Perimenopause: Brain Symptoms Come First

Dr. Mary Claire Haver breaks down everything you need to know about perimenopause, menopause, and postmenopause in this solo episode, answering critical questions about hormones, symptoms, and treatment with the medical expertise and personal experience that's made her a trusted voice for millions of women.

Most women don't realize perimenopause can begin at 35-36 years old, a full seven to ten years before periods stop. Dr. Haver explains why the first signs are often brain-related: fog, anxiety, feeling like "something's not right," rather than physical changes. Menopause itself is just one day (one year after your last period), but postmenopause represents 30-50 years of life without ovarian hormones. Understanding these three phases changes everything about how women can navigate this transition.

In this episode, Dr. Haver answers questions like: What is menopause and when does it really start? Why am I gaining weight around my middle even though my diet hasn't changed? Why am I suddenly experiencing anxiety and depression? What changes happen to the vagina and bladder? What are my hormone therapy options? And what about testosterone, do I need it?

With estrogen receptors mapped throughout the body, Dr. Haver reveals how declining hormones affect nearly every system. She lists over 40 potential symptoms beyond hot flashes: frozen shoulder, elevated cholesterol, insulin resistance, joint pain, kidney stones, even heightened hearing. Understanding the biology of how your hypothalamus frantically signals ovaries that can't respond explains why menopause impacts so much more than your cycle. She also explains why visceral belly fat triples during this transition regardless of diet and exercise changes, and what that means for long-term health.

Dr. Haver shares a revealing statistic: only 8% of OB-GYN residents feel competent treating menopause, and 77% receive zero menopause training. She explains what doctors should know but often don't: hormone therapy as first-line treatment for mental health changes in perimenopause, prophylactic vaginal estrogen for all perimenopausal women (considered safe even for many breast cancer patients), no mandatory stop date for hormone therapy when benefits outweigh risks, and affordable bioidentical options that exist beyond expensive pellets.

This episode arms you with knowledge to find menopause-educated clinicians, recognize quality care, and demand treatment that actually works. As Dr. Haver emphasizes throughout the episode, no woman should suffer unnecessarily when safe, effective options exist.

Articles:

• When zero doesn’t mean zero: the limits of coronary calcium in women (Dr. Peter Attia)

Guest links:

• Mary Claire Wellness

• The ‘Pause Life

• Dr. Mary Claire Haver (Instagram)

• Dr. Mary Claire Haver (YouTube)

Books

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

Other Resources

• The Menopause Society

• The Women’s Health Initiative

• Dr. Kelly Casperson

• Dr. Corinne Menn

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