Pleasure in the Pause: Midlife Conversations About Menopause, Sex & Pleasure

Hormone therapy after breast cancer is one of the most nuanced and emotionally charged conversations in women’s health.

For decades, many women have been told the answer is simply: no.

No discussion.
No nuance.
No consideration of quality of life, sexual health, bone health, brain health, or the individual woman sitting in the exam room.

But what does the research actually say?

In this episode of Pleasure in the Pause, I welcome back Dr. Susan Hardwick-Smith, board-certified gynecologist and certified menopause practitioner, for a grounded, evidence-informed conversation about hormone therapy after breast cancer.

This is not a conversation about ignoring risk.

It is a conversation about understanding risk clearly, asking better questions, and making informed decisions in partnership with your physician.

About our guest: Dr. Susan Hardwick-Smith is a Board-Certified Gynecologist and certified menopause practitioner specializing in women's midlife wellness, hormone optimization and sexual wellness. She is the founder of Complete Midlife Wellness Center in Houston, TX, and the best-selling author of "Sexually Woke- Awaken the Secrets to Your Best Sex Life in Midlife and Beyond." She also hosts the popular podcast "Empowering Midlife Wellness." Dr. Susan is the recipient of the Texas Super Doctor award over a dozen times, as well a multiple time recipient of H-Texas magazine's Top Doctor and Top Doctor for Women awards. She also has been chosen as one of Houston's "3 best rated" gynecologists several consecutive years. Dr. Susan is also an ICF certified life and leadership coach, multiple time marathoner and Ironman triathlete, and mother of 3 teenagers. 

Highlights from our discussion include:

• What the Women’s Health Initiative actually found — and why the headlines created so much confusion
• Why breast cancer type matters when discussing hormones
• What the research shows about hormone therapy and breast cancer recurrence
• Why some women on aromatase inhibitors may still be able to discuss options like progesterone, testosterone, and vaginal estrogen with their doctor
• How to prepare for a more informed conversation with your physician
• Why collaborative decision-making matters in women’s healthcare
• The importance of considering quality of life, sexual health, bones, heart, and brain health — not just risk 

My hope is that this episode helps you feel more informed, more empowered, and more confident asking questions about your own body and care. 

If you're seeking to reclaim your pleasure and vitality, join Gabriella at⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.pleasureinthepause.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for this enlightening journey into the heart of female pleasure and empowerment.

Resources:

Dr. Susan Hardwick Smith: https://drsusan.com/ 

Instagram: https://www.instagram.com/drsusanofficial/ 

Bluming review article in Cancer journal (2022): https://pubmed.ncbi.nlm.nih.gov/35594465/ 

Menopause Society consensus paper (January 2026): https://www.imsociety.org/statements/position-papers-and-consensus-statements/ 

Hormone Replacement Therapy After Breast Cancer: It Is Time Avrum Z. Bluming, MD LINK - https://bit.ly/4st0uji Menopausal Hormone Therapy for Breast Cancer Patients: What Is the Current Evidence? LINK - https://bit.ly/41leKyt

American Urological Association Guidelines on GSM 2025 https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

When you hear the word erotic, what comes up for you?

For most of us it immediately conjures images of sex, the taboo, or something forbidden. But eroticism is so much bigger than that. At its core, the erotic is about aliveness. It is our capacity to feel present, connected, awake to beauty, pleasure, desire, creativity, and the experience of being fully in our bodies.

And it is something so many women lose touch with, especially in midlife, when stress, caregiving, hormonal shifts, and the relentless pace of everyday life leave us feeling disconnected from ourselves.

In this episode of Pleasure in the Pause, Gabriela welcomes back somatic psychotherapist, sex therapist, and author Carly Mountain for one of the most expansive and thought-provoking conversations this show has ever had. Carly's new book, Untamed Pleasure: Unleash Your True Erotic Nature, is an invitation to examine the invisible cages that have domesticated our pleasure, and to find the keys that live inside us to open them.

Carly Mountain is a somatic psychotherapist, sex therapist, sacred space holder and author of Descent & Rising: Women’s Stories & the Embodiment of the Inanna Myth and Untamed Pleasure: Unleash Your True Erotic Nature. She is passionate about facilitating people to reconnect with their inherent erotic aliveness, power and pleasure. She lives in Sheffield, England with her husband and two daughters.  

Highlights from our discussion include:

• What eros and eroticism actually mean and why they are so much bigger than sex
• The cages — cultural and personal — that domesticate women's pleasure and how to start finding the keys
• Why midlife may actually be the most erotic chapter of a woman's life
• How communication is the skeleton key that opens every single cage
• The six bodies framework and why giving the emotional body its own wisdom is so important for women
• Creative transgression as a pathway back to erotic aliveness and what that can look like in practice 

When pleasure has gone quiet in your life, Carly says it is not a sign that something is over. It is a compass pointing you toward where you need to go next. The cages are real. And so are the keys. They have been inside you all along. 

If you're seeking to reclaim your pleasure and vitality, join Gabriella at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.pleasureinthepause.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for this enlightening journey into the heart of female pleasure and empowerment.

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Ep 10: Carly Mountain

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

What happens when a healthcare professional goes through surgical menopause at 42 and is handed nothing but a message in her patient portal that says "you are post-menopausal"? No education. No discussion. No next steps. Just a diagnosis and silence.

That is exactly what happened to Julie Parana. And even as an occupational therapist who spent her days supporting patients through major health challenges, she found herself doing what so many women do — minimizing her symptoms, pushing through the pain, and waiting far too long to ask for help.

Julie Parana, MS, OTR/L, CWHS, is an Occupational Therapist, Certified Women’s Health Specialist, Menopause Coach, and founder of The Menopause OT - Menopause Coaching, a virtual practice empowering women to feel informed, supported, and in control through perimenopause and menopause. She works with women at every stage of this transition, including early, surgical, or treatment-induced changes

Together, we talk about: 

✨ What adenomyosis is and why it goes undiagnosed for so long

✨ How surgical menopause differs from natural menopause

✨ The five lifestyle pillars that help women feel like themselves again

✨ Why affirmations feel awkward at first and why they work anyway 

✨ How to start small, build slowly, and actually stick to midlife wellness habits

Julie spent years dismissing her own symptoms because she was too busy caring for everyone else. What she learned on the other side of that is something every woman in this community needs to hear: menopause does not have to mean years of needless suffering. There is so much available to you. But you have to prioritize yourself first. No one is coming to do that for you. 

If you're seeking to reclaim your pleasure and vitality, join Gabriella at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.pleasureinthepause.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for this enlightening journey into the heart of female pleasure and empowerment.

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

There is a version of Mother's Day we all know. The brunches, the bouquets, the Hallmark cards. And then there is the version so many women carry quietly underneath — the grief of a mother who is gone, of never becoming one, of a child lost, of the mother we needed and never had, and the grief of a mother who is still here but already somehow leaving.

This episode of Pleasure in the Pause makes space for that fuller truth. Host Gabriela Espinosa sits down with Rebecca Soffer, co-founder of Modern Loss and bestselling author of the Modern Loss Handbook, for one of the most tender and honest conversations this show has ever had. Whether Mother's Day brings up something heavy for you this year or you are simply learning to live alongside a loss that has no clear shape, this episode gives you permission to feel all of it.

Rebecca Soffer is cofounder of Modern Loss, a media platform and global movement offering creative, meaningful and resonant content and connection addressing the long arc of grief. She is also the author of the bestselling The Modern Loss Handbook: An Interactive Guide to Moving Through Grief and Building Your Resilience and of Modern Loss: Candid Conversation About Grief. Beginners Welcome, and writes the Modern Loss Substack, one of the platform's top Health and Wellness publications.

Together, we talk about:
✨ The many forms of Mother’s Day grief that often go unseen
✨ Grieving a mother who is still alive but changing through dementia or illness
 ✨ How to support someone who may be hurting this Mother’s Day
 ✨ Finding connection, community, and meaning after loss
 ✨ Why grief and pleasure can coexist

Grief does not move in a straight line. It lives in us, shifts with us, and shows up in the most unexpected moments years after we thought we had made peace with it. What changes is not that it goes away. What changes is that we get better at knowing what we need when it arrives.

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Modern Loss Handbook | Book

RESOURCES:

Ep 101: Dr Bralove

Article by Colin Campbell

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

Have you ever wondered why intimacy feels harder than it should? Why desire feels distant, or why being fully present in your body during sex feels just out of reach — even when everything else in your life seems fine? Most women in midlife assume it is hormones. And sometimes it is. But sometimes the story runs deeper, back through experiences the body absorbed and quietly held onto.

In this episode of Pleasure in the Pause, Gabriella sits down with licensed clinical social worker, psychotherapist, and AASECT certified sex therapist Brooke Bralove for one of the most important conversations this show has ever had. They go deep into what trauma actually is, how it lives in the nervous system, and how it shapes desire, arousal, and the ability to feel safe in intimacy in ways most women never connect. They also explore a remarkable and fast-working therapy called Accelerated Resolution Therapy, or ART, and how it is helping women finally feel present and safe in their bodies again.

This is a tender topic. If anything in this episode stirs something up for you, please give yourself permission to pause and take whatever space you need.

Brooke Bralove is a licensed clinical social worker, psychotherapist, and AASECT certified sex therapist with over 20 years in private practice. She specializes in trauma, sexual health, and emotional healing, helping individuals and couples move through anxiety, trauma, and relationship challenges so they can feel more connected, confident, and fully themselves. A trained Accelerated Resolution Therapy practitioner and sought after speaker, Brooke is known for her warmth, her insight, and her gift for making complex emotional and neurological processes feel accessible and real. She practices in Bethesda, Maryland just outside Washington DC. 

Key Insights

• Trauma is broader than most women realize.
• The body holds onto experiences long after the mind has moved on.
• Low libido is not always hormonal. 
• Accelerated Resolution Therapy works fast.
• You are more than your past sexual experiences.

This conversation is for every woman who has ever wondered why pleasure feels so far away — and never thought to look at her history for the answer. The body is not broken. It is protecting itself the only way it knows how. And with the right support, it can learn that it is safe to open again. 

If you're seeking to reclaim your pleasure and vitality, join Gabriella at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.pleasureinthepause.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for this enlightening journey into the heart of female pleasure and empowerment.

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

This is a milestone episode. Episode 100 of Pleasure in the Pause marks two years of bold, honest conversations about women's bodies, pleasure, and sexual health in midlife — and this one is personal. For the first time, host Gabriela Espinosa steps out from behind the microphone and into the hot seat, interviewed by her friend and fellow midlife health advocate Karen Cerezo.

If you have ever felt dismissed by a doctor, confused by the changes in your body, or quietly assumed that pleasure was something you would just have to let go of in this chapter of life — this episode is your reminder that you are not alone, and that assumption is wrong. Gabriela shares the deeply personal story behind why she started this podcast, what she learned from 100 conversations with leading experts in sexual health and intimacy, and where the conversation is headed next. From the surprising gap in women's knowledge about their own anatomy, to cutting-edge medical tools most women have never heard of, to what it really means to step into your sixties with intention — this episode covers it all.

Karen Cerezo is a nationally board-certified health coach, certified personal trainer, menopause expert, TEDx speaker, and founder of Lifestyle Fitness. With over a decade of experience helping women in midlife navigate perimenopause and beyond, Karen blends science-backed education with real-life practicality to help women reclaim strength in their bodies, their choices, and their confidence. Karen specializes in menopause education, hormone health, strength training after 45, and the hidden cost of ignoring midlife health in the workplace. She is the author of Navigating Menopause: A Comprehensive Wellness Tracking Journal and a sought-after speaker who makes complex hormone conversations clear, relatable, and actionable. 

Highlights from our discussion include:

• Sexual pleasure in midlife is not over — it just looks different.
• Systemic hormones and local hormone therapy are not the same thing — and most women are only doing one when they may need both.
• Knowing your own anatomy is the foundation of self-advocacy.
• Pelvic floor therapy is one of the most underused and most effective tools available to women in midlife. 
• Pleasure is broader than the bedroom.

This podcast started because Gabriela had no language for what was happening in her own body. A hundred episodes later, that conversation has reached women in 106 countries — and it is just getting started.

If this episode resonated, subscribe to Pleasure in the Pause and share it with a woman in your life who needs to hear it. And if you have been part of this community from the beginning, thank you. This milestone belongs to you, too.

CONNECT WITH KAREN CEREZO:

Website: https://www.midlifehealthcoach.com/

Instagram: https://www.instagram.com/midlife_health_coach/

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

Have you ever struggled to put words to what you're feeling — in your body, in the bedroom, or even in your doctor's office? You're not alone, and it's not your fault. Most of us were never taught the language of our own bodies, and that silence comes at a real cost: disconnection in intimate relationships, unspoken pain, and leaving healthcare appointments feeling dismissed and unheard.

In this solo episode of Pleasure in the Pause, host Gabriela Espinosa explores what intimacy actually requires — not performance, not perfect words, but the ability to sense what's happening inside you and give it a name. Drawing on her work as an intimacy and attraction facilitator and a panel talk she gave at South by Southwest, Gabriela walks you through the neuroscience of body awareness (interoception), the three layers of intimacy practice, and a simple three-word framework — notice, feel, name — you can start using today.

Embodiment Tune-In Guided Audio. Create a practice of connecting to your body, tuning in to what there is to be felt and accessing the pleasure that lives within you.

Highlights from our discussion include:

• Intimacy starts with self-connection, not technique. 
• Your body is already speaking — learn to hear it.
• Disconnection costs you in intimacy and healthcare.
• The practice is simple: notice, feel, name.
• Build the muscle in ordinary moments.

What would change for you if you could clearly say I need to slow down — or I want more of that? That clarity isn't about confidence. It's vocabulary. Start small: today, pause once and name one sensation in your body. That's where it begins.

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

Have you ever been so consumed by someone just out of reach that you checked your phone obsessively, fantasized endlessly, and somehow wanted them even more because they weren't fully available? There's actually a name for it — and in this episode of Pleasure in the Pause, Gabriella sits down with journalist, author, and limerence expert Amanda McCracken to talk about why so many of us get stuck chasing love instead of receiving it.

At the heart of this conversation is a truth so many midlife women are quietly sitting with: we are all longing to be truly seen. But real love only becomes possible when we believe we are worthy of receiving it.

Amanda McCracken is an award-winning journalist passionate about experiences that highlight the intersection of wellness, travel, and relationships. Her work has appeared in The New York Times, Washington Post, Guardian, Vogue, National Geographic, Elle, NPR, Outside, ESPN, SELF, Runner’s World, and many others. She published her first article about longing in 2013, which led to additional articles featuring personal anecdotes and deep research and interviews with the BBC and Katie Couric. She is now considered a “limerence expert” and intimacy advocate. Her 2023 TED Talk, “How Longing Keeps Us From Healthy Relationships,” and her podcast, The Longing Lab, highlight how longing can become self sabotaging and shares how to change our patterns of longing. McCracken is also a part-time university instructor, massage therapist, triathlon coach, and competitive athlete. 

Highlights from our discussion include:

• What limerence actually is, how it differs from a crush, and why today's dating culture — apps, social media, hookup culture — makes it more common than ever.
• Why the brain gets hooked on the chase: the trigger, the behavior, and the dopamine reward loop that keeps so many of us stuck.
• The moment Amanda realized she was more comfortable longing for love than actually having it — and what that revealed about her deeper fear of intimacy.
• The practical tools that helped her break the pattern, including cognitive reappraisal, nervous system work, EMDR, and a nightly mantra her therapist gave her.
• What healthy, realistic love actually feels like in midlife — and why Amanda says she trusted her husband before she loved him.

CONNECT WITH AMANDA MCCRACKEN:

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My book: When Longing Becomes Your Lover

My podcast: The Longing Lab

Watch my TEDx talk

Read my NYT story on limerence

Instagram: @amandajmccracken

TikTok: @thelonginglab

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

Are you approaching a milestone birthday and feeling a mix of excitement and that quiet inner voice telling you to slow down, fade back, or play small? You are not alone — and in this special solo episode of Pleasure in the Pause, host Gabriella Espinosa turns 60 and invites you into one of the most honest, tender, and empowering conversations she has ever shared.

This is not a list of anti-aging tips. This is a celebration of what it means to grow into yourself — more rooted, more unapologetic, and more alive than ever — while also being real about the moments when the old stories still creep in.

Highlights from this episode include:

• Why turning 60 doesn't feel like fading. It feels like a deepening, and how Gabriella is stepping into this decade with more of herself, not less.
• The heavy cloak moment: how even the most grounded women can still be visited by the voice that says you've had your moment, and what to do when it shows up.
• How to move through life's transitions from a place of growth and openness rather than fear and uncertainty.
• Why “you don't look 60" is a compliment worth questioning, and the words that actually honor a woman at this stage of life.
• A powerful reflection prompt to help you ask: Who is the woman I am becoming now?

Midlife is not the beginning of decline. It is a threshold — a moment to shed the roles, the expectations, and the versions of yourself that no longer fit. If something in this episode landed for you, notice where you are already choosing not to shrink. Then share this episode with one woman who needs to hear it. That is how we change the narrative together.

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.

Have you ever stood in front of your closet full of clothes and thought, what in the world do I wear? Not excited, not inspired, just stuck. In this conversation on Pleasure in the Pause, host Gabriella Espinosa sits down with Christine Morrison, renowned journalist and author of Clothes Minded: Fashionable Essays About Finding Yourself, to explore how clothing becomes intertwined with the moments that shape us, from joy and ambition to grief, motherhood, and reinvention. 

This episode explores what it means to open your closet not with pressure but with curiosity, how to dress for the woman you are becoming instead of the woman you used to be, and why style in midlife is about self-expression, not constraint.

Christine Morrison is a renowned journalist and the creator of writing in black and white, a newsletter and online platform that explores fashion and beauty through the lens of aging. Every day, she challenges conventional narratives about growing older. Her work has appeared in The Washington Post, The Boston Globe and in campaigns for major fashion and beauty brands. A former Calvin Klein Vice President and current member of THE BOARD, Morrison brings sharp insight and personal perspective to Clothes Minded: Fashionable Essays About Finding Yourself, a collection of essays on style, identity and self-discovery.

Highlights from our discussion include:

• Fashion is not frivolous
• The white crisp shirt as superhero cape
• Dismiss the "age appropriate" rules
• Certain clothes hold entire chapters of your life

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The information shared on Pleasure in the Pause is for educational and informational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any decisions about your health or treatment. The views expressed by guests are their own and do not necessarily reflect the views of the host or Pleasure in the Pause.