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 programs teach menopause at all, and just five cents of every dollar spent on medical research goes to women's health. Melinda shares her own story — how, despite what she calls unbelievable privilege and access to the best health care in the world, it took three doctors to get the right care for her symptoms, and how chronic insomnia and brain fog left her doubting herself walking into meetings with world leaders and CEOs. She and Dr. Haver trace how the Women's Health Initiative halted research, education, and hormone therapy almost overnight, why the health care system was built for men's bodies by default, the racial disparities leaving women of color to suffer most with the least treatment, and the new research she's funding through Wellcome Leap into women-specific heart disease and microvascular diagnostics. The episode closes with Melinda's concrete advice for every woman who wants change: advocate for yourself at the doctor's office, educate your friends with credible information, contact your representatives, and vote — because midlife shouldn't be an off-ramp, but one of the most vibrant chapters of a woman's life. Guest links: Melinda French Gates (YouTube) https://www.youtube.com/@melindagates Melinda French Gates (Instagram) https://www.instagram.com/melindafrenchgates/ Melinda French Gates (Facebook) https://www.facebook.com/melindagates/ Melinda French Gates (LinkedIn) https://www.linkedin.com/in/melindagates/ Melinda French Gates (X) https://x.com/melindagates Pivotal https://www.pivotal.com/founder Moment of Lift Books https://www.momentoflift.com/ Melinda French Gates at the Gates Foundation https://www.gatesfoundation.org/about/leadership/melinda-french-gates Books: "The Next Day," by Melinda French Gates https://www.melindafrenchgates.com/ "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

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Women in our country are under tremendous stress. Our healthcare system, it is really failing certain parts of our population. Let's demand that our health system is built for us and not somebody else.

• 0:14Dr. Mary Claire Haver?

  It took me 20 years of practice to sit back and realize, women are not crazy. They're actually hurting.

• 0:20Speaker 00

  We should expect our national health institutes to put far more funding into women's health.

• 0:26Dr. Mary Claire Haver?

  Billions and billions and billions.

• 0:28Speaker 00

  Yes, our healthcare should not be determined by politics. It should be determined by science. I want women to step into their full power because when they do, we do change the world.

• 0:50Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.

• 1:08Dr. Mary Claire Haver?

  My guest today, Melinda French-Gates, opened a recent essay in the New York Times with an image I cannot shake. A hundred years ago, American women gave birth under twilight sleep, drugged unconscious, tied to the bed if they thrashed, no voice in the room, no memory of their own child being born. We shudder at that now, at the idea that women had no agency over their bodies at this incredibly important moment of their lives. And in her essay, Melinda asks a question I want us all to sit with. Will our granddaughters one day look back on how we treat menopause right now and feel exactly the same way? Nearly one in three women over the age of 40 has menopause symptoms that are severe enough to disrupt her life.

• 1:53Dr. Mary Claire Haver?

  Only about one in four actually gets treated. The rate of women on hormone therapy, the most effective tool we have, has collapsed to under 5%. Fewer than a third of OB-GYN training programs teach about menopause at all. And on top of that, McKinsey found that for every dollar the world spends on medical research, only five cents goes to women's health. In her essay, Melinda announced that she is giving $215 million in new funding, including a major grant to train the clinicians who keep missing the menopause symptoms in their patients. That brings her total investment in women's health to more than $600 million in two years, with menopause and midlife a priority for the first time.

• 2:38Dr. Mary Claire Haver?

  I applaud every dollar of it, but I didn't ask her here today to walk through a press release. I want to go deeper. Why is this happening at all? How can we meaningfully affect change at a policy level as well as in the patient-clinician relationship? Can more training fix a system that was never built for women's bodies in the first place? Philanthropist Melinda French-Gates has spent more than two decades fighting for women and girls. Today, she leads her own organization, Pivotal, and she is aiming her resources at women's health areas that are notoriously underfunded, including initiatives aimed at menopause and midlife care for women. I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynecologist and certified menopause practitioner.

• 3:22Dr. Mary Claire Haver?

  I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

• 3:43Dr. Mary Claire Haver?

  Melinda French-Gates, welcome to UnPaused.

• 3:46Speaker 00

  Thank you for having me. I'm so glad to be here.

• 3:48Dr. Mary Claire Haver?

  So you wrote an essay, the New York Times published, called "Women Deserve Better Than This," and you called for a menopause revolution. The day that dropped, I didn't know it was coming. My menopause-seek group chat exploded, you know? And every, it was just, we have about 50, 60 researchers, PhDs, you know, MDs, DOs together, and we talk about everything that's popping up on social media or in the news. So you were the topic of conversation. The same day, my Google Alerts went off because it was being picked up across, you know, multiple outlets. And my favorite podcast, all of a sudden, your Facebook's popping up everywhere. So I thought, this is big.

• 4:29Dr. Mary Claire Haver?

  I mean, this is, it spurred so much positive conversation, so much advocacy, so many people who were so excited that you had jumped into this discussion. You have focused on women's health for over 20 years. When I started digging around in the research, what's made you drawn to this especially? I know you're a mother of two daughters.

• 4:49Speaker 00

  I'm a mother of two daughters and a son. And my team and I, for a long time, have focused on women's health because only if a woman's healthy can she step into her full power, right? And I know that when women step into their full power, it changes their family, their community, their society. We have good research on this. So we had been focusing on the earlier stages of women's health over the last 20 years, but this peri-menopause, menopause phase, it just was so chronically underfunded and under-researched. It's like it was a glaring hole. People are talking about it. We're starting to see a little bit of change, and we thought, this just doesn't make any sense.

• 5:34Speaker 00

  We are half the population, and we all go through this. So it's just time.

• 5:39Dr. Mary Claire Haver?

  It's time. I agree 100%. The first year the National Institutes of Health, the NIH, tracked menopause research was 2023.

• 5:49Speaker 00

  The first year.

• 5:49Dr. Mary Claire Haver?

  The very first year. Yeah. So before then, we had to scramble and go and Google or, you know, do a search on the word "menopause" to see if it was in an article and then hand-count each one. There wasn't, even in ACOG, American College of OB-GYN, which I'm boarded, there's not a menopause subset when we do our yearly board recertification. It's kind of buried under office practice, you know, along with gonorrhea and, you know, lots of important things, but there's not a focus on this, even from the American College of Obstetrics and Gynecology. So I think spreading knowledge and awareness and advocacy is absolutely huge.

• 6:30Dr. Mary Claire Haver?

  So it's a pivotal point in our health trajectory where so many of us are not functioning, like you say, at our full power. And when women are well, they, everything gets better, right? They reinvest in their community. They take care of the younger generation. They provide a source of wisdom. But when we look at the data, at least in the data of work and how women are functioning in the office, I see it in clinics. So when a woman comes to me in clinic, she's usually seen five, six doctors before she was able to put it together for herself, comes to me and she's struggling. She's not able, and a lot of these women have very high-power careers, or they were so involved in their community, right?

• 7:14Dr. Mary Claire Haver?

  Even if they didn't get paid in a traditional job, they were running things to the kids' school or in their community. And suddenly, they are losing resilience. They're not able to function at the level that they were. And being able to restore that for someone is one of the greatest gifts I think I've ever done. I practiced medicine for a long time, delivered a lot of babies, done a lot of surgeries, super proud of all that. But now that I just focus on taking care of women after reproduction ends, it's like the greatest medicine I've ever practiced in my life. And watching those women go back to these careers that they've built, these lives that they've built, and being able to function, I think if we could give that gift to, you

• 7:57Dr. Mary Claire Haver?

  know, all women and have our, you know, medical community, you know, all of this focus, focus back on that, I think is huge. But what kills me is I'm a product of this system and super proud of the stuff I learned, but I didn't even realize it was a problem till I went through it. And that's a little embarrassing, right? I didn't realize, I just thought menopause was what they told me it was. The end of your periods, a few hot flashes, and then you just get on with it.

• 8:26Speaker 00

  A few hot flashes. Yeah, no.

• 8:29Dr. Mary Claire Haver?

  Not cardiovascular disease increase, brain fog, the road to Alzheimer's opens up wide and stiff and steep, and, you know, osteoporosis fracture. I didn't even know the percentage of women who would have an osteoporotic fracture, like that kind of information. You know, we've siloed so much of health into, okay, the orthopedists are going to take care of this, the cardiologists are going to take care of this, you know, OB is just going to take care of the breast and pelvis. And no one, what I realize now, is looking after our health because we disease differently than men do. It's like, once we get rid of the bikini area, what do we have left? And so I saw in Pivotal.

• 9:11Speaker 00

  Yes.

• 9:12Dr. Mary Claire Haver?

  So what is Pivotal first?

• 9:13Speaker 00

  So Pivotal Ventures is a company that I formed that does investments, but it's also now a philanthropic arm and it's an advocacy arm to try and move forward the key issues in society that I think are not being well-represented. And as you said, for a woman has, in my opinion, a woman has to be well to do well. And so over the course of my career, both when I was at the Gates Foundation and now with Pivotal Ventures, we've been investing in these stages of women's life, reproductive, maternal healthcare, and there's still so much more to be done there.

• 9:56Speaker 00

  So I've made, I've doubled down on my investments there. And now we're adding on this new stage for exactly the reasons you say. It is chronically underfunded, which means it's chronically under-researched. We just sort of neglected it and expected women to go through it and go through it well? Are you kidding me? And so if I think of even just one issue that people go through and that I went through in peri-menopause and menopause, okay, the chronic insomnia.

• 10:28Dr. Mary Claire Haver?

  Yeah.

• 10:29Speaker 00

  And then what it does to your brain, as you said, long-term. But even in the moment, I will say, because of the chronic insomnia, I started to have brain fog, and I doubted myself. I would be going in to meet with a world leader or CEOs somewhere and feel like, am I going to be able to do this? Do I have the facts and figures? Do I have the convincing argument I want to make? To doubt yourself right when you're in the peak of your career? This is happening. I will say, it's happening to so many women. One of the things that surprised me when we did, when I put out that New York Times article about menopause and having a revolution is, one, the number of women that wrote in and shared their stories and said, "I finally feel seen."

• 11:14Speaker 00

  But the number of women that wrote in and said, I had to take a day off from work. I had to take a week off from work. I have friends where many of them are stepping back from their careers right where than they're in their prime. And the research now shows that we know that one in 10 women takes at least, at least, and this is a minimum, and I wish we had better data, one day off because of menopause. But the truth is, what I saw in these New York Times comments, and anecdotally, my friends who talk to me, women are really having to take days off and step back to go seek the care they need, but also because they feel so unwell, right? That's just, that's tragic.

• 11:57Dr. Mary Claire Haver?

  And that's only tracking, Melinda, the data we know. That's only tracking hot flashes, you know? That's not tracking the things that are not commonly recognized as menopause, like brain fog, like anxiety, like depression, the mental health changes.

• 12:15Speaker 00

  You bet.

• 12:16Dr. Mary Claire Haver?

  And, you know, I think the numbers are probably a lot bigger.

• 12:20Speaker 00

  Oh, for sure they are.

• 12:22Dr. Mary Claire Haver?

  And I see it clinically, where they're coming in, CEOs, COOs, you know, and like, I'm struggling to do my job and outing myself. And can I do this, being passed over for promotions? And when, if we don't have a seat at the table, people tend to not look after you.

• 12:41Speaker 00

  That's right. You have to look after yourself at work, right? And so, and we, both at work, but also this is why, to use your thing, your point, which is, we need a seat at the table to change this.

• 12:54Dr. Mary Claire Haver?

  Yeah.

• 12:55Speaker 00

  And we can change this. I look, you know, when you look back at the history of breast cancer and what was known 40 years ago and what's known today, that changed because of the Susan G. Komen Foundation, right? And the advocacy they created and the walks for cancer and breast cancer. And so now, today, a woman knows how to screen herself. She knows she should get a mammogram. She should advocate for a mammogram, get early treatment if she has it. I mean, we have come a long way, but it's because of that start. And so that's why I called for a menopause revolution. Let's really start now.

• 13:37Speaker 00

  You've been doing a lot of work, others have, but we need to all come together and make change, demand that the system meets our needs, not that it's created for somebody else.

• 13:48Dr. Mary Claire Haver?

  And you struggled as well with finding a clinician that would recognize what was happening. Do you feel comfortable talking about that?

• 13:55Speaker 00

  I do. So luckily, I have older friends. So when I started going through some of these symptoms, I could recognize what they likely were, because I went through menopause much earlier than I expected. And so I'm in my 40s, but it took me three doctors to get the right healthcare for my symptoms. And here I am, like, I'm unbelievably privileged. I have access to the best healthcare in the world, right? But to have three doctors who could really go through and the finally, the last one say, okay, this is specifically what I think we should do. And you have to be in good dialogue with your doctor, because it's not always clear, even when you find a well-educated.

• 14:36Dr. Mary Claire Haver?

  And it's not a cookie cutter solution for everyone.

• 14:39Speaker 00

  And that's why even for my first investment in this area, we are focusing on training OB-GYNs. You're one of them, right? You have the right information, but we're only training a third of OB-GYNs. A third.

• 14:54Dr. Mary Claire Haver?

  A third. I was a former program director, so I can speak, at least until 2018. So at least until then, I knew the curriculum backwards and forwards. And menopause was basically an afterthought, you know? Obstetrician gynecologists are busy. We are delivering babies, doing surgeries, you know, kind of tasked with so much. And there's a lot of political pressure in different states on the obstetrics part of the world, and you know, that's a whole separate conversation. But menopause was like, oh yeah, you know, make sure she gets her mammogram, make sure she gets her bone density at 65, and you know, don't give her hormones because of the Women's Health Initiative, unless, you know, I trained, my residency was 98 to 2002,

• 15:38Dr. Mary Claire Haver?

  right as I was graduating was when the WHOI broke. So I was trained to give menopause hormone therapy. We probably had 40% of patients who were on it, you know, of who were eligible, who were on it, and that seemed like a reasonable number at the time. And then when the study broke, it was like, stop, stop everything. And all meaningful education also stopped. All meaningful research outside of alternatives to HRT stopped. And so when we look at the data now, it's probably, and depending on who you read, sending 2% of women who are eligible to 7% at best are being offered and electing to utilize menopause hormone therapy. And not that it's like going to cure everyone, or it's a fantasy or for everyone, but that's

• 16:21Dr. Mary Claire Haver?

  just, that's over 90% of the population not even being given the option or the conversation. And that's a systemic problem.

• 16:29Speaker 00

  That's right. And you're making several, you know, amazing points here. One is, why did we have one study? There should have been 30 studies. Again, if had we started this back when we started breast cancer, there would have been 30 studies. And so we could have compared, instead of misreading that piece of research, we could have done some comparisons to then say, oh, no, no, this actually is effective. And the problem is, as you said, things stopped. But now that we're finally have come back to that piece of research, as you said, so few women are getting the right information. I have two sisters-in-laws who are, have been going through this more recently.

• 17:14Speaker 00

  One's quite a bit younger than me. And again, she has a very good doctor, but getting all the right information about HRT, the moms in my mom's book club, who are younger than me, are all saying, yeah, I went to my doctor, but he's not sure, she's not quite sure. What are you doing? How are you thinking about this, right?

• 17:38Dr. Mary Claire Haver?

  I love the initiative to help Menopause Society. You know, I'm certified, but they didn't have a training course. They just had a booklet that we got and we studied, and then we went and took the test. But now, you know, giving money to help develop an actual training course where you can watch, you know, videos and have lectures and just like we did in medical school, because we're not, we're not getting it in our training programs. But it's elective. It's not mandatory. You know, the American College of OB-GYN doesn't recognize the Menopause Society guidelines. So ACOG, which is what I'm boarded at, has not changed their menopause guidelines since 2014.

• 18:18Speaker 00

  Hmm. So that seems like a fantastic place. I know you are all about advocacy, which we need. I mean, again, would you not train an OB-GYN how to deliver a baby? No. We expect our OB-GYNs to know what they're doing, right? So why would you, that's a stage of a woman's life. Why would you not expect to them to be fully, fully trained in menopause and it to be mandatory? And as you go get, you know, you have to go back and do medical training over time to stay licensed? Absolutely, that should be part of it.

• 18:56Dr. Mary Claire Haver?

  They're getting there. It's a very slow attrition for ACOG, but I think we need to mandate this. I think it needs to be bigger than OB-GYN. You know, we're busy.

• 19:07Speaker 00

  It needs to be healthcare providers.

• 19:09Dr. Mary Claire Haver?

  Every clinician who touches a woman.

• 19:11Speaker 00

  Primary care, you bet. And look, let's demand that our health system is built for us and not somebody else. I mean, if we're going to speak the truth here, the health system was built for men.

• 19:24Dr. Mary Claire Haver?

  Yes.

• 19:24Speaker 00

  And you've talked about, you know, a woman's body was assumed to be a default of a man's. No, no, no. We need to demand that the health system is built for the other half of us, right?

• 19:36Dr. Mary Claire Haver?

  One of the things I see, which I'm excited about, I get an alert, I'm kind of a nerd, and I get an alert on PubMed every day, the word, when the word menopause or perimenopause is mentioned in a research article. So I read every abstract, just to see, you know, where we're heading with this. And it's not really the OB-GYN literature, at least not in the US. NIH funding's a little tricky right now, but there's a lot of good worldwide stuff happening. It's the cardiovascular literature. It's the urology literature. It is the rheumatologist. They are starting really to do a deeper dive on sex-based differences in disease.

• 20:11Speaker 00

  That's right.

• 20:12Dr. Mary Claire Haver?

  And I think that's, menopause is more than reproduction, right? I think this is truly the health of women and how we are going to allow women to age in this last 30 years. We have so much room to go, but I am seeing every day, just more and more and more articles coming out, showing how we are heart disease. And I think you, your pivotal is really investing. And so for our listeners, you know, women, when we look at a heart attack, men tend to have the big widow maker, the LED, so the left anterior descending artery that comes to one of the coronary arteries, it gets a big clot and then a plaque way up high, right as it exits the aorta. Women, I didn't know this, no one taught me this, I learned this two years ago, tend to have diffuse microvascular disease, which is why.

• 20:59Dr. Mary Claire Haver?

  We show up in the ER with atypical chest pain, though we're 51% of the population and our heart attack is atypical. And then we're misdiagnosed 50% of the time. We have a much higher chance of dying from a first heart attack than a male. And the medications don't work as well on us as they do on our male counterparts. And the data is not stratified by sex, meaning male versus female. It's just like, oh, this particular drug worked great for this group. But when you look at the data and tease out the women versus the men, the women don't do as well.

• 21:28Speaker 00

  They definitely don't.

• 21:30Dr. Mary Claire Haver?

  And talk to me about where you want to see this investment going for heart disease.

• 21:34Speaker 00

  So I'm invested with an organization called Wellcome Leap through a model, Regina Dugan, who's an amazing scientist. I've known her a long time. And she's taking a model that came out of DARPA to help us. The model helps you get things much more, much more quickly, three to five years as opposed to 10 or 20. And so we are, that is exactly what they're looking at. They're looking at this plumbing around a woman's heart to say, okay, where are these places coming in microvasculature? And how could we come up with a better diagnostic? Because even to go to the right place to get the right diagnostic for women is one, expensive and available in very few places.

• 22:16Speaker 00

  So we're looking at, could you come up with a diagnostic that catches this much, much sooner? So the research is specifically focused on a woman's heart and the vasculature around it, not a typical heart, which is assumed to be the male heart.

• 22:32Dr. Mary Claire Haver?

  Yeah, I mean, that's really groundbreaking to me. Lisa Moscone, are you familiar with her work? So she's with Wellcome Leap as well with the care program, where they're using the same model to see what is this connection with Alzheimer's and dementia and menopause? Because we just see that acceleration.

• 22:51Speaker 00

  Well, and as you said, again, if a woman gets chronic insomnia and we see the symptom, which is brain fog, but the chronic insomnia can lead to so many things, right? And so there are just so many issues here. And for me, it's actually also exciting to see that we're finally going to be on the brink of this. We need so much more funding, though.

• 23:16Dr. Mary Claire Haver?

  Yeah, we do.

• 23:17Speaker 00

  I mean, so much more funding. We should expect our national health institutes to put far more funding into women's health of all the types you mentioned.

• 23:27Dr. Mary Claire Haver?

  Billions and billions and billions.

• 23:29Speaker 00

  Yes, because that is how research moves forward. It has been our government funding through the NIH that then goes to all the researchers around the world in the US. So, you know, again, to think that women live nine years unhealthy in life, we've miss thought, oh, well, that's at the end of their life, you know, because they live longer.

• 23:53Dr. Mary Claire Haver?

  No, half of it is pre-menopause.

• 23:55Speaker 00

  Half of it is those most productive years. And to me, it's just, it's tragic. It just shouldn't be. I think of these, these stages of women's life, they can be, either be off ramps or they can be continued on ramps into the life that they want, right?

• 24:12Dr. Mary Claire Haver?

  So how do you think, you know, and the advocacy arm for pivotal?

• 24:17Speaker 00

  Yes.

• 24:17Dr. Mary Claire Haver?

  And I'm, literally today, I testified this morning for a congressional hearing on menopause.

• 24:23Speaker 00

  Thank you.

• 24:23Dr. Mary Claire Haver?

  So, you know, what is the best way? You know, you, you've lived this life in business and advocacy to make this happen. I mean, I was doing pap smears and delivering babies, you know, back in the day. But I do think this needs to be mandated. You know, what do you think the best path to that is?

• 24:40Speaker 00

  Well, I don't have a perfect answer for that. Like, our government is very tricky right now in particular. But I would say this, I think there is absolutely room at the state level to make sure that we demand, and I say to this to all women and men who care about their wives and their sisters and their daughters, we should demand that we get women's health services on the agenda of insurance and Medicaid and Medicare, right? Because when a woman can take time off for menopause and have, if she needs it, but also be able to hook up to good insurance covering those menopause symptoms, it makes a difference. There are many women in this country who can't afford to go to the doctor

• 25:25Speaker 00

  to even begin to explore their menopause symptoms. That, that just shouldn't be. So that's a great place to advocate. I don't know, what else would you say? You're more on this issue than I am.

• 25:35Dr. Mary Claire Haver?

  So we have an advocacy arm through my company. And we track state by state all the legislation associated with menopause. Some are educational initiatives, some are mandating training initiatives. And so we take it all the way, see what dies in committee. But it is really bipartisan. I'm not seeing a clear that a red state or a blue state. It is really across the board.

• 26:00Speaker 00

  That's right.

• 26:01Dr. Mary Claire Haver?

  The one in Texas sadly died in committee, but at least we got something to the table. And I think women realizing that their vote really matters here. I end almost every stage that, you know, people always ask me, what can we do? And I'm like, vote.

• 26:15Speaker 00

  Absolutely.

• 26:16Dr. Mary Claire Haver?

  Vote for someone who cares about your health. Vote for someone who wants to see you healthy for your entire life.

• 26:20Speaker 00

  That's right.

• 26:21Dr. Mary Claire Haver?

  Because everyone does well. Because women tend to, not all women, give back and tend to reinvest in their community. They want to see the next generation do well. And certainly there are men who do that as well, but I, we just see that. You know, that when women do well in their 60s, 70s and 80s, those communities thrive.

• 26:43Speaker 00

  They do, because they are investing in the next generation. They're investing in the community. They often, as they get a bit older, have a little more time on their hands, right? Or they may have built a little bit of wealth and say, I'm going to give back to my community. So absolutely, people should vote and should pay very close attention to where their state representative is and even at the federal level to say, okay, I want to make sure that we have the right administration or people on the Hill who are going to advocate for the things we need in our lives, whether that is good childcare or good paid leave policies and women's health. These don't have to be either or, these should be ands.

• 27:24Dr. Mary Claire Haver?

  Ands.

• 27:32Dr. Mary Claire Haver?

  The World Economic Forum report really changed my life, I think. The one that talked about where we got the data on, and I, did you have something to do with that report?

• 27:44Speaker 00

  That specific one, the Gates Foundation had something to do with it, yes. When I was there.

• 27:51Dr. Mary Claire Haver?

  That was the first time I saw the data on that 20 to 25% of a woman's life is spent in poorer health than their male counterparts. When I saw the data on cardiovascular disease, when I saw the data on osteoporosis and the economic impact. And I sat there and I just went through it page by page by page. And I knew this could be life-changing if women knew this information, really knew it. So I immediately took it to my social media platform and just talked about it for months and months and months. And, you know, thank you for the foundation, you know, which was helping to fund that. Because without that data, I think we would be another 10 years behind.

• 28:29Dr. Mary Claire Haver?

  And I think women, at least the feedback I'm getting on socials, is they are upset. And they don't think it's fair. And, but they realize this doesn't have to be this way. That, you know, we have, when you look at, when I look at the research around GLP-1s, which is amazing, an incredible drug, we use it in our clinic. This was Operation Warp Speed, really. When you have the right motivation, medical research can move very quickly. And we can see incredible changes over time. Women's health deserves

• 29:04Speaker 00

  Absolutely.

• 29:05Dr. Mary Claire Haver?

  the same amount. Because I think we could change the world so quickly.

• 29:10Speaker 00

  That's right.

• 29:11Dr. Mary Claire Haver?

  You know?

• 29:11Speaker 00

  And part of the reason, so when I was at the Gates Foundation as a coach, I founded it, but one of the things that I stepped into was making sure we had a gigantic women's health arm of work going on. And the first thing I learned was that we do not have data about women's health. And I learned it because I was working in reproductive health. And when I would go to the developing world and women would say they couldn't get access to contraceptives, they knew about them, but they didn't have access. I would come home and read the reports. And the reports said that contraceptives around the world were stocked in. And that didn't make any sense to me because what I was seeing, this is why you always have to be close to what's going on in this work.

• 29:54Speaker 00

  And I was like, but that doesn't match what I'm hearing in place after place after place around the world. Well, you dig down into that data, sure, condoms were stocked in because of the AIDS work that was being done, which was great work around the world. But women would tell you in private settings, they're like, I can't begin to negotiate a condom with my husband in my marriage because either I'm suggesting I was unfaithful or I'm suggesting he was unfaithful. So I realized, my gosh, we have got to go collect the right data on women's lives. And it has to be not just reproductive health and not just maternal health, which we started to get much more data there. It has to be fully about women's lives.

• 30:38Speaker 00

  Because if we don't have the data, we don't know where to effectively fund and do the research. And so now we're finally at the stage of, okay, let's supercharge the funding. Part of me speaking about this and leading on this is to say, look, I'm one small, small funder here. But lead a charge so that others come in. And ultimately, it has to be government funding because then you get a Warp Speed type, uh, health intervention.

• 31:07Dr. Mary Claire Haver?

  So it's, it does take some courage right now in this, especially this political climate. But I don't think When we look at all of women's health, this, we didn't have the data. So I don't think any administration, including this one, has done a tremendous job with women's health, right? But a lot of donors don't want to fund this because it's a little bit of a hot potato. But you don't care.

• 31:31Speaker 00

  What I care is that women get the health care they deserve. And our health care should not be determined by politics. It should be determined by science. So again, part of this mis stepping is to say, this is a safe space to fund.

• 31:47Dr. Mary Claire Haver?

  Yeah.

• 31:47Speaker 00

  And to show some courage and to say, this is just what's right for society. And my hope is that others will then step in, just like we've seen in breast cancer or Alzheimer's research, right? Of course, we should fund women's health. Of course, we should.

• 32:04Dr. Mary Claire Haver?

  Yeah, awesome. You, in the essay, named some disparities out loud. White women are more than twice as likely as women of color to use hormone therapy, though women of color tend to suffer greater, much greater, and have more of the long-term consequences as well. But, you know, untreated hot flashes, you have a higher risk of heart attack, higher risk of stroke, higher risk of diabetes, more visceral fat, you know, all the things that lead to all these metabolic consequences. Why do you think that gap exists and what can we do about it?

• 32:36Speaker 00

  Well, our healthcare system is not only failing women in general in certain ways, it is really failing certain parts of our population. So I was down in Louisiana late last year and even just to see what the Dobbs decision has done for women who are going through miscarriages, who are saying, I can't get into the clinics. They don't, because they're confused. I would talk to the healthcare providers, they're confused about what they can do or not do. And the women are saying, I had to keep a dead baby inside of me because I couldn't get the healthcare services I needed. So we, you know, we've been failing black women in this country for centuries in terms

• 33:20Speaker 00

  of maternal health. Again, you know, when you're giving birth to a child, you're two to three times more likely to die if you're a black woman.

• 33:30Dr. Mary Claire Haver?

  Yeah.

• 33:30Speaker 00

  So we're failing black women and Hispanic women, but we're failing them here and here and all the way through.

• 33:37Dr. Mary Claire Haver?

  Across the transition, yeah.

• 33:38Speaker 00

  And the converse is true. I was down just a few months ago at a clinic in Alabama that was all about wraparound services for women. So the minute she stepped in the door, they start assessing her for her mental health. They do the pregnancy test, they do screenings for other things, and they give her services all the way through, both pregnancy and childbirth. And I met a woman named Asia who had had a terrible experience with her first child of black woman in the healthcare system. Then she miscarried, then she came to this clinic for her second baby, thank goodness. And she said, they are supporting me at every step along the way. And even the days I don't have the transportation money to get here, I get a little something to help.

• 34:23Speaker 00

  Like, women in our country are under tremendous stress, economic stress, to put groceries and a meal on the table, right? And so then to not have their health going well and to feel like, how am I going to provide for my family? That's just additional stress that is horrible for your health and for your family.

• 34:45Dr. Mary Claire Haver?

  I practiced obstetrics in Texas where my practice is, and we had a 22-week rule at the time. So that was the age of viability. So terminations were allowed up to that point. And then after that, it could get, you know, there were times when I had a 22-weeker and waters were rough, you know, we have some obstetrical, just horrific outcome on a wanted pregnancy. And sitting there for a split second, like,

• 35:14Speaker 00

  Can I do this?

• 35:15Dr. Mary Claire Haver?

  Can I do this? Is this okay? Who's on, you know? And when they dropped to six weeks, and at that point, I had left obstetrics and was just doing menopause care, I remember crying in my bed and telling my husband, I've walked away from this, but like, I would have, I don't know if I could have practiced under that uncertainty, you know, of the moral injury, the, you know, constantly worried of going to jail, you know, or having my license taken away because I was doing what I was trying to do.

• 35:47Speaker 00

  That's right.

• 35:47Dr. Mary Claire Haver?

  Which is now disagreeing with what some random lawmaker decided, you know? And it differs state by state.

• 35:54Speaker 00

  It differs state by state. So the confusion?

• 35:57Dr. Mary Claire Haver?

  Yeah.

• 35:57Speaker 00

  The confusion, I was shocked, actually, the amount of confusion in these Louisiana healthcare clinics I went into. And, and the residents who were there training, saying, well, so if I don't get trained in this, but I move to another state where I'm supposed to provide these services, what does that mean? Or if I do train in this, is somebody going to say I can't get my license? Right? Why would we create confusion in a healthcare system that is not already servicing women and families well?

• 36:30Dr. Mary Claire Haver?

  Yeah. So in your book, The Next Day, you talk about the transitions we all move through. You've been through a lot of changes. You've got grandkids now, congratulations.

• 36:41Speaker 00

  Thank you.

• 36:42Dr. Mary Claire Haver?

  And then, but for you, what have been the upsides? I want to talk about the positive stuff about transitions. Because what we see on social sometimes is, you know, it's all doom and gloom, it's over, all these horrible things are going to happen to you and your hormones go away. And I feel like I'm living my best life right now.

• 36:59Speaker 00

  Me too. My youngest daughter says, my mom is living her best life. And I was like, I think I am. I mean, look, you know, of course, it's sad when your kids go off to college and, but you've, but I felt like I've done my job. My sister said to me, look at it this way, you've done your job. They're always going to still be close to you. It's what's they're supposed to do in life. But what I didn't expect was the vibrancy that would come, right? I don't have all the stress of work and three kids and school forms and doctor's appointments for them. And it's like, oh, my gosh, not only is my time opened up, but a vibrancy in life. And what I say in my book about transitions is, I think during transitions, you both

• 37:43Speaker 00

  have some beautiful ones you want to go through and you have some tough ones. You don't get to 60 by not having many transitions in life. But what I've learned is there's growth in every transition. And even the hard ones, if you focus on the growth and know you're going to come out the other side better, you don't know exactly how you're going to come out of the other side or where, it can be one of the most beautiful times in life. I am loving this time in life. And I also love being a mom.

• 38:10Dr. Mary Claire Haver?

  I think, feel like every woman deserves that.

• 38:13Speaker 00

  Yes.

• 38:13Dr. Mary Claire Haver?

  Right? Like, coming out of this, you know, into this last decade, you know, last two to three decades of feeling like this is the best part of your life, rather than, oh, it's all gonna, things are going to start breaking and wearing down and, and, you know, that, you know, we go through a lot at this age. Our parents are aging or empty nesting, you know?

• 38:33Speaker 00

  That's right.

• 38:33Dr. Mary Claire Haver?

  Helping these people we raise launch into their adulthoods. But I'm, I am loving it. I'm living my best life and I literally, like, my mission in life is that every woman looks forward to her last three decades.

• 38:46Speaker 00

  Yes. It can be a beautiful time in life. And I was walking with my friends the other day and we were saying, you know, we just, the amount of built-up wisdom too, that you only get by living a certain amount of time, right? Again, we're watching many of our daughters and sons go through the transition now of getting married, right? And starting their own families. And you think, oh, gosh, I kind of wish they knew what I knew now. But they have to learn and live through those stages, right?

• 39:15Dr. Mary Claire Haver?

  Where do you, you know, writing checks for funding, you know, looking at, it's more than writing checks, of course, but like, what's your next? Where do you want to see some more research and funding going? What excites you?

• 39:28Speaker 00

  I want to see so much more research and funding going into women's health, not just into this perimenopause, menopause stage and into heart disease, but I want to see more in the autoimmune space. I want to see much more done for mental health for not just women, but for teenagers and young people as well, all the way through. I mean, we do have a mental health crisis in this country. So I think those are all places that I'm looking forward to seeing change come

• 39:57Dr. Mary Claire Haver?

  Yeah.

• 39:57Speaker 00

  in the future.

• 39:58Dr. Mary Claire Haver?

  Yesterday, I reposted a video of a young woman, a researcher, who was sharing a research study that found a gene for PMS and PMDD.

• 40:08Speaker 00

  Oh, my gosh, wow.

• 40:10Dr. Mary Claire Haver?

  So it's not just hormones. Hormones sets up a vulnerability, but there is a genetic marker they have found for this. I'm like, this is where we need to go. I think they're going to find one for endometriosis and all this, what's going on in autoimmune. Like, it's more than, you know, I was brought up, brought up, I say, in the medical world.

• 40:30Dr. Mary Claire Haver?

  To women tended to be dramatic was the bias.

• 40:35Speaker 00

  Oh gosh.

• 40:36Dr. Mary Claire Haver?

  Women tended to be emotional. And that would skew how she presented to the world. Right? So we always had a heavy sense of it's all in her head. You know, and Elizabeth Cummins wrote a great book about this. And I literally trained with that bias. And it took me 20 years of practice to sit back and realize women are not crazy. They're actually hurting. They're actually suffering. They're actually, you know, and it's sad that it took that long. You know, I wish I could be like my daughter, who's a fourth year med student now, you know, who would never tolerate this, who would never, you know, but I just was felt like I was lucky to be there. And if someone would tap me on the shoulder and say, we made a mistake.

• 41:21Dr. Mary Claire Haver?

  You really don't, you really didn't get into med school. Well, we're gonna let you stay.

• 41:24Speaker 00

  That imposter syndrome that so many women, yes, including me faced, yes.

• 41:30Dr. Mary Claire Haver?

  So, um, and to watch my children who are 22 and 25 not have that at all, or at least not express it to me. And never, I think we're doing a good job, you know?

• 41:41Speaker 00

  We are doing a good job.

• 41:42Dr. Mary Claire Haver?

  Changing the system.

• 41:43Speaker 00

  But we, you and I were sent, I'm older than you, but we were sent out into a system that was built for men. And remember, if we go way back in time, we used to say women were crazy and men had the ability to institutionalize them, right? And that wasn't always the case, why they were being institutionalized. So these, these myths, we just need to break through. Yes, we are emotional. Guess what? Men are emotional too. Guess what? Being emotional is a beautiful thing. It's how, as my mother always taught me, and she's still very vibrant and alive at 85 and exercises every day, but as she always said to me, emotions are neither right nor wrong. It's what you do with them.

• 42:23Dr. Mary Claire Haver?

  Yeah.

• 42:24Speaker 00

  Right? And so, understanding our full range of emotions and letting ourselves go through them and then stepping into the world in the way we want to, that needs to be allowed for women and allowed for men. And I'm gonna just add one point you made about research, which is, I love that they're finding these potentially new genes and sometimes it's a biomarker in different areas. I also like though, that as women are getting to better places in society, either at higher places in society, more lawmakers, more women at the table making good policy, more women running companies, more women investing in other companies.

• 43:07Speaker 00

  What we're seeing is it takes companies to come up with new products. It takes research. It takes the private sector to push things along. It takes our government. It takes all of those places, which is why I want women to step into their full power. Because when they do, we do change the world. Not because we have a better lens on society than men or a worse lens. We just have a different lens on society and we can create and we do create change.

• 43:39Dr. Mary Claire Haver?

  What do you think is the single most useful thing that a woman who's listening or watching right now can do to push for change?

• 43:46Speaker 00

  Oh my goodness. I'm gonna, it's hard to say one, so let me just say a few.

• 43:50Dr. Mary Claire Haver?

  Just give me a list.

• 43:52Speaker 00

  First of all, advocate for yourself at your doctor's office, always. Number two, talk to your friends and educate your friends or get them to educate you with real health information like you deliver, not some of the fake news that's out there in other places. Number three is advocate. Advocate to your congressperson, your senator. And number four is vote.

• 44:15Dr. Mary Claire Haver?

  And vote.

• 44:15Speaker 00

  And vote.

• 44:16Dr. Mary Claire Haver?

  For our listeners, if we have the Citizens Guide to Menopause Advocacy on our website, that shows you what legislation is currently, you know, in each state and how to, how to reach out to your congressman, how to reach out to your state representatives, how to advocate on a legal level so that we can age as healthily as possible.

• 44:38Speaker 00

  So beautiful.

• 44:39Dr. Mary Claire Haver?

  So women today who are really deep in this perimenopause and menopause transition are really being dismissed at most doctor's offices and, and told it's just aging. You know, if everything that you're doing and everything that I'm trying to bring a voice along with so many other doctors, advocates, you know, is successful, how do you think this is, this would change that experience?

• 45:02Speaker 00

  I, the way I would like to see it change is that anywhere a woman touches the healthcare system, they get good information about perimenopause and menopause. And there become many, many different tools to help them get through in a very healthy way, so that they can then go on to live completely vibrant lives.

• 45:22Dr. Mary Claire Haver?

  Amazing. All right. Melinda French Gates, thank you so much for coming on UnPaused. All of your advocacy, all of the funding and this incredible pivotal company that you've developed, it's changing the world and I'm just amazed to watch it.

• 45:40Speaker 00

  Well, Dr. Haver, thank you so much for having me and for what you're doing to make sure that women get credible health information.

• 45:47Dr. Mary Claire Haver?

  Thank you.

• 45:50Dr. Mary Claire Haver?

  I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at DrMaryClaire and get honest and accurate information on health, fitness, and navigating midlife at thepauselife.com. Full episodes of UnPaused are available on YouTube at Dr. Mary Claire. UnPaused is presented by Odyssey in conjunction with Good Roommate Media and Long Wave Digital.