 26 percent in just 12 weeks. That’s a meaningful shift for a strategy as simple as taking a capsule with breakfast.

Why might a probiotic influence hormones and potentially help ease some of the most common symptoms of menopause? Researchers have grown increasingly interested in the connection between gut health and hormone balance. The community of bacteria living in your digestive system plays a role in how the body processes and recirculates estrogen. When that internal ecosystem is humming along, it appears to support hormone levels in ways scientists are still working to fully understand.

For those of us over 40—already paying closer attention to our gut health for digestion, immunity and energy—the idea that the same daily habit could help support estrogen too is welcome news.

One option: Lactoxira SuperSmart 8-in-1 Probiotic Complex. Because it contains a blend of strains, it offers a convenient way to incorporate L. brevis alongside other beneficial bacteria.

Is this ‘estrogen supplement’ right for you?

If you’ve felt overwhelmed by the parade of products promising relief from menopause symptoms, here’s a refreshing takeaway: Sometimes the most effective tools are also the simplest. Adding a daily estrogen supplement in the form of a targeted probiotic could fit easily into the routine you already have—no major lifestyle overhaul required.

A few things to keep in mind before you start:

Talk to your doctor first. If you have a history of hormone-sensitive conditions or take medications that interact with supplements, your healthcare provider can help you decide whether a probiotic estrogen supplement makes sense for you.
Give it time. The 26 percent increase was measured at the 12-week mark. With natural strategies to increase estrogen, consistency matters more than quick fixes.
Pair it with the basics. Strength training, calcium- and vitamin D-rich foods, quality sleep and stress management continue to be cornerstones of feeling your best in midlife and beyond.

The bottom line on probiotics as a natural estrogen supplement

Menopause doesn’t have to be something you simply endure. Whether you’re noticing the first whispers of perimenopause or you’re well into the years that follow, small, science-backed choices can add up to real comfort. A daily probiotic may turn out to be one of the easiest—and most surprising—additions to your wellness toolkit.

Ready for more inspiration? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

Can Allegra and Pepcid Really Ease Menopause Joint Pain and Brain Fog?

lmaxbauer — Thu, 30 Apr 2026 23:00:55 +0000

The internet is buzzing about a new health trend that claims to calm frustrating symptoms of perimenopause and menopause. It involves taking two over-the-counter medicines at once—a combo of different types of antihistamines, such as Pepcid AC and Allegra. No prescription required. But does this dual antihistamine trick really work? Here’s everything you need to know about this viral health hack from experts and women who have tried it for themselves.

What do Allegra and Pepcid do in the body?

This trend focuses on taking two different classes of antihistamines together, which each block different histamine responses in the body.

An H1 (histamine) blocker like Allegra (fexofenadine), Claritin or Zyrtec targets cell receptors linked to allergies and inflammation. Choose these “second generation” allergy meds over first generation meds like Benadryl that can cause drowsiness.
An H2 (histamine) blocker like Pepcid AC (famotidine) targets receptors in the gut. You probably know it better as an antacid to treat acid reflux and indigestion.

As pharmacist Stephen Berkowitz, PharmD, explains on Threads, “You’ve essentially created a complete histamine blockade.”

What histamine has to do with hormones and menopause

Why might this combo help women, especially those struggling with midlife health symptoms? Estrogen and progesterone directly influence mast cells—immune cells that release chemical messengers called histamine. They can affect multiple systems throughout our body, triggering debilitating symptoms.

When hormones dip during midlife, our body may also become more prone to irritations and sensitivities. Think hip and joint pain, itchy ears and even labial discomfort. Histamine activity plus inflammatory responses can worsen symptoms like joint tenderness and pain. That’s where the antihistamine combo comes in: In theory, by taking both medications, you may be able to quiet symptoms that have gone into overdrive.

Who might benefit from Allegra and Pepcid

Women are experimenting with this combo that blocks histamine for various health conditions that share overlapping symptoms—brain fog, fatigue, sleep issues, joint pain, low energy and mood changes. These conditions include:

Perimenopause and menopause
Premenstrual Dysphoric Disorder (PMDD)
Endometriosis
Long COVID
Postural Orthostatic Tachycardia Syndrome (POTS)
Mast Cell Activation Syndrome (MCAS)
Histamine intolerance
ADHD

Real women share their Allegra and Pepcid results

In a viral social media video, one woman talked about how it instantly improved her mood and energy for her PMDD symptoms: “I just feel a wave of joy come over my brain and body, like somebody pressed a button. I think I took it maybe 45 minutes ago. I feel hyper.”

One woman on Threads shared: “My allergist prescribed this to stop multiple reactions, and it does help relieve brain fog amongst the rest of the issues it helps with.”

Another user expressed her surprise that it helped her so much: “I decided to try the Pepcid/Zyrtec combo because my joints are killing me. What the fresh hell is this magic?!”

Of course, results may vary. A third woman on Threads added this caveat: “I take it daily but I have severe histamine intolerance/possible MCAS. If you don’t have histamine intolerance, it won’t make a difference.”

What research says about antihistamines for menopause

Not much…yet. A study published in Frontiers in Cardiovascular Medicine shows antihistamines help with long COVID symptoms. Another study in Frontiers in Sleep, Immunity, and Metabolism conducted on men tested antihistamine use and insomnia. But we still need this Allegra and Pepcid combo tested specifically on perimenopausal and menopausal women.

Allergist Zachary Rubin, MD, author of All About Allergies, has weighed in on the trend. He explained online, “Taking this combination of therapy should make your symptoms better.” But he added, “There’s a lot of issues related to women’s health where there’s just not enough research out there. We need to do more, and this is a call to action.”

What doctors say about the Allegra and Pepcid combo

Integrative medicine expert Amy Shah, MD, confirms, “There is no clinical research on using this combination.” But in an online video, Dr. Shah, who completed an immunology fellowship and conducted mast cell research, says, “We do know that there is some effect, meaning that these medications could be helping in the histamine response.”

Ob-gyn Beverly Joyce, MD, medical advisor to HotPause Health, says, “There’s a theoretical connection. Yes, histamine can influence inflammation, and inflammation can play a role in symptoms like hot flashes or skin changes.” But she adds, “In medicine, we always want to distinguish between what’s plausible and what’s proven. This falls into the ‘plausible but unproven’ category. One of my bigger concerns is that women may delay more effective, evidence-based treatments while trying unproven methods.”

Dr. Joyce advises, “For most women, I wouldn’t consider this a first-line or evidence-based treatment for menopause symptoms. Far better-studied options exist, including hormone therapy.”

Why women are getting creative about menopause care

The frustration is real: Research is severely lacking on women’s issues, including menopause. And many women feel dismissed by their doctors about their menopause symptoms. Plus, the ongoing estrogen patch shortage has left many of us without access to proven treatments. One woman shared this relatable frustration on the Threads post above: “Why is it that women have to crowd source their healthcare? It is really time that our needs be taken seriously.”

Is it safe to take Allegra and Pepcid together?

Before you head to the drugstore, here’s what you need to know about safety. Always talk to your doctor before starting a new medicine or combination. “I am a huge advocate of never starting two medications at the same time unless absolutely necessary,” says physician Roxanne Reid Copper, MD. “If there are side effects, it clouds the picture. I usually start [an] allergy med for two to four weeks, then the GI [medication].”

One more important consideration: This is not a forever fix. There is some research in Frontiers in Aging Neuroscience that suggests prolonged H1 medication use in older adults poses an increased risk of dementia. So talk to your doctor about the appropriate duration for your situation.

The bottom line

While formal research is still needed, this antihistamine combo shows real promise—and many women are already experiencing relief. “Definitely something that you want to talk to your doctor about,” says Dr. Shah. “I’m kind of excited about this!”

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

Do You Lose Your Labia Minora During Menopause? ‘They’re Just...Gone'

lmaxbauer — Thu, 30 Apr 2026 00:00:56 +0000

Ever looked in the mirror lately after stepping out of the shower and thought, Where did everything go? Growing menopause awareness has inspired more honest conversations about surprising body changes and symptoms. And lately, women online have been saying the quiet part out loud by asking: Do you really lose your labia minora during menopause? Here’s what top experts say about the question so many of us are curious about.

Why women online are talking about ‘disappearing labia minora’ during menopause

Let’s start with a quick refresher on what we’re talking about when it comes to vulvar tissues: The labia majora are the larger, outer lips and the labia minora are the smaller, inner folds of skin protecting the vaginal opening. They can both change with age, leaving women caught off guard. One Reddit user shared her shock when her labia began shrinking after a hysterectomy. In a thread titled, “A Case of the Disappearing Labia?” she wrote, “It’s about one-fifth of what it used to be—no exaggeration… I know it sounds crazy, but I am being so serious. They’re just gone… I had no idea that this could even happen. It freaks me out.”

Others shared that it felt like their labia were disappearing before their eyes, almost overnight, essentially fusing with surrounding tissue. One woman on Threads posted: “Labia minora? More like labia no-mora.” And another woman posted the most relatable response, saying, “It’s a cruel twist of fate that the labia shrinks to nothingness, but the gut does not.”

Why your labia minora skin might change during menopause

“As estrogen levels drop, the tissue loses collagen, elastin and subcutaneous volume” so it appears thinner and smaller, explains Troy Hailparn, MD, an ob-gyn at the Cosmetic Gynecology Center of San Antonio. While she works in cosmetic gynecology, her clinical focus has been on understanding how genital tissues change across a woman’s lifespan. “I’ve performed over 1,000 labiaplasties,” she says, “but the bigger part of my work is educating women about their bodies.” Get ready for an eye-opening lesson…

How the labia minora changes with menopause

“Yes, the labia minora absolutely can shrink during menopause,” says Dr. Hailparn. “What happens is the labia thins, loses definition and in some women appears to recede into the labia majora.”

While many women focus on the visible, aesthetic changes, ob-gyn Barbra Hanna, DO, cofounder of MyMenopauseRx, explains, “Labia changes are a sign of underlying hormonal changes and, for some, is associated with bothersome symptoms of genitourinary syndrome of menopause (GSM).” That medical condition (formerly known as vaginal atrophy) affects roughly 50 percent of postmenopausal women, with symptoms that include burning, pain with intercourse, urinary urgency or recurrent urinary tract infections (UTIs). The good news: GSM is treatable.

The labia majora changes too

“The labia majora aren’t spared either,” Dr. Hailparn says. “They tend to lose fat and tone, and the skin can become loose and fragile. When women come to see me, they describe the whole area as drier, flatter, paler and less like what it used to look like.”

Signs your delicate vaginal tissue is asking for help

Common symptoms you might experience during menopause:

Pain during sex
Discomfort when you move, walk or exercise
Burning or stinging sensations
Persistent itching
Noticeable vaginal dryness
Tissues that feel thinner or more fragile than before
Increased sensitivity or irritation to touch

Thankfully, each of these symptoms responds well to treatment.

Why it’s time to speak up about labia minora changes during menopause

Changes to the labia often fall through the cracks in healthcare. Why? Dr. Hailparn says, “There’s no ‘menopause genital exam’ in the standard visit.” As a result, “Women don’t bring it up, and most physicians don’t ask. Most women discover the issue from looking in a mirror, a partner telling them or through an internet search or an online forum.”

Dr. Hailparn sees widespread misinformation about labia health online, which leads to a lot of confusion and unnecessary fear for women. So we’re setting the record straight with honest, fact-based information.

The best treatment to restore thinning, painful labia tissue

So, what treatments help? “Local vaginal estrogen—cream, tablet or ring—is the first line of defense for almost everyone,” says Dr. Hailparn. It’s been called the gold standard. “It works directly on the tissue with minimal systemic absorption.” Estrogen therapy helps nourish and plump depleted tissues to reduce discomfort. Since the FDA removed black box warnings on estrogen products, Dr. Hailparn and most doctors stress that estrogen treatments are overwhelmingly safe for the majority of patients.

Effective non-estrogen options for relief

While Dr. Hailparn notes that concerns about estrogen are often based on outdated information, she does recommend some other treatment options for women looking for alternative treatments. These three options have research-based evidence to back them up:

Vaginal DHEA: an FDA-approved prescription insert for vaginal dryness and painful intercourse associated with menopause
Ospemifene: an FDA-approved oral medication that works like natural estrogen to restore moisture and comfort
Hyaluronic acid moisturizers: over-the-counter gels or suppositories that draw moisture into cells to help reduce the pain, burning and irritation of thinning tissues

Can cosmetic treatments help ‘rebuild’ the labia?

Some people need or desire a higher level of treatment than medications can provide. “When it comes to actual volume loss, fractional CO2 laser (MonaLisa Touch), radiofrequency (ThermiVA), platelet-rich plasma injections (PRP) and fat grafting can rebuild what’s been lost,” Dr. Haliparn says.

But she adds an important note: “I reserve performing surgery on labia for cases of asymmetry or true mechanical problems—not for volume concerns that respond better to other treatments.”

How to protect your intimate health during menopause

Are there ways to avoid these natural age-related changes to your labia minora and majora? “You can’t prevent menopause, but you can intervene early,” says Dr. Hailparn. “The longer tissue goes without estrogen support, the harder full restoration becomes. Estrogen is like water to a plant. No water and the plant shrivels up. The same for women’s bodies.”

When to speak to your doctor about labia minora changes during menopause

“I always tell my perimenopausal patients not to wait until intercourse hurts to start the conversation,” Dr. Hailparn says. “By then we’re already behind.” Dr. Hanna agrees and reminds, “The most important advice: GSM is progressive. Treat it early and avoid the unwanted changes.”

Bottom line: Don’t suffer in silence. Feel empowered to bring up these menopausal symptoms with your doctor. Labia minora and majora changes during menopause are normal and treatable, so you don’t have to delay taking control. Dr. Hanna encourages, “Tissue changes of the labia are not just about changing anatomy; it’s about quality of life!”

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

The perimenopause truth that changed Dr. Mary Claire Haver's life

kmastrocola — Wed, 01 Apr 2026 13:00:04 +0000

Mary Claire Haver, MD, 57, is many things—a devoted wife and mother of two daughters and author of The New Menopause and The New Perimenopause, to name a few. But she is best known as a staunch advocate for women’s health. It’s a role she earned on the front lines of her own transition into perimenopause and menopause.

“I was anxious and gaining weight, and I couldn’t sleep,” she recalls. “When I finally understood what was happening hormonally, it was like someone turned the lights on. It redirected my career and my entire life.”

This new path led her to help women take their health into their own hands. “You don’t have to white-knuckle your way through the second half of your life,” she assures. “When women hear me say, ‘This isn’t your fault,’ something shifts. So many of them have spent years blaming themselves for brain fog, weight changes, mood swings. They were never the problem. The lack of information was.”

Still, she’s the first to point out that hormones are just one facet of aging well—alongside sleep, stress management and nutrition.

Here, Dr. Haver, who appears on the cover of this week’s Woman’s World magazine (get your copy here!), shares tips ranging from how to prioritize your needs to the exercise tweaks that boost longevity.

Mary Claire Haver’s #1 tip: Say yes to yourself

“I spent decades putting everyone else first—my patients, my family, my career,” Dr. Haver recalls. “And I see this in almost every woman who walks through my door. We’re conditioned to deprioritize ourselves.

What I want women to hear, at every age, is that taking care of yourself is not selfish. It’s the foundation everything is built on. Whether that means having an honest conversation with your doctor about hormone therapy or safeguarding your sleep, these are acts of health, not indulgence.”

Her nonnegotiable for energy: Why sleep comes first

“Energy is everything as we get older,” says Dr. Haver. “The fatigue, the mental fog, the running on empty—so many women accept that as ‘just aging.’ But a lot of it is hormonal, treatable and reversible.

“Sleep comes first, because nothing else works when I’m depleted. I also try to eat in a way that keeps my blood sugar stable, because those crashes are energy killers. And I’ve gotten honest about stress—what I say yes to and what I don’t.”

Mary Claire Haver’s strength-training mindset shift

“I resistance-train consistently, not just for my body but for my brain, because the mood benefits are real,” Dr. Haver says. Her advice to women? “Stop exercising to be thin and start exercising to be strong.”

“Strength training stabilizes blood sugar and preserves the muscle mass that determines how well we age. When I reframe exercise this way with my patients, their worlds open up. Suddenly movement is something they do because it makes them feel powerful. That’s a different relationship with your body, and it’s one that women in midlife deserve.”

Dr. Mary Claire Haver lifts weights and wears a weighted vest to stay strong
Callie Walker

Mary Claire Haver on aging well: Invest in social connections

“Loneliness is a health crisis, and midlife is when it often peaks,” notes Dr. Haver. “Kids leave, relationships change and women can find themselves isolated.

Friendships are key to health, she says. “Social connection is as important to your health as sleep and nutrition. The relationships I’ve invested in, the women I can call when things are hard—those connections are load-bearing; they hold me up. And I think women underestimate how much we need to prioritize friendships the way we do a workout or a doctor’s appointment.”

Quickfire questions with Dr. Haver

We asked Dr. Haver to share fast, fun insights about her life—from what inspires her each day to the scent that instantly transports her down memory lane.

Woman’s World: What’s a compliment you love to give?

Dr. Haver: You matter.

WW: What’s the last thing that made you laugh?

Dr. Haver: My daughter should be a comedian. She’s the funniest person I know.

WW: What’s one way you feel better than ever?

Dr. Haver: My daughter should be a comedian. She’s the funniest person I know.

WW: What’s one word that describes you in your 50s?

Dr. Haver: Unstoppable.

WW: What burden have you learned to let go of?

Dr. Haver: The weight of others’ opinions. I trust myself in a way I never did at 30. Menopause will do that for you. When no one else is listening to your body, you learn to listen to yourself.

WW: What’s one myth about aging?

Dr. Haver: That it equals decline. Aging means having the clarity to see what matters and the confidence to let go of what doesn’t. I’m stronger, both physically and mentally, at 57 than I was at 37. I lift heavier weights. I speak more directly. I sleep better because I’m not carrying everyone’s expectations. That’s not decline. That’s evolution.

WW: What does your childhood smell like?

Dr. Haver: My mother’s gumbo. The smell of the holy trinity simmering—onions, garlic, peppers—brings me right back to our kitchen in Louisiana, to feeling safe and like I belonged. Even now, when I make it, I’m transported. It’s more than food. It’s home.

Don’t miss Dr. Haver’s new book!

Mary Claire Haver’s latest book, The New Perimenopause: An Evidence-Based Guide to Surviving the Zone of Chaos and Feeling Yourself Again (out April 7), was inspired by the countless women who told her, “I just don’t feel like myself.”

The first step to flipping that script? Read Dr. Haver’s book, packed with tips to help you rev your metabolism, feel sunnier and enjoy thicker hair and better sleep. “Above all, get your menopausal status evaluated by someone who takes your symptoms seriously,” she urges.

Ready for more inspiration? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

Estrogen patch shortage? Don’t Panic—Try These Doctor-Backed Swaps

lmaxbauer — Wed, 18 Mar 2026 18:00:30 +0000

Menopause is not a time to stress. But we understand that the recent shortage of hormone replacement therapy (HRT) patches has women concerned. Luckily, one of the nation’s top menopause experts, Heather Hirsch, MD, founder of The Menopause Clinic at Brigham and Women’s Hospital and the author of The Perimenopause Survival Guide, is sharing exactly what to do during this estrogen patch shortage when supplies are scant. She assured her online followers with this message: “Can’t find your estradiol patch? Do not panic. You have options.”

The patch shortage is such a buzzy topic affecting women everywhere that even celebrities like comedian Amy Schumer, 44, and actress Lisa Rinna, 62, are speaking out about it. On a recent social media reel, Schumer said, “A good thing to do would be to get a three-month prescription from your doctor right now and to look into alternative kinds of estrogen—not just patches but gels. Try different brands and warn other women, because it’s real.” Keep reading for the latest, expert advice.

What’s causing the estrogen patch shortage right now?

It’s a scenario playing out at pharmacies across the country. Women who rely on prescription estradiol patches to relieve perimenopause and menopause symptoms step up to the counter for a refill, only to hear distressing news: “I’m sorry, we’re out. Those patches are backordered.”

Why is this happening? The good news: The shortages mean more women are getting prescribed the symptom-relieving, longevity-supporting hormones that were denied to us in past generations. Dr. Hirsch, a board-certified internist, is excited by that movement and the upsides it signals for women’s health. She tells Woman’s World, “If you start early, menopausal hormone therapy decreases heart disease, it decreases stroke risk, it decreases dementia risk, and it doesn’t increase breast cancer risk.”

But that growing popularity also means some manufacturers were not prepared and now pharmacy shelves are bare. In addition, the FDA recently removed the needless black box warnings from estrogen products, including patches, paving the way for more women to request them and more doctors to prescribe them. This huge surge in demand collided with ingredient shortfalls and global supply-chain disruptions and rising fuel costs to result in a shortage of these popular patches.

Why switching HRT forms is better than stopping cold turkey

If you can’t find your estrogen (estradiol) patch amidst the shortage, doctors recommend trying alternative formulations. “If it’s backordered, switching to gel, spray, oral estradiol or a ring is often better than stopping abruptly,” Dr. Hirsch explains. “Doses aren’t perfectly identical, so give it four to six weeks to adjust.” And a reminder: Dosing should always be individualized by a clinician.

A guide to switching from the estrogen patch to other HRT

No matter which estrogen patch strength you’ve been using, Dr. Hirsch has you covered with equivalent options that will keep you feeling just as good, starting with the lowest dose and working our way up.

If you can’t find a low-dose estrogen patch

If you’re used to wearing a weekly or twice weekly estradiol patch that delivers a 0.025 mg/day dose, but it is unavailable, Dr. Hirsch recommends trying one of these equivalent options:

Gel: 0.25 mg/day gel (such as DiviGel brand or a generic estradiol gel)
Spray: 1 spray daily/every 24 hours (of mist like Evamist)

It’s important to note that a wearable estrogen ring is not compatible with this low dose, Dr. Hirsch says. And any time you take systemic estrogen (whether patch, gel, spray, pill or ring), you need to balance it with progesterone if you still have your uterus. This protects your uterine lining and is an essential part of safe HRT.

If you can’t find a mid-range dose estrogen patch

If you’re used to wearing a patch that delivers a 0.0375 mg/day estradiol dose, Dr. Hirsch tells women to consider these options:

Gel: 0.25 to 0.5 mg daily
Spray: 1 spray daily
Pill: 0.5 mg daily

Remember, you’re switching from applying a patch every week or so, to applying a topical or taking a pill daily. And Dr. Hirsch doesn’t want women to fear oral pills. While not everyone tolerates them, “Oral estradiol is not dangerous for most healthy women,” she says. “It can be great for mood, great for hair, easy to take and affordable.”

If you can’t find a standard-dose estrogen patch

The 0.05 mg/day patch is one of the most commonly prescribed doses—and fortunately, you have plenty of effective swaps available:

Gel: 0.5 mg daily
Spray: 1 to 2 spritzes daily
Pill: 1 mg daily (or try 0.5 mg twice daily, once in the morning and at night)
Ring: insert and wear a 0.05 mg ring (like Femring)

If you can’t find a high-dose estrogen patch

Used to wearing a 0.075 mg/day patch? Dr. Hirsch says to consider:

Gel: 0.75 mg daily
Spray: 2 spritzes daily
Pill: around 1.5 mg daily (try 1 mg in the morning and 0.5 mg at bedtime)
Ring: wear a 0.05 or 0.1 Femring, depending on symptoms

If you can’t find your higher-dose estrogen patch

For women who are out of 0.1 mg/day patches, try these swaps:

Gel: 1 mg daily
Spray: about 3 spritzes daily
Pill: 2 mg daily (often split in two doses, morning and night)
Ring: wear a 0.1 Femring

Dr. Hirsch cautions, “Higher doses may need splitting for smoother symptom control.”

What to expect when you switch your HRT delivery method

Some breakthrough bleeding or symptom shifts such as breast tenderness or a temporary return to hot flashes can happen as your body adjusts for a few weeks. “Switching formulations is not perfectly equal,” says Dr. Hirsch. She assures, “Bleeding after switching does not automatically mean something is wrong.”

But she says switching formulas is better than quitting your HRT completely. Plus, there are even circumstances where this shortage can be a silver lining, introducing women to different formulations they like better.

Bottom line: “There’s no single ‘best’ form of estrogen. Patch, gel, spray, oral, ring. They all work,” Dr. Hirsch says. As always, consult with your doctor before changing any of your medicines. But even in times of shortages, you have more options and more support than you might think.

Ready for more inspiration? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

How Long Can You Take HRT for Menopause? The Answer May Surprise You

lmaxbauer — Tue, 17 Mar 2026 17:30:21 +0000

For years, women navigating perimenopause and menopause have received frustratingly mixed messages about hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT). But now that the latest research overwhelmingly shows it’s safe for your long-term health, the big question is how long can you take HRT? One of the world’s top menopause experts, Mary Claire Haver, MD, is cutting through the confusion with an encouraging message that might surprise you—there’s no mandatory age to stop taking HRT. And the health benefits could last a lifetime.

On a recent episode of the podcast What Matters With Liz, Dr. Haver, a board-certified ob-gyn, Menopause Society-certified practitioner and best-selling author of The New Perimenopause, addresses this top question that women are asking right now about HRT. Keep reading for her clear insight.

Why you were told to fear HRT and why that’s changing

Before we hear the exciting new recommendations, it’s important to review how we got here. HRT is the use of estrogen and progesterone, and in select cases testosterone, to treat common symptoms of perimenopause and menopause. For years, doctors told women to avoid HRT based on misguided study findings about potential side effects such as an increased risk of breast cancer. Those flawed conclusions led to fear and confusion about the benefits and risks of HRT.

Thankfully, in recent years, the conversation has improved and doctors have once again encouraged women to use HRT safely to treat symptoms of menopause. In fact, experts are now sharing how staying on HRT longer can have powerful health and longevity benefits.

The ‘sweet spot’ on HRT timing

“The earlier you start [HRT]—the closer to your menopause, at least in that first 10 years and for sure before the age of 60—we know that you’re going to have cardiovascular benefits,” Dr. Haver explains.

That window—the first 10 years after menopause and before age 60—is what Dr. Haver called the “sweet spot” for using HRT and getting the maximum benefits. If you’re in that window, this is a conversation worth having with your doctor sooner rather than later to improve your quality of life.

And even if you’re outside that window, there’s still reason for hope: Dr. Haver emphasizes that bone benefits continue every single day you take HRT, no matter your age. Dr. Haver says many of her patients also report unexpected perks from HRT: “I can’t tell you how many patients are like ‘I didn’t realize that my hip pain was going to get better’.”

How long can you take HRT?

Perhaps the most liberating thing Dr. Haver shared is her answer to a question many women carry quietly: How long can I actually stay on HRT?

One reader wrote into the podcast to ask “How long should a woman be on estrogen and progesterone? I started at 49 in perimenopause. Now I’m 51 and postmenopausal. Should I take MHT a few more years, 10 years, the rest of my life? How do I know when to stop?”

Here’s what Dr. Haver revealed: “As long as you take it, you have the benefits. As long as the benefits outweigh the risks for you personally, you can continue. There is no magical age at which you must stop.”
She notes, “When you stop taking it, your bones will return to the trajectory of bone loss you were on before. The cardiovascular benefit disappears. And your hot flashes may come back, regardless of how old you are. So as long as the benefits outweigh the risks, there is no reason to come off.”

This is the kind of clarity that can transform a conversation with your doctor. Instead of asking, “When do I have to quit?” you can ask, “Do the benefits still outweigh the risks for me?”

Different types of hormone therapy and what they do

If you’re picturing a single pill when you think of HRT, it’s worth knowing that hormone therapy comes in different forms that deliver hormones locally or systemically.

Topical estrogen creams, for example, can be applied to the vaginal skin to relieve genitourinary pain. Wearable HRT patches, on the other hand, deliver hormones to your entire body. This systemic delivery means the hormones circulate throughout your system, addressing widespread symptoms like hot flashes, bone loss, mood changes and sleep disruption.

Understanding the difference matters because your doctor may recommend one form, another or a combination, depending on your specific symptoms and health history.

The surprising range of symptoms HRT can treat

HRT does more than just ease one or two key menopause symptoms. Tamsen Fadal, menopause advocate and author of How To Menopause, agrees with the safety and wide use of what Dr. Haver is talking about. “Literally hundreds of clinical studies have shown HRT is the best treatment there is for the relief of hot flashes, night sweats, vaginal dryness and painful intercourse,” she says.

But Fadal doesn’t stop there. She adds, “Hormone therapy may also help with symptoms that are often not recognized as menopause-related, such as difficulty sleeping, joint pain and mood changes.”

So feel empowered to not only consider taking HRT for symptoms, but to feel safe taking it as long as you need it. You deserve to feel like yourself again. And according to some of the most knowledgeable voices in menopause medicine today, there are real options available and it may not be too late to explore or expand their use.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

Tired of Menopause Weight Gain? Doctors Reveal How To Lose Belly Fat

Jenna Cartusciello — Tue, 17 Mar 2026 14:13:00 +0000

For decades, we either talked about menopause weight gain in hushed tones or we didn’t mention it at all. Luckily, the world is changing. At the center of this shift is a message that millions of women need to hear: Menopause-related weight gain is not your fault. It is driven by profound hormonal changes and it responds to specific, science-backed strategies that go well beyond the old advice to simply eat less and move more.

“Menopause is increasingly out in the open—discussed with accurate information that reduces stigma and empowers women to seek the support and resources they deserve,” says Kim Boyd, MD, a Stanford-trained physician and WeightWatchers’ Chief Medical Officer. So if you’re dealing with stubborn menopause belly fat that you’d love to get rid of, let’s dive into the best ways to do it.

What causes menopause weight gain?

Board-certified ob-gyn, Menopause Society certified practitioner and New York Times best-selling author Dr. Mary Claire Haver has become one of the most prominent voices reshaping how physicians and patients approach menopause. In a recent episode of What Matters With Liz podcast with Woman’s World editor-in-chief Liz Vaccariello, she addressed a question from a 45-year-old woman named Sarah, a fit former college athlete who described her body as “looking 21″ from the belly button up—but “like I swallowed a watermelon” below.

Dr. Haver’s first piece of advice was practical: “First, if it truly looks like a watermelon, get an ultrasound. We want to rule out fibroids or other growths.” If imaging comes back normal, she said, the culprit is likely visceral fat deposition, a specific type of fat that surrounds the internal organs and accumulates in the abdomen.

A perimenopausal woman, on average, has a visceral belly fat measurement of around eight percent, Dr. Haver adds. “After the menopause transition, it’s 23 percent on average, no changes in diet and exercise.”

This is not a matter of willpower or discipline. It is a biological reality driven by shifting hormone levels.

Why traditional weight-loss advice may not work

“This is where the gym bros who are trying to sell you on ‘calories in, calories out’ go crazy,” Dr. Haver says. “They’re like, ‘That’s impossible. Fat is fat.’ I’m like, actually, no, let’s go back to science…it’s the estrogen, it’s the progesterone changes.”

Dr. Boyd echoed these points, explaining the medical mechanisms at work: “Lower estrogen levels play a key role, redirecting fat storage to the abdomen—changes that not only affect appearance, but also increase the risk of heart disease and type 2 diabetes.”

Lower levels of estrogen as well as the hormone progesterone also lead to lower muscle mass, stamina and activity levels, which directly and indirectly lower the amount of fuel our bodies burn each day to sustain themselves.

“Ongoing weight gain of approximately one-and-a-half pounds per year typically occurs in the 10 years before and after the menopause transition,” notes Robin Noble, MD, FACOG, a Yale-educated ob-gyn and the Chief Medical Advisor of Let’s Talk Menopause. But menopause weight gain can absolutely be lost, and there are more resources than ever to help.

With tailored programs like WeightWatchers for Menopause, which launched in September 2025, women can get menopause-specific nutrition and lifestyle advice, support from other women and access to a medical team that can prescribe treatments like hormone replacement therapy and GLP-1 weight-loss medications.

Companies like wellness brand ‘Pause Life from Dr. Haver are also working to fill the void for women whose healthcare providers may not yet offer menopause-specific guidance.

How to reverse menopause weight gain

There’s nothing inherently wrong with carrying a few extra pounds, especially if your doctor hasn’t flagged any concerns. But since menopause weight gain can increase the risk of chronic conditions such as type 2 diabetes, hypertension, cardiovascular disease or high blood pressure, taking steps to slim down can help you live a longer, healthier life. So we’re sharing some of the best strategies to help maintain a healthy weight.

Push your pace

Increasing your physical activity level is a must for everybody, but if your goal is to lose body weight or prevent weight gain during menopause, incorporating strength training and high-intensity interval training (HIIT) is key. Both have been shown to aid with muscle growth post-menopause, and more muscle mass can increase metabolism.

But if you’re short on time, prioritize HIIT, a type of cardio that involves alternating quick periods of all-out effort with rest intervals. Dr. Noble recommends two to three strength training sessions weekly and at least 150 minutes of aerobic exercise, or about 22 minutes of regular physical activity per day.

A study in Medicine & Science in Sports & Exercise found that doing three, 30-minute HIIT workouts per week over an eight-week period helped menopausal women increase their muscle mass. While the study involved indoor cycling, HIIT can also be done on a treadmill, rower or with bodyweight exercises. Not sure where to get started? Check out a 20-minute HIIT workout for menopause belly fat.

Focus on protein and fiber

Dr. Haver emphasized that many of us are falling short on two critical nutrients: protein and fiber. “Most women are not getting enough protein. Most are not getting enough fiber—the average woman gets 10 to 12 grams a day, when she needs much more,” she said.

And fiber, Dr. Haver stressed, isn’t just about digestive health. “It’s critical for belly fat reduction. Foods rich in fiber are also rich in vitamins, minerals and nutrients. Fiber is as important as protein here.”

She also cautioned women to avoid foods that cause inflammation, including heavily processed foods and convenience meals, which she said exacerbate belly fat accumulation, especially in this stage of life.

Fill up on leafy greens

Rather than stressing about counting calories—which can be at best ineffective and at worst creates anxiety around eating—focus on adding filling, nourishing nutrients to your diet. Dr. Noble recommends moving toward eating habits that follow a “green Mediterranean diet,” which emphasizes whole grains, legumes, fruits, vegetables and healthy fats and prioritizes fish and plant-based protein sources over red meat.

Lean protein- and fiber-rich foods like beans and tofu and healthy sources of plant fats such as nuts and avocado should replace foods high in saturated fats, animal fats and refined sugars, as well as ultra-processed foods.

Make yogurt or kefir staples

If probiotic-rich yogurt or kefir (a fermented yogurt drink) isn’t already part of your diet, it may be worth adding it in. A study in the Journal of Nutrition found that people who ate the most yogurt tended to gain the least weight during menopause.

Eating at least two servings of yogurt a week reduced the risk of obesity by 31 percent. The study authors theorize that both calcium and probiotics may play a role in helping mitigate menopause weight gain.

Catch extra Zzzs

Hot flashes and night sweats—and the hormone changes that cause them—can disrupt sleep during perimenopause and menopause. And poor quality sleep contributes to weight gain by reducing the body’s ability to use fat for fuel throughout the day, according to research presented at ENDO 2021. (Check out our tips for getting sound sleep here.)

Ask your doctor about HRT and GLP-1s

After years of misinformation about hormone replacement therapy (HRT), key clinical trials were recently reanalyzed and, per findings in the Journal of the American Medical Association, risks of serious side effects are far lower than previously thought. Researchers found the benefits generally outweigh risks, especially when treatment is initiated within 10 years of menopause or before age 60. Yes, there are still risks, so you do need to discuss what’s best for you with your doctor.

But HRT can provide relief from symptoms like hot flashes, vaginal dryness, frequent urination, insomnia, bone loss and more. And if weight gain is a concern, “hormone therapy can help ease some of these shifts by reducing belly fat and supporting healthier body composition,” says Dr. Boyd.

However, Dr. Haver was careful to note that HRT is not a standalone solution. “HRT helps. Women on hormone therapy accumulate less visceral fat. But it’s not enough on its own. You must also address lifestyle,” such as with the tips above that make it easier to lose weight.

There’s also the potential that HRT may make new GLP-1 weight-loss drugs like Wegovy (semaglutide) and Zepbound (tirzepatide) work better. “Emerging research from the Mayo Clinic has found that postmenopausal women receiving hormone therapy in combination with GLP-1 semaglutide achieved approximately 30 percent greater weight loss than those using the GLP-1 alone,” notes Dr. Boyd. Again, this is a decision to be made with your healthcare provider—but it’s good information to know!

What this means for you

If you are in perimenopause or have already gone through the menopause transition, here are the key takeaways when it comes to reversing (or preventing) menopause weight gain:

Don’t blame yourself. The shift in body fat distribution is driven by changes in estrogen and progesterone, not by a lack of effort.
Get checked. If you notice significant abdominal changes, Dr. Haver recommends a visit with your physician to rule out other medical issues.
Move with purpose. Prioritize HIIT and strength training, aiming for two to three strength sessions a week and at least 150 minutes of aerobic exercise.
Eat more protein and fiber. Most women are not getting enough of either crucial nutrient.
Add yogurt or kefir. Two servings a week was associated with a 31 percent reduction in obesity risk in one study.
Prioritize sleep. Poor sleep directly undermines the body’s ability to burn fat.
Consider HRT. The benefits generally outweigh the risks, especially when started within 10 years of menopause or before age 60.
Ask about GLP-1s. Research suggests HRT combined with GLP-1 medications may lead to approximately 30 percent greater weight loss than GLP-1 drugs alone.

The days of suffering in silence are fading. With better science, more willing doctors and growing community support, women dealing with menopause weight gain have more tools at their disposal than ever before.

Ready for more? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

Is It Too Late To Start HRT? Dr. Mary Claire Haver Reveals the ‘Sweet Spot'

cmosness — Tue, 17 Mar 2026 01:30:11 +0000

For those of us dealing with unwelcome symptoms of menopause such as vaginal dryness, hot flashes and even bone loss, you’ve probably found yourself wondering “When is the best time to start HRT, and have I already missed my window?” According to Mary Claire Haver, MD, a board-certified ob-gyn, Menopause Society certified practitioner and New York Times best-selling author, the answer for most women is clear. It’s not too late, and the benefits may be more wide-ranging than many realize.

Dr. Haver joined Woman’s World editor-in-chief Liz Vaccariello on the podcast What Matters With Liz to answer listener questions about perimenopause, menopause and the long-term health benefits of hormone replacement therapy (HRT). Keep reading to see the menopause myths that have been busted and what women can do right now to advocate for their own care.

Hormone therapy is safe for most women

For decades, many women were told that hormone replacement therapy increases breast cancer risk. Dr. Haver said that study has since been debunked and that fear has kept women from treatment that could genuinely improve their health.

“For the vast, vast majority of women, hormone replacement therapy is safe and beneficial,” Dr. Haver said. “And you are not selfish for taking it. You are at a place in your life where the loss of hormones is affecting every organ system of your body, and we can help you get some of those back.”

She added a clear caveat: “Can you be healthy without hormone therapy? Yes. I want to be clear. But what every woman deserves is an educated conversation and then let her make her own decision for her own health. And that is not happening.”

Generally speaking, menopause marks the point when a woman’s ovaries stop producing the hormones estrogen and progesterone, which play roles in bone health, heart health, brain function and more. Dr. Haver, who prefers the term menopausal hormone therapy (MHT), made the case that replacing those hormones can provide significant, measurable benefits.

When is the best time to start HRT?

One listener, a 50-year-old woman named Marie who was five years past her last period, asked a question many women share: “I am 50. My last period was five years ago. I have not had any hormone replacement therapy or menopause care. Should I start now, or is it too late?”

Dr. Haver’s response was unequivocal: “Absolutely start now. She is in the sweet spot. The earlier you start—the closer to menopause, especially in that first 10 years and certainly before age 60—you will have cardiovascular benefit. You’ll have bone benefit every day you take it, regardless of age. You might have mental health benefits.”

Beyond the well-known advantages, Dr. Haver said many of her patients discover unexpected improvements. “And I can’t tell you how many patients say, ‘I didn’t realize my hip pain was going to get better or that my skin would stop itching’ or things that would bother them would just go away.”

For Marie, the outlook was optimistic. “She’s going to get maximum benefit because she’s starting young,” Dr. Haver said.

The takeaway for women in a similar position: That first decade after menopause and before age 60 represents the window when starting HRT can deliver the most significant returns for cardiovascular, bone and overall health.

Why many doctors still aren’t prescribing HRT

If hormone therapy is safe and beneficial for most women, why are so many still being turned away by their own physicians?

“Those clinicians are undereducated. I was that doctor,” Dr. Haver said. “I was under the same assumptions, and I want to be clear: I was part of the problem. The agencies that trained me and maintained my medical certification did not prioritize women’s health after reproduction ends.”

She also acknowledged the systemic pressures facing physicians. “And to defend the medical community: Physicians are rushed, seeing patients in 10- to 15-minute visits. It is impossible to do comprehensive medical care the way most systems are set up today.”

The result, she said, is that many skilled clinicians—doctors who delivered babies and provided years of care—simply lack the specific training needed to manage menopause effectively.

How to find the right HRT doctor

For women who want to explore hormone therapy, “Go to the Menopause Society website at menopause.org and find a certified practitioner,” Dr. Haver suggests. “There are also telemedicine options that are training and certifying clinicians.”

And before making an appointment, “Call your doctor’s office and ask: ‘Do you do comprehensive menopause care? Do you prescribe HRT? Are you willing to have that conversation with me?’ Get that answer before you invest the time and copay.”

Additionally, Dr. Haver pointed women to her own platform: “On our website at thepauselife.com, we have testimonials from thousands of followers recommending doctors in their areas.”

The bottom line on the best time to start HRT

Whether you are approaching menopause, currently in it or years past it, the central message from Dr. Haver is this: You deserve an informed conversation about your options, and you should not let outdated assumptions prevent you from getting one.

The science, as she described it, supports hormone therapy as safe and beneficial for most women. The key is finding a qualified provider, asking direct questions and understanding that the first 10 years after menopause—and before age 60—represent the optimal time to begin.

Ready for more inspiration? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

Painful Sex After Menopause ‘Is 100% Treatable,’ Says Dr. Mary Claire Haver

cmosness — Mon, 16 Mar 2026 21:00:37 +0000

For millions of women navigating perimenopause, an uncomfortable and often unspoken problem can quietly reshape one of the most personal parts of our lives: sex becomes painful. But according to one of the country’s leading menopause experts, it doesn’t have to stay that way. On a recent episode of the podcast What Matters With Liz, board-certified ob-gyn, Menopause Society certified practitioner and New York Times best-selling author Mary Claire Haver, MD, addressed the issue of painful sex after menopause head-on and delivered a message many women need to hear: “[It] is 100 percent treatable.”

What is GSM, and why does it cause painful sex?

The condition at the center of this conversation is called genitourinary syndrome of menopause (GSM). Dr. Haver explains that it occurs when women lose elasticity and lubrication (leading to vaginal dryness) and the vaginal tissues begin to shrink. These physical changes are the most common cause of pain during intercourse for women in perimenopause and menopause, she said.

Host Liz Vaccariello, editor in chief of Woman’s World, introduced the topic on her podcast by reading a question submitted by a reader: “I am in my early 50s and I still feel vibrant. But my sex drive is non-existent. When I attempt to make love with my husband and it hurts, it’s not enjoyable. What can I do? Am I just done having sex already?”

Dr. Haver’s response was immediate and unequivocal. “You are not done,” she said.

Two common issues that cause pain during sex

One of the most important distinctions Dr. Haver drew during the conversation was between two separate challenges women may face.

“There are two things happening here,” she explained. “There’s desire—the want for intimacy. That lives in the brain. And then there’s the ability to act on that without pain. That’s a separate issue.”

Understanding this distinction matters because the treatments are different for each. Pain during intercourse in this population is most often caused by GSM, which is a physical condition with a physical solution. But diminished desire is a separate issue rooted in brain chemistry, and it, too, can be addressed.

Dr. Haver recommended that women experiencing pain start with an exam from someone trained in sexual medicine to confirm the diagnosis and rule out any other underlying medical conditions first.

Vaginal estrogen is nearly ‘risk-free’

From there, the most effective treatment for painful sex is vaginal estrogen, she reveals. “Vaginal estrogen, when given appropriately, will cure the pain,” Dr. Haver explains.

For women who may be concerned about the safety of estrogen therapy, particularly those with a history of breast cancer, Dr. Haver offered reassurance. Local estrogen therapy applied in the genital area does not become systemic, she explained. That means it stays where it is applied, rather than circulating throughout the body.

“You can have active breast cancer and use vaginal estrogen,” Dr. Haver said. “It’s local—like putting topical cortisone on your arm.”

This point is significant because fears about estrogen have historically kept many women from seeking treatment. Dr. Haver made clear that local vaginal estrogen and systemic hormone therapy are not the same thing, and the localized treatment carries essentially no risk when used properly with guidance from your physician. “This is easy for us,” Dr. Haver said.

What if your desire doesn’t come back?

For women whose pain during sex is resolved but who still struggle with low desire, Dr. Haver outlined additional treatments that might help.

“If desire doesn’t return on its own, we have options for that too,” she said. “We have testosterone—not yet FDA-approved, but widely used. And there are two FDA-approved prescriptions that work on dopamine in the brain to increase receptivity.”

Dr. Haver recommended starting by addressing the pain first. “I would start there. See if we can eliminate the pain and make intimacy comfortable again,” she said. Once pain is no longer a barrier, desire may return on its own. If it doesn’t, those additional treatments targeting the brain’s chemistry are available.

It’s okay not to want sex

While much of the conversation focused on solutions for women who want to reclaim their intimate lives, Dr. Haver also offered an important reminder: Not every woman wants that, and that is completely valid. “We need to normalize women who don’t want to want it. That’s okay,” she said.

But for those who do miss that part of their lives, Dr. Haver urged them not to push through pain out of a sense of duty. “For goodness’ sake, don’t grin and bear it. Don’t do it out of obligation. That only makes everything worse,” she said.

The bottom line on treating painful sex

The conversation underscores a reality that affects a vast number of women: Pain during sex after menopause is extraordinarily common, yet many women assume nothing can be done. Some don’t raise the issue with their doctors. Others believe that discomfort is simply an inevitable part of aging.

For women who recognize themselves in the reader’s question—who still feel vibrant but are struggling with pain or the loss of desire—the takeaway is clear: Help is available, treatment is effective and no one should feel they have to accept pain as the new normal.

As Dr. Haver put it: “If you miss that intimacy and you don’t want to hurt, we can help you.”

Ready for more inspiration? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

Is It Anxiety or Perimenopause? What Dr. Mary Claire Haver Wants Women To Know

cmosness — Sun, 15 Mar 2026 16:30:46 +0000

For so many women, perimenopause brings more than hot flashes. It brings brain fog so severe some are quitting their jobs, and anxiety so intense that years of carefully managed mental health unravel almost overnight. For years, the standard medical response to anxiety and other mood changes during perimenopause has been an antidepressant prescription. But according to Mary Claire Haver, MD, a board-certified ob-gyn, Menopause Society certified practitioner and New York Times best-selling author, that reflex may be getting the treatment order backward.

In a revealing conversation on the podcast What Matters With Liz, hosted by Woman’s World editor-in-chief Liz Vaccariello, Dr. Haver laid out what she believes is a more effective approach—and explained why the mood symptoms of perimenopause deserve far more attention than they typically receive.

Perimenopause starts in the brain

Most people associate menopause with hot flashes and the end of menstruation. But according to Dr. Haver, the process begins long before those more recognizable milestones

“What makes perimenopause so special is the process can last up to 10 years and it begins in the brain,” Dr. Haver said. “So the top two things you’re going to feel are brain fog and mental health changes.”

Rather than a brief physical transition, perimenopause is a prolonged neurological and hormonal shift that can profoundly affect how women think, feel and function in their daily lives. As Vaccariello put it when introducing the topic, perimenopause “affects every woman—and every man who loves a woman.”

Perimenopause brain fog is not dementia

For many women, the scariest part of perimenopause-related brain fog isn’t the memory blips themselves. It’s the fear of what they might mean. When you can’t recall a neighbor’s name, lose your train of thought mid-sentence or forget an appointment you’ve kept for years, the mind can spiral to a terrifying place: Is this dementia?

Dr. Haver addresses this fear directly, drawing on a distinction made by Dr. Lisa Mosconi: “Brain fog is ‘I can’t find my keys.’ Dementia is ‘I don’t know what my keys are.’”

Still, brain fog during perimenopause isn’t just a minor inconvenience. According to Dr. Haver, “Somewhere between one in 10 and one in five women are quitting their jobs because of brain fog.”

“I have incredibly high-functioning women come to my clinic who are devastated, feeling like they can’t do the life they built anymore,” she said. “For some, it gives them agency to leave a job that wasn’t serving them. But for others, this is their time. We’re supposed to be using our wisdom, leading companies, building things—and they just can’t. And then comes that devastation of what’s wrong with me?“

Dr. Haver emphasized that this perimenopause symptom is treatable and urged women not to simply accept it as inevitable. “This can be dealt with,” she said.

Is it perimenopause or anxiety?

Beyond brain fog, mental health changes during perimenopause are common and can be deeply unsettling, particularly for women who believed they had their mental health well managed.

During the podcast, Vaccariello read a question from Jenny, age 46: “I have struggled with mild anxiety for most of my life. I’ve had it managed with therapy and tools. But lately my anxiety is back with a vengeance. How do I know if this is connected to perimenopause and would be helped by hormone replacement therapy or if I need a mental health prescription?”

Dr. Haver’s answer pointed to a growing body of evidence that challenges conventional treatment approaches. “Great studies have been done on perimenopausal women with new-onset or exacerbated anxiety and depression, women who were previously well-controlled and suddenly aren’t,” she said. “For those women, starting menopausal hormone therapy in perimenopause had a better response than starting an SSRI,” or a selective serotonin reuptake inhibitor.

Dr. Haver’s approach is clear: “In my clinic, we would start her on hormone therapy and monitor her symptoms. She may still need an SSRI—we’re not dismissing that women do well with them when they need them. But it looks like first-line therapy for these patients should be hormone therapy.”

Are women in perimenopause being overprescribed antidepressants?

According to Dr. Haver, the rate of SSRI prescriptions, a common class of antidepressants, doubles across the menopause transition. “Ten percent of women are on them premenopausally, and it doubles to 20 percent postmenopausally then goes up another five percent at age 65,” she said.

Dr. Haver attributed this trend in part to the realities of a time-pressed medical system. Because a doctor hears “mood” or “anxiety,” they have 10 minutes and that’s what they’re trained to do. That’s what gets written on the prescription pad.

The implication is significant: Many women may be receiving antidepressants when menopause hormone therapy could be a more effective first option. Dr. Haver is not arguing that SSRIs have no place in treatment—she explicitly said women do well on them when they are needed. But the reflexive reach for an antidepressant may be shortchanging patients whose symptoms are being driven by hormonal changes, not a primary mood disorder.

What this means for you

For women in their 40s and 50s who are experiencing unexplained brain fog, a sudden resurgence of anxiety or mood changes that seem to come from nowhere, Dr. Haver’s guidance offers both validation and a potential path forward. The symptoms are not a personal failing. They are not necessarily a sign of a new mental health condition. They may be perimenopause, and the treatment options may be different from what a hurried appointment produces.

Dr. Haver, whose book The New Perimenopause catalogs a comprehensive list of symptoms, is leading the shift in how we approach this life transition. A key takeaway worth carrying with you: You’re not losing your mind. You’re navigating a biological process that medicine is finally learning to take seriously. And you deserve a doctor who will, too.

Ready for more inspiration? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

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