Dr. Mary Claire Haver: Everything Women Were Never Told About Their Bodies

Episode Transcript
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Speaker 1 (00:00):
Your period as a vital sign. It should never disrupt
your life, It should never cause you pain. A normal
cycle should be regular. The most likely time a women
is going to commit suicide is between the ages of
forty five and fifty five, and so much of this
is preventable.

Speaker 2 (00:14):
Doctor Mary Claire Haber, Board certified OBGUIM thirty years in Medicine,
New York Times number one best selling author, breaks down
what women were never taught about their bodies, from their
cycle to fertility, to perimenopause and menopause. Why has women's
health historically been so misunderstood?

Speaker 1 (00:32):
Modern medicine was built by men for men. The way
we practice medicine was built on the male body is default.

Speaker 2 (00:40):
And how early would you recommend people freeze their eggs.

Speaker 1 (00:44):
The younger you do it, the better your chances are
of having successful embryos or pregnancies from those eggs. Women
go right from birth control to trying to get pregnant
without ever understanding what their cycles.

Speaker 2 (00:57):
Arely are women being prescribed to birth control to ours?
I think, Hi, guys Kate here, thank you so much
for tuning in to today's conversation with doctor Mary Claire
have This is about to be a very informative episode.
If you are enjoying post run high, please be sure
to follow the show wherever you are listening. We will

(01:18):
be right back after this shortbreak, Doctor Mary Clare, have
millions of women have turned to you because they felt
ignored by the very doctors that were supposed to help them.
You've essentially become the doctor that they never had. So

(01:39):
how would you summarize your overarching mission at this stage
of your life.

Speaker 1 (01:43):
It's a big shift in the way I used to practice.
I am a very well trained obstrician gynecologist. I just
realized as I was aging and my patients were aging,
there was a huge gap in my knowledge. And it
also made me realize there was a lot of bias
built into the system and how we were trained. And
I finally got to the point in my life where

(02:03):
I stopped asking men for permission to do anything in
my professional life, and I decided to focus on menopause.
And I didn't know anyone who had done that. I
and really not just menopause, focusing on women's health outside
of reproduction, and like, what does that even mean? Like
there's no women's health specialty, right, It's obgyn, and we

(02:25):
take care of amazing things, the breast, the uterus, the pelvis,
you know, pregnancies, But what about her heart, her brain,
her bones, her muscles, you know, how she ages her
geriatric life. No one's really looking at that. So deciding
to focus on that and giving women the best health
of their you know, last thirty years of their lives

(02:45):
became my focus. But what I realized now is that
starts in our twenties and thirties and forties to build
that foundation so that we don't end up with dementia
and osteoporosis and preventable heart disease.

Speaker 2 (02:59):
And it sounds like what you're saying too, is when
it comes to female health, there really has to be
a holistic approach taken.

Speaker 1 (03:06):
Absolutely. It is not just whether or not you take
birth control, whether or not you have regular periods. It
is your lifestyle, your nutrition, your exercise, your stress reduction,
your sleep, and really learning how to put yourself first.
I mean, if the only lesson that your listeners and
viewers come away with here is that they need to

(03:26):
prioritize their own health, put that oxygen mask on first
before they take care of anyone else in their lives
before they decide to start a family before you know,
that is the most important thing, so that you can
then turn around and take care of those people.

Speaker 2 (03:41):
When you said before that you wanted to stop asking
men for permission, are you referring to also other men
in the women's health medical space?

Speaker 1 (03:52):
I mean, traditionally, It's just the jobs that I had
taken were all all my bosses happen to be mostly male,
and that's just the way the system was built, right.
I've been in academics for thirty years, and you know,
definitely I've had women that I've worked with, and some
of these men have been amazing. But like I always
felt like I could not make decisions for myself in

(04:13):
my medical practice that I had to go, you know,
could not step away from guidelines, had to go with
permission to see a patient or permission just you know,
when I decided to step away and open my own practice,
build my own clinic, I didn't have anyone to turn to.
I you know, I'd never done anything like this. I
literally bought something similar to the Idiot's God for opening
a medical practice because you know, and that I could

(04:36):
build the practice of my dreams exactly the way I
wanted it, and that was just something I didn't know
I could do. And that's a lesson I'm teaching my
daughters now is you can do whatever you want. You
don't have to wait to have permission. You know, I
just grew up with imposter syndrome. I just thought, oh,
it was an accident. I got into medical school, so

(04:57):
I had to work really hard and make the best
raids and be at the top of my class. Otherwise
they weren't going to let me stay. It was an accident.
I got the top of my residency choices. You know
that I took that spot away from some other guy,
and I had to work ten times harder than everyone
else to like earn my place there. None of that's true.

Speaker 2 (05:14):
Yeah, none of that's true. And it's amazing that even
when you were getting to the top of X, Y,
and Z thing, you had imposter syndrome.

Speaker 1 (05:22):
Totally totally.

Speaker 2 (05:23):
When did you find your voice online? Because you not
only have an incredible practice, but you have become very
outspoken online and millions of people trust in what you say.

Speaker 1 (05:34):
I started kind of playing around on Facebook. I got
on Facebook I think in twenty ten. That was my
first touch into social media, and it was really for
friends and family. We had had a very devastating hurricane
that wiped out our town that I've lived in for
the last twenty seven years in Galveston, Texas. So we
had a big hurricane come called Hurricane Ike, and we

(05:56):
had lost our home. Most of our friends had had
severe damages, you know, and joined Facebook as a way
to communicate, you know. We were sharing pictures and like
whatever photographs we could get of the island and just information.
And then I realized, oh, people are doing other things
on Facebook too. So sometime probably twenty twelve twenty thirteen,

(06:17):
I started talking a little bit about my job and
started trying to educate on Facebook. Joined a created a
Facebook page, like a professional page for the first time,
and I was doing like little online courses on how
to do that. It was a passion project. It was
nothing that I was going to try to build a
business around. I wasn't even talking about menopause back then.
I was literally educating about your body, your periods of

(06:40):
birth control, et cetera. But I was getting dopamine hits
because I was getting more followers and more views, and
it was exciting for me. So probably you know, in
the early twenty tens is when that that developed.

Speaker 2 (06:51):
Yeah, And I also feel like it's because for so long,
conversations around women's health have been so taboo, where even
like saying, oh, I'm going to the gynecologist or I'm
going to obigyn. I remember my mom used to kind
of like pull me aside and be like, without my
brothers and dad listening, Oh, like you have an obgyn appointment,
you know.

Speaker 1 (07:12):
Yeah, And I think social media has become the water
cooler for women in a lot of ways where like oh,
she said menopause, Oh she said periods. Oh, let's lean
into this. One of the problems with these social media
platforms getting so big and then having to police themselves
is a lot of the female health content get suppressed
because we say things like proper anatomical terms like vagina,

(07:36):
you know, where they automatically assume it's porn And I've
got friends in the space who have to fight you know,
meta and fight you know, these big algorithms to allow
them to advertise or even say these words that hey,
we're not talking about pornography here. This is women's sexual function.
If you know a friend of mine Cindy owns a
company where they sell an after you approve medication for libido,

(07:57):
and she's had to really work with Meta or to
even get their ads out there because there's so much,
you know, policing around that when it's just our basic anatomy,
just our basically anatomy.

Speaker 2 (08:08):
And I even think about that too, Like I'm currently
seven months pregnant, and even when I talk about the
type of birth that I'm having, it's like, it's so
much easier to say, see section, even though I'm having
a vaginal birth. But it's like the idea of saying
vaginal Oh.

Speaker 1 (08:20):
Immediate flag, immediate flag, immediate suppression. Yeaheah.

Speaker 2 (08:23):
It's so interesting. Why has women's health historically been so misunderstood?

Speaker 1 (08:29):
Gosh, you know, when I started digging into the literature,
when you look at Elizabeth Cohmen's book, it's all on
her head. When you look at Eleanor Klighorn's book. There's
a lot of great books that have been written in
on this, and they looked historically as to what was happening.
So there's several things that play here. One, modern medicine
was built by men for men, and most of them

(08:51):
were Caucasian. Right. The way we practice medicine was built
on the male body is default, and anything outside of
reproduction is abnormal and a female if we present differently.
So one of the most famous examples is heart disease. Okay,
when men have a heart attack in general, not all men,
but it is the very Hollywood heart attack. So when

(09:13):
I say heart attack, what do you think if you're
going to see someone have a heart attack on TV?

Speaker 2 (09:16):
Well, when you say Hollywood heart attack, I'm immediately thinking
about what is it?

Speaker 1 (09:19):
Sex in the city.

Speaker 2 (09:20):
Yeah, big has a heart rab his.

Speaker 1 (09:22):
Heart fall on the ground. Okay, when a woman has
a heart attack, those symptoms are considered to be abnormal,
are atypical because we disease differently than men. Men tend
to have disease in the very large parts of the
cornary arteries, so they have this very acute all of
a sudden, they're fine and then they you know, climb

(09:44):
stairs or they do something vigorous and it affects their
heart and they like grab the heart. They have pain
in their jaw radiating down their arms. Women have diffused
microvascular disease way down deeper in multiple spots, and so
they have fatigue, nausea, It goes on for weeks. They
just don't feel right, you know. They think it's indigestion.
They think because we weren't taught that this is how

(10:05):
a woman presents with heart disease, you know, athroscorotic disease
versus a man. And so we were always taught that
this is a typical chest pain. Though we're fifty one
percent of the population, our heart attack should be typical.
Men's very typical, right, So that's kind of so then
that transmits to the er. Woman comes into the er
with her heart attack, she's fifty percent more likely than

(10:26):
a man to be misdiagnosed and sent home for indigestion,
panic attack, anything but the actual physiology of what's going on.
She's also much more likely to die from a first
heart attack than a man. Now ad in socialization, she
doesn't put her health first. Oh, I'll go after I
take care of the kids and my husband. I can't
leave them. I can't tell you how many times in
obstetrics this happens. A woman comes into the ED with

(10:47):
an acute issue during her you know, pregnancy, but because
she has other children at home, chooses to leave and
not follow through with care because there's no one to
watch the children she has, you know, And so we're
so used to putting our own health secondary to everyone
else's needs. That is, that's part of it. And then

(11:08):
the bias built into the system. I was taught this
is hard to say that women tend to somaticize psychological issues.
If we can't figure out what's going on with you,
she must be a little crazy. And Elizabeth Cohman, who
went to Harvard, calls this the bitches be crazy school
of Medicine. You know, you're just women are just a
little crazy. So if she's coming in with multiple day complaints,

(11:31):
you know, and it's so typical in perimenopause. So I'll
tell you a story from my residency when I was
an intern my very first year, my first block was
labor and delivery nights, rock and roll. I was a
fishing water. Is the most fun I'd ever had. Babies
are flying out left and right. I'm catching babies. Okay,
next block, next six weeks is gynecology, and half of
that time we spend in clinic, not a menopause clinic,

(11:52):
and gynecology clinics. So discharges hysterectomies, you know, gnecologic issues,
and we get a so all four years are there
with four years of residency. So the upper levels get
the charts from That's how old I am. We had
paper charts. They would run to the charts and find
the surgical cases they want to operate. They need their numbers,
so they're grabbing all those charts. The interns get whatever's
left at the bottom, okay, And it would be this

(12:15):
woman in her forties or her thirties with multiple VA complaints.
She's tired, more fatigue than usual, she's not sleeping well.
She's maybe having some menstraal irregularities, maybe not. She's gaining
some weight, her libido's a little bit off. She's having
some aches and pains, joint pains, whatever. She's having a
little trouble at work, you know, concentrating. And I look

(12:35):
through the chart, like, what if she had worked up?
Who's seen her family medicine, saw her into chronology, saw
her guest room in Teslino sorrow. No one can find
anything wrong, right, her labs are normal. So I'd go
to my upper level because we have to check out, right,
they're in charge of us and I'd be like, oh,
I've got miss Smith. She's forty three with blah blah
blah blah complaints. And he'd be like, what workup has
she had? And I'd say this is normal. Da da

(12:56):
da da da, and he's like, hmm, you got a
ww And I'm like, what's that? And he's like, well,
don't write this in the chart. But that's a whiny woman.
Pat her on the knee, tell her it'll be okay.
Maybe offer her birth control, see if that'll help. And
there's really nothing we can do for her. And now

(13:18):
I realize it took you know, I was writing the
book and the story bubbled up again, and I'm like,
she was in perimenopause, Like she was in full perimenopause,
and we didn't know how to recognize it, to connect
the dots right, And so that was just He wasn't
a bad guy. He was taught this. He taught it
to me. This whole system was propagated. I've talked to

(13:38):
other doctors across the country. They're called status hispanicus, total
body delor whiny guyanys like this is pervasive across the US.

Speaker 2 (13:47):
Yeah, and it's derogatory towards women. And in that moment,
did you feel.

Speaker 1 (13:51):
That look imposter syndrome? I felt so lucky to be there,
and I'm like, okay, am I embarrassed about that? Yes? Now, yes,
but I was just out of my you know, medical school,
so so so scared I was going to kill someone,
so scared I was going to mess up at work.
And you know, here's this like venerated person telling me

(14:12):
she's a little crazy and there's nothing we can do
for her. And so I just took it at face value.
And it took really twenty years of practice to un
lock that part of my brain, you know, to unpeel
all those layers and realize this was bias, systemic bias
built into the system, right.

Speaker 2 (14:28):
And I feel like also, you know, as like as
a doctor, my aunt's an orthopedic surgeon, and everything that
you do is so buy the books. And then it's
like it does take years of practicing and getting comfortable
and seeing so many different scenarios and situations for you
to start being able to make your own hypotheses.

Speaker 1 (14:48):
On her, right, And you know, so much of what
I was doing was ob so much is what I
was doing with surgery. You know, when we got to perimenopause.
I had no training, no understanding, no way to connect
the dots. It took twenty years for me to figure
this out.

Speaker 2 (15:01):
So for someone that has never come across your work,
tell us why it matters.

Speaker 1 (15:07):
Because you know, menopause is an optional. If we live
long enough, one hundred percent of us will go through
perimenopause and then menopause simply by the aging process. And
it is it is a normal transition. It happens to
all of us, normal meaning common. But for so many
women it blindsides them and they end up suffering needlessly.

(15:28):
And so my focus is to make sure that we
provide enough tools, education, and support to get them through
this transition where they remain functional and enjoy the lives
that they're mental lead For.

Speaker 2 (15:39):
Men listening, why should this matter to them?

Speaker 1 (15:42):
Because all of the women in your life who you
love are going to go through this and it's going
to affect them dramatically. So, for example, we see risk
of depression and riskive anxiety increase forty percent across the
menopause transition. We see the divorce rate skyrocket. The most
likely time a women is going to commit suicide is
between the ages of forty five and fifty five, and

(16:04):
so much of this is preventable. So you listening to
this and understanding what these hormone changes, how they could
affect her, will you'll just be a better partner in
her life.

Speaker 2 (16:14):
It's important for our male partners in every stage of
our life, whether it be when we're pm messing, going
through our period, or having a baby or postpartum, or
going through perimenopause and menopause, they have to know how
to support us because it's going to affect them too.
And what I love about you and what you're doing
is we don't have to wait until we're thirty five

(16:35):
plus or experiencing perimenopause symptoms to start thinking about these things.
We can educate ourselves starting early. So for the purpose
of the conversation, I would love for us to just
go through the different stages of a woman's life. You know,
let's let's start with our baseline. Potentially women in their twenties,
maybe younger if this relates to you, But really, for
the purpose of women in our twenties, what should a

(16:58):
healthy cycle look and feel like?

Speaker 1 (17:01):
Sure, so, your period is a vital sign that is
so important and a lot of women don't understand this.
It should never disrupt your life. It should never cause
you pain, you know, it should never take the life
that you've built and not let you be able to
lead it. A normal cycle should be regular, should be predictable. Okay. Now,

(17:26):
if you are twenty five day cycler or a thirty
two day cycler, that's still within the range of normal.
But you should be able to look at a calendar
and say, I'm going to start my period here, I'm
going to ovulate here, and my cycle is going to
stop here month after month after month, whatever that looks like.
And twenty eight days is average. But again we're still

(17:46):
twenty five days is still normal, Thirty two days is
still within the normal window if that's not, and it
should not cause you to get up in the middle
of the night, like whatever products you can buy over
the counter should manage your period. So if you're bleeding
heavier than that, that's not okay. You know, you shouldn't
have to leave your job or your classroom. You shouldn't
have to stay home because the cramps are so bad.
None of that is okay. Those are all vital signs

(18:09):
that something is going on in your body. Inflammation, intobitriosis,
adnomiosis PCOS that needs to be evaluated as soon as possible.
So if you can't predict your cycle to the day,
and if it's causing you so much pain or disruption
of your life, these are huge red flags that you
should get evaluated immediately.

Speaker 2 (18:28):
That's so interesting too, because I feel like growing up,
I even like, until you just had that, I had
no idea that having a heavy flow or severe cramping
was something to look into when it comes to your period.
I always interpreted it as you know, and as somebody
that's always had a relatively light period and an easy
period thankfully to manage. I've always interpreted somebody having a

(18:49):
more extreme scenario as just oh, that's just how their
pathot is.

Speaker 1 (18:53):
Right, yeah, no, no, yeah, it is just how their
period is. But it means that something pathologic is potentially
happening and we need to go figure this out.

Speaker 2 (19:01):
What are things that women right off as just stress
that are actually hormonal signals worth paying attention to.

Speaker 1 (19:07):
So many things and this is our entire lives, and
so irregular periods, so policistic goal varian syndrome cycles that
are coming too frequently. These are all signs that something
differently is going on hormonally with you. So let me
kind of explain what's happening. One of the biggest ways
that the female, the people born female, differ from males

(19:28):
is that women are born with all of their eggs
in the ovaries. Okay, and if you think about it,
the egg that made you was inside of your grandmother.
Those were formed when we're embryos, So we start developing
eggs as embryos. It's like you were inside of your grandmother.

(19:48):
Your data isn't that amazing, and so you're like, huh, okay,
thanks Grandma for the good for the good house, so
that moms, you know, eggs could develop as healthy as possible.
So we're born with all of those eggs. They start
deteriorating while we're still in utero. So by the time
we're born, we're down to one to two million eggs.

(20:09):
That's what we start with in general. Okay, some people
have more than people have less. By the time we're thirty,
so that's two years from you, you are down to
ten percent of the original egg supply. That's still plenty
of eggs for most women. By the time we're forty,
that drops to three percent, and full menopause represents the
end of your egg supply. That's what that is, and

(20:30):
then we go on for the next thirty years living
without those eggs if we're lucky.

Speaker 2 (20:44):
First, I want to talk about birth control because I
feel like as soon as we start getting our periods,
shortly after, we start having conversations with our moms and
our gynecologists about birth control. So I'm curious are women
being prescribed to birth control too early?

Speaker 1 (20:57):
I think I love having contraceptive options available to patients.
You know, contraception was developed to stop pregnancy. It turns
out it has other uses. It can be really helpful
for acne controlling to stosterone levels, dropping those androgens. You
don't see it in the skin. It can be extremely
helpful in some patients for indometriosis, helping to control pain
because we're dropping their estrogen levels. It can be really

(21:18):
helpful for heavy periods, in irregular periods, like we have
lots of uses for this. Where I think we're going
a little quickly is we're not working up the patients
as to why these things are happening, okay, And I
think a lot we women deserve centuries of research but
I think one of the areas is how else why

(21:38):
are these diseases happening? You know, what is the root
cause of this? That contraception can be a band aid
and it can give so much symptom relief, and I'm
so grateful to have it available. But I think where
we're not doing due diligence for a lot of women
or younger patients is that we're not figuring out why
this is happening. Oh, your soccers are irregular, Let's get

(21:58):
on birth control. Oh you're having acne, let's get on
birth control. Ope, you're you know, and so, and we're
not thinking about downstream of you know, the long term
consequences of being on these medications for a long period
of time. When I talk to my pay you know,
my friends who are in the fertility world, they're like
women go right from birth control to trying to get

(22:18):
pregnant without ever understanding what their cycles really, you know.
And I'm the mother of two daughters who use contraception
and so, you know, and they're happy to talk about
it if you know, you can talk about them separately.
But you know, I love having options for this. I
think that we are utilizing it without doing the best
work up that we could as to why this is happening,

(22:40):
because that's going to affect interim triosis. Will is not
a disease of reproduction. This is a disease affecting the
whole body. This is a pro inflammatory disease. It puts
her increased risk for heart attacks, increased risk for stroke,
you know, And we're just giving her contraception to manage symptoms,
which works for a lot of patients. But like, do
you know we're spending less percent of the budget, you

(23:01):
know on enomytriosis, which affects ten percent of the population horrifically, So,
you know, policist to go varian syndrome. Birth control builds
control the symptoms of that, really really well. I'm a
PCOS patient. I was on it for years and years
and years. So grateful to have those things controlled. But like,
no one sat me down and talked about fertility. No

(23:21):
one sat me down and talked about you know, what
this could do to my general urinary system, my bones,
et cetera. And I think we can do a better
job at that.

Speaker 2 (23:30):
I think so too. And so I actually have PCOS,
and I didn't realize I had it until I was
trying to get pregnant, and I kind of always had
a feeling that something was there, Like I always had
a feeling that I had something that was like a
little bit wrong, like whether it was weight fluctuations happening, acne,
irregular hair, like I had all of these weird symptoms,
and I remember being like, I must have something a

(23:51):
little bit like wrong, you know. But I went on acutine.
It cleared up my skin. My skin with them would
always hormonally come like it would always come back. Anyways.
I did birth control for a little bit, which helped
manage some of the symptoms. And then when I was
trying to get pregnant, I asked my doctor. I was like,
can you just scant like do a like check for
me if I have PCOS? And sure enough I did,
And I had wished instead of trying acutine, and you know,

(24:14):
going on all of these different medications to kind of
treat the symptoms that I had kind of checked in
on my diet, how my hormones were, Like what was
really going on I had? You know, I have high
androgen levels, I have a high testosterone, like I have
all of these things that are off that I feel
like could have been fixed in a more holistic way.

Speaker 1 (24:32):
I think we're missing the boat here, and I don't
want to demonize contraception. There's a big push on social
media and you know, I see, you know, I see
so much in women's health that there's this like, oh,
birth control is bad and women shouldn't be on it
and it's poison, and I'm like, that is I will
never say those things, but I think women deserve, you know,
the holistic approach, and you know, thank god we have

(24:54):
these options, but like you said, like you know, you
deserved probably a bigger work up and knowing what you
were facing once you got off and then we're trying
to start a family.

Speaker 2 (25:05):
So what are signs that your birth control, if it's
an oral pill that you're taking or an IUD, is
not a good fit for you.

Speaker 1 (25:14):
So we have, oh gosh, dozens of oral contraceptive options
on the market, and what most people should realize is
that most of them contain ethanol estradiol as the estrogen component,
and so symptoms associated with you know, maybe too high
of EE levels are going to be nausea, you know,

(25:35):
like that's one of the biggest reasons I have to
back off on that in the pill, and then there
are probably forty if I had last time, I counted
forty to fifty progestines on the market. So progestogens are
progesterone like compounds that bind to the progesterone receptors and
each of them have very very different components. So we
have likectrosperinone which is used in yaz or yasmin if

(25:57):
you're you know, and there's a million generics on the market,
so that one is better. It has a diuretic component,
so it's better for bloating, it's better for it's really
good for acne. Northendron is good for acne, but it
does convert to estradiol, you know, in the metabolic process.
So there's so much nuance. And like on my podcast,
we have a two hour discussion on all different or

(26:19):
all got reseptive options out there, and so that you
know things that I was taught in residency. Pick a pill,
any pill, they kind of work the same and you
can kind of fight through the different side effects. So
I think we can do a better job educating our
clinicians on all these different medications. And so you know,
if you're having any symptoms at all. You may need
to we need to change dose, or change formulation, or

(26:41):
change delivery methods. So we have patches, we have gels,
we have rings, we have so many different options. We
have injections. You know, we have progestin only options. I mean,
they're literally we could talk for hours about this, but
I don't like when it's pick apill any pill, pick
a patch, any ring. You know, they're all worked the same.
You'll be fine. We'll just mess around. It can take

(27:02):
a while to find the right combination for you that's
gonna work best with your.

Speaker 2 (27:05):
Body and one percent, and you hear about so many
people switching between different types of medications and seeing what
works for them. I'm curious how long if you're somebody
that's recently gotten onto a form of birth control and
you're trying to figure out is it going to work
for me? You're kind of in that waiting period. How
long should that waiting period be?

Speaker 1 (27:23):
I always tell patients a couple of months. Let's give
it to two packs, two rounds to see. Now. Certainly,
if you were like in that first week, just like
this is not I can't do this, then we're going
to switch immediately, but in general, if you're okay, but
you know, let me see if this settles down a
little bit. Especially the nasea. Nausea does tend to get better.

(27:44):
So if it's some mild nausea, it's like you're queasy,
but you're not dying, you know, Let's give it six
weeks a month and see in this next pill pack
if this gets better. It really depends on what the
symptom is. Now, acne takes three months to get better,
you know. It depends on what treating right.

Speaker 2 (28:01):
Yeah, And I mean, just for reference Freddie Girls Wondering,
I was on lo low estrogen and it really helped
my skin. But I remember being so scared when I
was going off of it, and I actually went off
birth control not even before trying to get pregnant. I
went off of it like years ago, just because I
wanted to start figuring out how to regulate my hormones normally.
I had been through like three rounds of acutane. It
wasn't working, and I was just like, what is going

(28:22):
on in my body? So anyway, so I wanted to
basically go off of all medications and just kind of
see if I could treat some this a little bit
more holistically, which I ended up doing. But I'm curious
for somebody coming off of birth control. And I remember
going down such a spiral of information because I was like,
Oh my god, am I going to get off birth control?
And my skin is it going to purge? You know?

(28:43):
So that was my main concern. I know there's other
concerns that people have.

Speaker 1 (28:46):
Yeah, but that's important to you. Yeahah, my kids both
dealt with acne.

Speaker 2 (28:50):
So like, what can people expect in the first three
to six months of getting off of birth control? And
then what should they proactively be doing before they pulled
the plug?

Speaker 1 (28:59):
So not all our control is the same. Like, if
you have an IUD, then you are you should be
ovulating normally in the background. Right. IUD is meant to
be locally acting. Depends on what kind of value do
you have it as a progestine or as the copper,
And so once you pull it, it may take three
to four months, like if it had progestin in it
to build that lining backup. We don't recommend pulling an

(29:21):
a progestin containing IUD and trying to get pregnant right
away because we need to build that lining up for
the you know, a nice the healthy lining. So I'm
telling my patients, wait until you go back to a
normal cycle, Like what for you was normal amount of
three to four days of bleeding, whatever that was for
you before we put in the ID. You want to
go back to that before you try to get pregnant,
because then we know that your lining has built up again.

(29:43):
The copper iud I would say wait a full period
before you try, because it's copper and it causes an
inflammatory reaction in the lining of the years. You do
not want to get pregnant, you know, it's higher risk
of miscare is right after removing one. There's a lot
of nuance coming off of oral contraception. You know, if
you're doing the shot, if you're doing the depo PRAVA shots,

(30:04):
it could be eighteen months before it's out of here,
before you go back to normal. We've seen patients it
could be suppressed. Now most are not that long. Three
to six months and then oral contraception. It really depends
on the patient. I have some patients who just look
right right back to normal and it's like postpartum. Some
people take months years, you know. Other people like, oh,
they're pregnant, like before they even realized, you know, their

(30:26):
period had can come back yet. So it's variable amongst patients,
but we do try to give them rough timelines. But
say you're an individual and your body may not listen
to what I say.

Speaker 2 (30:36):
Right, and then say, like, becoming pregnant isn't even a
reason you want to get off of it? You're just
like me and you're like you want to be like
off of it? Yeah, I just want to be off
of it. What should you be doing in maybe the
three months? Like do you wean off of it?

Speaker 1 (30:48):
You need to stop cult Turkey. There's no weaning off
of contraception. You get off and then you wait for
your hypothelmalsbituitary to realize there's no hormones coming anymore, and
then it starts cycling through the tuitary pushing out the
LHNFSH to get the oars to wake up again.

Speaker 2 (31:03):
And what can people expect in maybe those three to
six months post getting off cold Turkey to hell?

Speaker 1 (31:08):
Like if you were treated for PCOS, you're likely going
to be regular for three to six months, right, that's
your most because you've suppressed all the androgens that your
ovaries were building up for so long. PCOS patients actually
are the most fertile right after getting off the pill.
And so now that's not for everyone. But I'm like,

(31:28):
don't be surprised if the hair starts coming back, the
acne comes back, like all the signs of the higher androgens,
but that may take six months or so to do that.

Speaker 2 (31:36):
Is there something that people can do to kind of
manage those symptoms? Like what if you're like me and
you're like, I do not want my acnie to come back?

Speaker 1 (31:43):
So fortunately, you know acne. Really, when we look at
the like everything that contributes to acne, diet, exercise, sleep,
Like all the things that contribute to heart disease and
to bone and muscle strength contribute to the inflammatory process
in our skin. So like really honing in on your diet,
making sure you know you're avoiding processed foods, elevated sugars.
I mean really the added sugar seems to be such

(32:06):
a pro inflammatory component and contributes to acne. So I
just had a plastic surgeon on and I'm having a
dermatologist on and nutrition is really really key here, and
of course topical products, you know, to make sure you're
limiting things that are really harsh on the skin, that
can like cause inflammatory on top of the skin. You know,

(32:26):
you really want to use gentle cleansers and make sure
your makeup and everything is clean.

Speaker 2 (32:32):
Yeah. So it's really like you need to have a
good plan in place for when you go off of it,
just to make sure you're treating everything as much as
you possibly can. Yeah. I actually remember when I came
off of it. I was kind of I was actually okay,
which was kind of nice, but I know for some
people it's the total opposite.

Speaker 1 (32:49):
It took so I had a daughter who moved to
the city in the summer and had stopped and she's like,
my skin is great, I'm doing so great. And it
took about six months and she was back in school,
kind of back in the she was living so clean,
so healthy here walking every day. You know. Then she
went back to college for her last year, fell into

(33:09):
some of those habits, and by three months back, you know,
by October, the acne was back the worst she's ever
had it. So it was pretty she's got it back
under control now. But I was like, yeah, what are
you doing differently than what you were doing in New York.
She's like well, you know, relying on more processed foods
because I'm rushing for you know, not eating as healthy
as I was and sleeping, going to football games, you know,

(33:33):
all the fun stuff kind of doesn't help our skin.

Speaker 2 (33:45):
Okay, fertility, we've talked a lot about pregnancy, coming off
the pill, things that can happen. I'm curious at what
age does female fertility actually begin to change.

Speaker 1 (33:55):
So it's a continuum, it's a spectrum. So you are
never more fertile than you you are probably at sixteen
to seventeen, you know, a couple of years of normal,
regular cycles, and you're never more healthy. Right, your body's
not accumulating the hits of aging, exposure to chemicals, exposure
to stuff. So fortunately, you know, we don't want to
be pregnant at sixteen, most of us. It's not optimal

(34:16):
for most women even though they're their most fertile and so,
but you are not. Your fertility at twenty five is
not the same at thirty is not the same at
thirty five. Remember, our equality and quantity is declining every
single day we're alive, and so now rather that reaches
a point where so when we look at fecundity, which
is how likely are you going to get pregnant at

(34:39):
twenty five versus thirty five? You know, we see a
dramatic uptick in the loss of ecundity at thirty five ish,
so we see everything kind of really starting to accumulate,
where that for the risk, the chance of you getting
pregnant naturally spontaneously, that really starts dropping off for most
women at around thirty five and really tanking at forty.

(35:01):
But women get pregnant in.

Speaker 2 (35:02):
Forty all the time, right, And I know we talked
about this on our walk, but it's, uh, you know,
when I go to the I'm you know, I'm seven
months pregnant. I'm twenty eight years old. I am like,
by far one of the youngest people in the key
doctor's office in New York, you know. And it's because
so many women are choosing to have kids later, which is,
you know, great to see that there are so many
options that it can still happen for you later in life.

Speaker 1 (35:24):
So it really took me sitting down at that roundtable
with Stephen bartlan On Diary's CEO and listening to you know,
I kind of like dabbled in fertility when I was
an obgu ian, but like I would just refer to
a fertility specialist, like we used to say, give it
a year. Do not do that, you know, especially if
your periods aren't regular, if you're having pain, you know,
if you're not having that predictable, painless monthly cycle, get

(35:47):
in to see someone immediately. And it may not just
be a regular obgu an. You may need to see
fertility specialists to go ahead and get that testing done.
If you have a family history of infertility, your mom,
your grandmother struggled, couldn't get you know, you should look
into this and see why it's happening. So much of
endometriosis does not get diagnosed until you are trying to

(36:09):
get pregnant. So if you take a woman who goes
into her doctor complaining of pain with her cycles or
you know, pelvic pain, if she's trying to get pregnant,
she's more likely to get diagnosed years sooner withindometriosis than
if she just goes in complaining of pain. This is
a problem, right, We are missing the diagnosis of indometriosis,
missing polycistic ovarian syndrome. You know, these are these are

(36:32):
not only do they affect fertility, These diseases affect heart
attack rates, stroke rates, chronic health, you know, chronic health problems.

Speaker 2 (36:39):
Yeah, and endometrios metriosis. Now that i'm you know, I
have a couple of friends that are trying to get pregnant.
One of my friends does have endometriosis and it is
so true. She didn't know about it until she was
kind of at this stage of trying to get pregnant,
and then it's like, oh, you have to get this surgery,
and you know, X, y and Z things are happening
because you have it.

Speaker 1 (36:58):
It's scary, it is, and you know, when you look
at the tremendous lack of funding that goes into this
very very unique disease process and all the downstream effects
that it has, it's really something we have to fight for.
Is mandating funding for these diseases.

Speaker 2 (37:16):
Is endometriosis genetic?

Speaker 1 (37:18):
It can be there's a genetic penetrance, meaning if your mom,
if your sister's had it, you're much more likely to
have it. But it doesn't mean you're not going to
get it, you know, if no one in your family
had it.

Speaker 2 (37:29):
So I remember when I was going into the process
of getting pregnant and I got pregnant really quickly. But
I remember being I'm just like a total worry freak,
and I was like, Oh, it's going to be so
hard for me to get pregnant, you know. I remember
telling all my friends, my friends that are nurses. I
was like, it's going to be so hard for me.
They were like, I don't know if it is, you know,
And I was just kind of like speaking nonsense, and
Jeremy's laughing at me because I whatever I was, I

(37:51):
was convinced my husband it was going to be like
a challenge because everybody talks about it being so hard
and I have pcos and whatever. So I'm curious because
then I asked, you know, my aunt's and my mom,
was it hard for you to get pregnant. I'll keep
in mind, I'm a twin, so my mom was like hyperfertile,
and she was like, no, it's not hard for me
to get pregnant. So, for women out there that maybe
haven't asked their parents yet, is it true that the

(38:15):
way your mom gets pregnant and your you know, relatives
like your aunts and grandparents, is is that how you
get pregnant.

Speaker 1 (38:23):
It's not one to one, it's definitely not one to one.
I am one of eight children, so my mother and
father had eight biological children together. I mean, she would
look at him and get pregnant and you know, and
she had babies in her teens, twenties, thirties, and forties.
You know, like this twenty two year stretch of you know,
getting pregnant, staying pregnant, and having babies. She never had
a miscarriage, and you know, here I roll up with

(38:45):
Polysiscoverian syndrome. My first pregnancy at thirty one, miscarried, and
she was like, well that was bad luck, you know.
And then my second pregnancy, multiple complications, finally made it
to barely term, had a baby, and she just was
like completely like couldn't understand how this could happen to

(39:05):
me because she had had it so easy and all
her sisters had it so easy. So I believe my dad.

Speaker 2 (39:09):
Interesting, Yeah, well that I mean, and you know, the
really hard thing about pregnancy, and you know now that
I'm at the age where I do have friends that
are trying to get pregnant, I have friends that have
recently gone through their first miscarriages. Is you look at
some people that my mom's one of five same thing.
You know, I'm one of three, you're one of eight.
It's like, and they never had issues getting pregnant. They

(39:30):
were able to have all five, all three, all eight
of their kids, no miscarriages whatever. And then there are
women that have, you know, multiple miscarriages, still go on
to have healthy pregnancies and healthy babies. But it's so awful.

Speaker 1 (39:42):
Well, and it's so much of it as like, oh,
it's just bad luck. There's always a reason. There's always
a reason, right, and like whether you want to pursue
the reason is really up to you. But I think
we're not giving out the best device that wait a year,
Oh this happens. You know, there is a reason this
is happening, and maybe it's something that was preventable, and
we're not really doing due diligence by the patients. I

(40:04):
just have so many friends, like you said, who like
wait so long and just just take things for granted
and would have frozen eggs, would have, you know, taken
steps had they have known that this might have been
an issue for them.

Speaker 2 (40:17):
What are the most common reasons you see women having miscarriages?

Speaker 1 (40:21):
So when they've gone and about and I haven't looked
at the data recently, because I stopped doing OBE about
eight years ago. But when you know, at that time,
it was chromosomal abnormalities. So when they looked at you know,
the products of conception, the you know fetuses or you
know they do the dncs, the almost you know, a
huge percentage of them had a chromosomal abnormality, and most

(40:43):
of that is due to this aging egg phenomenon now
more like down syndrome. Babies are born to younger women
because more younger women have babies, but the percent of
babies with chromosomal abnormalities increases with age, So there are.

Speaker 2 (40:57):
Real benefits to either a freezing or having babies younger.

Speaker 1 (41:03):
Yeah. Yeah, it's easier and you have the healthier eggs
that have less chance of having accumulated chromosomal abnormalities, not
just down. So there's lots of trice and meuse and
oh yeah.

Speaker 2 (41:16):
I mean there's so much that can go wrong with
fetal medicine. I almost feel like a lot of fetal
medicine is still very archaic.

Speaker 1 (41:23):
I think you're right. I think we're getting better, but
you know, I have I know younger patients, young are
really interested in egg freezing now and I mean really
for the reason of there's no Once you do it,
then you take that off their plate. There's no rush
to get into a relationship or hurry up and get married,

(41:43):
or hurry up and like try to start a family.
You know, before you're ready, you have that in reserve.

Speaker 2 (41:49):
Now.

Speaker 1 (41:49):
It's expensive, it's not for everyone, but I think more
younger patients are considering it an option so that they
don't have pressure while they're trying to pursue their careers.

Speaker 2 (41:58):
How early would you recommend people freeze their eggs.

Speaker 1 (42:01):
So I've talked to fertility. Again, I'm not an egg freezer,
but when I talked to the fertility specialist, I mean, no,
the younger you do it, the better your chances are
of having successful embryos or pregnancies from those eggs. And
so you know, I know patients as young as twenty
five who are still like deep into education for their careers,

(42:24):
who are considering having it done.

Speaker 2 (42:25):
I feel like I had a friend in college whose
dad's in the medical field, and she froze her eggs
once she was like twenty twenty two, and I remember thinking, damn,
that's so young.

Speaker 1 (42:34):
But I mean I was resistant to the idea. At first,
I'm like, oh my god, you're so young, you should
be thinking about this, blah blah blah blah blah. And
then I sat on a panel for eight hours with
the fertility specialist and was like, I'm going to call
my kids and see if they're down for this, so
if they want to learn more.

Speaker 2 (42:49):
Right, and what goes into egg freezing, like for people
that know, because I feel like we hear all the
time egg freezing and sometimes there's people on social media
that document their journey, but I still am like, what
are we actually doing?

Speaker 1 (42:59):
Yeah, So basically the process is you want to get
as many eggs as you can and still not have
it not be dangerous. So that's generally going to require me.
You can do it on a normal cycle and just
pull out one egg. Okay, that's really not hedging your bets.
So you want to do it in the shorter time
is possible and get the most eggs that you can.

(43:19):
So that's going to require stimulations. You're gonna have to
take medications for a couple of weeks to stimulate more
eggs to come to the party. So those hormones we
talked about earlier, they're going to give you fsh which
will stimulate more force more follicles to try to ovulate
and get them out so that you can retrieve them.
So it's called hyperstimulations. You're going to hyper stimulate the

(43:39):
ovaries to try to get you know, five, ten, however
many you can out of one cycle. Then you go
in to a surgical procedure, usually done transvaginally, where they
take an ultrasound probe with a needle on the end
and they then they watch where the ovary is and
they take the needle and they suck the eggs out
of each follicle on both sides, and then they go
there's an embryologist there who examines the eggs to see

(44:02):
if they're what the quality is, and then they pick
the ones that look the most healthy. They can do
testing on them if they need to, and then they
freeze those for future use later.

Speaker 2 (44:11):
And then the future use looks like what.

Speaker 1 (44:14):
That's where it gets a little fuzzy for me. You'd
have to talk to a fertility specialist, but I assume
defrost and either they can do an IVF procedure where
they would then take sperm from your partner from a donor,
and then you know, try to get the embryos and
then implant the embryos back inside the uterine cavity. But again,
that's a whole level of training that I never did.

Speaker 2 (44:34):
What do you think women that wait to get pregnant
wish they knew earlier on at maybe twenty eight twenty seven.

Speaker 1 (44:41):
That maybe your fertility should never be taken for granted,
that your periods of vital sign that there are science
that this may be a struggle for you, that they
everyone says, I would have started sooner. I would have
not put this off. I would have you know, if
that is that, if if being a mother and having
your own biological children is important to you, you know,
and at any age, if you are not having predictable,

(45:03):
painless monthly cycles, you need to go in and get evaluated. Also,
not all fertility is issues there female, and so the
woman takes the blame for everything. Go get your partner treating.

Speaker 2 (45:17):
Oh yeah, and I mean there's so much planning that
goes into getting pregnant. I feel like I had no
idea even.

Speaker 1 (45:22):
Before we Yeah, fifty percent of infertile couples, it's it's
like close to fifty percent is male. There's a male factor,
So like, don't overlook your partner and.

Speaker 2 (45:31):
Rare diseases, genetic diseases, like you have to get blood
work done to make sure you don't have anything that
kind of pops up between the two of you, right,
that increases your chances. There's so much that goes into it. Okay,
So hormones when we get pregnant. So I talked about
my I talked to this to my sister in law
about this, who's forty one, she has three kids, and
she was saying that it would have been good. Obviously,

(45:53):
this is hindsight, is twenty twenty, and I did not
do this, but she was saying it would have been
good for me pre pregnancy to know what my hormone's
baseline was.

Speaker 1 (46:01):
Like a serum level, like a blood level.

Speaker 2 (46:03):
I guess.

Speaker 1 (46:03):
So, I mean, that's that's good in theory. But remember
we don't live in a steady state of our hormone levels.
There's no baseline, right, So when we're like trying to
see if we're worried about your fertility, we're going to
check a day three level. Day three of your period,
that is when your estra dial levels are the lowest
and your FSH levels would be low. So everything's really
done with this caveat of is she going to have

(46:23):
trouble getting pregnant? Instead of what is her peak extra
dial level? Typically? What does it drop to? Typically we
know basic ranges based on population studies, but no one's
checking that for you. But remember, you know, estradol has
a baseline and then it surges at ovulation, then it
drops off. We have a second kind of ovulation as
progesterone goes up. It's not a steady state. So that

(46:47):
is not something we do regularly to say. Really, it's
like when your postpartum, how do you feel? Are you
back to normal? You know your body better than any
lab test, and so if if you don't feel like
your energy is back, you're sleeping back.

Speaker 2 (47:02):
I me.

Speaker 1 (47:02):
You have a newborn, you know, and so that's kind
of weighing into the picture. But especially if you're older.
We are seeing legions of patients go right from postpartum
into perimenopause, so they never get back to there. What
do I feel like baseline? They're all and then we're
adding in a newborn care on top of it. So
now you're a perimenopausal with a baby. One hundred percent

(47:25):
dependent on you. So it is hitting postpartum. Perimenopause is
hitting patients so much harder than it would have at twenty.

Speaker 2 (47:32):
And then what are like when we talk about perimenopause
and then having a kid kind of in that same timeframe,
what are the long term effects of maybe having a
kid later versus earlier.

Speaker 1 (47:44):
So one of the things that I just read that
really just blew my mind is that in the postpartum
period when we are nursing, this is a low estrogenic
state on purpose, right, and we are meant to nurse
our babies. I am not saying don't nurse, but we
have a lot of bone loss. We have this acceleration
of bone loss, and if you go right from that
to your perimenopause, perimenopause is another acceleration of bone loss.

(48:08):
And so it is so important that we get baseline
bone densities on these women because they are getting a
double whammy. If you're twenty and you nurse, the bone
loss you experience from nursing will come right back. But
we're not seeing that in the perimenopausal patient. She's getting
hit twice back to back and then never able to
recover and so there are you know, bone loss is preventable.

(48:31):
There are things we can do, your vitamin D, make
sure you're calcium, the weightlifting, the training, and hormone therapy,
all of that can protect your bones. But no one's
thinking of this. And I think this is one of
the next frontiers in medicine for us to persons prevention.

Speaker 2 (48:42):
Absolutely, And it's so nice that you know there's people
like yourself that are speaking about it and educating women
so early, because I mean we've we talked about this
too on the walk, and we alluded to it in
the beginning, but I feel like a lot of women's
health almost blindsides us, even like getting your period at
whatever age it is.

Speaker 1 (48:56):
Ten times, I mean, we're really like, and I'm dating myself.
Blue Lagoon was a really big movie when I was like,
you know, Brookshields and I are roughly the same age.
I don't know her, but you know, like I remember
her like getting her period in the Lagoon and like
she thought she was dying, like no one had prepared
her for puberty, and and so then I feel like
we're all Brookshields in the Blue Lagoon. Her character as

(49:19):
we go through perrimenopacause. No one is prepared us for this.
I mean, I know what's blind excited like I and
it always it was all retrospective for me. I was
not okay. I was like raging. I was yelling at
my kids. That was the closest I ever came to divorce.
And I'm all like, what is that about? You know,
like I love him, like we have a thirty year,

(49:39):
thirty three year relationship. And I'm like, oh my god,
that was perimenopause. And we're just letting women do this
without any help or understanding. This is crazy.

Speaker 2 (49:58):
Okay, So what is perimenopause?

Speaker 1 (50:00):
Okay, So perimenopausemetically is defined as the transition from neurmal
mistrol cycles to full menopause. Like that means nothing in
real time. Basically, think of the hormonal signals from the
brain we talked about on the walk, So when we
reach a critical egg threshold level, the signals from the
brain no longer work on the ovaries the way they
used to. So what used to be day fourteen, you're

(50:22):
going to do this, Day twenty eight, you're going to
do this. Day one, you're going to have your period.
Because we're not getting the same feedback loop. You start
going into chaos. The brain starts working harder and harder
and harder to force the ovaries to push out those eggs.
We end up getting hyperstimulation, and so in what we
call loop ovulation, so we get double ovulation some months

(50:44):
where you get these massive surges of estrogen. Progesterone can
never quite keep up because we're not having enough follicles recruited,
and so what used to be very predictable EKG like
right month after month after month now becomes a zone
of chaos. So those four key hormones FSHLH, project sterone,
and estradiol lose their predictability. We start seeing massive surges,

(51:05):
massive crashes, and so this very very hyper mobile curve,
and so the brain hates that our neurotransmitters are how
we utilize glucas in the brain starts changing dramatically. This
is happening to one hundred percent of us. So quite
often the first symptoms are not your cycle being disrupted,
not general urinary symptoms, not hot flashes, but mental health changes,

(51:29):
sleep disruption, and brain fok. So there was a great
study that came out last year called I just don't
feel it myself. I don't feel it myself. And I
can't tell you how many patients came to me. And
I knew these women. I worked in a small town
with a big university. Okay, these were PhDs, these were
moms in my fore mom groups. These were women. I

(51:49):
went to church with women, I went to dinner with women.
I did book club and running club and all the
things with I knew them. I knew their bodies, I
knew their habits. Nothing had changed, but there was something
internal changing. And we didn't know how to connect the
dots and say, this is probably your hormones, or at
least there's a component here that we should address.

Speaker 2 (52:06):
And how early have you seen this start?

Speaker 1 (52:09):
I mean, for patients with premature varian insufficiency in their twenties.
You know it can happen young, but on average, somewhere
between thirty five and forty five, you're gonna start noticing.
There will ady'll be signs, Oh my god.

Speaker 2 (52:21):
And I said this on the walk. I can't like,
thirty five is way too soon. I'm like, I feel
like I'm just getting on top of my period. I
still feel like a little kid on my period because
when I was on birth control for so many years.
It was like I didn't even get it. I skipped
my sugar pills, and now I'm like, just.

Speaker 1 (52:33):
I did two. I love not having a period. It
was amazing.

Speaker 2 (52:36):
Whyse people would have been so hard. It's like, you know,
all these different stages of life. It's like crazy that
we go through with perimenopause. How do you treat those symptoms?

Speaker 1 (52:46):
Yeah? Great question. So we have two options. Really, if
we're looking at hormonal treatments, we can treat symptoms individually,
but then you end up on polypharmacy. You end up
on something for your palpitation, something for your joint pain,
something else for your you know, a sedative for your sleep.
You know that is not the route to go. I'm
not I don't recommend that to anyone. So now we're
looking at hormonal options old school. Anybody who was treating

(53:09):
perimenopause was birth control pills only. We're just going to
override the system, shut everything down and calmer down. For
a lot of picsions that works, okay, if you need contraception,
if you're having heavy, heavy periods, you know, birth control
pills can be a really great option for people. If
you're having pain. It can work. Okay, it is a
band aid. We're not treating perimenopause. We're just minimizing the symptoms,

(53:30):
which for some woman that's fine, or we can try
menopause hormone therapy definitely for the mental health. And it
is clear that International Federation of obstetos and Kynecology has
been very clear on this. Transdermal estradial and menopause hormone
therapy is the way to go. That is going to
be the best thing because we're taking the amplitude out
of the craziness of the chaos. You're still ovulating in

(53:51):
the background. Menopause hormone therapy doesn't stop population. It's not
birth control, so don't use it for contraception, but it
can take some of the chaos, the amplitude out of
these wild swings, so you can function better, but you're
still having some hormone stuff in the background.

Speaker 2 (54:07):
And hormone therapy, there's been misconceptions around it for years, right,
And is it true that people think it causes cancer?

Speaker 1 (54:15):
Yeah, so that has been disproven. That was a study
that was before you were born. Probably you know from
a lot of you were born who were listening. That
really kind of went viral before the Internet, and it
was the number one medical news story of two thousand
and two. It's geared the b Jesus out of women
and their clinicians. It was, you know, the findings were
really misinterpreted, the risks were massly overstated, the benefits were understated.

(54:39):
We know now a lot of that's been walked back
that for the vast majority of patients, hormone therapy is safe, efficacious,
you know, especially in early perimenopause and menopause.

Speaker 2 (54:49):
And what does hormone therapy look like? Is it literally
an infusion? Like is it an injection?

Speaker 1 (54:53):
Good question, So we have when we look at it,
we're looking at three hormones and how to get it
into your body. So there's the estrogens, the and like testosterone,
and the progestogens like progesterone. So in modern menopause care,
most of us for menopause, hormone therapy, which we might
give in perimenopause is using estradyl and progesterone. We're trying
to give you back exactly what you're overse used to

(55:13):
make or are used to make at a certain level. Okay,
And so how do we get that in your body.
We have to look at them each individually. So for estrogens,
most of us are using just estradyl. We can do
oral or non oral orals A pill easy right. Non
oral could be a cream, a patch, a gel, a pellet,
a shot, an injection, a ring that puts in the vagina.
So we have lots and lots of options. It is

(55:35):
not cookie cut or it is not one size fits all.
Most of us are using oral micronized progesterone for our
chosen progestine. About ten percent of patients don't tolerate it.
So I love having options. So then we're going to
use something like a compy patch or an IUD to
protect the lining of the uterus. So if you have
a uterus still, if you give someone an estrogen, you

(55:56):
must give them a progestogen to protect the lining of
the uterus. But uster own is also great for sleep,
so it's optional. It's mandatory with the uterus, but optional
without one.

Speaker 2 (56:06):
Wait, what do you mean if you have a uterus still?

Speaker 1 (56:08):
So some women have hysterectomies or were born without uteruses
you know, or have a progestine containing IUD, But there's
still there could be a role for an oral progestogen.

Speaker 2 (56:17):
Okay, because I thought for a second you were going
to say, like carry your uterus goes away. No, it's
gonna be the.

Speaker 1 (56:22):
Way that would break the internet. Right, So no, it
doesn't go away.

Speaker 2 (56:25):
But if you know.

Speaker 1 (56:26):
Spirits, a huge percentage of women end up with hysterectomy.
It's getting better, but like twenty five it was the
most common surgical procedure after of a sectomy, you know,
So it's a huge percentage of women end up with hysterectomy.
So always, you know, they're like, oh, my doctor said,
I don't need a progestin. I don't have a uterus anymore.
It was removed. I'm like, we can still talk about it.

(56:46):
It's not mandatory, but it's optional.

Speaker 2 (56:48):
So you have a new book coming out very soon.
Your book is sitting behind you. I don't know if
you guys can see it if you're watching, but it's
the New peri Metopause. What inspired this book and what
is something that you learned while writing it that really
surprised you?

Speaker 1 (57:03):
So I wrote The New Menopause, right, and it was
a New York Times best set, number one New York
Times bestseller, and really I mean it had legs like crazy.
We stayed on the list for six months, you know,
and it's still selling like crazy. It's like in book
clubs and everything. But there were the perimenopausal and they
keep coming like everyone's aging. I keep getting new patients
with perimenopause, like what about me? What about me? And

(57:24):
it's really its own distinct biological transition, and it's really
a guide on how to get ahead of this, right,
how to educate yourself. Lifestyle, We go hard, hardheart on
lifestyle and nutrition, exercise, stress, reduction, all the things that
we know work to help you build that foundation so
the transition can be minimized and you can get through this.
And then all the hormone therapy options, how to talk

(57:45):
to your doctor, and it just really it's not the
waiting Room for menopause. It deserved its own book.

Speaker 2 (57:51):
Because how when you say the waiting room for menopause,
it's kind of this middle stage, right, right, So how
many years typically is seven to ten? Seven to ten,
I mean that's a long period of life. And if
you're just chalking it up to.

Speaker 1 (58:02):
Being I'm crazy, Yeah, I'm stressed. I mean, but you know,
women are getting divorced, they're quitting their jobs, they're changing
the trajectory of their lives over this. This doesn't have
to happen.

Speaker 2 (58:11):
You know, we reference this on the walk, so I
want to dive into it a little bit deeper here too,
is you know, you mentioned certain things that have to
do with like longevity and aging, and we were saying that, like,
the conversation around longevity is very broad. It kind of
loops women and men together and says there's X, y
and z things that you can do to age and
reverse and age backwards. Whatever. We've had Brian Johnson on

(58:33):
that does all the different things from red light therapy
to cairo and you know whatever. So let's talk about
longevity and aging as it relates to perimenopause.

Speaker 1 (58:42):
So when my patients come to me, usually it's put
out this fire of menopause. Perimenopause like get me back
so unfunctional. Okay, put out this fire then, okay, So
we put out the fire. She feels like she's got
her life back, you know. Then she's like, okay, I'm like,
let's talk about the next thirty to forty years. How
did your mother age, how is she aging? How about

(59:02):
your grandmother's. What about your aunts, your great aunts? Like,
how are the women and your family tackling that last decade? Okay,
women win the longevity race. We are going to live
six years longer than our male twins. Okay, we win,
all right, Brian Johnson without just by breathing, I'm going
to beat you, all right. However, I don't have a
single patient who wants to live to one hundred and twenty,

(59:24):
not yet, not one. She doesn't want to be a
burden on her family. She wants to live as independently
for as long as possible. She doesn't care about the
quantity of her years. She cares about the quality. That's
where we have so much room. And it's not all
these esoteric those are sprinkles. It's not the peptides, it's
not the cold plunges, it's not those have not been
meaningfully shown to extend a woman's life. Okay, what does nutrition, exercise,

(59:51):
connection using your brain? You know, I've had gerontologists on this.
Have someone who actually takes care of the elderly and
talk to them rather than these people doing all these
crazy protocols. Like the women who are taking care of
the women who are aging I'll say the same thing.
It's joy, it's connection, it's using your brain. Those are

(01:00:11):
the things that are most predictive. It's fiber intake, most
predictive of a woman living independently, long and healthy and
not smoking and getting adequate sleep. Those are the core things.
If you're not doing those things, it doesn't matter all
of these little esoteric how much red light therapy and
I like red light therapy, you know, I hate being
called I'm not getting in a cold plunch, you know, like,

(01:00:34):
those are not the things that.

Speaker 2 (01:00:35):
Are working for us, right, It's I mean, it's even
the things that you mentioned, they're so like primitive too,
it's like simple, you know.

Speaker 1 (01:00:43):
I do track. I like tracking. Yeah, I warn the
glucose monitor. It's a bad boyfriend for me. It makes
me feel guilty. It doesn't you know. I don't recommend
those unless you're pre diabetic. It's an interesting tool to
learn about yourself, and I learned I don't need this.
This is making me crazy. I like my sleep monitor
whoops a really good one as well. I just the
band bothered me in sleep. But I track my sleep

(01:01:06):
because it's taught me about the things that are affecting
my sleep. If I'm not getting good quality sleep, I'm
at hiris for dementia. My mother and my grandmother were
terrible sleepers, both ended up with Alzheimer's and we don't
have the gene. So like, what are the lifestyle things
I can do? And it is not the cold plunges
are the peptides. It is literally sleep hygiene. Limiting my

(01:01:26):
alcohol intake close to bed, you know, like making sure
I'm getting my relaxation in, I'm taking a hot bath,
I'm doing the things I do like a saana blanket.
It does tend to help my sleep.

Speaker 2 (01:01:36):
When you say using your brain, because I really like
this one, because I really do. I think it is
important for women to like stay cognitively active and what
I'm like.

Speaker 1 (01:01:45):
Knitting majong, taking courses, you know, women who stay volunteering,
talking to people, like getting out there and like living
their lives. Part of probably why my mother's Alzheimer's got
so bad, she isolated herself. In the last five years,
she lost my dad and three of my brother So
that's also what I'm coming from, is three brothers who
didn't make it past my age right now fifty seven,

(01:02:06):
you know, and then my dad died of COPD related causes.
And you know, my mother really just locked herself in
a room and was depressed. And I just watched the
mental decline after that. And so those are the things.
You know, it didn't matter if she would have sat
there and cold blunched all day, it wouldn't have mattered.

Speaker 2 (01:02:22):
And it's also, like you knows, as hard as it
is to go through the loss of a parent, it's
important to look at their life objectively and say, Okay,
you know they died at this they passed away at
this age. What were the things that they did in
their life that maybe I could adjust it my own.

Speaker 1 (01:02:38):
And not blaming them because they my mother, my grandmother
followed the advice they were given. They tried to stay thin,
and they didn't do They didn't exercise the way I exercised.
They didn't eat the way I eat. You know, they
ate a lot of processed foods, and my mom especially,
And you know, I'm going to I'm changing those things.
I don't want this to be the biological inevitability for

(01:02:59):
my daughter, So experimenting on myself to show them the way.

Speaker 2 (01:03:02):
Yeah, and there are so many things that women have
to do differently than men when it comes to fueling
our bodies, making sure we're staying strong. And we talked
about osteoporosis. Actually, well, if you want, we could dive
into it a little bit. But we have a lot
of runners that listen to this show, and I know
that you asked me if I've ever checked my bone density,
which I have not, and now I feel like I should.

Speaker 1 (01:03:23):
So not all runners, right, but the more longer distance
ultra marathoners tend to have more problems with osteoporosis, So
you know it, it really shocks my patients who have
been incredibly fit who then get this surprise diagnosis of
lobone density and they're like, what yeah, And so we

(01:03:44):
think the latest papers I've read just looked at this
this week for a friend. It's under chronic underfueling because
you're spending so much time exercising to do these longer distances,
you're just not able to keep up with the chloric intake,
and that is chipping away at your bone and muscle strength,
and so it's not you know, early intervention. So hormone
therapy is FDA approved for the prevention of osteoporosis, and

(01:04:08):
so especially if you're a runner in your forties and
you have a baby and you go right from perimenopause
to postpartum lake. All runners, I think should just get
a baseline bone density at thirty five and see where
you're at.

Speaker 2 (01:04:20):
What are the best workouts for women?

Speaker 1 (01:04:25):
Yeah, so if you're sedentary, walk, If your sedentary, if
you walk thirty minutes to day, I will cut your
risk of diabetes by fifty percent. I will cut your
risk of stroke, cut your risk of heart attack dramatically. Okay,
So say you're a walker, load you walk, put on
a way to vest. You're gonna, you know, have other improvements.
You're gonna put more load on that bone and muscle.
You're gonna probably decrease your risk of ostroporosis. You know

(01:04:47):
you are. Now, if you're already walking, pick up some weights.
So increase your cardio. So, like, the perfect workout probably
for women is very complicated, and it's going to be
at least hundred and fifty minutes of cardio a week.
I just read a study that said three hundred. I'm like, girl,
we have no time for this, you know, one hundred.
So five thirty minute walks a week you need to

(01:05:08):
add some sprints in in there to get that VO
two max going okay, and it doesn't have to be
long three four minutes. A couple of times a week.
You need to probably do some jump training to protect
your bones so that you know when we there are
little fluid capsules inside the osteo class that when we
bounce and pound on them, we send a signal to
make the bones get stronger when we have load pulling

(01:05:31):
when we're doing weightlifting. I've totally changed my more. I
used to work out to be thin, step, aerobics, all
these things. No, now you know, I'm doing all my
zoom calls are on a walking desk at work. When
I'm doing stuff for business, when I don't have to
be all you know, made up for podcasts and stuff.
I'm walking with the vest on an inclining because I'm
I have a place in the mountains. I'm training also

(01:05:53):
for my walks in the summer when I'm walking in
the mountains like at ten thousand feet and climbing too.
I love it.

Speaker 2 (01:06:00):
And walk on a treadmill by the way, Yeah, I
mean it can work out.

Speaker 1 (01:06:02):
It's such a great workout. I'm hitting so many of
my goals. I'm so lazy. I'm trying to stack everything
when I can and so and then I'm doing three
solid days if not for of weight training, so a
push day, a pull day, a leg day. I Am
just trying to hit all the major muscle masses. And
it's so fun because I've been so thin my whole
life to watch my muscles grow, to watch the scale

(01:06:23):
get heavier and not freak out about it and be like,
oh my god, that's my bones and muscles. Doing regular
body composition scans, you know how much of this weight
is this one hundred and twenty eight pounds is muscle,
is bone, is fat, is vistrial fat, And knowing that
those are within my control by my lifestyle is amazing.

Speaker 2 (01:06:39):
What I love about doctors too, is you guys, take
even my friend that's a nurse. She takes such a
scientific approach to her body, you know, and like how
she trains and how she cuts when she wants to,
you know, cut some weight, gain weight. It's really interesting
and it is cool that your body really does come
down to a science so you can properly to fuel.

Speaker 1 (01:07:01):
So now I'm training for my old lady body, not
for a bikini. I'm training to be unbreakable.

Speaker 2 (01:07:07):
But we should all be training to be unbreakable. Yes,
never too early to start.

Speaker 1 (01:07:10):
Never too early, And if you can lock those habits
in at twenty, at thirty, at forty. You know, my
kids are in their twenties. I am trying to preach
to them. It is still mom. They're not really going
to listen to me. I'm just trying to get them
wear sunscreen, you know. So you know, I get it,
you're invincible at twenty. But like I think most of
us in our thirties start realizing, you know, I'm not invincible. Things,

(01:07:33):
things start hurting, things start breaking, and so but locking
in those habits as early as possible is only going
to serve you in the long run.

Speaker 2 (01:07:39):
Okay, so pregnancy training, since you were an obgin, I
just you are in OBI. Would you say you are open?

Speaker 1 (01:07:45):
I'm still bored certified, but I've dropped obstetrics from my practice.

Speaker 2 (01:07:49):
When you were an obgin and you had pregnancy patients
come in, you know, I know there's people of different
beliefs on this. What are your thoughts about training while pregnant.

Speaker 1 (01:08:00):
It is not the time to start training for the
first time for a marathon. Yeah right, hard stop, you know,
hard stop if you're already a marathon, or you can
keep running. I'm just looking at your pelvic floor. If
you start leaking urine, you should probably back off and
work on your pelvic floor and see your peblic floor
physical therapist. Because you're running with a lot of weight
now on this very tenuous hammock. There's no bones holding

(01:08:23):
our girl steps in. Everything's pushed up. Your uveal to
your title max is different, like lots of things change,
but god, you know, telling a woman she shouldn't exercise
at all, it's going to cause all these things. I'm like, no,
we need to. You're training for your nothing is going
to attack your body more than labor. It is your marathon,
you know, and so you need to be as healthy

(01:08:43):
as possible for it, and exercise is part of that.

Speaker 2 (01:08:46):
I feel like exercise has helped me so much throughout
the pregnancy, even like now I'm, you know, seven months
in and everything's getting harder. Like what I do my
running interviews when people still want to come on and run,
I'm like, oh my god, because it's.

Speaker 1 (01:08:58):
You're growing a kidney. I mean, like you just grow
an eyeball and you're trying to run.

Speaker 2 (01:09:02):
It's hard. It's hard, and then you just get so
much breathier and literally like all your organs get pushed up.
It's harder for me to talk and run. But I
do have to say, I feel like it would have
been so much worse had I not kept my activity
level up.

Speaker 1 (01:09:15):
So you know, horseback run things where you would fall,
or bats and balls with fly at your abdomen. These
are not the things you want to be doing so
much in pregnancy. But you know, as long as you're
not risking tearing the placenta from a traumatic injury, you
know you should be.

Speaker 2 (01:09:30):
You should be okay, Yeah, that's the big thing, tearing
the plus out of the abrasion or whatever or whatever. Yeah,
you don't want to fall, and then your balance does
get worse.

Speaker 1 (01:09:37):
Balance is a lot harder. So make sure, ladies, you're
holding the rail when you walk, like I can't tell you.
Don't climb a ladder when you're very pregnant, like not okay,
Like hold on to the rail when you're going up
and down the stairs, non negotiable. Don't be carrying the
laundry or whatever, you know, like that needs to go
out that you can't see, you can't your balance is different.

(01:09:59):
Protect your balance.

Speaker 2 (01:10:00):
Yeah, I even like when I'm in a workout class. Now,
I go to this class called Sodo Method, which I love,
and I feel like I really leaded into it during
pregnancy because the founder of it trained on the app
that they have throughout her entire pregnancy with twins, and
so I was like, Okay, it's safe to do. Which
is awesome that there is successful workouts like that. But
when I go to the class in person, I literally

(01:10:20):
go to the back so I can hold the wall
just in case we have to do any sort of
like Lund series because I'm so nervous I'm going to fall. Okay,
we talked about everything leading up to menopause. How do
you know that you have hit menopause?

Speaker 1 (01:10:32):
So if you are over the age of forty five
and you have not had a cycle for one year,
that is the medical definition. Now there's you know, menopause
is really that's the medical definitions. There's multiple problems with that, right,
what if you don't have a regular periods, What if
you've had a hysterectomy or you have a marine iud
you know, what if you had policies toc ovariance in

(01:10:54):
drome and you you really can't rely on this, Does
that you don't get to have menopause? What if it's leapier,
do we have to wait three hundred and sixty six days?
Like it's ridiculous We use this as the diagnosis. It
really so. But if you haven't had a period for
a year and you're over the age of forty five,
ninety nine percent of the time your menopausal.

Speaker 2 (01:11:13):
And then what about frozen shoulder?

Speaker 1 (01:11:15):
Yeah, so the muscular Skelettle syndrome of menopause is real.
Estrogen is a potent anti inflammatory hormone. We remove its protection, okay,
And so if you see I mean they even call
it forty year old shoulder fifty year old shoulder in
some countries. And so one of the best researchers in
the area right now is doctor Joscelyn Witstein, and she's

(01:11:36):
at Duke and I interviewed her on the podcast and
she said she was seeing all these patients who were
on some of the ovarian suppression medication for their treatment
of their breast cancer, and they were so many of
them were coming in. We're Froseden shoulder and she's like,
you know, in the most likely time for a woman
to have or it's a woman who gets it, and
she's most likely between the ages of forty and fifty,

(01:11:57):
you know, forty to sixty. And she's like, if there's
something to do with menopause, and like all the men
in the room go, can't be And turns out it is.
So she did the actual studies that proved it. And
it's pretty phenomenal that it took into the twenty twenties
for us to figure out something that's been happening in
all of humanity to everybody, like everybody experiences. It's a

(01:12:18):
progressing inflammatory disorder that affects the shoulder joint. You could
also do the hip as well.

Speaker 2 (01:12:23):
And what does it feel like.

Speaker 1 (01:12:24):
One of the first signs you lose it hurts. Okay,
so you have phases, and the first thing is you
lose some of your So you can't put your arm
behind a woman in a picture, you can't do your
bra you're struggling to do your hair because the joint,
you know, so it hurts and then you then it freezes,
so it's in the joint capsule becomes actually inflamed and

(01:12:47):
then scarred, and then like in the post treatment, you
have to break up the scar tissue to get it
to move again. And if you have one side, it's
a high probability that you're going to get the other side.
And what they found is that women on menopause hormone
therapy have a lower chance of that happening, of developing it,
and they have a shorter course and they respond to
therapy better.

Speaker 2 (01:13:05):
Okay, so it is important to be doing the hormone therapy.
It can be yeah, oh my gosh, the frozen shoulder.
When I started looking into this, I was like, that's
what I'm most that at hot flashes.

Speaker 1 (01:13:15):
So I'm always like checking my movement to make sure
I still have full range of movement.

Speaker 2 (01:13:20):
What are the biggest misconceptions women have about menopause?

Speaker 1 (01:13:24):
That it won't happen to them, that is just hot flashes,
that there's nothing they can do about it, and that
hormone therapy is dangerous.

Speaker 2 (01:13:30):
Yeah, and then if a woman does the right things
in her twenties, thirties and early forties, how different can
her menopause experience actually be.

Speaker 1 (01:13:40):
So remember it it's not just hot flashes. It affects
every organ system of our body. It is a turning
point towards increasing risk of cardiovascular disease, increasing risk of stroke,
increasing risk of diabetes, and increasing risk of dementia. And
so what we can do is attenuate those risks by
locking in those healthy lifestyle factors earlier.

Speaker 2 (01:13:58):
Yeah, during our perimia pause years. So, coming out of
reading your book, what is the one takeaway you want
people to.

Speaker 1 (01:14:04):
Have that they're not scared of this, that is a
normal transition, but they have the tools and the resources
available to help them manage this easily.

Speaker 2 (01:14:13):
Coming out of today's conversation, what is the one thing
a woman in her twenties should understand about her body
that would completely change how she moves through her life.

Speaker 1 (01:14:25):
You only get one body, and it's going to serve you,
hopefully for the next eighty to ninety years. Take care
of her, Take really good care of her. Listen when
your body's not feeling right, you need to listen to
her and go get help.

Speaker 2 (01:14:38):
Doctor Mary Clare Haver, how can everybody stay in touch
with you and stay ups day on everything you've got
going on?

Speaker 1 (01:14:43):
Across social media? You can find me at doctor Mary
Clare and our website is thepauselife dot com. We have
so many resources there for every age. We have guides,
we have quizzes, we have you know, things you can
print out and take to your doctor to help you
advocate for yourself at your appointments.

Speaker 2 (01:14:58):
Well, thank you so much for being here with me today.

Speaker 1 (01:15:01):
Awesome.

Speaker 2 (01:15:05):
Hi guys, Kate here. If you've made it this far
into the conversation, thank you so much. I don't know
if you guys can tell, but I am a little
bit sick. We didn't talk about this during the podcast,
but when you're pregnant, there's very limited medicine that you
could take, So I'm sorry if I was a little
bit nasily today. But we did just learn so much
about women's health and this will definitely be an episode

(01:15:27):
that I will be coming back to periodically whenever I
have questions that I need answered about what's going on
in my body. As always, if you're enjoying post run high,
please be sure to follow the show wherever you're listening
from and share this episode with a friend. We have
weekly episodes coming your way, so we will see you
next week.

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Host

Kate Mackz

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Dr. Mary Claire Haver: Everything Women Were Never Told About Their Bodies