unPAUSED with Dr. Mary Claire Haver

This week on unPaused, Dr. Mary Claire Haver sits down with Cindy Eckert, founder and CEO of Sprout Pharmaceuticals and creator of Addyi, the first FDA approved treatment for low libido in women. Cindy is a pharmaceutical entrepreneur who began her career at Merck before founding her first company in 2007, focusing on undermarketed FDA approved products. After successfully building and selling a male sexual health company, she became the only woman running a sexual health company and witnessed firsthand the stark contrast between how medicine treats male versus female sexual dysfunction. Her journey to bring Addyi to market became a cultural battle about whether women's sexual desire matters, leading to two FDA rejections, public hearings, and ultimately a historic approval in 2015 after a six year fight.

In this conversation, Dr. Haver and Cindy explore how Addyi works differently from Viagra, targeting brain chemistry and desire rather than blood flow and arousal. Cindy explains that Addyi is a mood drug originally developed for depression that showed an unexpected effect on female libido during clinical trials. The medication works on neurotransmitters in the brain, building over approximately eight weeks to restore spontaneous thoughts, fantasies, and desire in women with hypoactive sexual desire disorder or HSDD. She walks through the massive clinical trial requirements, including 13,000 patients compared to Viagra's 4,000, and the three things they had to prove with statistical significance versus placebo: increased interest in sex, more satisfying sexual experiences, and decreased distress from the condition.

ADDYI, flibanserin, is for women <65 with low sexual desire disorder who have not had problems with low sexual desire in the past, and who have low sexual desire that is troubling to them no matter the type of sexual activity, situation, or sexual partner. The low sexual desire is not due to a medical or mental health problem, problems in the relationship or medicine or other drug use. ADDYI is not for men or to enhance sexual performance.

Your risk of severe low blood pressure and fainting is increased if you drink 1-2 standard alcoholic drinks close in time to your ADDYI dose. Wait at least 2 hours after one to two drinks before taking ADDYI at bedtime and skip your dose if you drink three or more drinks that evening. If you take certain prescription, OTC or herbal medications, or have liver problems, the risk of low blood pressure and fainting increases and you should not take ADDYI.   Do not take if you are allergic to any of ADDYI’s ingredients. Sometimes serious sleepiness can occur. Common side effects include dizziness, nausea, tiredness, difficulty falling asleep or staying asleep and dry mouth. See PI and Boxed Warning at addyi.com/piGuest links:


Cindy Eckert 


Cindy Eckert (Instagram)

Recommended Books:


“Mars and Venus in the Bedroom: A Guide to Lasting Romance and Passion,” by John Gray

Articles:


Women with hypoactive sexual desire disorder compared to normal females: a functional magnetic resonance imaging study (Neuroscience)


Sexual Dysfunction Induced by Antidepressants—A Pharmacovigilance Study Using Data from VigiBaseTM (Pharmaceuticals)


Enhancing Sexual Health for Cancer Survivors (Symptom Science And Palliative Care)


Flibanserin Approval: Facts or Feelings? (Sexual Medicine)


Clinical trial evidence supporting FDA approval of novel therapeutic agents, 2005-2012 (JAMA)

Other Resources:


Addyi


What is Patient-Focused Drug Development?


International Society for the Study of Women's Sexual Health (ISSWSH)


FDA Expands Approval of Flibanserin for Postmenopausal Women’s Sexual Health (Drug Topics)


A Pill for Sexual Desire Reaches a New Group of Women (TIME Magazine)Drug Trials Snapshots Summary Report 2024 (FDA)


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An estimated 7.2 million Americans age 65 and older are currently living with Alzheimer's dementia. The part that should alarm every woman listening is this: almost two thirds of them are women.

In this episode, Dr. Mary Claire Haver sits down with neurophysiologist and Alzheimer's researcher Dr. Louisa Nicola to unpack what's really happening to women's brains during perimenopause and menopause and what we can do about it. Louisa Nicola is a neurophysiologist, human performance coach, and founder of Neuro Athletics, a consulting firm that works with elite athletes and high-level professionals to optimize brain health and performance. A former world class triathlete, she transitioned into neuroscience and earned her Master of Medicine in neurophysiology from the University of Sydney. Dr. Nicola is currently pursuing her doctorate studying the effects of resistance exercise on brain health. She focuses on optimizing brain function and longevity, particularly in women, through sleep, nutrition, and exercise interventions.

Dr. Nicola reveals how Alzheimer's disease doesn't suddenly appear at 70 but starts quietly in our thirties and forties, building up over a 30-year progression. She explains what's happening in the brain as amyloid beta proteins and tau tangles accumulate, why the hippocampus is the first area to go, and the critical role that sleep plays in clearing these proteins through the glymphatic system. The conversation explores why women are more predisposed to tau protein accumulation than men and how estrogen, progesterone, and prolactin inhibit the enzyme that causes tau proteins to become hyperphosphorylated and toxic. Dr. Nicola explains the connection between declining estrogen during perimenopause and increased Alzheimer's risk, including how estrogen helps mediate glucose metabolism in the brain, supports synaptic connections, and why the loss of this hormonal scaffolding leaves women vulnerable to cognitive decline.

Guest links:

Louisa Nicola (Instagram)

Louisa Nicola (Facebook)

Louisa Nicola, MMed, PhD(c) (LinkedIn)

Louisa Nicola (YouTube)

Louisa Nicola (X)

Neuro Athletics

The Neuro Experience Podcast (Apple Podcasts)

The Brain Code

Books

“Joyspan,” by Dr. Kerry Burnight

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In this episode Dr. Mary Claire Haver is joined by Dr. Rachel Rubin, a board-certified urologist and nationally recognized expert in sexual medicine, fellowship trained in both female and male sexual health. As assistant clinical professor of urology at Georgetown University and former education chair of the International Society for the Study of Women's Sexual Health, she brings unique insight into the stark disparities in how sexual dysfunction is treated across genders. Dr. Rubin founded the Sexual Medicine Research Team, and her advocacy work has been instrumental in changing FDA labeling on hormone therapy and advancing the American Urological Association Guidelines on genital urinary syndrome of menopause.

During the conversation, Dr. Haver and Dr. Rubin explore the intersection of menopause, hormones and women's sexual health, revealing why most doctors, including OB-GYNs, receive virtually no training in sexual health despite sexual dysfunction affecting millions of women. Dr. Rubin explains how men's sexual health benefits from 27 fellowship programs while women's sexual health has only three, and why erectile dysfunction research receives billions while female orgasm research gets nothing from the NIH. She breaks down the complete anatomy of the clitoris that most medical professionals never learned, explaining why understanding this matters for surgical outcomes, pleasure, and treating conditions like vulvar vestibule pain that affects penetration, tampon use, and pelvic exams. Dr. Rubin discusses how the vulvar vestibule, the hormone sensitive tissue surrounding the urethra, becomes a source of pain for many women during perimenopause, on birth control pills, or postpartum due to low estrogen and testosterone.

Guest links:

Dr. Rachel Rubin (Instagram)

Dr. Rachel Rubin (YouTube)

Dr. Rachel Rubin (Website)

Dr. Rachel Rubin (LinkedIn)

Dr. Rachel Rubin (Facebook)

Dr. Rachel Rubin (X)

Books

“Vagina Obscura: An Anatomical Voyage Hardcover,” by Rachel E. Gross

Articles

Sexual function after hysterectomy according to surgical indication: a prospective cohort study (Sexual Health)

The human cervix: Comprehensive review of innervation and clinical significance (Clinical Anatomy)

Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves (Brain Research)

The Impact of Glucagon-like Peptide-1 Receptor Agonists on Erectile Function: Friend or Foe? (Biomolecules)

Effect of Saw Palmetto Extract on Erectile Dysfunction and Libido in Patients with Lower Urinary Tract Symptoms Because of Benign Prostatic Obstruction (International Journal of Applied Research on Medicinal Plants)

“Not feeling like myself” in perimenopause — what does it mean? Observations from the Women Living Better survey (Menopause)

Updates on Therapeutic Alternatives for Genitourinary Syndrome of Menopause: Hormonal and Non-Hormonal Managements (Journal of Menopausal Medicine)

Menopausal Hormone Therapy and Cardiovascular Diseases in Women With Vasomotor Symptoms: A Secondary Analysis of the Women’s Health Initiative Randomized Clinical Trials (JAMA Internal Medicine)

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In this continuation of their conversation, Dr. Jocelyn Wittstein and Dr. Mary Claire Haver shift from understanding why menopause affects bones and joints to what actually works for building stronger bones and preventing fractures. If you've been told your bone density is declining, or you're worried about falls and fractures, this episode delivers the practical protocols you need.

Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor at Duke University specializing in sports medicine and the female athlete across the lifespan. She's also a former collegiate gymnast and mother of five. Her research focuses on frozen shoulder, ACL injuries in female athletes, and the musculoskeletal syndrome of menopause. As president of the Forum for Women in Sports Medicine, Dr. Wittstein is changing how we understand the intersection of hormones, movement, and independence in women's bodies.

They tackle the questions women ask most. How much exercise is enough? What types build bone? Is jumping necessary? They discuss the LIFT More trial and EFOPS trial, research showing women in structured exercise programs had fifty percent reduction in fracture risk, even as bone density eventually declined. This reveals something crucial: preventing fractures goes beyond bone density numbers alone.

Guest links:

Jocelyn Ross Wittstein, MD (Duke Health)

Jocelyn Wittstein, MD (Instagram)

Duke Female Athlete Program

Milken Institute Women’s Health Initiative

Books:“The Complete Bone and Joint Health Plan: Help Prevent and Treat Osteoporosis and Arthritis,” by Dr. Jocelyn Wittstein and Sydney Nitzkorski, MS, RD

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If you've ever struggled to put on a bra, reach behind your back, or lift your arm without searing pain in your shoulder, you're not alone. Frozen shoulder strikes women in midlife at alarming rates, yet for decades, medicine dismissed it as a mystery condition with no known cause. Orthopedic surgeon Dr. Jocelyn Wittstein saw what others missed: her patients with frozen shoulder were almost all women between forty and sixty, experiencing hot flashes, night sweats, and other symptoms of perimenopause and menopause. What she discovered is changing how we understand the impact of declining estrogen on women's joints, bones, and muscles.

Dr. Wittstein is a practicing orthopedic surgeon, researcher, and associate professor at Duke University, specializing in sports medicine and the female athlete across the lifespan. She's also a former collegiate gymnast and mother of five. Her research focuses on frozen shoulder, ACL injuries in female athletes, and the musculoskeletal syndrome of menopause. As president of the Forum for Women in Sports Medicine, Dr. Wittstein is changing how we understand the intersection of hormones, movement, and independence in women's bodies.

In this conversation, Dr. Mary Claire Haver and Dr. Wittstein explore how declining estrogen during perimenopause and menopause impacts joints, bones, muscles, and connective tissue. They discuss why frozen shoulder disproportionately affects women in midlife, with some Asian cultures having their own term for it that translates to fifty year shoulder. Dr. Wittstein explains the critical window for treatment, why early intervention can be transformative, and how hormone replacement therapy may prevent it, with preliminary data suggesting women using systemic estradiol have half the risk of developing frozen shoulder. She shares why physical therapy during the inflammatory phase can worsen it and how to recognize the early warning signs.

Guest links:

Jocelyn Ross Wittstein, MD (Duke Health)

Jocelyn Wittstein, MD (Instagram)

Duke Female Athlete Program

Milken Institute Women’s Health Initiative

Books“The Complete Bone and Joint Health Plan: Help Prevent and Treat Osteoporosis and Arthritis,” by Dr. Jocelyn Wittstein and Sydney Nitzkorski, MS, RD

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