Mary Claire Haver+

Why You Still Can’t Sleep in Menopause, and What Actually Works

Hormone therapy is not a sleeping pill. It does one job well, but the treatment with the best evidence is often overlooked.

Hormone Therapy With High Blood Pressure, Diabetes, or High Cholesterol: New Guidance for Menopause

If you’ve been told no to hormone therapy because of high blood pressure, diabetes, cholesterol, or your weight, a joint position paper from the International Federation of Gynecology and Obstetrics and the World Heart Federation (Global Heart, 2026) lays out a different approach: assess your individual risk, then tailor the type, dose, and route.For women at higher cardiovascular or clot risk, the paper’s preferred option is low-dose transdermal estrogen (a patch, gel, or spray) with micronized progesterone if you have a uterus, after a real conversation about benefits and risks. For women at

Recurrent UTIs That Won't Go Away? New Research Reveals What's Really Happening

Recurrent UTIs that never resolve are one of the most common stories I hear, and one of the most misdiagnosed.New research in The Journal of Sexual Medicine, reported by NPR this morning: in 253 women carrying a recurrent UTI diagnosis, only 15 percent had a problem limited to the bladder. The rest had hormonally driven vulvar inflammation, pelvic floor dysfunction, or both.Important context: this was a specialty referral population, meaning antibiotics had already failed these women. The finding is not that UTIs are imaginary. The finding is that when antibiotics keep failing, nobody is exami

Hair Thinning in Midlife Women: Topical vs. Oral Minoxidil

Hair thinning in midlife women can have treatment options, including topical and oral minoxidil. This week on unPAUSED, dermatologist Dr. Erica Kelly explains how hormonal changes can affect hair follicles and why minoxidil comes up in conversations about hair loss. We discuss the topical version and low-dose oral minoxidil, which is prescribed off label for hair loss. If you’re noticing thinning, a dermatologist can help determine what’s behind it and which treatment makes sense for you. ✨Watch the full unPAUSED episode: https://m.youtube.com/watch?v=HJCAjXcD4gc&list=PL8U90xMuKu986oEs-S6gX

Menopause Skin Treatments: Botox, Lasers and Lifestyle

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Erica Kelly, board-certified dermatologist, Clinical Professor at the University of Texas Medical Branch, and founder and director of UTMB's Cosmetic Dermatology Division — and this time it's the practical half: sunscreen, routines, treatments, and hair. Dr. Kelly settles the questions filling everyone's feed — chemical vs. mineral sunscreen, whether the endocrine-disruption fears are backed by evidence, why some filters are banned in the US but not Europe — and explains why the best sunscreen is simply the

Still Tired on HRT? New Research on Adding Testosterone for Women

Two hundred seventy-nine women, all already on estrogen therapy. 92.9% still had fatigue. 89.6% still had low libido. 88.9% still had memory problems. Researchers added transdermal testosterone without changing anyone's estrogen dose. At three months, 15 of 24 symptoms had significantly improved. Energy, musculoskeletal, mood, cognitive, genitourinary and endocrine symptom clusters all improved significantly. Neuropathic and cardiopulmonary symptoms did not move at all, which is actually reassuring, because a treatment that improves everything usually is not improving anything. Also worth s

Can Hormone Therapy Prevent Heart Disease? Breaking Down the New JAMA Research

What they found: maybe 22% CVD reduction with early hormone therapy. What they couldn't answer: which formulation (if any) drives it, why Black women benefited differently, or if selection bias accounts for the whole signal. What we need: stratified RCTs by formulation type and race, powered to detect differences, not just detect average effects. Stop treating OCPs and menopausal HT as interchangeable hormone exposures. The commentary authors acknowledged the analysis was underpowered for formulation subgroups. That's not a limitation to note and move past. That's a research mandate. Sourc

Menopause Has a Data Problem. AI Is About to Inherit It.

Her symptoms can be scattered throughout her medical record without anyone recognizing the reproductive transition. That gap affects her care today and the technology being built on those records.

Skin Aging in Midlife Women: How Sun Exposure Changes Your Skin

Skin aging in midlife women isn’t only about age. Sun exposure makes a visible difference. On this week of unPAUSED, dermatologist Dr. Erica Kelly compares the skin on her patients’ forearms with the skin on their abdomens. They’re the same age, but the difference in sun exposure can be striking. She also explains how cigarette smoke accelerates visible skin aging. ✨Liste to the full unPAUSED episode: https://m.youtube.com/watch?v=SpI0pOv-h54&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m --- Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pa

Dry Skin and Itchy Ears in Menopause: What’s Happening to Your Skin?

Dry skin and itchy ears in midlife women can show up during the menopause transition. On this episode of unPAUSED, I ask dermatologist Dr. Erica Kelly why skin can feel so dry as estrogen declines. She explains how changes in ceramides can weaken the skin’s moisture barrier, while changes in hyaluronic acid can affect how much water the skin holds. And yes, we talk specifically about itchy ear canals. ✨Listen to the full unPAUSED episode here: https://m.youtube.com/watch?v=SpI0pOv-h54&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m --- Order Dr. Haver’s new book, The New Peri

Skincare for Midlife Women: A Dermatologist’s Simple Morning and Night Routine

Skincare for midlife women can be simple: sunscreen, a retinoid, an antioxidant, and a moisturizer. On this week of unPAUSED, I ask dermatologist Dr. Erica Kelly which three ingredients she recommends besides sunscreen. She chooses a retinoid, an antioxidant, and a moisturizer, then walks through how she puts them into a basic morning and evening routine. Listen to the full episode here: https://m.youtube.com/watch?v=SpI0pOv-h54&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=2&pp=iAQB&ra=m --- Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-pe

Menopause Skin Changes and the Science of Skincare

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Erica Kelly, board-certified dermatologist, Clinical Professor at the University of Texas Medical Branch, and founder and director of UTMB's Cosmetic Dermatology Division — and the first physician who ever connected the dots for Mary Claire between estrogen, collagen, and what happens to women's skin in midlife. Dr. Kelly explains why so many women feel their skin change almost overnight in their 40s and 50s — the sudden dryness, sensitivity, sagging, easy bruising, and acne all at once — and the mechanism behind it: women l

Breast Cancer Is Over. Why Don’t I Feel Like Myself?

The overlooked physical and emotional effects of breast cancer treatment, and where to find support

Do GLP-1s Work Differently for Women? What New Research Reveals

Women are not the same as men when it comes to how are bodies react to GLP-1 therapy. References: Siddiqui H, et al. Sex differences in the efficacy of GLP-1 receptor agonists. Diabetes Obes Metab. 2025; 27:6847-6856.Yang Y, et al. Sex Differences in the Efficacy of Glucagon-Like Peptide-1 Receptor Agonists for Weight Reduction. J Diabetes. 2025;17. Zawadka M, et al. Sex differences in trial representation and cardiovascular effectiveness of newer glucose-lowering agents. Diabetes Obes Metab. 2026; 28:2183-2202.Rivera F, et al. Enrollment of Females in Randomized Trials for Glucagon-Like Pepti

Hormone Therapy for Sleep: Why Progesterone Helps in Perimenopause and Menopause

Tired but wired? Wide awake at 3 AM? You’re not imagining it. 😵‍💫 Sleep disruption is one of the most common and frustrating symptoms of perimenopause and menopause, and hormones play a MAJOR role. Progesterone helps calm the nervous system and support deeper, more restorative sleep. But during (peri)menopause, progesterone can drop sharply, leaving you waking more often and feeling exhausted the next day. The research is clear: for some women, menopausal hormone therapy, especially estrogen paired with micronized progesterone, may improve sleep. Exhaustion is common, but it is not somet

Hair Loss in Menopause: The Real Reasons Your Hair Is Thinning

If you’re experiencing hair loss in midlife, you deserve more than “it’s just aging.” There can be multiple contributing factors, which is why the right evaluation matters. Understanding what your hair may be telling you can help you have a more informed conversation with your clinician and advocate for the care you deserve. Here is a link to listen to the full podcast: https://youtu.be/1vAVzr5IkkA Here is a link to request the hair loss guide: https://thepauselife.com/pages/the-midlife-hair-loss-guide Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/t

Menopause and Allergies: Is There a Link?

If your allergies showed up out of nowhere in your forties, you are not imagining it. New hay fever at 44. Hives with no trigger you can find. Asthma that was controlled for twenty years and suddenly isn’t. Skin reacting to a moisturizer you’ve used since your thirties. Estrogen and progesterone act on mast cells and on airway inflammation. When those hormones start swinging, allergic disease moves with them. That part is established. What is not established is what anyone should do about it. There are no evidence-based guidelines for diagnosing or managing allergic disease in perimenopausal a

Why Hormone Therapy Alone Is Not Enough for Healthy Aging

Hormone therapy is not a replacement for strength. In my conversation with Dr. Gabrielle Lyon on unPAUSED, we discussed the biggest needle mover for maintaining muscle, function, and independence as we age: resistance training. Listen to the full conversation here: https://m.youtube.com/watch?v=V7S8a_9d5Wo&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m Aim to strength train at least two days a week, eat enough dietary protein, and continue challenging your muscles over time. That does not always mean lifting heavier. Progressive stimulus can also come from changing the exercise

Building Muscle in Menopause: Protein, Creatine and Strength Training with Dr. Gabrielle Lyon

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Gabrielle Lyon, board-certified family physician, founder of the Institute for Muscle-Centric Medicine, and bestselling author of Forever Strong — and this time, it's the practical roadmap: exactly how to eat, train, and supplement to build muscle in your 40s, 50s, 60s and beyond. Dr. Lyon explains why your first meal after the overnight fast is the one that matters most — and why hitting 30–50 grams of protein at that meal can change your body composition even if you do nothing else. She breaks down anaboli

Why Muscle Matters More Than Body Fat for Women’s Health

Women, body fat does not tell the full story of our health. Muscle may be the more important metric. On this episode of unPAUSED, I sat down with Dr. Gabrielle Lyon to discuss why America’s health crisis is not simply a body fat problem. It is also a muscle problem. Resistance training is essential for building and maintaining muscle, and it cannot be replaced by a supplement, medication, or nutrition plan. The goal is not simply to weigh less. It is to build a stronger body that supports our metabolic health, mobility, and independence as we age. ✨Listen to the full conversation at the li

Why Do Doctors Give Different Answers About Menopause Hormone Therapy?

If three doctors give you three different answers about hormone therapy, they may be reading different guidelines.

Is Walking Enough for Healthy Aging? Why Women Need Strength Training

Listen to the full conversation here: https://m.youtube.com/watch?v=Pw--28G4gB8&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m Walking may not be enough to protect our independence as we age. This week on unPAUSED, I sit down with Dr. Gabrielle Lyon to discuss why muscle is so important for metabolic health and healthy aging. A daily 30-minute walk can reduce the risk of type 2 diabetes in a sedentary person by 50%. That benefit is not simply about calories burned. Muscle plays a major role in how the body manages glucose. But if we want to preserve strength, mobility, and in

Muscle is the Organ for Longevity with Dr. Gabrielle Lyon

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Gabrielle Lyon, board-certified family physician, founder of the Institute for Muscle-Centric Medicine, and bestselling author of Forever Strong, to explain why skeletal muscle — not body fat — determines how well women age. Dr. Lyon shares the case that changed her career: a patient in her mid-fifties who had done everything she was told — dieting, cardio, the food pyramid — yet showed signs of accelerated brain aging. The real problem wasn't her fat. It was her muscle. Dr. Lyon explains why muscle is the body's largest si

Hair Loss Blood Tests: What Women Should Ask Their Doctor to Check

Our free Midlife Hair Loss Guide can be found in the episode show notes as well as here: https://thepauselife.com/pages/the-midlife-hair-loss-guide? Your hair is a vital sign. If it suddenly looks or feels less healthy, you deserve a medical workup. Changes in your hair may point to an underlying nutritional, hormonal, thyroid, or metabolic issue. Depending on your symptoms and medical history, your clinician may consider checking ferritin, a full thyroid panel, vitamin D, vitamin B12, a CBC, and a complete metabolic panel. --- Order Dr. Haver’s new book, The New Perimenopause today: http

Perimenopause and ADHD: How Estrogen Affects Focus, Memory & Emotional Balance

Midlife can change how ADHD shows up. As estrogen shifts, focus, memory, emotional regulation, and overwhelm can feel harder to manage. That doesn’t mean you suddenly became less capable. It may mean your brain needs different support than it did before. Here is a link to read the full blog on ADHD & Midlife: https://thepauselife.com/blogs/the-pause-blog/adhd-and-menopause Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/page

Prevent Dementia and Muscle Loss: The Science-Backed Strategies

Learn more in our Pause Strong Challenge. It's totally FREE! https://thepauselife.com/pages/the-pause-strong-challenge Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times bestselling book, The New Menopause today: https://thepauselife.com/pages/the-new-menop

The Random Chin Hair Women Over 40 Know Too Well 😂

Listen to the full unPAUSED Menopause Masterclass episode about hair loss: https://m.youtube.com/watch?v=1vAVzr5IkkA&pp=ygUVZHIgbWFyaWUgY2xhaXJlIGhhdmVy&ra=m Nothing keeps you humble quite like discovering a chin hair in the middle of recording. 😂 Please tell me I’m not the only one this has happened to. --- Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the

Why Hair Loss in Women Over 40 Is Often Misdiagnosed

✨Listen to the full episode here: https://youtu.be/1vAVzr5IkkA?si=2SyadJIFm-mUIeHW The most missed cause of hair loss in women may be iron deficiency. In one study of women with hair loss, iron deficiency was found in roughly 70% of participants. Many still had a normal CBC or hemoglobin result. A normal blood count does not necessarily rule out iron deficiency-related hair loss. This is why women experiencing hair loss deserve a more thorough workup instead of having it dismissed as stress or a cosmetic concern. --- Order Dr. Haver’s new book, The New Perimenopause today: https://thepaus

Why Are You Still Exhausted on Hormone Therapy?

Your hot flashes are controlled, and you still can’t get through the day.

Widening Hair Part in Women: What It Could Mean

Listen to the full unPAUSED episode on hair thinning and hair loss: https://m.youtube.com/watch?v=1vAVzr5IkkA&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m A widening part can be one of the first signs of hair loss in women. Your hair can reveal important information about your iron, thyroid, vitamin D, hormones, inflammation, and metabolic health. Hair loss is not simply a cosmetic concern. It is a medical condition with real causes and real treatment options. Watching and waiting may allow it to progress. If you’re noticing more scalp where you part your hair, you deserve a

Menopause Masterclass: Why Your Hair Is Thinning and What Works

In this solo episode of unPAUSED, Dr. Mary Claire Haver tells the truth about hair loss in women over 40 — a medical condition with real, identifiable causes, not a vanity complaint to be dismissed as stress or aging. She breaks down the biology of the hair growth cycle and the hormonal mechanism driving midlife thinning: as estrogen declines, androgens like DHT take over at the follicle, shrinking it with every cycle. She walks through the five most common causes of hair loss in midlife women — female pattern hair loss, telogen effluvium (including the dramatic shedding triggered by illness,

Menopause and Your Feet: Why Heel Pain and Shoe Size Changes Aren't Random

Your shoes may fit differently in midlife because your feet can actually change. As estrogen declines, it affects the collagen, fascia, ligaments, and bone that support your feet. That can show up as stubborn heel pain, flatter arches, a wider forefoot, or discomfort in shoes that once fit perfectly. Bone loss also accelerates around the final menstrual period, with women losing approximately 2% of bone mineral density per year during this window. Persistent foot pain deserves a closer look, especially when it feels sharp, keeps returning, or worsens with activity. Foot pain, changing arche

Social Media Filters Are Not Reality: Watch This Filter Transformation

What you see isn't always reality when it comes to social media. Dr. Haver walks you through what she looks like with and without filters. Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times bestselling book, The New Menopause today: https://thepauselife.com

Why Did Women Stop Gaining Indepedent Years After Age 65?

Women were ahead in 1982. Here is what medicine did in the next 30 years. https://drmaryclairehaver.substack.com/p/why-did-women-stop-gaining-indepedent?utm_source=youtube

Why Did Women Stop Gaining Independent Years After Age 65?

Women were ahead in 1982. Here is what medicine did in the next 30 years.

Why Is It So Hard to Find a Menopause Doctor?

Listen to our full conversation on unPAUSED: https://youtu.be/BTV-hUcY_GQ?si=CDijbIfwgtoUmZiE Finding the right menopause care should not take three doctors. Melinda French Gates has access to some of the best healthcare in the world, yet she still struggled to find a physician who could properly evaluate her symptoms and help her create an individualized plan. There is no cookie-cutter solution for menopause. Women need informed providers who listen, understand the latest evidence, and work with them to find the right care. --- Order Dr. Haver’s new book, The New Perimenopause today: htt

How Menopause Brain Fog Affects Women at Work

Listen to the full conversation on unPAUSED: https://m.youtube.com/watch?v=BTV-hUcY_GQ&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m Brain fog and chronic insomnia don’t stay at home. They follow women into meetings, major decisions, and the peak of their careers. Melinda French Gates shared how menopause symptoms caused her to doubt herself before meetings with world leaders and CEOs. She also heard from countless women who had taken time off or stepped back from their careers because they felt so unwell and needed to seek care. Women are not losing their abilities. They are

Why Does LDL Cholesterol Rise During Menopause?

LDL can climb about 17 points during the menopause transition, with the steepest rise around your final period.

Why the Healthcare System Fails Women in Menopause

Listen to our full conversation on unPAUSED: https://m.youtube.com/watch?v=BTV-hUcY_GQ&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m Sitting down with Melinda French Gates to talk about the future of women’s health was a conversation I will never forget. The healthcare system was built around men. It’s time we demand one built for women, too. Menopause is about so much more than reproduction. Researchers across cardiology, rheumatology, and other specialties are finally examining how sex-based differences affect disease and the way women age. Women deserve a healthcare syste

Melinda French Gates Is Fighting to Close the Menopause Funding Gap

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Melinda French Gates, philanthropist and founder of Pivotal, to talk about her call for a "menopause revolution" — including the $215 million in new funding for women's health she announced in her New York Times essay, bringing her total investment in women's health to more than $600 million in two years. Melinda opens with the numbers driving her urgency: nearly one in three women over forty has menopause symptoms severe enough to disrupt her life, only about one in four gets treated, fewer than a third of OB-GYN training progr

Low Libido & Painful Sex in Menopause: Why It Happens and What Actually Helps

If your sexual desire feels different than it used to, if intimacy is uncomfortable, or if orgasms have become harder to achieve, you are not broken. These are common biological changes that happen during perimenopause and menopause, and in many cases, they're treatable. Too many women are told to accept these symptoms as "just aging." You don't have to. That's why we created our free Sexual Wellness Checklist: a practical, evidence-based guide to help you understand what's happening in your body, the treatments worth discussing with your clinician, and simple strategies that can help suppor

The Unexpected Upside of Menopause: Confidence, Strength & No More People-Pleasing

another side to this transition that doesn't get talked about enough: what you gain. This isn't about ignoring the challenges of menopause. It's about naming the part of this transition that can feel like coming home to yourself. Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Ha

Low Libido in Women: Why a Urologist Began Studying Testosterone

Listen to the full conversation on unPAUSED: https://m.youtube.com/watch?v=SZNz8trnamo&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m "You’ve ruined our relationship.” That was the call Dr. Mohit Khera received after helping a male patient improve his libido. His patient’s wife wasn’t calling to thank him. She was calling because her experience had been left out of the conversation. That call changed how he practiced and led him to study female sexual dysfunction, testosterone, and women’s hormonal health. Women’s sexual health deserves attention in its own right. Our questio

Sexual Dysfunction Affects 48% of Women. Why Is It Still Overlooked?

Listen to the full episode here: https://youtu.be/SZNz8trnamo?si=jAMK70C-Z44K7f0G If a condition affected nearly half of women, you would expect it to receive serious attention. Female sexual dysfunction can include low libido, decreased arousal, difficulty with orgasm, or pain that causes distress. Yet on this episode of unPAUSED, Dr. Mohit Khera shares that although 48% of women experience female sexual dysfunction, only 19% receive therapy. The bias is impossible to ignore. When a man experiences sexual dysfunction, we often look for a physical explanation. When a woman does, she is stil

What Is Your Circadian Rhythm, and Why Does Menopause Disrupt It?

Six specialists on unPAUSED kept bringing up the same thing: your body clock. I was never taught how it worked, and neither was your doctor.

Low Testosterone in Women: Symptoms Beyond Low Libido

Listen to the full episode here: https://m.youtube.com/watch?v=SZNz8trnamo&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m Low libido may be the most specific sign of low testosterone in women, but it may not be the only one. Changes in mood, energy, cognition, muscle mass, and body composition may also occur. The challenge is that many of these concerns overlap with symptoms commonly experienced during menopause. On this episode of unPAUSED, Dr. Mohit Khera and I discuss what may happen when symptoms persist despite treatment with estrogen and progesterone, and why some women

Testosterone Is Not a Male Hormone: Levels, Dosing, and What It Does During Menopause

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Mohit Khera, board-certified urologist and Professor of Urology at Baylor College of Medicine, where he holds the F. Brantley Scott Chair in Urology, to tell women the truth about testosterone — the hormone women actually make more of than estrogen, yet still cannot access in a single FDA-approved formulation. Dr. Khera explains why testosterone is one of the most biologically active hormones in the female body, with receptors in the brain, heart, bone, muscle, and genitalia, and why the research to prove its full benefits

Anti-Inflammatory Diet for Perimenopause: What to Eat to Fight Inflammation

What you eat during perimenopause either fuels inflammation or fights it. Your plate is one of the most powerful tools you have right now. An anti-inflammatory diet may reduce cholesterol, strengthen immune function, and help protect against hormone-related cancers. Small, consistent changes to what you eat every day add up to real results over time. Here is a link to our free Pause Strong Challenge: https://thepauselife.com/pages/the-pause-strong-challenge Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going

The Menopause Care Gap: How to Find a Doctor Who Gets It (Part 2)

Why it is so difficult to find Menopause Care: Part 2 Source: Patil R, Batur P, Ridgeway B, Williams M. Building a Comprehensive Menopause Program. Obstetrics & Gynecology, 2026. Narrative review. Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times bestsell

Why Is It So Hard to Find Good Menopause Care? (Part 1)

Why it is so difficult to find Menopause Care: Part 1 Source: Patil R, Batur P, Ridgeway B, Williams M. Building a Comprehensive Menopause Program. Obstetrics & Gynecology, 2026. Narrative review. Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times bestselli

How Perimenopause Affects Mental Health: Brain Fog, Rage, Anxiety and Depression

Listen to the the full episode here: https://youtu.be/dSDYO9oolXQ?si=YIDBJstIp6B2b-sN Mental health disorders double across the menopause transition. So do SSRI prescriptions. That's not a coincidence; that's estrogen dropping and dopamine taking the hit. I sat down with Dr. Rena Malik on the book tour for The New Perimenopause, and we covered what nobody prepares you for: the brain fog, the rage, the forgetfulness, and women leaving relationships and jobs during this transition. Not because something's wrong with them, but because their brain is undergoing a massive rewire and they need sup

Is Hormone Therapy Safe? Who Can Take It, Who Cannot, and What the FDA Just Changed

For twenty years you were warned off estrogen by a label that experts say should never have been there. In February 2026 the FDA took most of it off.

Why Are Women Least Happy at Age 47? The Perimenopause Connection

Listen to the full episode with Dr. Rena Malik here: https://m.youtube.com/watch?v=dSDYO9oolXQ&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=2&pp=iAQB&ra=m 47. That's the loneliest year on the happiness curve for women. It's also peak career age. And it's smack in the middle of the age range where women are most at risk of suicide. Three things. Same age. Nobody's been connecting them. I sat down with Dr. Rena Malik on my book tour for The New Perimenopause. We break down what's actually happening in this window, and why so many of us have been told it's "just stress" or "just a hard year."

Dr. Mary Claire Haver on Menopause: Recorded Live from LA with Dr. Rena Malik

This episode of unPAUSED was recorded live at the Wiltern Theater in Los Angeles in front of an audience gathered to talk about perimenopause, menopause, hormones, sex, brain health, and bone health. Dr. Mary Claire Haver is joined on stage by Dr. Rena Malik, a board certified urologist, pelvic medicine specialist, and sexual health expert, for a wide ranging conversation about what is actually happening in women's bodies during the menopause transition, and what every woman navigating midlife health should know. The conversation moves through the zone of chaos that is perimenopause, the horm

Estrogen Patch Shortage: What to Do If You Can't Get Your Refill

Can’t find your estrogen patch? You may have more options than you think. Different manufacturers, strengths, schedules, and other forms of transdermal estrogen may help you avoid an unnecessary interruption in treatment. The key is knowing what to ask before your supply runs out. This is general education to help you have a more informed conversation with your care team, not individualized medical guidance. Never change your dose, delivery method, or progestogen without your clinician. Full article: https://thepauselife.com/blogs/the-pause-blog/heard-about-the-estradiol-patch-shortage-here

Stop Feeling Guilty About Your Bloated Belly After a Workout

@gnarlybynature did a great video on how you can be super fit but also have bloating. High intensity training can actually contribute to fluid redistribution and retention. This is temporary. View the original video here: https://www.instagram.com/p/DbT_uDROfty/ Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https:

Why Women Are More Likely to Be Misdiagnosed: The Women's Health Gap Explained

These are the numbers that changed how Dr. Haver sees women’s health. Not because they surprised her, but because they proved the neglect was MEASURABLE. Conditions that only affect women received less than 1% of research funding. Women were misdiagnosed during heart attacks, prescribed medications tested largely on male bodies, and left without answers while the evidence sat unfunded. The gap was never in our heads. It was built into the research, the funding, and the standard of care. https://www3.weforum.org/docs/WEF_Closing_the_Women%E2%80%99s_Health_Gap_2024.pdf Order Dr. Haver’s new

Frozen Shoulder: The Signs to Look For

Listen to the full conversation: https://m.youtube.com/watch?v=XjNDnN1nceI&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=2&pp=iAQB&ra=m If you’re in perimenopause or menopause and notice your shoulder getting stiffer or more painful, it could be frozen shoulder. As estrogen declines, inflammation increases, affecting the connective tissues that support your joints. In this episode of unPAUSED, I talk with Dr. Vonda Wright about what’s really going on and how you can move better, hurt less, and take back control of your body. --- Order Dr. Haver’s new book, The New Perimenopause today: htt

Listen Again: Build Strength, Live Longer: The Menopause Longevity Blueprint with Dr. Vonda Wright

What if weak bones and muscle loss aren't just "normal aging" but the result of decades of misinformation? In this episode double board-certified orthopedic surgeon Dr. Vonda Wright joins Dr. Mary Claire Haver to shatter the myth that frailty, fractures, and decline are inevitable for women in midlife. Dr. Wright explains why women can lose up to 20% of their bone mass in just five years after menopause—and more importantly, what we can do to prevent it. She reveals how stress, inadequate nutrition, and neglecting strength training and hormonal health create the very outcomes we've been taugh

Why Are So Many Midlife Women Left to Suffer Without the Right Care?

Listen to the full unPAUSED conversation with physician and author Dr. Lucy McBride about women’s health, the gaps in our healthcare system, and what better care can look like: https://youtu.be/xkqzfuCNfBI?si=L1AW3ULGecfJZ8yr "I feel great. And I’m angry because I was allowed to suffer for so long.” I’ll never forget this patient. She came back for her follow-up after starting treatment, sat down in my office, and told me she felt great. But she was angry. Because feeling better made her realize just how long she had been struggling without the care she needed. That moment stopped me in m

Why Women’s Menopause Symptoms Are Often Treated Separately Instead of Connected

Watch my full unPAUSED conversation with physician and author Dr. Lucy McBride about women’s health, navigating the medical system, and what it looks like to care for the whole person: https://m.youtube.com/watch?v=xkqzfuCNfBI&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m What happens when every symptom is treated separately, but no one stops to ask if they might be connected? I’ve had patients come to me on multiple medications. One for sleep. One for palpitations. Another for mood. Each prescribed to address an individual problem. I was guilty of this too. I wanted to help m

If She’s Menopausal and on a GLP-1, Are We Only Treating Half the Problem?

The weight comes off and the chart says success. The muscle and bone that came off with it don’t show up anywhere in that note.

Did You Have PMDD or Postpartum Depression? Here's What It Means for Menopause

Your PMDD and postpartum history are not separate stories from menopause. They are the same story. A 2026 study of 180 women in menopause clinics found that prior reproductive depression, severe PMS, PMDD, and perinatal depression, independently predicted worse depressive symptoms during the transition. Prior depression unrelated to hormones did not, once the reproductive history was accounted for. The published data names the pattern: hormonal mood sensitivity. The clinical reality it misses is that most menopause intakes never ask about it. If your mood shifted with your cycle or after a b

Is Wellness Culture Harming Women’s Health?

Listen to the full episode with Dr. Lucy McBride here: https://m.youtube.com/watch?v=xkqzfuCNfBI&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m When did taking care of our health turn into another way for women to feel like they’re failing? More protein. More exercise. More mindfulness. More optimizing. And if you’re still struggling? The message can become that you simply haven’t done enough. Lifestyle matters. Exercise matters. Nutrition matters. But as Lucy points out, the problem is when we’re told these things are necessary AND sufficient for health. You shouldn’t have

How to Get What You Need From a 15-Minute Doctor's Appointment with Dr. Lucy McBride

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Lucy McBride, a Harvard and Johns Hopkins trained primary care physician and author of the new book Beyond the Prescription: A Doctor's Guide to Taking Charge of Your Health. Dr. McBride has spent twenty five years watching patients bounce between a rushed medical system and a wellness industry. The conversation opens with a hard truth about modern healthcare: doctors interrupt patients within eleven seconds of them speaking, and fifteen minute appointments leave almost no room to understand the whole person behind the diag

Build Muscle and Strength with Protein, Fiber & Zone 2 training: Your step by step guide

It's not too late to start the challenge. You can start it anytime! Here is the link to request the guide: https://thepauselife.com/pages/the-pause-strong-challenge Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times bestselling book, The New Menopause today

Perimenopause Fatigue Isn't in Your Head | New Study Explains Why ⭐

Perimenopause raises psychological symptom burden 52%. And it’s not what you think. A new peer-reviewed study of 7,975 women across 20 countries measured it on the Menopause Rating Scale: 7.3 in perimenopause versus 4.8 in premenopause. We assume that load is anxiety and depression. It isn’t. The single largest jump was exhaustion, up 56%, followed by irritability. Depressive mood and anxiety rose too, but they were the smallest movers, not the headline. And this is the part most coverage skips: the increase held after adjusting for age, education, income, ethnicity, BMI, smoking, alcohol, a

Strong Not Skinny Challenge: How I'm Building Muscle with Protein, Fiber & Zone 2 Training

Join me for the Pause Strong Challenge! It's totally free! Here is a link: to request the guide: https://thepauselife.com/pages/the-pause-strong-challenge Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times bestselling book, The New Menopause today: https://

How Does Modern Life Disrupt Your Sleep?

Listen to the fun unPAUSED episode with Dr. Kristen Holmes: https://m.youtube.com/watch?v=jBOQHC4NELA&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m "Good sleep is a skill.” That stopped me in my tracks. Dr. Kristen Holmes explains why modern life can make it genuinely difficult to protect our biological sleep, and why being intentional about sleep may need to start long before the first symptoms of perimenopause. I also share how much I misunderstood about my own health when I was living in chronic sleep debt. --- Order Dr. Haver’s new book, The New Perimenopause today: htt

Menopause Sleep Reset: A Recovery Plan You Can Start Tonight with Dr. Kristen Holmes

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Kristen Holmes, Vice President of Performance Science at Whoop and author of the new book Aligned, moving from the science of circadian rhythm into a practical recovery plan a woman can start using tonight. Dr. Holmes lays out a realistic strength and cardio prescription for women who only have thirty minutes a day, and explains how sleep governs the release of growth hormone and the capacity to build and preserve muscle as we age. She introduces the idea of alignment over willpower, framing consistent habi

Why Do I Keep Waking Up at 3 AM During Perimenopause?

Listen to the full unPAUSED episode with Dr. Kristen Holmes here: https://m.youtube.com/watch?v=8Or4gMn-pc8&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m#bottom-sheet Why do so many midlife women wake up at 3 AM? Dr. Kristen Holmes explains the role circadian rhythm and amplitude may play, and why the answer isn’t that you did something wrong or somehow sabotaged your sleep. There’s biology behind what’s happening. --- Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Ch

Open Access Isn’t Free. It Just Moves the Paywall.

Making research free to read doesn’t make it free. It moves the cost from the reader to the writer, and in women’s health, that can mean the researchers who most need support are the ones left out.

Why Don’t Sleeping Pills Fix Menopause Sleep Problems?

Listen to the full episode of unPAUSED with Dr. Kristen Holmes here: https://m.youtube.com/watch?v=8Or4gMn-pc8&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB0gcJCckLAYcqIYzv&ra=m Being asleep and getting quality sleep are not necessarily the same thing. In this conversation with Dr. Kristen Holmes, we unpack why sleep disruption in menopause may not simply come down to hot flashes, and why sedatives can affect the depth of your sleep. If you’re sleeping but still waking up exhausted, this is an important conversation. --- Order Dr. Haver’s new book, The New Perimenopause today: h

Menopause and the 3AM Wake Up: What Light, Meal Timing and Hormones Do with Dr. Kristen Holmes

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Kristen Holmes, Vice President of Performance Science at Whoop and author of the new book Aligned, to unpack why sleep and circadian rhythm matter as much as hormones when it comes to the symptoms women feel in perimenopause and menopause. Dr. Holmes explains the concept of circadian amplitude, the contrast between activity and rest, light and dark, and fed and fasted states that keeps every system in the body running on time, and why women with lower amplitude tend to report more frequent and more severe symptoms. She walk

What It Was Really Like Being an OB-GYN During the First Year of COVID.

The ICU beds were full in the hospital where I worked. Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times bestselling book, The New Menopause today: https://thepauselife.com/pages/the-new-menopause-book Want to try our supplements? Order Here: https://the

What If Men Lost Testosterone at Midlife? The Truth About Estrogen and Women's Health.

A little over a year ago, I had the pleasure of joining the @armchairexppod, and it remains one of the most fun, informative, and collegial conversations I've had. Grateful to @daxshepard and @mlpadman for such a thoughtful discussion. If you listened when it first aired, I'd love to hear what stayed with you. Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the f

Why Do People With ADHD Feel So Much Rage?

Listen to the full unPAUSED episode with Dr. Sasha Hamdani, where we discuss emotional dysregulation, rage, sensory sensitivity, and other ADHD symptoms that often go unrecognized: https://youtu.be/tzXxiD9xJW8 Ever feel like a tiny annoyance triggers a huge emotional reaction? For many people with ADHD, that's not a character flaw. It's part of emotional dysregulation, a common but often overlooked aspect of ADHD. A small trigger, like someone chewing, tapping a pen, or making repetitive noises, can feel much bigger than it seems to everyone else. It's not because you're overreacting. ADHD

An ADHD and Menopause Toolkit: What Actually Helps with Dr. Sasha Hamdani

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Sasha Hamdani, a board certified psychiatrist and ADHD clinical expert who wrote Self-Care for People with ADHD and the forthcoming Too Sensitive, moving from diagnosis into what to actually do once ADHD and perimenopause or menopause start colliding. Dr. Hamdani explains how ADHD symptoms and medication effectiveness shift across the menstrual cycle, tracing the pattern back to the drop in estrogen and rise in progesterone that hits right before a period, and walks through where nonstimulant medication opt

Why So Many Women Aren't Diagnosed With ADHD Until Adulthood

Listen to the full unPAUSED episode with Dr. Sasha Hamdani, where we discuss why ADHD has been missed in so many women, how symptoms differ between girls and boys, and what to do if you recognize yourself in this conversation: https://youtu.be/WeGj2lc6szc?si=pggqdQ4py57ddCG- For decades, ADHD research focused primarily on young boys. As a result, many girls with ADHD didn't fit the expected picture and were never recognized. Instead of being disruptive in class, many girls present with inattentive symptoms. They may be quiet, organized enough to get by, helpful, or labeled as daydreamers. Be

Is ADHD Genetic? What the Research Says

✨ Listen to the full unPAUSED episode with Dr. Sasha Hamdani, where we discuss ADHD in women, why it's so often missed, and what to do if you think you may have it. ADHD often runs in families, and many women don't realize it until their child is evaluated. Research suggests ADHD has a heritability of 75–88%, making genetics one of the strongest risk factors. Many adults first recognize their own symptoms while helping their child through the diagnostic process. If that sounds familiar, you're not alone. Recognition can be the first step toward understanding yourself and exploring whether a

Ten Things in the Menoverse That Changed My Brain Chemistry

Ten publications and cultural moments that completely changed how I think, practice, and care for women in midlife.

Why Ovarian Aging May Be the Missing Piece in Women's Health Research

One of the biggest mysteries in women's health is hiding in plain sight. Our ovaries age at least twice as fast as the rest of our bodies. ✨Watch the full episode of unPAUSED with Dr. Jennifer Garrison, PhD here: https://youtu.be/P-r3sD3QLwM?si=KNadFVx5NrW3l4s6 That isn't just about fertility. Ovaries produce hormones that influence nearly every organ system, including the brain, heart, bones, muscles, metabolism, and immune system. When ovarian function declines decades before many other organs, it may help explain why women's health changes so dramatically during and after menopause. The

The Menopause Autoimmune Connection: Why Women Face Higher Risk After Midlife

When we talk about menopause, we often focus on hot flashes, sleep, or bone health. But one of the biggest unanswered questions in women's health may be the immune system. In this conversation, Jennifer Garrison, PhD, explains that women and men have fundamentally different immune responses. ✨Watch the full episode of unPAUSED here: https://m.youtube.com/watch?v=P-r3sD3QLwM&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=2&pp=iAQB&ra=m Women tend to respond differently to viruses and vaccines, yet we still don't fully understand why. We do know one striking fact: about 80% of people living w

The Ovary’s Job Doesn’t End at Menopause: A Top Neuroscientist Explains

in this episode of unPAUSED, Dr. Mary Claire Haver talks with Dr. Jennifer Garrison, a neuroscientist and founder of the Global Consortium for Reproductive Longevity and Equality, about why the ovary should never have been labeled a purely reproductive organ. Dr. Garrison explains that ovaries function like a second brain in the body, sending and receiving chemical signals to nearly every tissue system including the heart, bones, brain, immune system, and metabolism. She walks through her research on the hypothalamus and the brain ovary signaling network, describing how inflammation in this pa

Can Hormone Therapy Help Prevent Disease, And Not Just Relieve Symptoms?

We were trained to treat menopause as a moment to get through. The science says it’s a health event that deserves real medical care for every woman, at every age.

Menopause Math: The Broken System Nobody Is Talking About

Is it just us or should there be a better way! Join our free community and share your journey with other women just like you. Here is a link to join: https://thepauselife.com/pages/the-pause-life-community Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times b

My Hormone Therapy Routine for Menopause: What I Take, When & Why

This must watch podcast is a step by step guide to what Dr. Haver takes, when she takes it and why she takes it. Here is a direct link but you can also search this channel for her Menopause Masterclass: My Menopause Toolkit - HRT and more https://www.youtube.com/watch?v=S7Lo__0SjOc&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=5 Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and

How to Prepare for a Gynecologist Appointment: Questions Every Woman Should Ask

Listen to the full unPAUSED episode with Dr. Karen Tang here: https://m.youtube.com/watch?v=V_ZwYIH-9Vw&list=PL8U90xMuKu986oEs-S6gX39_c9T70tQ_D&index=1&pp=iAQB&ra=m Don't walk into your next doctor's appointment without a plan. If you're living with endometriosis, fibroids, vulvar symptoms, or entering perimenopause or menopause with unanswered questions, preparation can make all the difference. In this episode, Dr. Karen Tang shares how to make the most of your appointment: write down your concerns, prioritize your biggest questions, bring a support person if it helps, and don't be afraid

Menopause Weight Loss: How Much Protein Do You Need To Preserve Muscle?

Weight loss shouldn't come at the expense of the muscle that protects your metabolism, strength, and independence. Here's how much protein research suggests you need to preserve it.

The Exercise Prescription I Give Every Woman in Menopause

It’s less than you think, and most of it isn’t cardio.

How Fast Can Medicine Move? Apparently, It Depends Who’s Asking.

A new alcohol study had me celebrating the science and quietly furious about everything around it.

The Labs I Run on Every Menopausal Patient. Print This. Bring It to Your Doctor.

Standard labs might just miss the things that matter most in midlife.

The GLP-1 Update for Women in Midlife: What’s Changed, What’s New, and What’s Next

New research on GLP-1 medications, hormone therapy, visceral fat, metabolic disease, medication interactions, and what emerging treatments may mean for women in menopause.

Your OB History Is Your Cardiac History

Two new cardiovascular guidelines now formally name women’s reproductive history as cardiovascular risk. Here is what that means for you.

My Grandmother, My Mother, and My Daughters

The Generational Cost of What Women Were Never Told About Midlife Health

What You Really Need to Know About Histamine, Mast Cells, and Your Hormones

The conversation no one had with us in medical school. With Dr. Zachary Rubin.

Why Many Doctors Still Misunderstand Menopause

The education gap, WHI fallout, and what women need to know now

The New Perimenopause with Dr. Mary Claire Haver

A recording from Dr. Mary Claire Haver, MD and Katie Couric's live video

The Menopause Toolkit: What Actually Works

Everything we can actually do, and how to build a personal plan that supports your body in midlife

The Estrogen-Brain Connection

What Brain Scans Reveal, Why Timing Matters for Dementia Prevention, and What You Can Do Right Now

The New Perimenopause

It’s Here. And It’s for You.

The 10-Year Window Medicine Ignored

Perimenopause lasts up to a decade. Most women are not told it has started. This is what that silence costs, and what The New Perimenopause was written to change.