Summary
Pessaries, internal bladder support devices, are discussed as a solution for women experiencing pelvic floor issues. These devices come in various shapes and must be fitted by a medical professional, such as a urogynecologist or physical therapist. The fitting process can be complex, as it often requires adjustments based on the patient's anatomy and activities. The use of topical vaginal estrogen is emphasized as a necessary complement to pessary use to maintain tissue health and prevent irritation.
The conversation also addresses the importance of pelvic floor training alongside pessary use for optimal results. Women are encouraged to explore over-the-counter options, such as silicone pessaries available online, which can provide support during physical activities. The discussion highlights the need for ongoing follow-up care to ensure proper fitting and compliance, as well as the potential for self-management techniques to improve pelvic floor health.
Additionally, the episode touches on common pelvic floor issues, such as urinary incontinence and prolapse, and stresses the significance of lifestyle habits, including proper toileting techniques and the avoidance of straining during bowel movements. The hosts advocate for a proactive approach to pelvic health, encouraging women to seek specialized care and engage in preventative measures to enhance their quality of life as they age.
Show Notes
In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with board certified pelvic floor physical therapist Dr. Sara Reardon, known on social media as The Vagina Whisperer — and this time it’s the toolkit: what you can actually do, starting today, to protect and rebuild your pelvic floor. They begin with pessaries, the internal support devices so few women are offered, why getting one fitted properly is harder than it should be, and the over-the-counter silicone supports that let women run, lift, and travel leak-free while they strengthen. From there they get into the everyday habits that quietly weaken the pelvic floor: pushing when you pee, straining on the toilet, scrolling past the five-minute mark, and holding your breath while lifting — plus hemorrhoids, what healthy stool should look like, and why a simple toilet stool changes everything. They then take a deeper dive into genitourinary syndrome of menopause (GSM), why nearly three quarters of women with symptoms never mention them to a clinician, and why hormones alone aren’t enough — you lose urinary sphincter strength every year after age 35, so the muscle training has to happen too. Dr. Reardon covers keeping vaginal tissue healthy with or without a partner, what vaginismus is and why “just relax” fails, the woman who endured ten years of searing pain — and surgery to remove her labia — when the real culprit was a compressed pudendal nerve, the $5 billion vaginal rejuvenation industry, her five free daily pelvic floor habits, and the message she wants every woman to hear: it’s never too late, with patients in their 80s and 90s still getting better. Guest links: Dr. Sara Reardon (Instagram) https://www.instagram.com/the.vagina.whisperer/ Dr. Sara Reardon / The Vagina Whisperer (Website) https://thevagwhisperer.com/ NOLA Pelvic Health (Website) https://www.nolapelvichealth.com/ The V-Hive App (The Vagina Whisperer) https://thevagwhisperer.com/membership/ Books: “Floored: A Woman’s Guide to Pelvic Floor Health at Every Age and Stage,” by Dr. Sara Reardon https://thevagwhisperer.com/floored/ “The New Perimenopause,” by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book “The New Menopause,” by Dr. Mary Claire Haver https://www.amazon.com/dp/B0CKBZ4K1Z Never miss an episode—sign up for The ‘Pause Life Newsletter: https://thepauselife.com/pages/newsletter Medical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, the unPAUSED podcast, and The ‘Pause Life are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship.
More from unPAUSED with Dr. Mary Claire Haver
In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Sara Reardon, board-certified pelvic floor physical therapist, founder of The Vagina Whisperer, and author of Floored, to talk about the muscles 68% of postmenopausal women say no one ever taught them they had. Nearly 1 in 3 women lives with a pelvic floor disorder — urinary leakage, prolapse, pain with sex — and the US spends over $20 billion a year managing it rather than fixing it, while women are offered a device, surgery, or “just live with it.” Dr. Reardon explains why leaking isn’t just part of being a woman, why diapers aren’t your destiny, and why these symptoms are treatable at every age. Dr. Reardon walks through what happens at a pelvic floor PT appointment (you can self-refer in every US state, covered by insurance), why over 50% of women do Kegels incorrectly — and why Kegels alone were never the answer — the difference between a weak and a too-tight pelvic floor, and stress vs. urge incontinence. They dig into night-time bathroom trips and the fall-and-fracture risk nobody connects to them, why vaginal estrogen should be prescribed proactively — including the study showing it cut recurrent UTIs from 5.9 infections per patient-year to 0.5 — the truth about prolapse (half of women over 50 have some degree of it), what to ask before consenting to any prolapse repair, and the vaginal mesh scandal. Framed throughout by Mary Claire’s own mother’s story: three failed incontinence surgeries, decades of leaking, and the hip fracture after which she never walked again. Guest links: Dr. Sara Reardon / The Vagina Whisperer (Website) https://www.thevagwhisperer.com/ Dr. Sara Reardon (Instagram) https://www.instagram.com/the.vagina.whisperer/ Books: “Floored: A Woman’s Guide to Pelvic Floor Health at Every Age and Stage,” by Dr. Sara Reardon https://www.thevagwhisperer.com/floored “The New Perimenopause,” by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book “The New Menopause,” by Dr. Mary Claire Haver https://www.amazon.com/dp/B0CKBZ4K1Z Never miss an episode—sign up for The ‘Pause Life Newsletter: https://thepauselife.com/pages/newsletter Medical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, the unPAUSED podcast, and The ‘Pause Life are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship.
In this episode of unPAUSED, pulled from the archive because it’s one worth hearing again, Dr. Mary Claire Haver sits down with Dr. Rachel Rubin, board-certified urologist, nationally recognized expert in sexual medicine, assistant clinical professor of urology at Georgetown University, and a lead advocate behind the 2025 American Urological Association guidelines on genitourinary syndrome of menopause. The conversation starts with the number that explains everything: three training programs in the last three years even acknowledge women’s sexual health — men have more than 27. The reason your doctor doesn’t know how to talk to you about libido, arousal, orgasm, or pain is that no one ever taught them. Dr. Rubin delivers the anatomy lesson medicine skipped — why the clitoris and penis are the same tissue, why the cervix is triply innervated despite being taught as nerve-free, and why “my orgasm changed after my hysterectomy” is biology, not psychology. They cover why sex should never hurt and pain always deserves a diagnosis, the vulvar vestibule tissue most doctors were never taught to examine, the hormone changes that start in your 30s — not at menopause — and the case Dr. Rubin has built her career on: vaginal estrogen and DHEA prevent more than half of UTIs and could save Medicare an estimated $6–22 billion a year. Plus the medications that quietly affect sexual function, the two FDA-approved drugs for low libido most women have never heard of, and the five hormone options every woman deserves to know are on her menu. Guest links: Dr. Rachel Rubin (Website) https://www.rachelrubinmd.com/ Dr. Rachel Rubin (Instagram) https://www.instagram.com/drrachelrubin/ Dr. Rachel Rubin (X) https://x.com/drrachelrubin Books: “The New Perimenopause,” by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book “The New Menopause,” by Dr. Mary Claire Haver https://www.amazon.com/dp/B0CKBZ4K1Z Never miss an episode—sign up for The ‘Pause Life Newsletter: https://thepauselife.com/pages/newsletter Medical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, the unPAUSED podcast, and The ‘Pause Life are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship
In this episode of unPAUSED, Dr. Mary Claire Haver sits down with entrepreneur Mark Cuban, cofounder of the Mark Cuban Cost Plus Drug Company, to unpack the estrogen patch shortage and why so many women in perimenopause and menopause struggle to find and afford hormone therapy. Holding up her own patch, Dr. Haver asks the question her patients keep asking: why is this so hard to get? Mark explains why the shortage hit so hard — patches require specialized manufacturing that pills don't, demand surged after the black box warning was removed, and supply couldn't keep up — plus how Cost Plus Drugs has worked to buy every patch manufacturers can produce, and who gets served first when a generic drug runs short. Then they take apart how drug prices are really set: how pharmacy benefit managers (PBMs) decide what your insurance covers, how rebates drive list prices higher, and why a handful of conglomerates now own the insurer, the pharmacy, the PBM, and the physician practice all at once. They compare what a generic estradiol patch costs to make against what many women pay at retail, cover Dr. Haver's case for vaginal estrogen as one of the most affordable treatments in menopause care, why there's still no FDA-approved testosterone for women, how untreated symptoms push women out of the workforce, and the playbook for lowering your prescription costs — from 90-day supplies to comparing cash prices with your copay. Guest links: Mark Cuban Companies https://markcubancompanies.com/ Cost Plus Drug Company https://www.costplusdrugs.com/ Mark Cuban (Instagram) https://www.instagram.com/mcuban/ Mark Cuban (X) https://x.com/mcuban Books: "The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book "The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/dp/B0CKBZ4K1Z Articles: Menopausal Hormone Therapy Use Among Postmenopausal Women (JAMA) https://jamanetwork.com/journals/jama-health-forum/fullarticle/2823976
In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Pamela Brown, CNN anchor and chief investigative correspondent, and host of the network's new women's health streaming series Body Language by CNN — born from an experience Pamela nearly kept hidden. In the same year she lost her mother, while covering the White House, she was blindsided by postpartum OCD: intrusive thoughts that grew louder and scarier, hidden from everyone — including her husband — while she reported live on air. Dismissed when she flagged the highest score on a postpartum screening form, she finally found her own diagnosis through an article online, and turned the experience into an eight-part series covering perimenopause, GLP-1s, egg freezing, PCOS, thyroid disease, the fourth trimester, and Alzheimer's. Pamela and Dr. Haver dig into what the series uncovered: why intrusive thoughts are not psychosis — and why that distinction matters so much for new mothers — with Dr. Haver sharing her own postpartum intrusive thoughts as a young resident, and what the Andrea Yates case changed for her generation of OB-GYNs. They cover the "GLP-1 babies" boom and why fertility rises on these medications, the GPS protocol (GLP-1, protein, strength training), the telemedicine revolution in menopause care and its limits, the FDA hearing on testosterone for women — including both women's own experience using it — the estrogen patch shortage and the letter-writing campaign that forced the FDA to respond, and why Dr. Haver believes vaginal estrogen could prevent half of UTIs in older women, along with the falls and fractures that follow. The episode closes with why the postpartum system fails mothers — one six-week appointment — and what needs to change. Guest links: Pamela Brown (Instagram) https://www.instagram.com/pamelabrowncnn/ Pamela Brown (X) https://x.com/PamelaBrownCNN Pamela Brown at CNN https://www.cnn.com/profiles/pamela-brown-profile Body Language by CNN https://www.cnn.com/videos/title-2600886 Books: "The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book "The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/dp/B0CKBZ4K1Z
In this episode of unPAUSED, recorded on location at the Aspen Ideas Festival, Dr. Mary Claire Haver sits down with Dr. Trisha Pasricha, neurogastroenterologist at Beth Israel Deaconess Medical Center, assistant professor of medicine at Harvard Medical School, and author of the new book You've Been Pooping All Wrong. Women in perimenopause and menopause who describe bloating, new constipation, or digestion that suddenly feels unfamiliar are often told it's stress or age — Dr. Pasricha explains the real biology, starting with the estrogen receptors inside the gut's own nervous system, and makes the case for treating the gut as a second brain rather than plumbing. She breaks down why IBS affects women about twice as often as men, and why women with gut pain are so often told it's all in their heads — in her words, it's not the stress causing the symptoms, it's the symptoms causing the stress. They cover the less obvious causes of bloating — including pelvic floor dysfunction — accidental bowel leakage after menopause and how it's treated, the link between smartphones in the bathroom and hemorrhoids, what to expect from GLP-1s, and why women treating iron deficiency can often take oral iron every other day to ease constipation. Then it's the serious part: the four colorectal cancer red flags women should stop normalizing, which stool colors need attention, why colonoscopy is the only screening option that prevents colorectal cancer, and why new bloating after menopause should always be evaluated. The practical takeaways include daily fiber targets, the case for psyllium and fermented foods, why ramping up fiber slowly prevents gas and bloating, a realistic approach to cutting ultra-processed foods — and the habit Dr. Pasricha asks of her own patients: look at your stool every day, because knowing what's normal for you is how you notice when something changes. Guest links: Dr. Trisha Pasricha (Website) https://www.trishapasricha.com/ Dr. Trisha Pasricha (BIDMC Gut-Brain Institute) https://research.bidmc.org/gut-brain/people/team-member-1 Dr. Trisha Pasricha (Instagram) https://www.instagram.com/trishapasrichamd/ Dr. Trisha Pasricha (TikTok) https://www.tiktok.com/@drtrishapasricha Gut Checker (Substack) https://gutchecker.substack.com/ Ask a Doctor (Washington Post) https://www.washingtonpost.com/people/trisha-pasricha/ Books: "You've Been Pooping All Wrong: How to Make Your Bowel Movements a Joy," by Dr. Trisha Pasricha https://www.penguinrandomhouse.com/books/776380/youve-been-pooping-all-wrong-by-trisha-pasricha-md-mph/ "The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book "The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z