Hi, I'm Mayim Bialik.
And I'm Jonathan Cohen.
And welcome to our breakdown.
This is a very special month.
It is Women's Health Month.
Yay!
In honor of Women's Health Month, we're revisiting one of our most informative episodes that we have done regarding women's health perimenopause menopause.
We did it last year. with Dr. Mary Claire Haver, one of the most trusted names in women's health.
She's a board-certified OB-GYN.
She exposes the hidden truths about menopause and perimenopause, the real cause of that weight you can't seem to get rid of, mood swings, anxiety, depression, sleep disruptions, how perimenopause can often be worse than menopause, and also she tackles the myths surrounding hormone replacement therapy and what you can do to make the right decision for you.
We also covered what most doctors are not telling you.
You need to know about your health and the scary fact that doctors only receive one hour of study on menopause education during their education.
It's kind of frightening.
It's very frightening considering that 50% of humans are female and will experience menopause.
Dr Haver also reveals proactive steps you can take to lessen future symptoms, including how hormone replacement therapy can help you with brain fog fatigue and how to avoid losing muscle mass which is crazy critical to aging in a healthy and safe way.
She talks about the best exercises for menopause, weight loss and why women's gut health is so different from men's and how that impacts your menopause journey.
It's not all doom and gloom, though.
She also has some incredible menopause success stories.
It is never too late to take control of your health today, women.
Just before we get to the episode, I have a quick favor to ask that will only take a second.
Check to see if you're subscribed.
Click that subscribe button anywhere you're listening.
It helps support the show and it's totally free.
And now, in honor of Women's Health Month, enjoy our episode with Dr. Mary Claire Haver.
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Dr. Mary Claire Haver, welcome to The Breakdown.
Thanks for having me.
We've been waiting for you for a very long time.
Some might say through all of menopause.
I wonder if you can sort of give us a little bit of an overview.
How did you get here?
How did you become the lady that everyone asks about menopause?
I was a very well-trained but very basic OB-GYN.
So I went through medical school residency the whole traditional route and went into initially three years of private practice in Houston, which is the area that I've kind of lived for the last almost 30 years.
And then I went back into academics and became a professor back at where I did my residency program, starting in 2005.
I ran the residency program.
I had a private practice through the university.
I taught, you know, kind of in...
And I would have considered myself a really amazing doctor.
You know, I still do.
But until I went through my own menopause journey, I realized there was a humongous gap in my knowledge.
So, when I really think about it and I've talked to multiple people across the country I got one hour of menopause in medical school in a four-year curriculum one lecture.
And in my OBGYN residency, of which I am insanely proud of everything I learned.
I had six hours of menopause.
There were no menopause clinics.
There was no real clinical training.
We had six one-hour lectures during reproductive endocrinology in my second year.
And that was it.
We talked a little bit about osteoporosis and medications to treat that, but we didn't talk much about prevention, if I really think about it.
I had one professor who I ended up going into practice with when I came back, who had a very special interest.
So everything I kind of knew about menopause and perimenopause I learned from him because I would run down the hall and be like what do I do with this?
So when I went through my journey I got completely blindsided and realized this is, I can't survive.
I cannot live like this.
And I very reluctantly went on hormone replacement therapy, absolutely terrified that I would kill myself with breast cancer.
Because that's what I understood.
My last year of my residency.
My chief year is when the Women's Health Initiative study.
You know I'm kind of the last group of residents who even thought about prescribing hormone therapy.
And then our hands were slapped when the WHI came out.
So I kind of moved forward with that study. thought process of, well, it's more harmful than good.
And we really only want to give it if there's absolutely nothing else that's going to work for her, including antidepressants and Neurontin and other medications.
So here I am. very menopausal.
And I had been on birth control pills for a really long time to treat polycystic ovarian syndrome.
And I did really well on them.
I had nothing bad to say about that.
And then when I got off, my brother passed away.
All this kind of happened at once.
And I was really grieving his death.
And then I was having horrible hot flashes, incredible bouts of depression, incredible bouts of anxiety, like getting up at two in the morning.
And everything I've ever done, you know, every person I've ever hurt, you know, all of that's just swirling and I couldn't turn it off.
And I just thought, oh, I'm grieving.
This is normal for my life stage.
And then, when the grief fog started to lift at about month six after his death of June of 2016, I started realizing I'm still not okay.
Like I feel the grief leaving and I'm able to not think about him constantly, and you know all the regret.
But I'm still struggling.
And then I realized, when was my last period?
Okay, I'm the expert.
Like—
I guess let myself for months.
And I never had regular periods, but I started putting two and two together.
And then the hot flashes were just absolutely hammering me.
And we pretty much know in medicine that a hot flash is almost always menopause.
You know, if you're a certain age, you know, I was like, oh my God, I am in menopause.
And so I went and got the blood work to confirm it.
And then really struggled with what do I do about these hot flashes?
I can't sleep.
I can't live like this.
And I went on the medication.
I went on estradiol or CompiPatch was my first.
My practitioner, I had a nurse practitioner I worked with.
And we went on CompuPatch and the hot flashes went away and I was sleeping like a baby.
And then all of a sudden, all these other things got better.
My joint pain got better.
My resilience got better.
I stopped snapping at the kids as much.
My relationship with my husband improved.
And my kids were teenagers while all this is going on.
So, you know, help us all when that's, I was like, we're at your exact stage right now.
And so I mean like I was like wait a minute, okay.
And then I was also dealing with new weight gain which, as a thin person, my whole life, who had thin privilege, this was not okay.
You know, I had really so much of my self-worth was tied into my weight and suddenly that was taken away from me.
And you know it sounds very vain, but like That was what all of my patients were complaining about.
And I had given them all the same advice.
Work out more, eat less.
Just try a little harder.
Come on, honey, you got this.
And it wasn't working for me.
It wasn't working for anyone else.
So when I kind of first started looking into menopause, it really was from the lens of why are so many of my patients gaining weight?
And I didn't understand the body composition changes.
It was just the scale, right?
So I called the PhD nutrition department and half of them were my patients at the time.
I was working at a big university.
And I was like, what the hell is going on?
And they're like yeah, there's some new studies coming out about body composition, how it's tied to menopause.
So they're shoving articles at me and I'm going down rabbit hole after rabbit hole.
And I'm realizing.
Wait a minute.
There's a ton of data here about menopause that you know.
American College of OB-GYN, the American board, is not putting in front of me for my CME.
I'm learning all kinds of important stuff, but there's nothing about menopause.
And all of this stuff is important.
All of my patients are going through this.
So I started talking about it on social media.
Really start about weight gain and menopause and body fat and belly fat and all the things.
And things started exploding just because I said the word menopause.
I mean, I started, like all of us did, with zero followers, right?
And my dopamine's going off because I'm getting so many views.
And, you know, they're sharing.
And I'm like, wait.
You know.
So it wasn't with this grand intention that I would become TikTok famous or whatever famous.
I really started on Facebook just sharing with friends and family.
And then it got so big I developed a business account just to separate you know, pictures of my children from you know— talking about medical things and started getting friendly with other people who were growing on social and using that, learning how to use it as a tool for massive education.
So from Facebook, then COVID hit.
And my kids were like, mom, you should do this TikTok thing.
And they're showing me videos of doctors kind of dancing but teaching and pointing to like.
So that's how I started.
I was literally like shaking to music and pointing to informational slat.
You know, I put in the little floating words of... belly fat, weight gain.
And you started talking about nutrition and vitamin D and that really exploded.
So in the first year of me being on TikTok and again everyone was on social because of COVID we grew to a million followers and it just I was letting my followers inform, you know.
Ask the questions.
They're like, could my frozen shoulder be related to menopause?
And instead of me saying no, I would be like I don't know, let me check.
Yeah, actually there's an article here.
And so, as I'm growing, learning myself, teaching everything, I'm learning on social, I'm making more friends in the space, finding other experts, people who are really focusing on this.
So it really just grew organically.
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A lot of people are having symptoms that they are not related.
Right.
Or they don't think.
Or they don't realize.
Yeah.
So let's go back to the lack of education problem, right?
We're not focusing on women's health after reproduction ends.
Mm-hmm. at all.
And what most clinicians don't realize there's a few pockets that do is that we have estrogen receptors everywhere in our body in our brains and our bones and our muscle and our gut and our lungs kidneys, you know.
And when those estrogen levels fluctuate in perimenopause and decline post, multiple organ systems can be affected.
And it looks very different.
So instead of the cliche hot flashes which 85 of us have because that thermoregulatory center in the hypothalamus is kicking in perimenopause and menopause, you know we can stabilize that with Neurontin, can do it sometimes and you know some of the SSRIs might do it.
But giving the woman back estrogen will fix that problem.
But guess what?
Her urinary system gets better.
Her brain fog decreases.
Her rate of mental health challenges decrease.
I mean, it's, you know, and so many clinicians don't know this.
I did not know this until three years ago.
There's so much to get into with kind of the practical aspect.
Right.
But I do want to talk about, you know, 6,000 women reach menopause every day in the United States.
This is something that affects 50%.
51.
Right, 51% of the humans on this planet.
Yes.
And yet your training provided for a dismal, amount of education.
Tiniest sliver.
And you were someone specializing in women's health.
You look at vaginas all day.
You're delivering babies.
You're helping people regulate their hormones during pregnancy.
And yet, The one aspect of life that... Just falls off a cliff.
Falls off a cliff you were given so little training about.
It's such a source of rage for me when I think about you know and shame that it took my own menopause and
You know, to be completely honest, I was a terrible menopause doctor for most of my career.
And I'm so sorry if any of my former patients are listening.
Please forgive me.
I'm doing everything I can to rectify that.
What were you trained to tell people?
This is a normal part of life.
You know only to recognize hot flashes of vasomotor symptoms as truly a symptom of menopause.
We did learn about the loss of bone and bone density, but almost as a natural part of aging, not so much as a menopause thing.
It just happens to happen to women in menopause, and here's some medication to grow the bone back right.
Nothing about prevention, other than rolling up the rub so she doesn't fall, okay?
And then genital urinary system.
We were learning a little bit about that, but almost like you, wait till it breaks and then we fix it.
We have a very reactive healthcare system.
And, you know, I'm super proud of what I learned, but man, massive gaps.
And it's not an individual clinician problem.
It is a systemic problem rooted in the history of women in medicine.
So considering that, yes, women were not men with uteruses.
So women, women used to die earlier.
That's true.
But yeah, it's been a minute since women died in childbirth actively, as a routine part of our existence.
If you ran the gauntlet of childhood diseases, infections and childbirth death from you know, from being pregnant or having a baby, then you get.
You know.
Most of those women actually lived past menopause.
Right.
So this is what's fascinating to me.
We've had hundreds of years, if not thousands, right?
Where we've had women living into this phase of life.
And I just, I mean, forget about rage.
It's like the sorrow that I feel for women who were just told, oh, this is your existence.
You marry someone that you likely don't love.
You were told to marry him, or it's expected that you marry him, because culturally for you know, then you're kind of his property.
You have to take care of his parents, BS, right?
Half your kids may die of some disease unless you're in a certain echelon.
You know of income earning.
Um, and access to healthcare.
And then you raise these kids.
You probably don't have a career.
No one really seems to care what your interests are.
And then, once they leave the house, you're stuck with this dude who still wants three meals a day and two snacks.
And then things will happen to your body and your mind that just feel miserable.
Miserable and out of your control.
And you're just told that's what being a woman is.
Yeah.
And there are certain parts of the world today And a lot of parts of medicine today how we practice Western medicine that say the same thing, including a lot of the people who controlled the menopause microphone.
If you go right now to PubMed, which you and I know, which is the clearinghouse for medical research articles that are vetted, And you type in the word pregnancy,
Right now, you get a little over 1.1 million articles.
Important stuff.
They're studying everything.
Right.
We know lots about pregnancy.
We probably have a lot more to learn.
But, you know, great.
But what those number of articles wrote?
That's the number of times the word pregnancy is mentioned in an article.
1.1 million times.
So...
That's brainpower, NIH funding, research dollar.
You know all the things that it takes to crank out that amount of research.
If you type in the word menopause, it is a little over 98,000.
So more than 10 to 1.
So we're one-tenth of where we are for pregnancy.
You type in the word perimenopause, it is about 6,800.
That's a 10-year process.
You're in perimenopause a lot longer than you're pregnant.
I have an alert on my phone every day.
More women will go through perimenopause and menopause than have children.
Only 87-ish percent of women bear children.
So for whatever reason, choice, or they just can't.
So you know, I'm like am I only worth?
Is this part of my life, the last third of my life, when I am living my best life?
I'm my smartest, most full of wisdom.
I'm ready to lean in and kick ass.
I'm not worth all this money we spent on getting me pregnant, which I'm very grateful for keeping me pregnant.
So there's so many reasons why this is happening and it's not a quick fix, but you know, this is the reality of where we are today.
I'm going to ask kind of a, this is a human question.
I'm asking you, you know, less as a doctor and more as a human.
When I hear these things As a woman, how can I not feel a tremendous amount of disappointment and despair about how medicine has evolved to either ignore me, tell me I'm crazy, or just ignore the fact that I have needs?
It's so weird.
And I'm not trying to make a conspiracy of it.
I'm like, oh, they hate women and they don't want... But it's like...
That's so crazy.
So two awesome books on the subject.
Unwell Women by Eleanor Cleghorn.
And then It's All in Her Head by Elizabeth Komen.
So Elizabeth is a breast oncologist.
And she looks at it from, you know, so we've got one woman who's a social scientist.
Incredible work.
And both of them shook me to my core because I see it.
Like, you have to step back from your training.
It is what it is.
You go through and then you realize— it's all in her head was a thing.
You know, was it written in the chart?
But I was taught that women tend to somaticize their feelings.
And men tend— What did that mean to you as a clinician?
It's all in her head.
You know, she's a little bit crazy.
Oh, God.
You know, I'd see the laundry list of problems coming in.
So I have this really sad story from my residency.
If you read the book, it's called The WW.
And WW was a code we used for something called The Whiny Woman.
And if she was Caucasian, The Whiny White Woman, WWW.
And so I was an intern.
I just finished labor and delivery nights, you know, rocking, sucking all night, delivering babies.
It's this crazy high energy, sleep all day, party all night, you know, kind of thing.
And then boom, next block is gynecology, and we had two days in the OR and three days in clinic, and then we'd rotate.
So my clinic days, you rush to the clinic.
Now this is, I'm dating myself, paper chart days.
So there'd be stacks like 70 charts of all the patients we had to see that day.
And these poor ladies are all waiting in the waiting room.
And the upper level.
So the third and fourth year residents run to grab the surgery cases because they want to operate right.
They get to get their numbers.
And that leaves everything else for the lower levels.
And the interns get the dregs, right?
So I'm just like picking through the last few charts.
And I pulled this woman's chart.
She's in her 40s.
She has a laundry list of complaints weight gain, not feeling great brain fog.
You know some joint pain.
Doesn't want to have sex, vagina hurts a little bit but her periods are still regular.
It just sounds like yesterday for me.
So, and I'm like, huh.
So my upper level comes up because they're in charge of me to make sure I don't kill anybody.
And it's a dude and he's super sweet and I love him, but he's in cowboy boots.
I mean, like total Texan.
I grew up, you know, I did my training in Texas.
Cowboy boots with scrubs.
That's the thing with his long white coat.
He's got what you got.
And I said, oh, patient, blah, blah, blah, blah, blah, blah.
And he goes, hmm, did you check her thyroid?
I said, yes, she had that checked a couple weeks ago in family medicine.
It was normal.
And he asked for a few things, reasonable things.
And he goes, well, you got a whiny woman.
You got a WW.
And I said, excuse me?
He said, whiny woman.
And he said, this is just what women go through at this age.
Pat her on the knee.
Tell her it's going to be okay. check a few more labs, but probably they're going to be normal.
And this is just what it is.
This was taught to him.
I am not putting laying this at the blame of any individual doctor, because most docs are good people who want to help people.
But this is the mindset of how we were trained.
Now, we didn't write that in the chart.
That was not taught to me by my professors.
This was lore handed down from upper to lower level.
So I internalized that.
I was going to say, so when you hear someone— So it bubbled up when I was writing the book.
Right.
When someone says to you you've got a whiny woman as a doctor, you're thinking there's nothing I can do for her.
There's really not.
I'm just going to hold her hand and be sweet to her and tell her, it'll be okay.
It'll pass or whatever I can do.
Have some wine, go for a jog, you know.
Just some nebulous, ridiculous advice.
And I just didn't know enough to know that this woman was probably in perimenopause.
That's the most powerful part.
You didn't know enough.
Right.
Because, as painful as that story is, we want to get angry at the doctor, but literally he has no effing clue.
No framework in order to, we were taught nothing about perimenopause.
Like when I say we got six hours of menopause.
That was what happens when you go into ovarian failure.
Right. right?
And so nothing about the transition between the two.
Absolutely nothing.
So not dissimilar, you know, and I'm a home birth, you know, that kind of birth hippie.
So we see the same, you know, often in sort of pregnancy and OBGYN circles, in that we're treating this as a crisis about to happen, right.
A lot of women are kind of taught, here are all the things that could go wrong, right?
This is like, we know what to do if you hemorrhage.
We know what to do God forbid if you need an emergency C-section.
Or we know how to prepare all these things.
But in terms of seeing this as a part of life, that's normal natural, beautiful has ups and downs, complexity.
That's kind of the way we've looked at perimenopause and menopause right.
What's the crisis?
Oh, if their bones start breaking and if they're falling and if they have prolapse, right?
And their uterus like falls out on the floor.
We have a 40% increased risk of increasing diagnosis of mental health disorders.
The divorce rate, the highest time for a woman to commit suicide is between the ages of 45 and 55.
The most likely time for her to have a new autoimmune diagnosis is in perimenopause.
We have the most rapid loss of muscle mass through the perimenopause transition.
The most rapid expansion of visceral fat in the perimenopause transition.
That's a big fucking deal.
It's not beautiful.
And I'm going to say this.
Look, I love being menopausal.
Kiss my period goodbye.
I am living my best life.
But had I not rethought the process and made some significant changes to my life, I would not be here.
So let's talk about some of these significant changes.
Less than 4% of eligible menopausal women use hormones approved by the FDA.
Approved by the FDA.
So we think that the actual use is probably double when you add in compounded options which are impossible to track.
I'm sorry, that's not enough.
Still 8%, yeah.
Even if I'm being generous with the statistic, even if you told me 10 of eligible women, even if you told me 50 of eligible women, that's not enough.
So before the WHI, we were at about 38 to 40% FDA usage, and it was mostly permanent and prem pro.
Talk about the WHI.
People still.
Still.
People still believe.
Let's just say it.
I'll let you say it.
You're the doctor.
What do people believe about hormone replacement therapy?
That it's dangerous.
That it's more harmful than good.
It's not true.
It's going to give you cancer.
And it's going to give you cancer.
Like, I'm going to get... It will cause... This is what I hear.
Do I want to get breast cancer?
That it will somehow cause a malignant transformation from a healthy cell into a cancerous cell.
That is not how cancer biology works.
We have estrogen, you know...
Premature ovarian insufficiency or ovarian failure, right?
Women going through menopause before the age of 40 have a 50% increased risk of breast cancer.
Sure.
That's a thing, though, that we know, and we know about it.
So you know, I have a million statistics I can throw at you.
But the hysteria that, the misrepresentation and the announcement it was.
Estrogen causing breast cancer was the number two medical news story in 2002.
It went viral before the internet, right?
It was on the cover of every big major newspaper.
It was on all the big magazines.
That's how people shared information back then.
I was the chief resident.
It scared the hell out of us.
And then no one, and it's been walked back.
All the findings have been walked back.
We've reanalyzed.
But people still don't know.
So I'm giving you the opportunity.
So the same megaphone that shared the hysteria has not shared.
So I did not know this information until, so I had already written Galveston Diet.
I was sitting at my first big menopause conference, which is in San Diego.
And I saw Avrin Blooming and Sharon Malone and Carol Tavris.
Avrin and Carol wrote Estrogen Matters.
And Sharon was the emcee.
And they were talking about everything from the WHI and the statistics and everything being walked back.
And I sat in the audience.
And I was on HRT very reluctantly at the time, knowing I was going to kill myself.
But I couldn't live either way, so I might as well die of breast cancer.
But happy.
And...
Tears.
My daughter was sitting.
She just got accepted to med school.
And tears are running down my face.
What the fuck?
I did not know this.
I have been practicing medicine for how many years?
This was not put in front of me by ACOG, by the American Board of OB-GYN.
What the hell is going on?
I didn't even know the Menopause Society existed.
You also were living life considering.
You were on borrowed time because you chose to use hormone replacement therapy for yourself.
Right.
And so I was like, and that moment, sitting in that audience, my life changed.
Mm-hmm.
And I thought, you know, I probably had a couple hundred thousand followers, which is amazing.
You know, back then I was like for the rest of my life.
My job is to spread this message about the safety and efficacy of hormone replacement therapy.
And then finally in 2022—
The Menopause Society changed the guidelines, but the American College of OB-GYN has not changed theirs since 2014.
It still says, more dangerous, lowest amount for the shortest time possible.
I sometimes wonder if there's a danger to everything being thrown into the perimenopause menopause bucket.
Yeah, that's how my critics love to talk about that.
Here's the thing.
A lot of random things will happen to you as a human being on this planet, whether you're a woman, whether you're a man.
Exactly.
So what is aging?
How do you untangle the two?
And some people are just kind of like unicorns and have like a bunch of crazy symptoms that now, a lot of times, people are like well, you're in perimenopause.
So that's it.
So what we are learning.
So let me take you through a patient experience in my clinic.
She comes in.
Usually by the time they get to me, they've been to six, eight doctors.
They've been gaslit.
They are on multiple medications for…
They're individually treating each symptom that they have.
No one has kind of put it together that this might all be estrogen-related.
Or she's just coming in de novo, not on anything, like, please help me, I'm dying.
You know, I feel horrible.
Or I just want to be proactive and set me up for success through the next 30 years.
I'm like, okay.
So I do do a lot of blood work because a lot of these symptoms are similar to hypothyroidism, nutrition deficiencies.
I don't want to miss diabetes.
I've diagnosed lupus twice this year.
So I'm doing a lot of blood work to rule out concomitant causes or overlapping causes.
And then for a lot of patients, we start a trial of hormone therapy and see what gets better.
And then we kind of pursue.
So, so many things are related to aging, but we know we have acceleration.
So, for example, we tend to develop atherosclerotic plaques as humans, as at you know, once we get older, but that process accelerates through menopause.
So a woman's LDL cholesterol tends to go up dramatically through the menopause transition with not a change in diet and exercise.
That freaks women out.
Like that's one of my most viral videos.
They're telling me that I must be literally eating fried food all day because I don't eat meat or dairy.
And they're like, what are you eating?
I'm like, I promise.
Nothing has changed.
Insulin resistance goes up.
So we have new prediabetes.
We have HOMA-IR scores going up, you know, with no changes.
So a woman's visceral fat which is cosmetically why they come to see me sometimes, which is the intra-abdominal fat, and this, you know, subcutaneous fat, cosmetically distressing, gives us curves, really not by that biologically active.
It is not pro-inflammatory, not nearly as much as the intra-abdominal fat.
Very different forms of fat.
A woman in premenopause, body fat percentage, total body fat, 8% is visceral, age-matched women.
Take her through the transition, it goes up to 23%.
That's a big change.
That's a huge change.
That's like you're not fitting into your clothes.
You look like a different person.
And I don't have to tell a woman this is happening.
She knows.
Right.
So, and now in our clinic I have a body scanner so I can actually measure her muscle mass, measure her visceral fat, measure her total body fat and give her you know.
Then we start talking about the next 30 years and you know what are your risks.
What's your mom?
Let's talk about your women and your family diseases and how we're going to move you away from that path.
Is there a one-size-fits-all answer here?
So how do you get around that as a patient?
As a patient.
So I ask for permission and then forgiveness.
You know, I...
Tell them.
In perimenopause, it's like pinning the tail on a moving donkey, because you are going through this very dramatic fluctuations on the downward trend of your hormones and it is wreaking havoc.
Symptoms are probably worse in peri than full, especially the cognitive and mental health changes.
They do tend to stabilize postmenopause.
And then in postmenopause, it's easy because they bought them out and I'm just replacing, right?
But in peri, it's a lot more challenging.
So I say, you know, we have a lot of options here.
We have multiple formulations.
We have multiple doses.
We have multiple ways to get it in your body.
And so we are going to have to figure out what is right for you.
And I don't have a magic wand to figure that out.
So let's be patient.
Let's give this X amount of time.
And then if this isn't working, or you develop X, Y and Z, then we're going to consider another formulation, dose adjustment, whatever we need to do.
You just identified why most women are not getting appropriate care.
Like, that's it.
I mean... Well, we're not training our clinicians.
Well, first of all, we're not training our clinicians.
And also, you know, I love to give my example.
I grew up at Kaiser.
You know, my dad was a public school teacher and that was the insurance I was given.
And we had... You know, I rail a lot about just sort of the system here because...
I know what it's like to be given a 10 or 15 minute slot by a doctor who will probably say to someone I've got a whiny woman.
I'm going to put her on SSRIs or I'm going to sedate her.
I'm going to give her Xanax and hope that she stops complaining.
So a woman, you know, across the menopause transition, we double the rate of SSRI use.
Yeah.
And beautiful data coming out of Australia in the last couple of years looking at treating mental health changes in perimenopause with hormone therapy.
Wow.
And they are doing great.
And they're responding much better than they are to SSRIs.
SSRIs are kind of resistant in perimenopause.
So what does that look like?
I mean, obviously, big pharma doesn't love this story.
So when we look at treatment, you know you're in perimenopause, you have kind of two branches of options.
We have replace, like suppress and replace, which is the doses found in contraceptives.
If you think about contraceptives were made to stop pregnancy, right?
Mm-hmm.
They have multiple other uses, but they're off-label, like acne, like heavy periods, et cetera.
We use them for a ton of stuff because they suppress the hypothalamic pituitary ovarian axis, right?
They shut the whole thing down.
And then by using hormones, then you have those hormones in your system.
So suppress and replace versus support, which is give menopause hormone therapy doses which stabilizes, for a lot of women, doesn't provide contraception, will not control her heavy periods and will not suppress all ovulations.
But it is enough, we think, to feed back to the brain to say, calm the fuck down.
Because if you think about why we ovulate each month, it starts in the brain, not the ovary.
The ovary is just a machine that pumps out hormones and eggs each month.
Our hypothalamus is constantly sensing our blood from puberty till death, looking for estradiol.
And when those levels decline, it will send a signal to the pituitary gland saying hey, it's called GNRH.
You know, hey, dude, we're getting low.
Pump out, you know, tell the ovaries to do their job.
Pituitary pumps out LH and FSH.
I'm simplifying something very complicated.
And then we have these little cells around the egg, the follicular and granulosa cells that are bound.
You know they have receptors.
Then that's where the steroid hormones are made, our sex hormones.
So we pump out estrogen with ovulation, that spikes.
And then after the ovulation, the corpus luteum creates progesterone.
And that cycle goes beautifully like an EKG every month in a healthy woman.
Very predictable on day 14, she's going to do this.
Day 21, she's going to do that.
We've all seen the curves.
Perimenopause is when you reach a critical egg threshold level, because surprise females are born with their entire egg supply and it runs out.
Men get to make their stuff fresh.
He's like, don't look at me.
Um, every day until they die it gets harder, but they can still produce sperm and all the things until death usually.
Um, So we fall off this cliff.
So in perimenopause, the feedback cycle to the brain goes cattywampa.
So the brain is like, where the hell is my estrogen?
I sent the signal.
And so we get bigger bursts of GnRH, which makes bigger bursts of FSH and LH, which then causes these massive dumps of estradiol.
So we get these wildly fluctuating on the downward trend.
Levels of estradiol.
Progesterone never kind of catches up.
And the brain hates it.
It directly affects our neurotransmitters and throws a wrench in things.
And our cognition.
ADHD new diagnosis.
The world goes crazy every time.
I even say that all these women on the internet
Like, is it social media or is it perimenopause?
Right.
I don't actually know how to ask this question, because I think it may be controversial is that, of course, women are having massive health changes going through this process.
However, a lot of just humans in general, aren't in the best health to start with.
Right.
How you show up health-wise when you start going through this change, is a tendency, right?
So if you are on the healthier end, if you are already eating low processed foods and you are exercising regularly and you are prioritizing your sleep and you're getting therapy and you're doing all the things right, you tend to have an easier transition as far as your basic symptoms.
And you, you know, we all have a genetic shelf life of our egg supply.
We can speed that shit up.
If we smoke, if we're stressed, if you look at trauma.
What does that look like?
So there was a study done on women who were sexually abused, who then had kids who were sexually abused, and they go through menopause eight to nine years sooner than they would have had.
They had a twin, an identical twin who did not have trauma.
Can you talk a little bit about that mechanism?
So this was the only study where they looked at this.
And what we are seeing now that people are actually looking at this is whatever your trauma, you know, whatever your cortisol levels and your stress, the ovaries will take a hit.
So if you're inflamed, either through radiation surgery smoking, you are decreasing your follicular count and rapidly you are shaving off years of life off of your ovaries.
Now what we don't know is If you were genetically programmed, if everything was perfect in your world and you had no stress and you ate perfectly, then your ovaries are still going to die at 51.
Can we extend that?
Now there's a lot of research in the fertility world going.
Are there ways to extend the life of the ovaries?
Should we all be getting one ovary removed at 25 and then re-implanted at 50?
You know, is that a thing?
Are we going to create a superhuman race of females, you know, who live forever?
So one way to think about this is women are racing towards this process and this change and, almost like a professional athlete, I want to prepare as much as humanly possible for that added stress, because it's going to help, as I go through that, maximize or minimize actually the effects.
And yes, of course medicine should support.
But what can people be doing before they get into that change to best prepare them?
So we look at.
You know what are the long-term effects of menopause as far as muscle mass loss and visceral fat gain?
So high-fiber diet.
So if I could go back and talk to my 35-year-old self, right?
Or even my kids are in their 20s.
What do I tell them?
Nutrition over calories.
You know, I grew up in my medical life, thin is healthy, thin is healthy, thin is healthy.
What I didn't realize.
I was chipping away at my bone and muscle strength, which I will desperately need in my 70s and 80s.
We reach our maximum bones, you know, natural bone and muscle strength.
We can improve on that, but it is work.
You can't just like live a normal life, you know, like not work out.
So like prioritize protein, prioritize plants, limit your processed foods, you know, all the things because that's going to keep your cardiometabolic system healthier, all of that.
And so I'm telling my kids that now, because in my mind back in my 30s I was doing aerobics and I never lifted a weight until I was in my late 40s.
It's like fat burning stuff.
That's what we were told to do.
Exactly.
Yeah, work out more, eat less.
That was the key to health and happiness and looking cute in a bikini.
And I'm like God if I could just go back and lift some damn weights, you know, in my 30s, because now I'm fighting low— genetically low muscle mass.
And my mom— I mean, all of this, I'm so selfish.
But, you know, my mother— has Alzheimer's and fell at New Year's and broke her hip.
And so it is horrific what this disease process is doing to her.
And no one in her life talked to her about prevention.
No one talked to her about what she needed to do at 30, at 40, at 50 to decrease her rate.
My mother jogged, which is why her heart is probably so healthy and she's not going to die, but she's going to have this long, protracted course in her elder years of complete loss of independence, which is ultimately once you get through the fire of menopause and you get back your shit together.
Now my patients are like I don't want to be like my mom.
Help me.
What do we need to do?
I'm like, okay, reasonable.
Let's, you know, get to the gym, lift weights, protein, you know, Keep your brain active.
Keep your community connections.
Get your friend group going.
You know, like all these things we know decrease the rates of dementia as we age.
Because my patients are like, let's put out the fire.
Now we're going to build a path. for the next 30 years.
So you, you know, no one expects to live forever.
That's the other thing.
All the wellness bros are like, we're going to live to 120.
And I'm like, no woman wants to live to 120.
Not like this.
They're like, I just want to not break.
I just want my brain not to break.
I don't want to lose my independence.
I don't want to be peeing in the bed.
You know, I don't want to lose my continence.
Like, that's all they want.
And I'm like, okay, there's definitely things we can do.
Because guess what?
Women will live longer than men by four to five years.
But it's not, we live 25% of that life in poorer health than a male twin would.
The trauma piece is so fascinating and I really, I want to know so much more about that.
Is it true that you know, even in kind of a normal menstrual cycle and a normal kind of variability, that women who have trauma or more difficult backgrounds struggle more on a monthly basis as well?
Is this something anecdotally you've seen?
Anecdotally, and I'm sure there's data.
I just I've been so focused on menopause that I haven't looked at, you know.
Yeah.
Well no, I guess the reason I was asking is Because we know PMS PMDD, you know, is a real thing.
Absolutely a real thing.
Well, so I think that was sort of... That's sort of the question I'm getting at.
You know, for women who, like never, could get through a cycle without feeling suicidally depressed.
Right,
For women who have these kinds of patterns where, kind of like your whole life, you feel like you're struggling hormonally and you tried the pill and you tried this and all these things.
I see them in perimenopause absolutely collapsed.
Because it's so much worse.
Right.
Because what used to look like the EKG and they could like you know, now it's so much bigger higher faster, longer.
And they're really, really struggling.
Wow.
Or, you know, they had a little bit and they could manage it.
And then all of a sudden it's like, wham.
Hmm.
Yeah, I've heard, and what my hope was which hasn't been my experience was that you know, once you stop getting your period, for a lot of women there's a tremendous amount of relief.
Oh, yeah.
Women who experience— If you have traumatic periods.
Well, right.
So can you talk about, for women who, let's say, have had a lot of depression with periods, who find relief in menopause—
Who are those women versus the ones who are like, all of a sudden I'm depressed.
What do I do?
Yeah.
So we have a subset of women, you know, with PMS PMDD, really heavy, heavy periods you know once, and very traumatic things associated with their menstrual cycles that you know it's almost like after hysterectomy if that's their course.
You know they're like I got my life back.
I don't, this is not a thing for me to worry about anymore.
And I'm just, ugh.
And I wish I would have done this sooner.
And so we do see women who really struggled with those things.
Once we take the fluctuations out and they flatline, they feel better. things are removed.
Now their bones are still deteriorating and their brain fog and you know all the things, but their cholesterol is going up.
But they're just so much happier that they don't have that monthly traumatic experience every month.
I wonder if you can talk a little bit about this increase in autoimmune diagnosis.
A lot of women, and I think social media has been a place where a lot of people can share a lot of this.
A lot of women are are surprised that there are actually categorizations and diagnoses for what used to be a kind of a conglomeration of symptoms that many people were told were just in your head.
What's happening during perimenopause and menopause that is contributing to these autoimmune diagnoses?
So estrogen is a really powerful anti-inflammatory hormone and it's very, very protective.
And when those levels.
Now there's kind of two schools because some autoimmune diseases, like in pregnancy.
If you have an autoimmune disease, the tendency in pregnancy is you get a honeymoon period.
And then when the hormones crash postpartum, we see, not only they come back, they come back with a vengeance.
So I'm always watching.
Well, when I did obstetrics, I've given up that part of my practice.
I was always, you know warning watching, checking levels.
Labs looking for inflammatory markers for my Lupus patients are like a really good.
Though pregnancy is really stressful on the whole body system, lupus patients tend to not do well, you know, in pregnancy.
But if she kind of ran the gauntlet, then I'm like really checking postpartum.
So estrogen seems to be protective for a lot, not all, of autoimmune diseases.
So we take that protection away and then boom, here they come.
Is it possible that, with the appropriate replacement of estrogen, that we might be able to prevent autoimmune diseases?
Not at all.
Well, no, but I'm saying is this a technique or at least to ameliorate some symptoms?
It's definitely an area we should invest a lot of money into studying.
But, you know, menopause got, there's not even a division in that.
Well, who knows what's happening with the NIH, you know, right now.
But historically, in 2023, of a $45 billion budget, 15 million went to menopause.
There's not even a menopause section.
All women go through menopause.
It affects all of us.
15 million.
It's 0.003% of the budget went to studying women after reproduction ends.
So when you think of all these symptoms, you know in particular the special kind of weight gain, you think of thinning hair, you know decreased libido and you know Those are the most distressing.
Right.
Fatigue is the other most distressing.
Fatigue, brain fog.
So...
Are there women listening who, upon receiving appropriate hormone replacement therapy, might see those things literally go away?
Absolutely.
In my clinical practice and in the menopause, like my little ragtag group of menopause friends who are doing clinical care.
We have a group chat every day.
We're sharing articles, information.
It's our own little think tank.
And it just is astounding to us I can show you patient letter after patient letter.
I've got my life back.
You know, it's not perfect.
You're not 25 again, but you're back to your level of resilience where you've got this.
You built this life with stresses that you took on.
You knew you had children.
You have aging parents.
You had all the things.
You had it.
You had it.
You were kicking it.
And then all of a sudden you can't.
That has been taken away.
And giving a woman back the ability to manage the life she built is the greatest gift I could ever give her.
What about ADHD?
Yeah.
We talk about brain fog.
Obviously, people are experiencing low energy brain fog, making it hard to concentrate.
So the brain fog seems to be the worst in perimenopause.
So when the fluctuations happen, that is really jacking with neurotransmitters and how signals are going across and how we're processing in the brain.
And Lisa Moscone, who has written The Menopause Brain and done tons of research.
She actually has now moved into the private sector with funding and she's doing a ton on Alzheimer's.
So...
If you're not on the path to developing Alzheimer's, it does tend to get better.
Unfortunately, it can take years.
And a lot of women, like one in five in the UK and at least one in 10 in the US, are leaving their jobs because of this.
Because they don't feel like they can do their job safely or adequately because of this disruption.
And so what we're seeing with hormone replacement therapy.
And then they go in and they have what a 4 chance right now of being treated with hormone therapy.
So we got 96% of women who are raw dogging menopause.
And you know, they're quitting their jobs.
They're moving on to, and maybe that's good.
Maybe it was a job that was toxic or, you know, they're leaving marriages.
They're doing a lot of things that had they been given a chance, and maybe it was a marriage that she didn't need to be in
But, you know, This is changing decisions and changing what a woman feels like she can do.
And just thinking about the economic cost like Yeah, so McKinsey Report, they actually looked at what the economic and, oh God, who was it?
One of the big menopause researchers coming out of Chicago, I think, looked at what they feel like the economic impact is.
And it is billions when you look at time off, when you look at women who are having to go to the doctor and what the economic cost of all of this is.
It's astounding.
I mean, just the loss from the workforce is astounding.
The trade-off for actually taking the money for preventative care would have such huge downstream benefit.
It's so short-sighted to not have the research, to not have the preventative care.
So that's been looked at as well, and what they feel like the economic impact would be if all women who were candidates were offered and say half accepted.
The cost savings to Medicare and Medicaid and insurance would be unbelievable, because oral estradiol is 2.
Estradiol patches are $20 for the month.
I mean, this is not, we're not talking Ozempic prices.
This is like affordable for the vast majority of women, you know, and mostly covered by insurance.
They're not being offered.
What's stopping the mainstream from adopting this?
Fear.
Fear of breast cancer.
Still.
The Women's Health Initiative.
It has... you know, Peter Atiyah, I'm stealing his words.
He feels like it is the big and Marty Macri, the biggest F up in the history of medicine is the Women's Health Initiative.
How the misinterpretation and just the hysteria around you know was propagated and never walked back in a reasonable fashion.
And guidelines are still struggling.
The NIH database now says...
We've prevented X amount of cases of breast cancer, which they did not.
We've prevented heart disease.
Jesus God Almighty, it's protective against heart disease.
You know, we know that it is so protective of the endothelium.
It decreases the rate of which we form clots and plaques and calcifications.
And atherosclerosis, it cuts year by year.
If you start between the ages of 50 and 60, we can cut your risk of heart disease 50 per year.
Given that window of opportunity,
How do we get people to trust the doctors that they do have to see?
So again, they weren't trained.
So this is not your doctor being an asshole.
This is your doctor who was not allowed to... receive this information in a timely fashion.
This is a doctor who—I was that doctor, right?
And I didn't have the time to go seek training outside of what was put in front of me.
I was forced to see patients in a 10 15-minute window, including a pelvic exam, so with their legs in stirrups while I'm still talking and getting a history.
I need 15 minutes just to get into the stirrups and feel good.
I was expected to do all of my charting on my own time at home, when I'm trying to be a mom and a wife and stay married and do all the things.
What this medical system has evolved into is sick care.
Very little prevention.
You know, it is what it is.
And you know, for that reason, and there's no medical model that will support what it takes to do good menopause care, you know, in the current insurance system, which is an hour-long visit really.
Because there's a lot of stuff.
My symptoms take 15 minutes just for me to list them.
You know, and I don't think and let me be clear to your listeners, I don't think all of women's health after reproduction ends should be dumped in the lap of the poor, busy OBGYN.
This should be mandatory education for every medical student, for every clinician, for any clinician who touches a female.
Mm-hmm.
Menopause, you know, what happens to the human body after estrogen walks out the door and ovaries fail should be part of cardiology, nephrology.
I mean, it affects everything.
I've been told more about Kegel exercises than anything after literally giving birth to two humans.
That's kind of what is offered, you know.
And I used midwifery care, obviously, because I was a home birth person.
I mean anyone ever talk to you about pelvic floor physical therapy and all the fabulous?
No, I mean, that's the thing.
Like, even beyond that...
It's something we need to start telling women in their 20s and 30s like while they're out, like partying and having a good time.
Also, this is the way to exercise.
Your vagina is going to expand to the size of a bowling ball.
You're going to push a human through a layer of muscle and tendons that you know you were designed to do this, but it's not going to be the same.
Yeah. we were also designed to run marathons.
We got to prep for that.
Yeah.
Yeah.
Well, and I think and I think sort of you know, what I'm sort of reflecting on is there was so much more attention paid to like getting your uterus back to its size and making sure your vagina is in good shape after having kids, instead of you know, every OB visit that I had after that was like are you doing your kegels instead of you're on the cusp of a 10-year process that is going to rock your body and your brain in ways that We're not screening for perimenopause.
We're not, you know, it's not built into the woman exam.
And then if you... So say you find a provider, one of the 4%, right?
Right. that is educated and willing and knows what they're doing.
Usually midwives are the only ones who were knowing this.
They were the only ones willing to talk about it.
It really, you know, it's a systemic issue.
Let's talk about gut health.
Yeah.
What should people know?
What are the misconceptions that are leading people astray?
Well, I learned zero about it in medical school, zero about it in residency.
Everything I've learned.
It's like through other providers and through CME and through you know, but it's really.
It was considered woo-woo.
I remember...
Learning about the transmutation, watching like a little bacterium go through the wall of the colon.
And it took 10 years for that paper to get even recognized, and you know that that could actually happen.
And the whole gut health thing was met with such skepticism.
And now it's becoming more widely accepted.
But you have this whole generation of physicians that don't know anything about it and don't know how to talk about it or treat it.
And so it was me going back to school.
Well training and getting the culinary medicine certification where I really learned about the gut health and you know I've worked with Zoe who and I did the Zoe test had to collect my own stool sample and send it off and get everything tested.
Super fun.
I had to eat the blue cookie and wait till my poop turned blue and that was a party.
But um, but I science.
You know I did it for science and the female gut microbiome completely changes to that of a man's after menopause.
The estrobilone, which is the subsection of gut bacteria that recirculate estrogen through the gut, is dramatically affected by menopause.
I did not know that was a thing.
I did not understand the metabolism of estrogen.
We get a boy gut.
We get a boy gut.
And then with that comes all the boy things, like increasing risk of heart disease.
We burp a lot.
I'm glad I'm not the only one.
So that is one surprise of perimenopause was...
So what are the other symptoms that women develop that are more similar to men after their change in gut?
Well, there's symptoms and then there's the cholesterol.
So let's talk about heart disease, right?
Before menopause, a woman enjoys a much lower risk of cardiovascular disease.
Once she goes through menopause, we pass you guys up.
And we massively pass you guys up.
So our risk factors increase.
And gut health is part of it, right?
And just looking at the quality of the gut microbiome, of the number of species you know.
So we lose the amount, the overall, how many we have and the amount of species.
So females tend to have healthier guts and they feel like it's part of the circulation of estrogen.
The estrogen helps to keep the gut healthier, the inflammatory part, the whole nine yards.
Take that away and disrupt it.
We tend to be less healthy.
And hormone replacement then allows them to maintain their female gut or it still changes?
We're just starting to look at that.
But Zoe, who was studying doing stool samples, is looking at gut health for women on HRT versus not.
And they're seeing what appears to be a healthier gut.
You know, maintaining the health of the gut microbiome with HRT.
And it's like oral more than you know.
There's pros and cons to everything, because if you're ingesting the estradiol, it's going through the gut versus transdermal.
So, you know, the first pass effect of the liver, you know, we have pros and cons to both methods.
And there are other things that women should be doing.
Obviously, eating a diverse range of fiber is huge.
Plants and protein, plants and protein.
That's what I preach to my patients, especially on a GLP-1.
What about probiotics?
I'm a fan.
So I'd prefer for them to get them.
Okay.
So when I look at the data on inflammatory markers in postmenopause and gut health in postmenopause, it's hard to find a study that doesn't include probiotics either eating something rich in probiotics.
So when you look at cultures that have a diet rich in probiotics, like a lot of Asia, they don't do dairy but they're doing fermented foods heavily.
So they're getting their probiotics that way.
Most in the US, the main source of probiotics is yogurt.
But unfortunately, the way we create yogurt, commercially available yogurt in this country.
They dump so much shit in there that it just cancels out anything healthy.
So you know what I talk to my followers patients, whatever is I do plain Greek yogurt, just straight up, nothing in it, and you add your stuff to it.
So I'm like hemp flax, chia nuts seeds, you know berries, whatever you need.
You know drizzle of honey if that's your jam.
But to, you know, then you can add in the additives and make sure that they're healthier.
But that's a great source of probiotics.
Studies are done though with probiotic supplementation and they're kind of all over the place.
So there was one done on obese women with hypertension and they supplemented with bifidobacterium and maybe lactobacillus and they saw better blood pressure, better gut health.
So I always quote to my patients, you know women who eat diets rich in probiotics.
Plus or minus a supplement if you need it.
Have lower visceral fat.
But you're just restocking the pond.
You can't like take a round of probiotics and expect you know if you're cranking that stuff.
It goes straight through.
And for the portion of the population that doesn't eat dairy or can't process, there are also non-dairy
Miso, kimchi.
Right, there are other versions.
Tofu.
There's lots of fermented foods.
It's a taste thing sometimes.
So if you just can't do it, you might want to consider.
So the days I don't have yogurt, I'll take my probiotic supplement.
People still think that tofu gives you cancer also.
You can throw that in with the hormones.
Diet's rich in soy.
They're actually anti-carcinogenic.
So, yeah.
Vitamin D.
Huge fan.
Most people are deficient in vitamin D. So when you get into menopause, we're up in the 80% range.
And that tracks with my patient population.
So we're looking at, if you use 60 as optimal, probably 90% of my patients are suboptimal.
And it's really hard to get enough in our diets.
The way, you know, absorption goes down, the...
All of that gets harder.
Talk a little bit about vitamin D for people who may not know about this magic vitamin.
So vitamin D is a vitamin.
It's also a hormone.
And it has multiple receptors throughout the body, almost as much as estrogen.
And it's just a cofactor in so many enzymatic processes in the body.
And so we know people who are deficient in vitamin D, which is most people have.
You know.
Hair loss, weight gain, increasing cardiovascular disease risk like all of the cardiometabolic risk factors, tend to get worse, and bone density right.
With low vitamin D intake.
Really tough to get enough in your diet.
You know, I always say diet first, you know, get it through nutrition.
Where is it?
Oh, sorry.
Fatty fish, salmon, tuna, mackerel.
You got to eat a crap ton of mushrooms, but they're there, you know, to get enough.
And a lot of people don't want to eat fish because it's also full of mercury and metals and other things.
So where else is vitamin D?
So mushrooms.
Mushrooms.
And those are kind of the two real main sources.
So we don't have like a plethora of places we can get it from.
Some dairy.
So yeah, you can get it from dairy.
And some people are like, well, I'm out in the sun all the time, but they're not…
Out enough with enough exposed skin at the right periods of time.
And so few people live in that small bracket of the world that you can actually metabolize it.
That is really effective and metabolize it.
And then what if you're dark-complected?
You're not doing much of that either.
That melanin that's protecting you against cancer is also decreasing the amount that you can convert in the skin.
So I see a lot of argument, you know, oh, I'm out in the sun.
I'm like, are you naked?
Are you in this latitude ring?
You know and they're, And not that this is prescriptive, but what are the general ranges of supplementation that someone should be looking at?
So sure, you should get a baseline before you start.
So if, for whatever reason, you are jamming on your own without needing to be supplemented, then don't take it, you know.
However, that's not most people.
So get your level checked, see where you're at.
If you're deficient, You can go up to four and some papers say 5,000 without worries of toxicity.
Any vitamin that's stored in fat... you can become toxic.
So there's the rando person who got the 50,000 once a week and took it every day for a month.
She's a little toxic, okay?
So it's hard to become toxic on vitamin D, but it can happen.
So we always caution.
And that 50,000 is prescriptive strength.
So over-the-counter, You know, I'm giving, I'm starting at four to 5,000 a day.
That's.
But if they're already deficient, I'm giving them 50000 a week as a loading dose, taking the four to five, you know ours is four.
I have one commercially available.
That's 4,000 on the other six days of the week.
We recheck in 12 weeks, see if they're like back up in a nice, great range.
And then we maintain.
A lot of my patients and me included.
Once or twice a year I'll have to go back on the higher dose to boost me back up, you know, get me to where I need to be with the 50000 a week.
What about magnesium?
Everyone talks about it.
It's like... I'm a fan.
I take it.
And there's a thousand different types.
Not really, but there's a lot.
There's a lot.
So there are different forms of... So magnesium is a mineral.
And people are like, oh, I checked my magnesium level.
It's fine.
Well, that's great.
It's a water-based mineral that you pee out every day.
So a one-time blood test is not telling you what your stores look like, or you know.
We don't use a one-time blood test of magnesium only to see if you're severely hypo or hyper.
You know which can happen in cardi.
It's important in cardiovascular disease.
So...
Most people dietarily with the standard American diet are not getting enough magnesium in their diet.
It's something that fluctuates minute to minute in our bloodstream.
What's it in?
Magnesium is in.
I like pumpkin seeds for my favorite source of magnesium, but a lot of people supplement.
So milk of magnesia, we've all heard of it.
Doesn't really absorb well into the bloodstream, stays in the gut, pulls water into the gut and induces bowel movements diarrhea,
That's why we take it for constipation.
It's why we use it in Golightly for getting prepped for a bowel.
If you haven't had a colonoscopy, remember, very important.
So, you know, you're gonna have a lot of magnesium, but it's not gonna get into your bloodstream.
Then there's other forms that absorb rapidly into the bloodstream and raise the levels, but doesn't really cross the blood-brain barrier that well.
And then there's Mag-L-Theronate.
Mag-T Neuromag that does cross the blood-brain barrier has great studies for SSRI-resistant depression.
It looks really promising for that.
I've taken it for sleep.
They just, they did a, or my aura ring.
So they did some studies.
Aura's starting to do a lot of studies in sleep and menopause.
I'm actually flirting with them for their scientific board to get involved in some of those studies, because sleep disruption is real and hormone therapy does not help everybody for, you know, progesterone is actually estrogen.
We'll stop the hot flashes if that's what's waking you up.
But for people who are having the middle of the night awakenings or restless legs or the anxiety at night, progesterone is magical.
And so just as an overview, what are the names?
Because you listed them really quickly.
Oh, gosh.
There's so many.
Magnesium L-theronate.
So that's Mag-T neuromag.
So that one's very specific.
It crosses the blood-brain barrier well.
So they're studying it in kind of neurological things.
Then there's mag citrate, mag oxide, mag glycinate.
You know there's probably 12 out there that are being used and they are all touting specific benefits.
A lot of cherry picking of data going.
But I'm like, you know, if you're trying to raise your magnesium levels, fine.
You just don't want to take too much of it.
And people are finding relief from X, Y and Z.
I wonder if I don't mean to be this downer person, but I know a lot of people listening are not going to have access to the kind of care of let's do blood work and then let's set a Zoom appointment for 15 minutes to go over your blood work and make changes.
And just in my own journey through perimenopause and menopause, like it's taken, I mean I've been to like three different specialists, tried like at least a dozen different combinations of things right,
And it takes this kind of tinkering.
So let's say for someone listening, If they don't have access to that and that may not be in their life plan, what are the five recommendations you would make nutritionally for people to take on that they can go to the market, go to Whole Foods, go to wherever that-?
What would be the five things you would suggest people take?
Limit processed foods as much as possible.
Okay.
Okay.
That is just never going to serve you.
You know, occasionally is fine.
We all have emergencies.
I was eating processed food yesterday.
I was stuck in a car for four hours, you know.
But that should not be the main source of your diet.
Fast food should not be the main source of your diet.
You know, really dial in on an anti-inflammatory kind of program, whatever that looks like, whether it be Mediterranean.
We kind of base Galveston Diet on that like really avoid processed foods as much as possible.
Make sure you are getting enough protein.
Most women are not.
So when we looked at The WHI.
WHI is just a data set.
There's great information in there.
It's just kind of how things were interpreted and things that were blown out of proportion.
But when we looked at frailty scores for women living in nursing homes who were on the WHI and they looked at protein intake, they found that women with the highest quartile, like 16 grams for every kilogram of lean body mass, were much less likely to be frail.
You know?
You need protein to be strong.
Like that's just the third grade version.
And when you grew up in the mind of caloric restriction as the way to be healthy, protein for most women in the US took a back seat.
We weren't focusing on.
You know, most women in the US right now have no protein with breakfast, a little bit with lunch and they kind of stack evening.
And they're only getting 30 to 40 grams, maybe 50, 60 total for the day.
And that's likely less than half of what they need.
So things that people can do if they're not going to eat, let's say, a breast of chicken or a piece of fish three meals a day.
Some days I feel like I'm gnawing on a chicken breast all day.
But you can supplement with healthy protein powders.
You can put those in smoothies.
You can sneak it in other ways.
It's for convenience.
Okay, so upping protein.
Okay, so that's two.
I need three more.
Upping protein, yeah.
Look at your movement, your exercise, okay?
Oh, you're talking, you want me to go nutrition?
Yeah, I didn't know if you'd be like, everyone should take vitamin D or, you know.
Yeah.
Get your vitamin D level checked and absolutely supplement if you are low.
It will turn your life around.
If you're running around with a vitamin D level of 15, I can rock your world just by giving you vitamin D.
So get that vitamin D level checked and supplement you know if you feel like it's necessary.
Fiber.
Fiber.
Most women are getting 10 grams of fiber per day, 10 to 12 maybe.
We need 25, minimum 35 for optimal cardiovascular health.
Can you measure fiber by poops?
No.
No.
No.
Okay.
I mean you can have a general, you know.
But you've seen those poop videos where they're showing all the different consistencies of poop.
A lot of stuff goes into that.
But you know you should be having something like toothpaste or you know— the consistency of toothpaste-ish every day.
A formed stool, not diarrhea, but you know.
But fiber is, it's vegetables.
Like when I think of fiber, I'm always like, oh, eating my rice and my grains.
No, really.
It's beans.
It's beans, it's chia seeds, it's avocado.
You know, those are like— I'm like, chia seeds, seeds, nuts, avocado, beans.
Those are going to be like the biggest pain for your back.
Okay.
To make sure—
Oh, surprise.
They're also packed with a whole lot of other shit that makes you healthy.
So vitamins, minerals, nutrients.
So you're looking for plant-based sources for fiber.
Well, that's where they come from.
But you know, doing like really zooming in on high fiber foods is going to really click a lot of buttons.
Yeah.
At the same time.
Okay.
And then limited added sugars.
So keto movement, everybody stopped eating sugar.
Oh my God, it's horrible.
It's horrible.
It turns out, things that contain sugar from God, fruits and vegetables are not that bad for you, you know.
But it's when we add sugar—
Or drink soda.
Or drink soda or alcohol which are high in sugar contents.
We are seeing tremendous effects to multiple.
You know, your insulin, your cortisol, your cholesterol, like all of that.
So women who limit their added sugars to less than 25 grams a day, not to say you can never have an occasional treat or you know your coffee with however you like it, but If you limit those you are gonna do way better.
You're gonna have less insulin resistance.
You're gonna have lower visceral fat.
You're gonna have less cardiovascular disease.
The other thing I wanted to ask you about.
Let's say, someone is ready to go to their doctor to try and bring this issue up right.
A woman feels like she hasn't been listened to.
So yeah, what would you recommend?
It is shameful to say.
You cannot expect your fabulous OB-GYN, who did incredible care, who you have adored your entire life.
When you cross this threshold and this is the new phase of your life.
They most likely did not receive enough training to be helpful.
And they may be wonderful.
And I hope for your sake that they admit it.
That they say, I have no time.
This is not my area of expertise.
So what's a way that someone can advocate for themselves in this arena?
So on our website, you know, and if you go on Instagram you go to my link in bio we have the menopause empowerment guide.
And the first two things are how to find a doctor who got more training.
You go to the menopause society, menopause.org, you look for a certified provider.
Not everybody on the list is taking the test, right?
It's not perfect.
On our website, we have crowdsourced testimonials from our followers.
Did you have amazing care?
And they write this beautiful paragraph or whatever, and then we look them up by city and state and we organize it.
So that's another way to do it.
There's some fabulous online companies, telemedicine companies that have been developed just for menopause care.
And they're female founded, they saw a gap, they saw a need, and they decided to fix it.
And I've looked at some of their protocols and I agree with what they're doing.
And if you're someone who, let's say, maybe doesn't have an OBGYN, that's treating them at this phase of life, but you're kind of going to your regular doctor and you're complaining.
So I have a couple of articles.
The latest position statement from the Menopause Society on menopause hormone therapy that they can print out.
The article from the cardiology from Circulation, the Journal of Circulation, that listed the you know, safety and efficacy and heart protective values.
Those two articles together, you can just slide them if your doctor's willing to learn.
If they admit they don't know, say, here, get started here.
And I'm like, listen, Just tell them this.
Use this script.
Hi, I would like to try this for three months and I'll come back and tell you how I'm doing.
Does that sound fair?
That works for most.
Yeah, I think a lot of people have trouble and just from the questions that we, you know, have kind of gotten from our, from our listeners and our viewers, I think a lot of people don't feel listened to.
And many women, you know, also separate issue, but it's concurrent with this.
We're not taught to be advocates for ourselves.
And especially if it's, If it's an authority figure in many cases, if it's a man, you know we sometimes can feel pushed aside or like we don't know how to advocate for ourselves.
If you could give kind of your sort of like minute of empowerment to women, what would that sound like?
You have to advocate for yourself at this time of your life, because if you're not the CEO of your own healthcare, the system was not built to serve a woman in menopause.
And I'm fighting to change that, but we're not there yet.
So you have got to take the reins here or bring an advocate with you who's going to fight for you if you can't do it.
This is really going to help a lot of people.
Where can people go to find all of the things that you just talked about?
So across social, we're Dr. Mary Claire, all one word, D-R-M-A-R-Y-C-L-A-R-E.
And then we have a website, The Pause Life, where we have blogs, tools, aids, guides.
It's all free.
Go check it out.
You know, lots of resources for you to advocate for yourself and all the science behind it.
So thank you so much.
You're welcome.
I really appreciate not only the information but the sort of the encouragement of advocating for yourself, because while the information is fantastic, if you can't communicate that to a person, It goes nowhere.
You know she has created a citizen's guide to menopause advocacy Simple Steps for Transformative Change.
It's something that is so important for practitioners, but also for patients, to be able to say this is happening to me.
It's not in my head.
It's a thing.
And hormones can help me and I have the right to have access to them.
And obviously there are women for whom that is not an option because of cancer and certain genetic profiles.
But what she's speaking to is the vast majority of women should have access to this and deserve to get more information about it.
It's not an overstatement to say that there's a revolution happening, a revolution in understanding what's really going on for people and the list, just a really long list of symptoms that people think are disparate but are actually underlying, have an underlying related cause that can be solved.
That can be addressed.
For sure.
People don't need to suffer this extent without getting help.
And the fact that the medical system just had no information about this.
Well, 51% of people appreciate you saying that.
So thank you.
The book she mentioned, the subtitle is Truth and Lies.
Early medicine taught us about women's bodies and why it matters today.
It still does matter today that outdated information has not caught up to mainstream care.
Hope you enjoyed this episode.
Sure.
Grateful that we had Dr. Haver on from our breakdown to the one we hope you never have.
We'll see you next time.
It's Mayim Bialik's breakdown.
She's going to break it down for you.
She's got a neuroscience PhD or two.
One fiction, one thing.
And now she's going to break down.
It's a breakdown.
She's going to break it down.
