The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts

“I was lucky that I had the ability to self-diagnose and self-treat. I was also fortunate in that I had access to research and medical insight that helped me create a comprehensive approach to my own care. This included nutritional strategies, exercise, and stress reduction techniques. Fortunately, the combined approach worked, and I began to feel better.”

The author employs a reflective and self-aware tone, acknowledging her privilege in having the ability to “self-diagnose and self-treat.” This admission highlights the broader issue of unequal access to healthcare resources. The repetition of “fortunate” underscores the rarity of her position, emphasizing that while she was able to take control of her health, not all women have the same opportunities. Dr. Haver’s use of a structured approach—“nutritional strategies, exercise, and stress reduction techniques”—illustrates her belief in holistic care, reinforcing the idea that addressing menopause symptoms requires a multi-faceted approach. By stating that the “combined approach worked,” she conveys a message of hope and empowerment, encouraging women to consider similar comprehensive methods.

“At age forty-seven, I was told by a gynecologist that perimenopause isn’t real and was asked if I had a psychiatrist. I was told that it’s all in your head. Welcome to your new normal.”

Here, the author uses personal testimony to highlight the dismissive attitudes many women face from healthcare providers regarding perimenopause. The anecdote showcases the frustration and invalidation women who experience significant symptoms feel, only to be told that their concerns are psychological rather than physiological. The phrase “I was told that it’s all in your head” reflects a broader issue of medical gaslighting, where medical professionals minimize and disregard legitimate health concerns, particularly in women’s health. The sarcastic “Welcome to your new normal” further emphasizes the lack of empathy and care provided to women navigating menopause. This rhetorical strategy —using a personal and relatable experience—critiques the systemic failure in recognizing and validating the perimenopausal experience and contributes to The Emotional and Psychological Impacts of Menopause.

“Estrogen isn’t just a pretty hormone that’s key to reproductive capabilities; it’s responsible for so much more. There are estrogen receptors throughout almost every organ system in your body, and as your levels drop, these cells begin to lose their ability to assist in maintaining your health in other areas, including your heart, cognitive function, bone integrity, and blood sugar balance.”

The author emphasizes the multifaceted role of estrogen in women’s health, challenging the misconception that it primarily affects reproductive capabilities. By stating that “estrogen isn't just a pretty hormone,” she critiques the tendency to minimize its broader health implications. Dr. Haver’s use of direct, accessible language makes complex biological processes more understandable. Her reference to how estrogen impacts multiple systems reinforces the argument that declining estrogen levels during menopause can lead to widespread health issues, such as heart disease and cognitive decline. This excerpt exemplifies her broader mission in the book—to educate women about the extensive effects of hormonal changes and empower them to take proactive steps in managing their health during menopause.

“I know the mention of hormone replacement therapy might bring up a lot of emotions, including fear. This is understandable—MHT has what some would describe as a troubled past, and it’s not the right approach for everyone. But what I’m going to offer you in this book is something you maybe haven’t gotten in your doctor’s office, and something you deserve: a comprehensive discussion on the topic of hormone replacement therapy.”

The author acknowledges the emotional and psychological barriers surrounding HRT or MHT. She is empathetic toward readers who might feel fearful or apprehensive due to HRT’s controversial history, which has raised concerns about potential risks like cancer. The phrase “might bring up a lot of emotions, including fear” reflects her sensitivity to these concerns. Dr. Haver’s use of “troubled past” positions her as someone who is not dismissive but understands the complexity of HRT’s reputation. Through the promise of a “comprehensive discussion,” Dr. Haver reassures her audience that the book will provide an informed, in-depth exploration of HRT that goes beyond the surface-level information people typically receive from doctors.

“When estrogen diminishes in the postreproductive phase, namely menopause, and all these symptoms arise, what’s the point? There are some theories, but I have my own suggested take on this transitional stage of our lives. I think we should consider these symptoms a sign that there’s a living being needing great care. And that being is YOU. You need attention, you need love, you need support, and you should consider yourself ushered into an unprecedented era of much-needed self-care.”

The author reframes menopause as an opportunity for self-care rather than merely a phase filled with difficult symptoms. The phrase “a living being needing great care” emphasizes the individual woman, positioning menopause as a time to focus on personal well-being. Dr. Haver’s use of the second person (“YOU”) directly addresses the reader, creating a more intimate and motivational tone. The short, powerful statements like “You need attention, you need love, you need support” emphasize empowerment and self-compassion. This approach reframes the physical and emotional challenges of menopause, encouraging women to see this period as a call to nurture themselves rather than merely a time to endure discomfort.

“In 1998, the Women’s Health Initiative (WHI) launched menopausal hormone therapy trials to finally use this gold standard of testing to evaluate MHT and its effect on cardiovascular disease and cancer in postmenopausal women. With twenty-seven thousand participants and a planned fifteen-year duration, it was part of the ‘largest women’s health prevention study ever.’ What happened next would again change the course of the use of hormone replacement therapy and alter the lives of an incalculable number of menopausal women.”

Here, the author highlights the pivotal role of the WHI in the trajectory of MHT. The phrase “largest women’s health prevention study ever” underscores the magnitude of the study and its importance in women’s health. By focusing on the sheer scale of the trials—27,000 participants and a planned 15-year duration—Dr. Haver emphasizes the significance of this research. However, the use of “What happened next” signals a turning point, hinting at unexpected outcomes that would disrupt previous understandings of MHT. The rhetorical shift from hope to unforeseen consequences introduces a dramatic impact on the lives of menopausal women. This sets the stage for a deeper exploration of the changes in medical practices and patient experiences because of the WHI study findings.

“The media reinforced the message so repeatedly and so emphatically that the WHI study became the top medical story of 2002. The result, as I mentioned above: Women everywhere abruptly stopped taking hormone therapy, and 70 to 80 percent of those who had been taking hormones failed to renew their prescriptions. This means millions of women stopped getting relief from menopausal symptoms, and countless more failed to reap the preventative benefits of MHT.”

The author critiques the role of media in shaping public perception of the WHI findings on menopausal hormone therapy MHT. She emphasizes how media reporting simplified and exaggerated the findings. The drastic response—where 70 to 80 percent of women stopped their hormone prescriptions—illustrates the widespread impact of media coverage. Dr. Haver expresses concern over the negative consequences, as many women, in the wake of this reporting, lost access to treatments that could have alleviated their symptoms. She stresses the harmful effects of sensationalized reporting, which led to a sudden shift in public and medical approaches to MHT, detrimentally affecting women’s health.

“One of the significant flaws of the WHI study was the use of a single formulation of MHT. As you may recall, group 1 (the group associated with increased cancer risk) was given a combination of estrogen and a progestin. More specifically, the formulation was conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA), which is a synthetic version of progesterone. Group 2 was given CEE alone; there was no increased cancer risk seen in this group. This is significant for a couple of reasons. The first reason is that it’s possible it was the type of progesterone used in the study that correlated to cancer risk and not the estrogen, as was reported.”

Dr. Haver critiques a significant flaw in the WHI study by pointing out the limited use of a single formulation of MHT. The study divided women into two groups: one received a combination of CEE and synthetic progestin (medroxyprogesterone acetate), and the other received CEE alone. The increased cancer risk found in the first group suggests, according to Dr. Haver, that it may have been synthetic progestin, not estrogen, responsible for the heightened risk. This distinction is crucial because it challenges the generalized fear of MHT that followed the study, as the findings may not apply to all forms of hormone therapy. Dr. Haver’s critique highlights how the study’s design may have contributed to the broad public misunderstanding and discontinuation of MHT. She uses this example to emphasize the importance of more nuanced research and individualized treatment.

“If you are a candidate for hormone therapy, an increasing amount of science shows that MHT has the greatest potential to deliver preventative benefits when started less than ten years after your menopause. This means documenting the age at which you enter menopause is important, and so too is having the discussion on MHT with your informed healthcare provider.”

Dr. Haver references the growing body of scientific evidence that suggests MHT is most effective in delivering preventative health benefits when started within ten years of menopause. This underscores the need for women to have informed discussions with healthcare providers about MHT options. Dr. Haver uses a factual, research-based tone to communicate the significance of early intervention, positioning MHT not just as a solution for symptom relief but also as a preventative measure to support long-term health. This approach highlights her aim to empower women with knowledge and encourage proactive health management during menopause.

“The government is also getting legislative pressure to do more for menopause. A bill introduced in 2023 recommends that the NIH be required to evaluate the current state of menopause research, including identifying any gaps and calculating the total amount of funding the NIH has allocated for menopause and midlife women’s health research for the previous five years. Other medical societies, such as the American Heart Association (AHA), are recognizing the importance of the menopause transition and its role in worsening disease states, specifically with regard to cardiovascular disease risk.”

Dr. Haver underscores the growing recognition and political momentum surrounding menopause research and healthcare. By referencing legislative efforts and the involvement of prominent organizations like the NIH and AHA, she illustrates the increasing acknowledgment of menopause as a significant health issue that demands more attention and resources. Rather than merely stating the facts, Dr. Haver uses this excerpt to highlight the systemic gaps in menopause research and funding, pushing her audience to consider the broader societal implications of underfunding and under-researching women’s midlife health. The mention of cardiovascular disease risk is particularly strategic, as it links menopause to a widely acknowledged and serious health concern, reinforcing the urgency for action.

“Dr. Mosconi’s work is focused on early detection and prevention of cognitive aging and Alzheimer’s disease in at-risk individuals, especially women. She has brought attention to a statistic that may be surprising to many, which is that two-thirds of all patients suffering from Alzheimer’s disease are postmenopausal women. Yikes. Perhaps more unsettling than this is her remark that this discrepancy has for far too long been written off as inevitable simply because women live longer than men. In other words, it is often assumed that we should just accept this reality and move on.”

The author sheds light on Dr. Mosconi’s critical research on cognitive aging and the heightened risk of Alzheimer’s disease in postmenopausal women. By referring to the statistic that two-thirds of Alzheimer’s patients are women, Dr. Haver speaks with a sense of urgency, highlighting the gravity of the issue. The rhetorical strategy here involves the juxtaposition of startling data with a critique of how this disparity has been historically downplayed. Dr. Haver emphasizes that this higher prevalence in women has long been dismissed as a consequence of women living longer, a viewpoint she challenges by drawing attention to the need for deeper inquiry. Her tone, laced with both concern and critique, calls into question the complacency of medical and societal attitudes toward women’s health. Additionally, using causal language such as “yikes” makes her writing more approachable to the everyday individual. In doing so, Dr. Haver urges women to rethink the acceptance of such gendered health disparities, stressing the importance of proactive prevention and research.

“A woman’s menopausal journey is made up of three discrete medical stages: perimenopause, menopause, and postmenopause. By definition, these are different stages, but in terms of experience they can feel very much the same. The reason symptoms can be similar throughout the stages of menopause is that they are all caused by deprivation of sex hormones (estrogen, testosterone, progesterone) that results from the decline and eventual end of ovarian function. It’s usually the severity of symptoms, not the actual symptoms, that will vary as you move through the menopausal transition to menopause and then into postmenopause.”

The author provides a clear and organized breakdown of the three stages of menopause: perimenopause, menopause, and postmenopause. Her use of the term “discrete medical stages” emphasizes that while medically distinct, these stages can feel similar due to the common root cause—sex hormone deprivation. By explaining that it is the intensity of symptoms, not their type, that changes over time, Dr. Haver demystifies the often-confusing nature of the menopausal experience. This strategy of blending medical terminology with accessible explanations helps bridge the gap between clinical knowledge and everyday experience to emphasize The Biological Changes of Menopause. Dr. Haver’s straightforward approach enhances understanding of menopause as a continuum rather than isolated events and reinforces the importance of recognizing the hormonal shifts that underpin these stages. This encourages a more informed and proactive approach to managing the journey.

“Women who have never birthed children are more likely to go into premature or early menopause compared with those who have. So too are those who had their first menstrual period at age eleven or younger. When these factors are combined, that is, someone has not birthed a child or children and they experienced menarche at a young age, there is a fivefold increased risk of premature menopause and a twofold increased risk of early menopause compared with women who started their periods at age twelve or older and had two or more children.”

Dr. Haver presents statistical information on how reproductive history and early onset of menstruation can influence the timing of menopause. By referencing specific factors, such as the age of first menstruation and the experience of childbirth, she establishes a clear correlation between these variables and the increased risk of premature or early menopause. The use of quantifiable data like “fivefold increased risk” and “twofold increased risk” lends credibility to her claims, making the discussion both scientifically grounded and accessible. This excerpt highlights Dr. Haver’s approach of blending personal health advice with medical research to inform her audience.

“Between 40 and 50 percent of postmenopausal women will experience a fracture related to osteoporosis during their lifetimes. Studies have also found associations between vasomotor symptoms, such as hot flashes and night sweats, and lower bone mineral density, osteoporosis, and even bone fractures.”

The author emphasizes the serious health risks associated with postmenopausal osteoporosis, highlighting that nearly half of postmenopausal women will experience a fracture due to the condition. The inclusion of statistical data— “40 to 50 percent”—underlines the prevalence and severity of the issue. Additionally, Dr. Haver draws attention to the link between vasomotor symptoms, such as hot flashes and night sweats, and reduced bone mineral density, signaling that these common symptoms of menopause have broader implications beyond discomfort. By connecting seemingly unrelated symptoms to conditions like osteoporosis and fractures, Dr. Haver reinforces her central message that the health impacts of menopause are far-reaching and demand proactive management. Her approach combines medical evidence with a clear, accessible explanation to raise awareness about the importance of monitoring bone health during menopause, encouraging women to take preventative measures to mitigate these risks.

“Women often come in feeling completely distressed, complaining that other healthcare providers offered only, if anything at all, vague advice to ‘work out more and eat less.’ My approach is to explain that a successful strategy will be much more specific than that, and I also stress the dangers of doing nothing to counter the effects of visceral fat gain. To be clear, I am not discouraging acceptance of your changing body—you should accept the heck out of your body and all it’s done for you! But that doesn’t mean you should acquiesce to changes that can have serious health consequences.”

Dr. Haver uses a personal, conversational tone to address the frustrations many women feel when they receive generic advice from healthcare providers. The phrase “work out more and eat less” serves as an example of the vague and often unhelpful guidance women encounter. By contrasting this with her approach—offering a “much more specific” strategy—Dr. Haver positions herself as both an empathetic and knowledgeable guide. The use of strong, direct language like “completely distressed” and “serious health consequences” emphasizes the emotional and physical toll that menopause-related changes can take on women. Dr. Haver balances acceptance of the body’s natural changes with a clear warning against passivity, encouraging women to embrace their bodies while also taking action to protect their health.

“Clinical sarcopenia is most commonly diagnosed in individuals sixty-five and older, but muscle loss begins to happen much earlier, around the age of thirty. After thirty, it’s estimated that we lose between 3 and 5 percent of our muscle mass each decade, and this accelerates to up to 10 percent after menopause. Your risk for sarcopenia goes up after menopause, and additional risk factors include type 2 diabetes, smoking, physical inactivity, and malnutrition.”

Dr. Haver presents clinical sarcopenia as a crucial health concern, emphasizing that muscle degradation begins much earlier than people might assume, around the age of 30. By providing concrete statistics on muscle loss, she quantifies the gradual decline that accelerates after menopause. This clear use of data strengthens her argument, framing sarcopenia as a serious yet preventable issue for women as they age. Dr. Haver links muscle loss to menopause and other risk factors like diabetes, smoking, and malnutrition, underscoring the multifaceted influences on women’s health. Her use of factual information, combined with relatable markers of age and lifestyle factors, makes the content accessible and alarming, encouraging her audience to consider proactive measures for preserving muscle mass.

“The birth control pill (often referred to as ‘combined birth control’) and menopause hormone therapies are both made up of the same basic hormones—estrogens and progestogens—which is why many patients come in asking me if they can’t just continue taking the pill. The primary difference in these medications is dosage. MHT was developed to control the symptoms of menopause, and birth control pills were developed to suppress ovulation and prevent pregnancy; you need much higher doses to accomplish the latter.”

Dr. Haver compares birth control pills and MHT to clarify a common point of confusion. She explains that while both medications contain similar hormones, the key difference is in their dosage and intended function. MHT is formulated to control menopausal symptoms, whereas birth control pills are designed to prevent ovulation and pregnancy, requiring much higher doses of hormones. Through this comparison, Dr. Haver simplifies the concept, allowing her audience to understand the necessity of transitioning from birth control to MHT during menopause. This approach highlights her ability to provide clear, practical guidance, making complex hormonal changes more accessible for women going through menopause. By focusing on the purpose and dosage difference, Dr. Haver effectively educates her audience on the importance of tailored treatment approaches during different life stages.

“The decision to embark on MHT should always be based on your unique medical history, risk factors, and symptoms. And your healthcare provider should be consulting current research and clinical guidelines to help ensure you’re getting the most up-to-date recommendations. For far too long, women have been denied access to the most effective treatment for menopausal symptoms on the basis of misconceptions and misinformation. We deserve and can demand better!”

Dr. Haver emphasizes the importance of individualized medical care when deciding whether to start MHT. By stating that the decision should be rooted in a person’s unique medical history, symptoms, and risk factors, she reinforces the need for personalized treatment plans. Dr. Haver criticizes the historical lack of access to effective menopausal treatments, pointing out that many women have been misled by misconceptions and outdated information. Her use of assertive language, such as “we deserve and can demand better,” underscores the call to action for women to advocate for better healthcare. Through this, she positions the individual as an empowered agent in their health decisions, highlighting the broader social issue of gender bias in medical care and the necessity for updated, research-based recommendations from healthcare providers.

“When researchers from Yale University looked at over five hundred thousand insurance claims from women in various stages of menopause, they found that three hundred thousand of the claims were related to patients seeking medical assistance for significant menopausal symptoms—and that 75 percent of the patients left without treatment.”

The author highlights a significant gap in the healthcare system’s approach to menopause treatment. By referencing Yale University research, she presents alarming statistics that showcase the systemic neglect faced by menopausal women. Specifically, the fact that 75 percent of patients seeking treatment for menopausal symptoms left without receiving any care points to a widespread failure in addressing women’s health needs. Dr. Haver uses these statistics not only to validate the experiences of many women but also to emphasize the urgency of improving menopause care. The use of concrete figures (“over five hundred thousand insurance claims” and “three hundred thousand related to menopause”) lends credibility to her argument. Additionally, the rhetorical impact of stating that the majority leave untreated draws attention to the severity of the issue. This excerpt further reinforces Dr. Haver’s focus on Empowerment Through Education and support for women during menopause and the necessity of addressing these medical oversights.

“If you haven’t already, start keeping a symptom journal of any noticeable changes to your health. Make note of any new aches and pains, increases in fatigue, gastrointestinal issues, differences in hair or skin, weight gain or loss, mental health or memory challenges, and so on. Be as detailed as you can–your doctor will want to know how long you’ve been experiencing the symptoms and if they’ve become more or less severe.”

Dr. Haver advises women to take an active role in tracking their menopause symptoms by keeping a detailed symptom journal. The recommendation to document changes in health—such as aches, fatigue, gastrointestinal issues, skin, and mental health—highlights her emphasis on self-advocacy in healthcare. This strategy empowers women to provide their doctors with clear and detailed information, making it easier for healthcare providers to diagnose and address menopausal symptoms. The detailed nature of the symptom tracking also reflects Dr. Haver’s broader approach to encouraging proactive, informed health management. By framing this advice in a practical, action-oriented way, Dr. Haver not only gives women a tangible tool to manage their health but also reinforces the importance of patient-doctor collaboration.

“My generation of medical students and ob-gyn residents received little training in menopause: maybe a one-hour lecture in medical school and another six hours in residency. There were no ‘menopause clinics,’ meaning no specialized care training in menopause. And by the end of my residency, we were under the assumption that hormone replacement therapy was dangerous because of the initial findings from the WHI study.” 

Dr. Haver reflects on the inadequate training her generation of medical students and OB-GYN residents received regarding menopause. Her mention of receiving “maybe a one-hour lecture” and the lack of “menopause clinics” underscores the systemic gaps in medical education when it comes to women’s health, particularly menopause care. The brief and insufficient training reflects a broader issue of medical oversight, leaving healthcare providers ill-prepared to address the complexities of menopause. Dr. Haver’s reflection on her early medical education serves as both a critique of the medical field’s historical negligence and a call for reform. Additionally, her acknowledgment of how early findings from the WHI study influenced the negative perception of HRT shows how flawed studies can lead to widespread misinformation, further limiting the quality of care women receive. Through this analysis, Dr. Haver demonstrates the importance of educating future healthcare professionals and correcting past misconceptions to improve menopause care.

“A core foundation of the Menopause Tool Kit is anti-inflammatory nutrition. As estrogen levels decline during the menopausal transition, you lose an incredibly valuable ally in the fight against inflammation. You can compensate somewhat for this loss by being highly strategic about what you eat. Anti-inflammatory nutrition means eating healthy fats, lean meats, and antioxidant rich fruits and vegetables, and increasing your fiber intake. It also means limiting intake of alcohol, processed meats, and processed foods generally.”

Dr. Haver highlights the importance of anti-inflammatory nutrition as a key strategy, as mentioned in her Menopause Tool Kit, to combat the body’s heightened inflammation during menopause. She explains that as estrogen levels drop, the body’s natural defenses against inflammation weaken, but strategic dietary choices can help compensate for this loss. The use of terms like “ally” and “strategic” emphasizes that managing nutrition is not just about basic health but also about actively fighting a battle against menopausal symptoms. By recommending foods rich in healthy fats, lean proteins, antioxidants, and fiber and discouraging processed foods and alcohol, Dr. Haver blends practical advice with scientific reasoning. Her rhetoric of empowerment through dietary choices encourages women to take control of their health during menopause by making mindful food selections. In doing so, she frames nutrition as a proactive tool in managing menopausal symptoms and long-term health.

“My primary goal in creating this Tool Kit is to provide you with the tools that can help relieve menopausal symptoms and reduce associated increases in health risks. But I also want the Tool Kit to serve as a tool of expansion; I want it to open the minds of people (in the public and in the medical community) to the many ways menopause may manifest itself symptomatically.”

Dr. Haver emphasizes the dual purpose of her Menopause Tool Kit. First, she seeks to provide practical tools for relieving menopausal symptoms and reducing associated health risks. Her use of the word “tools” depicts an empowering, actionable approach where women are equipped with tangible resources to navigate menopause effectively. However, she also introduces a secondary, broader goal—expanding awareness in both the public and medical community about the diverse ways menopause can manifest symptomatically. This notion of “expansion” points to her mission to shift outdated perceptions and encourage a more nuanced understanding of menopause. Dr. Haver positions her tool kit as not only a personal resource but also as a catalyst for cultural and medical progress.