Your Body Is Not Betraying You: Understanding the Science of Menopause - with Dr. Mary Claire Haver - The Daria Hamrah Podcast

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Mary Claire Haver (00:03):
All right , everyone, welcome back to the
show.
I'm Dr Daria Hamrah, your host,and today's conversation is
going to change the way youthink about aging, health and
the most overlooked transitionin women's lives, which is I'm
sure you all guessed menopause.
My guest is none other than DrMary Claire Haver.

(00:24):
Menopause my guest is noneother than Dr Mary Claire Haver
I'm sure you've heard of herthrough social media and she's
been on many podcasts recentlyin the past year who is a board
certified OBGYN and certifiedmenopause provider and
best-selling author of her bookthat she published last year the
New Menopause.
This is more than a medicaldiscussion today, so it's a

(00:47):
wake-up call, a re-education anda movement to empower every
woman to step into this nextphase of life with strength,
with clarity and science on herside, whether you're a woman
going through it or a spousetrying to understand it, or a

(01:09):
practitioner seeking to treat itbetter.
You need to hear this.
So let's dive into theconversation on menopause, one
that's really long overdue.
So I want to start this by aquote, with a quote by Mark
Twain, who says the two mostimportant days in our life are

(01:32):
the day you're born and the dayyou find your why.
So, Mary Claire, what is yourwhy?
Why did you take time out ofyour busy practice in life to
write this book called the NewMenopause?
And why did you call it the NewMenopause?
Is there an old menopause?

Dr. Daria Hamrah (01:53):
So my why is realizing that I spent four
years in medical school, fouryears in residency and probably
18 years in clinical practiceand I knew more about the bottom
of the ocean than I did aboutmenopause and health and women
and that just became my why andmy passion, because sadly it

(02:15):
took for me going through my ownmenopause transition and just
absolutely I thought I'd be oneof the lucky ones who would have
this whisper of inconvenience.
I thought.
I'd be one of the lucky ones whowould have this whisper of
inconvenience, but it was astorm that completely took me
out and I just thought if I'msitting here suffering, what are

(02:42):
all the other women doing?
I can't be alone in this.
And I realized that so manypatients were trying to tell me,
but I didn't know how to listen.
I didn't know how to connectthe dots between every organ
system that was affected by thechange in hormones in the female
body.
Just, we were never taught that.

Is it something that happened suddenly
?
Or did it creep up on you andyou just didn't understand how
to interpret the symptoms andput two and two together?
I mean, you talk about thestorm, but did you see clouds on
the horizon and wondering wherethey're coming from and when
they're going to get here?

(03:15):
Because obviously you are aboard certified OBGYN and you
knew, and then even knew, one ortwo things about women's health
.

So now that I look back, there were clouds on
the horizon, but I didn't knowhow to recognize them.
I rewarded myself by being thebusiest person I knew.
Right, I was a mother, raisingchildren, working as an OB-GYN
you know all of us who take onthese incredible roles in our
lives and there was no time forme to have downtime.

(03:49):
But something was changing.
Another thing was I was onbirth control pills to control
polycystic ovarian syndrome.
So I realize now that most ofprobably the overt symptoms were
masked by the fact that I wastaking hormones for a different
reason and I got off the pill atabout 48 to see where I was

(04:09):
hormonally, and that's when thesymptoms hit me like a train.
I wonder if I hadn't had thatkind of abrupt transition.
You know, if I would have beenso motivated to, you know, get
to the bottom of this had itbeen less dramatic for me.

But my point is the symptoms that
you're describing.
How are they same for everyone,or did they?
They're different.
So can you walk us through thesymptoms, first of all your
personal symptoms, if you wantto share them, and then the most
common symptoms that areoverlooked not just by the
patient but also by the primarycares and the ob-gyns, by the

(04:52):
medical system, because that isvery important for women
listening in my training I wastaught that menopause was hot
flashes.

About 85 of women would have hot flashes and
most of us are taught that.
We all know that it is ahallmark and it's interesting
because that is a symptom that'shard to blame on something else
.

Sure.

Right.
So most of us know cyclemenstrual irregularities, hot
flashes, generally urinarysyndrome, but only like later,
like older menopausal ladieswill have dry vaginas and stuff.
I never was taught that thatcould start in perimenopause and
we knew that down the roadosteoporosis might be a factor
as well.
And that was it.
I had no idea that menopauseaffected the brain, affected

(05:31):
sleep, affected our liver in theform of changing our
cholesterol numbers, affectedour insulin resistance, affected
our musculoskeletal system.
The greatest acceleration ofbone loss and muscle loss is in
perimenopause and I didn'trealize that menopause was the
turning point for thedramatically increasing risk of

(05:53):
cardiometabolic disease.
And so, just you know, taking awoman through the menopause
transition increases the risk ofmetabolic syndrome.
Two to three X, you know, ifyou age match them increases the
risk of metabolic syndrome.

Two to three x, you know, if you age
match them, and and so how isthe general medical community
responding to these symptoms?
Um, and compared to from 20years ago, I know there was a
study relating hormonereplacement therapy, for example
, to breast cancer, and thatobviously omitted a lot of women
from getting proper care whenit came to replacement therapy.
How is today different?

(06:32):
Because there is not, I wouldsay, one or two patients a month
, or even a week that come to methat have the symptoms.
When I ask them if they havediscussed hormone replacement
therapy with their patients,either the answer is no or they
say my doctor doesn't recommendit because of the risks, and

(06:54):
this is 2025.

Yeah, so I have a daughter in medical
school.
I was a residency programdirector until 2018.
So there's a little bit of agap between when she started
school, what I know they'rebeing taught now versus what we
were teaching up until 2018.
And it was that hormonereplacement therapy for most

(07:17):
patients, the risk wouldoutweigh the benefit, and that
theory is based on the veryoutdated study.
One study that did not reachstatistical significance in 2002
changed the course of women'shealth outside of reproduction
for decades and when you thinkabout that, you know there have
been multiple looks back at thestudy.

(07:38):
The data has been walked back.
For the vast majority ofpatients, especially starting
early, the benefits will faroutweigh the risks.
Her quality of life willimprove.
She'll live longer, she'll haveless cardiovascular disease,
less osteoporosis, less dementia, and most docs have not gotten
the message Now.
This is not the fault of theindividual clinician.
This is the fault of the system.

(07:59):
Women's health has beenoverlooked and undervalued
outside of reproduction.
When you look at time andtraining, nih funding, all of
the critical, you know ways thatwe measure what matters in
health and how we're going toteach our you know, educate our
clinicians.
Women's health outside of thebreast and uterus is almost
non-existent.
You know, like, how we diseasedifferently, how we have

(08:23):
cardiovascular disease, how ourbones deteriorate quicker, how
we have increasing rates ofdementia, those are just
classically understudied.

So wasn't that study debunked, though 10
years later?
And I mean we're talking aboutat this point 10 years Multiple?

things have come back and walked back, but
it went viral before there wasviral right.
It was the number one medicalnews story of 2002.
It was on the cover of everypaper.
It was on NBC Nightly.

News.
I remember it was on GoodMorning America.

I remember I was the chief resident the year
it broke and we were terrifiedand all we heard was estrogen
causes breast cancer.
That's not even what it said,right, it was the estrogen and
progestogen arm, which is asynthetic progester which none
of us use anymore, you know, hada non-statistically significant
increased risk and it was a.

(09:12):
It was a, you know it was.
It was a relative risk, not anabsolute risk.
The absolute risk was minimaland so therefore, women 80% of
women threw their prescriptionsin the trash.
They were absolutely terrified.
Everyone bought into thisnotion that somehow the natural
hormone our bodies make issomehow trying to kill you.
Where in pregnancy, when wehave the highest levels of

(09:35):
estradiol floating around ourbodies, breast cancer is almost
non-existent.
You know it happens, but it'sextremely rare and the most
likely time we're going to getbreast cancer is when we have no
estradiol in our systems.
You know it.
Just when you think about itlogically, it really doesn't
make sense.

So where do you think the medical system
has failed?
In that that they didn't makethe debunking of those old
studies viral enough so that itwould penetrate the medical
system Right?
So guidelines.

You you know it takes 17 years to change a
guideline.
You know that right, yes.
And so the guidelines, like theAmerican College of OB-GYN
guidelines today it is 2025, saythe lowest dose for the
shortest time possible.
That is based on nothing.
There's no clinical evidence tosupport that.
The Menopause Societyguidelines say it's completely
different.
Benefits outweigh the risks.

(10:26):
Keep her on it as long.
As for her, the benefitsoutweigh the risks.
There's no age at which youmust need to stop right.
It will always protect yourbones and it's FDA approved for
the prevention of osteoporosis.
So our guidelines are notagreeing across different
medical specialties.
There needs to be.
No one is in charge.
There are no adults in the roomwhen it comes to women's health
after reproduction ends.

So once we're done.

Having babies no one's in charge.

Well, the fact that there is a menopause
society and then there is theOBGYN society, that in reality
they should be one, they shouldbe one society.
I mean, menopause is, as far asI remember from basic biology,
is part of women's health, sobut I mean think about it.

Should the poor, busy ob-gyn, who's a part
surgeon part, you know we'rewearing so many hats really be
in charge of the whole shebang?

no I agree, so yeah so I agree in
subspecialization, but to thethe very least they should be
aware of that.
They should agree on one typeof treatment.
They should know the symptomsand they shouldn't poo-poo or
minimize the symptoms and thenecessary treatment for

(11:38):
menopause, so they can at leastchannel the patient
appropriately and answer theirquestions.
So at least they should havethe same message.
They shouldn't necessarilytreat them, at least they should
have the same message.
Not they shouldn't necessarilytreat them, but they should have
the same message.
And that is the thing that isbizarre, like why has medicine
gone so siloed that twospecialties or subspecialty and

(11:58):
a specialty can communicate?
And we see that throughoutmedicine.
This is not just for OBGYNmenopause, this is for all
specialties and subspecialty.
There is this tribalism going on, almost this false sense of
pride where you know.
Sometimes I ask myself, why arewe even in this field?
We're in this field to servepatients, not to.
I don't know, to be honest.

(12:20):
I don't know the reason.
But here's the good news, maryClaire.
I think people like you, or theinternet, social media, they
have raised patients' awarenesswhere they are now able to look
things up themselves so thatthey can ask the proper
questions.
And if they don't get theproper answers.
They can then make a decision.
They have a choice to go seek adifferent opinion.

(12:43):
I think this is the era ofempowerment.
I think social media, even AI,significantly have empowered the
patient.
And the other downside is thedistrust in doctors now.
I mean that isn't on the rise.
I mean we can't deny it Right.

That is undeniable and it is a shame
because most doctors are amazingand wonderful human beings and
the lack of knowledge andeducation around menopause is
not that doctor's fault.
They're doing their best withwhat they were taught.
They're overscheduled,overworked.
You know.
I never want to say you knowthey're, of course they're bad
apples.
They're in every, every, everywalk of life.

(13:24):
But I think you know they're,of course they're bad apples.
They're in every, every, everywalk of life.
But I think you know mostpeople went into this to help
people and they're really tryingto do their best job.
And and what's happening inmedicine as far as the
corporatization and theadministrative burden put on the
physicians, you know, to seemore patients in a shorter
amount of time, I mean,menopause is complicated, it's
hard, it mirrors so many otherdiseases.

(13:46):
How can you do that in 10minutes with your feet in
stirrups?

I mean you're being very kind by saying
that.
You put it in a very kind way.
I'll be a little more directbecause I feel as physicians
because we're dealing withpeople's lives we have a bigger
responsibility.
It's a more of a calling thanblaming the system, I feel I

(14:14):
kind of don't agree with thatbecause it's you're basically
leaving the door open for anyonewith an excuse to walk through.
You're basically leaving thedoor open for anyone with an
excuse to walk through, and Ithink we have a greater
responsibility.
To the very least.
Don't tell the patient thathormone replacement therapy is

(14:36):
bad and they're going to getcancer, like that's where I
would draw the line, that's aproblem you can't.
There's no excuse for that.
I agree with you when you saywell, they're overwhelmed.

They can say well, I'm not an expert in it,
but I can refer you to someone,to a menopause specialist.

You don't have to practice menopause care
, yes, but to scare the patientsand do fear mongering.
I mean, that is completemisguiding and that's where I
draw the line and for me thereis no excuse and based on the
science, today it's borderlinemalpractice.
Because let me ask you aquestion, maybe you can answer
that how many relationships?

(15:17):
If you give me a percentage,now we know I think it's
something like 70% of.

Marriages they end up in a divorce.
I read that somewhere, I think.

I think 70% are initiated by women.
It's it's a right over 50 thatin the war, okay, so so.
So do you think Menopause hasanything to do with it?

Absolutely and not in all cases, of course,
but I I have two or three, fourgood friend patients who are
divorce attorneys and they loveto talk about this.
So they gave me all theiropinion on everything, because
they are in it every day andthey say two things happen.
One, she circles the wagonsaround herself and says this was

(16:02):
not a relationship that wasserving me.
I've got 30 more years to liveand I'm not going to live it
with this guy.
Okay, there's something aboutmenopause that gives you the
power and permission to putyourself first.
So that's like some of thedivorces, but others are.
She is going through a massivetransition and overhaul and, and
her whole life, the way shelooks at things, the way she's

(16:24):
reacting, we see a tremendousloss of intimacy.
You know at least 50% of mypatients are suffering from
decreased libido, meaning theymiss it.
They had it.
They had a healthy sex lifethat they loved and they they
miss it.
It's not there anymore and theylove their partner and you know
it's not a relationship issuethat can destroy marriage.

(16:44):
You know they're they'reemotional.
40% of women have an increasein mental health disorders, you
know.
So across the menopausetransition and so all of these
things.
You know she is changing, he isnot, and that's going to create
a disconnect in a relationshipand that might be part of the
divorces as well.

(17:04):
So the divorce attorneys arelike if we treated general
urinary syndrome of menopause,if we treated mental health
disorders in perimenopause, ifwe, if these weren't a thing, if
this was like nipped in the budand we get all these people,
you know, taking care of, howmany divorces would we avoid?
And they think a lot.

I know I mean geez, I don't know if
they've done a study on that,but it's hard to do a
prospective study but at leastlike a retrospective study where
I had just had a patient lastweek, literally.
I took her medical history andI saw she's on hormone
replacement therapy.

(17:43):
I'm like so, it alwaysimpresses me.
I'm like, okay, I asked himwho's your doctor and how did
you find out?
How long have you been on it,et cetera.
And she looked me in the eyesand with tears in her eyes, she
said it saved my life, it savedmy marriage.
And then she looks over to herhusband and they both start
hugging each other and I'msitting there.

(18:05):
I'm like, okay, do you want meto leave you guys alone?
I can come right back.
But the the?
That's when I realized howimportant this is for
relationships.
You know, not just for, for,for a woman of, as a
self-empowerment or health tool,but relationships.

(18:26):
And that's why I asked you thatquestion, because until I saw
that couple it wasn't on myradar.
I didn't even think in thoseterms.
I was just thinking in healthterms.
Now, if you're a womanlistening to this, what can you
tell them as far as symptoms tolook out for and before you

(18:48):
maybe say that, can you describeperimenopause, you know the
process of perimenopause, how itleads to menopause,
post-menopause, so that womenthat are listening, in all
groups of ages, can understandwhere they are, and then they
can correlate those symptoms.

So menopause is when we run out of eggs.
So human females are born withour entire egg supply.
We have about one to 2 millionat birth and then by the time
then we go through a processcalled atresia, which is
survival of the fittest.
The healthiest eggs live andthen the weaker egg.
The weaker eggs kind of die offat a very quick rate.
So by the time we're 30, we'redown to about 10% of our egg

(19:28):
supply, and by the time we're 40, we're down to about 3% of the
original egg supply.
And menopause represents the endof eggs, ovulation and the
production of our sex hormones,which is basically estrogen,
progesterone and testosterone.
Now we have other sources oftestosterone, so I'm going to
leave that out of theconversation for now, but

(19:52):
estrogen and progesterone.
Um, ovulation begins in thebrain.
So we have a gland in our braincalled the hypothalamus.
You and I know what it is andit is always looking for
estrogen.
There's a little wire justpretend that goes into the blood
and is like where's theestrogen?
So when estrogen levels startdropping off after ovulation, it
says Whoa, I want more estrogen.
So it starts sending signals tothe ovary.
It's basically something calledGnRH talks to our pituitary
gland Pituitary makes LH and FSH.

(20:14):
Those go and bind to the cellsaround the eggs to create
estrogen and then progesteroneafter ovulation.
So we have this beautiful EKGlike ebb and flow of our monthly
cycles in a healthy woman whois pre-menopausal.
Okay, month after month.
You know, on day 12, you'regoing to do this day 18.
You're going to do that Now ifyou have, if you have

(20:35):
hypothyroidism or PCOS.
This is not you, right?
But this is a woman who has anormal monthly cycle.
Here comes perimenopause.
The brain detects low estrogen,the signals go to the ovary but
we don't have enough eggs torespond like we used to.
So the brain is like, hey, Ishould have gotten my estrogen
by now, I don't see.
It Starts pumping more and morehormones from the brain to the

(20:58):
ovary so that FSH and LH getshigher and higher and higher.
Boom, we get the ovulation.
We get these surges inestradiol, much higher than we
ever did in our normal menstrualcycle.
So what used to look like anEKG now becomes very chaotic.
We have delayed estrogen.
Very erratic, sporadic ebbs andflows, and progesterone never
kind of catches up to where itused to be.

(21:19):
So I call it the zone of chaosand it becomes more and more
chaotic until the whole thingit's like a jalopy and just
until you're out of eggs andthat is full menopause.
That chaotic zone can lastseven to 10 years.
So before your cycles everbecome irregular, the brain
knows something is wrong.

(21:41):
So in perimenopause, quite oftenthe first signs and symptoms
that we see begin in the brainsleep disruption, mental health
changes, cognitive changes inbrain.
Fog Periods are still regular,but the brain is working harder
and harder, which is affectingour levels of neurotransmitters.
Okay, serotonin, dopamine,norepinephrine all of them start

(22:05):
becoming a little bit moreerratic.
So we don't.
The brain doesn't function aswell.
All of them start becoming alittle bit more erratic.
So we don't.
The brain doesn't function aswell.
So 70% of us will complain ofcognitive changes, 40% increase
in mental health disordersacross the transition.
Now those are the people comingin complaining and getting a
diagnosis.
Imagine how many people neversaid anything and just kind of
dealt with it.
So perimenopause, actually thefirst symptoms we see are in the

(22:25):
brain.
All of a sudden, you're notsleeping as well as deeply,
you're waking up in the middleof the night, you're struggling
to go to bed, more nighttime,anxiety, restless legs we're
just seeing you know before yourperiods ever become irregular.
Now here comes the joint pain,here comes your elevated
cholesterol.
Actually, a beautiful studyjust came out of I think it's

(22:46):
China, somewhere in Asia.
A beautiful study just came outof I think it's China,
somewhere in Asia, where they'relooking at small dense LDL
particles as a marker ofperimenopause, because we don't
have a good blood test forperimenopause.
But it looks like tracking thisone particular LDL particle is
going to be really good becauseit doesn't increase with age,
only with menopause.

Is that why women post-menopause are at
higher cardiovascular risk?

Yes, so across the menopause transition, like
I said, 2 to 3X syndrome.
So we lose the elasticity inour endothelium, so we have
increased blood pressure.
So, yeah, the arteries, so ourarteries, become stiffer, so we
have elevated blood pressure, wehave much higher levels of
insulin resistance inprediabetes and of course then

(23:31):
diabetes, and all of that leadsto, and of course our LDL goes
up, our HDL tends to decline,ldl goes up higher than HDL
drops, but all those threetogether is the trifecta that
leads to increasing risk.
And there's something, thisanti-inflammatory property of
estrogen, that decreases therate of plaque deposition that

(23:53):
you see in a pre-menopausalwoman.
She's protected against thataccelerated plaque deposition
where she loses that when shebecomes post-menopausal.
So we do lag behind men forabout 10 years in the risk of
cardiovascular disease once wego through menopause, but then
we pass them up.

Dr. Mary Claire Hav (24:09):
Interesting , and that's the reason why our
endothelial cells have estrogenreceptors right.

Yes, and that's what we think.

Interesting .
So at what point, then, in theperimenopause, should a woman
adjust her hormones with actualHRT?

Well, this is all expert consensus, because
there's not been a single largestudy done on the treatment of
perimenopause.
Nothing, we have nothing.
That's shocking, so it is abunch of experts who get
together and like my friends onour group chat on WhatsApp, the
menopause and like how would youtreat this?
What if she comes in with this?
We're like, okay, earlyperimenopause, she's still

(24:49):
cycling regularly, she's havingmental health.
You know it really have to lookat it symptom by symptom.
But really the sooner, thebetter we know for mental health
, the sooner we support theestrogen, the better we know for
sleep, for and especially forcognition and risk of long-term
dementia.
The earlier you treat, thebetter, including early
perimenopause and forcardiovascular disease risk.

And then let's say you haven't gotten the
early treatment and what is thecurrent consensus in initiating
HRT treatment?

So it depends on what you're trying to prevent
, right?
Hrt is not FDA approved forprevention of anything.

True.

Sorry, except for osteoporosis.
But the U?
S preventative task force hasnot.
You know, again, they're notall agreeing right and the task
force so, like people who are inthe old menopause, are saying
well, the U?
S PTF is not recommending it,so we can't recommend it.
Yet the FDA has approved it forprevention of osteoporosis, for
prevention of osteoporosis.
So you know what I'm just gonnado.
What's right for the patient andif she wants to prevent

(25:53):
osteoporosis I'm going to talkto her about this is the most
effective way to do it, you know, is hormone replacement is not
be menopausal and we have anartificial way to do that with
hormone replacement therapy.
If she wants to preventcardiovascular disease, that's
different.
Estrogen is better atprevention than cure, so you
need to get it on board beforeshe develops those calcified
plaques.
So the only way you know thatin an older patient with risk
factors is to get a calciumcardiac score and then use that

(26:16):
number to help guide yourtreatment options.
So I can't promise hercardiovascular protection after
the age of 60.
Now maybe if she doesn't haveexisting cardiovascular disease,
we may be able to get her a fewyears, but starting the younger
the better.

So let's say, 10 years after menopause.
You see your 10 years postmenopause and they say you know,
these studies show that ideallythis works if you do it within
the first 10 years, correct,Right?
Does a woman get any benefitsif they do HRT after that time?

Yeah, certainly if she is having, if
she's still symptomatic as faras based on motor symptoms, yes,
she will have benefit.
No doubt no one's arguing withthat.
There was a great study thatcame out looked at Medicare
beneficiaries who were continuedon HRT after the age of 65.
Okay, so women who kept goingafter 65 had lower all cause
mortality.

(27:08):
They lived longer, they hadless cardiovascular disease and
less dementia.
That is something worth payingattention to.
Hot flashes are the bell ringerof stroke, cardiovascular
disease and diabetes.
If she's still into her 60s andhaving hot flashes, I can't

(27:29):
promise we're going to preventthose diseases.
But you know you want toprevent her hot flashes.

Interesting Because she's not sleeping
Right.
Well, I mean, I think anyonelistening to this either knows
someone or is someone that hasthese symptoms in menopause or
postmenopause, mean it's uh, itbaffles me why we don't have
enough studies when it's themost common it's a hundred

(27:55):
percent of it.
It's the most common.
Yeah, right, so, and we don'thave enough studies.
What is?
Is it because it's not um,doesn't have enough incentive
for pharmaceutical industry?

is it because, like, that's, that is a problem
, right?
So the nih they had a billiondollar grant.
It was the biggest study inwomen's health ever was the whi.
We were so happy and so excitedthat women were finally being
studied, and then the wholething got cocked up, right?
So then that scared the NIH offof anything clinically
reasonable in hormone therapy,right, like not even a

(28:30):
discussion.
So then you have big pharma.
All they're working on areCERMs, selective estrogen
reuptake modulators, so sothings that are, you know, kind
of look like estrogen but work alittle bit differently, and we
need those.
There are patients who can'ttake estradiol or shouldn't
because of risks, and so CERMscome in really handy for them,
but they're not, you know.

(28:50):
And then there's VOs that justtreats them.
A regulatory center in thebrain, that's it.
It doesn't treat your bones,your muscles or anything else.
It's not the root cause.
So but as plain oral estradiolis $2, nobody makes money off of
that, it is $2.
So no one cares.
It's's like when you look atthe economics of it hrt is cheap

(29:13):
so but it's easy.

Therefore , it's easy to conduct a study,
right, I mean?

you would think.
But to get that thing approvedis really hard, and you know I
don't want to get into politicsbut getting anything approved is
really hard.
But you know I don't want toget into politics but getting
anything approved is really hard.
But you know, stepping outsideof the NIH, there are still
studies going on.
Lisa Moscone has just been ahuge grant it is from a

(29:40):
pharmaceutical like foundationto look at what is the
connection between menopause andAlzheimer's disease, and she's
not having to publish, you knowshe.
They're not forcing her topublish papers every five
minutes.
She just basically is focusedon outcomes and she thinks she
could do it in three years.
So there is some innovationgoing on with how we're doing
studies, um, by you know, and soI'm I'm really positive about
that, and there's still tons ofstudies going on outside of the

(30:02):
U?
S.
So don't give up hope, you know.

Yeah, no, it's, it's just, uh, it's sad
there's many fields in inmedicine that don't get funding.
They're so crucial because ofthat issue that we're talking
about and you would hope, atleast you know, there would be,
you know, private funding, or atleast academic institutions.

They would support that just for the sake
of medicine and advancing health, and it's just, you know this
country is about to have thebiggest wealth transfer in the
history of the world from men towomen, as this generation dies
off and money goes to theirwives.
And these women don't buyrockets and they don't buy jets
and yachts.
They invest, and they invest inresearch and philanthropy.

(30:43):
So we're hopeful that we'll beseeing more yes this kind of
research coming out.

Yes, so what do you?
You know, let's talk about somepractical stuff for women.
Listening to this, what aresome of the things that women
can do?
By the way, can you, if youdon't get hormone replacement
therapy, can you do anythingthrough lifestyle changes to
improve?
The symptoms and theprogression.
Can you kind of give us somepractical advice, and you're so

(31:13):
good about it on your socialmedia.
But I just want for ouraudience, our listeners, if you
can kind of guide them with verysimple, practical things that
are doable and sustainablelong-term.

So when I, you know my patients leave clinic
with a toolkit, I'm not justgiving them estrogen and
progesterone, it's not just ahormone clinic.
I don't do that Right.
They get a whole lifestylerecommendation.
I have a body scanner where I'mmeasuring visceral fat and
muscle mass, and we're havingdeep conversations around
longevity and I call it nursinghome prevention.

You, know , women live longer than men
like by five years.

So no woman I know wants to live to 120.
She just doesn't want to be ina nursing home.
That is our goal.
So I'm like, okay, I got you onthat one Weightlifting, you
know what.
Muscle preservation andbuilding muscle.
The most geroprotective thingin the woman is the muscle and
the ovary, and we lose ourovaries.
So those are the two things.

(32:08):
So how do we do that?
Make sure you're gettingadequate protein, so many?

women are not getting enough protein in
their diets to sustain musclemass.

So I didn't, I didn't.
I was focused on weight loss myentire adult life.
Like, stay small, stay small,stay small.

And it's so beautiful now that I'm
getting bigger and if you go tothe gym you see a spinning class
or some aerobic class, it'sfilled with women and you go
into the weightliftingdepartments only men and there's
getting better?

I think so.
I, you know, like my generation.
They hear the call.
Everyone's buying weightedvests, they're joining gyms,
they're hiring trainers.
They're you know, they'rehearing the message that this
muscle is going to protect mefrom the last 10 years of my
life being plagued with chronicdisease and frailty.
They don't want that.
They're getting it.
Adequate protein, adequatefiber.

(33:00):
Most women in the US are onlygetting 10 grams of fiber per
day.
We need 35 to 45.
Fruits vegetables.
Fruits and vegetables, wholegrains, seeds, legumes, nuts,
you know, like plants andprotein.
That's what I tell my patients,especially on GLP-1s.
I am like plants and proteinare your goal.
Don't look at anything like.
That is what your foundationshould be your protein, and then

(33:22):
fill the rest of the plate withplants.
We have a 30 plant a weekchallenge.
Can you get 30 different plantsin your diet per?

week.
I don't even know if I know 30plants.
I gotta look at that.
Um top of my head I could comeup with 12, but jeez, I gotta
look at that so movement stressreduction, you know like well,
that's easier said than done.

Oh my god, your cortisol levels are high.
You're a woman yeah, like howare we gonna bring them down?
You know I'm like oh, yourcortisol levels are high.
You're a woman Like how are wegoing to bring them down?
You know, I'm like don't watchthe news.

Don't watch the news.

Get off your phone but like take that time to
like sit in silence, meditate,journal, pray.
You know what is it going totake to bring you back inside of
yourself.
Do a gratitude To me.
Gratitude journaling changed mylife.
To sit down and write all thegood things in my life every
morning, how do you?

motivate patients.
I do that personally and Ialways talk to patients about it
.
I realize as soon as I tellthem that their eyes start going
to the sides, they think, likethis is like woo-woo stuff.
How is that going to help me?
It's easy for him to say how doyou get them to actually buy
into it?
They have to help me.

(34:31):
It's easy for him to say yeah,he's, you know, it's it's.
How do you get them to actuallybuy into it?

they have to buy into it.
I talked about the time I hitrock bottom and they and like I
was desperate, I like had to dosomething because I was gonna
can you?

can you talk us?

uh, talk to us a little bit about that I was
in the pause and I had twoteenage daughters and my older
daughter.
I just felt like I lost her,like I lost any, any real
connection with her.
And this is my daughter inmedical school now.
You know, like, like, on thesurface it just looked like
everything's fine, she's goingto go to med school, she's a

(35:02):
straight A student, she lookslike me.
But I just felt like I didn'teven know her anymore and I
wanted that back and I had tostop blaming her for that and
look into what I could do.
So I got therapy and I alwaysthought it was woo woo.

Did you used to blame her oh?

totally, Totally Blamed her.
She doesn't understand, shedoesn't appreciate but like but.
Then I thought back to myrelationship with my mother,
which is not a place.
I saw she and I heading towardswhere I am with my mom and I
didn't want that and I realizedI had to change.
She was the kid and that thiswas me as an adult and my

(35:40):
responsibility and I was riskingthat relationship with her for
the rest of my life.
And it was hard and it was overtwo years and and it's never
going to be perfect.
But, like me, working on mechanged everything, everything
in my life.

And they call my relationships better.
How did you do that?

I got therapy.
I worked through some of mytrauma.
I, you know, went throughcognitive behavioral therapy.
I learned how to self-regulate.
My daughter was asked to gointo her own therapy, which she
did, and I, you know, writingchecks left and right for
whatever she wanted and it it'sso much better and it's made
everything better and it justreally made me appreciate how

(36:26):
all of us have something right.
All of us have have trauma butlike we've got to come back to
ourselves and, you know, I lovemyself now and I'm doing good in
the world.
And one of the most powerfulthings when I feel like that,
you know I get dragged on socialmedia or have a you know
colleague.
You know want to take me downfor something.
What do I know is true?
Want to take me down forsomething.

(36:48):

You.

I am a good person, my intentions are, are
pure, my you know, maybesometimes I don't say the right
things, but you know, taking itback to yourself and taking that
time to write down what is goodabout me and you know forever.
I was always so self-criticalyou're not working hard enough,
you're not this enough, you'renot that enough.
And I really think menopausehas given me the permission,
that gift to give myself, youknow, because if I didn't, I
wasn't going to make it wow,what a powerful story and how

(37:23):
long did it take.

How how long was that process?
And how's your relationshipwith your daughter now?
Do you guys ever talk aboutthose times?
It's funny.
Does she know what you wentthrough?

I mean, she's in the grind, she does.

Because that would be very valuable for
her if she hits that point atsome point in her life.
You know, remembering how itwas with her mom.

She's studying for step one in the other room,
so you know she is in the grindright now.
I hope she's studying for stepone in the other room.

So you know she is in.
I hope she's listening secretly.

She's like we were with some elderly
grandparents who were reallystruggling and I was I was
trying to juggle, you know,cleaning and you know, all
trying to act like everything'snormal, when we got two really,
really sick grandparents and shekind of caught me in the corner
like heavy breathing, and I waslike I'm trying to
self-regulate.
She said I see you, mom, I seeyou, it's okay, you know, and I

(38:16):
really felt like that was aconnection, you know, like I was
like okay, okay, okay.

And so, out of when you share these
stories with your patients andyou try to motivate them to,
basically you're, you're tryingto make them buy into the
treatment, the stuff that theycan do, and it's always hard to
sell someone a treatment regimenthat involves, um, the patient
put in, putting in a lot of timeand effort themselves, as

(38:46):
opposed to just a pill.
Right, I mean that, mean thatis a hard sell.

So what I frame is the outcome, and the
outcome is not looking good in abikini or whatever.
It is avoiding the diseasesthat are plaguing her elders.
And if she's taking care of anolder parent or aunt or
grandmother, or watch thedisease and suffering.
She's motivated.
I just have to point it out.
And then they're.
They're like, okay, I'll doanything not to be like that,

(39:13):
not to burden my children, notto have the decisions I'm having
to make for people who can'ttake care of themselves anymore.

You know, I don't want to live like that,
that's a great most motivatingthing doesn't it require a lot
of self-awareness from thepatient standpoint though?
I mean, don't you have patientsthat they always blame the
outside for whatever miserythey're in and don't necessarily
buy into an outcome thatinvolves them putting a lot of

(39:42):
work in?
How many percent of yourpatients would you say?
I want to know your experience,and I'm being a little cynic on
purpose.
I want to play devil's advocatehere.

Most of my patients follow me on social
media, so they've been on ajourney with me, right?
Because?

it takes a long time to get into seeing
and they follow and they watchand they've read the book.

So I'm so lucky that.
I'm not meeting strangers, Idon't know them, but they're
coming in and they knoweverything about me and what
I've said and what I've read.
So that's a little bit uniquein my practice, because they are
already bought in and they justwant to know the numbers.

Okay, let's talk about the time where
you didn't have a social mediaplatform.
By the way, when did you startthis approach?
When did you get into menopause?
I did you.
When did you start thisapproach?
When did you get into menopause?
I know you said like what, 2018?
Was it?

2018 was when I launched.
I started kind of like playingaround on social media and
women's health.
In like 2015 is when my brotherdied and when I started working
on nutrition end of the program,and so I was kind of mark
everything by then.
So it's been about 10 yearsthat I've been doing this.
Now I was growing kind ofsteadily.
And then COVID I really blew upon TikTok, so that was like the

(40:57):
first way where I hit 2 millionlike within a year.
And then Instagram kind of tookover and when reels launched,
and so now we're at about 2.7million on Instagram.
So I have over 6 million acrosslike the big four YouTube,
Facebook, Instagram, six and ahalf million.
So that's been a few bursts,but fairly, you know, it's been

(41:19):
tracking for about 10 years.

So it so obviously it's easier for you to
have your patients buy intoyour trip, because they're
already listening to yourcontent.
They're already, so to speak,primeded.
How was it before that, though?
Um yeah, so when I first openedthe clinic.

Yeah, so you know it takes me an hour to see
the patient and I've steppedoutside of the third party model
and so I just have a one-on-onerelationship without an
insurance company telling mewhat I can and can't do.
And I have no, I am the boss,which is the funnest thing ever,
and so, and if I need to takemore than an hour, I do, but
like, I schedule a good solidhour of face-to-face time with

(41:57):
the patient, so we have time tokind of work through and I have
extensive paperwork they doahead of time, so I know their
family history, their medicalhistory.
I know what their chief thingsare when they get there and we
can really just start drillingdown and and helping her kind of
craft what she wants, what areher goals and how are we going
to meet those?

And so how did you?
Because that's very interesting, for we have a huge audience of
physicians listening to mypodcast and I'm sure there are
many I know personally know them.
They're contemplating thetransition from going away from
the third party model, thatparty model like you have, which
can be a little scary which isscary because you know it's not

(42:38):
very predictable.
You're not gonna, you don't knowhow your business is going to
or whether or not your businessgot.
So how did you obtain thecourage to do that and how was
it in the initial stages for you?

so I had always been employed.
I had just walked into anemployee contract for every job
I've ever had I've had three,you know and I just showed up
with my stethoscope and mylaptop or my iphone, you know,
and went to clock in, clock out,clock in, clock out of.
Clock in, clock out?
Of course we never clock out,true, always doing stuff.
So, you know, I knew I had goodrapport with patients.

(43:15):
I knew, like, once I got themin the door, like that would be
fine, I took my girlfriends outto dinner like six of them and
said, okay, I'm dreaming ofopening this clinic.
Would you come?
Like, would this be somethingyou would come?
We're not going to takeinsurance.
And would you come Like, wouldthis be something you would come
, we're not going to takeinsurance.
And like it was overwhelminglyyes.
Like, if you don't do this, youhave to do this.

Like this is your passion, this is what
you're doing, so I got buy-infrom my like six mom friends,
right, I did not know how toopen a practice.

I like had to go buy a guide like the idiots.
And I had a few friends inconcierge medicine.
I didn't want the exact likemonthly payment concierge model,
but I talked to a ton of people, a ton I interviewed with a
couple of concierge practicesdidn't feel like the right fit
and I think I really just wantto do this on my own.
So my CEO at the time COO, waslike here I'll help you build it

(44:07):
.
She was my office manager, butwhen you, I didn't need a nurse
because I'm not doing physicalexams.
I didn't need seven people inthe back office running
insurance forms.
We were just collecting moneyup front.
I mean, I went through thestate guidelines to make sure we
did all the things.
And I threw up a shingle andstarted advertising on Google
and for local patients and so,and talked about a little bit on

(44:29):
social media and I had a prettybig email list at the time so
we just, kind of, on a wing anda prayer, figured out what it
would take for us to break evenwhat would we want in
profitability, how many patientswould that take and figured it
out, you know.
And so did we make mistakes?
Yes, would I do it a little bitdifferently?
Yes, but now we have, you know,we've bought our own building.

(44:50):
I rented for three years.
We bought our own building.
I have another physician andthree nurse practitioners and we
have a waiting list of over athousand.
So it was profitable.
So if anybody out there islistening and you want to do a
no third party model, however,you want to decide what you want
to charge, so that's reasonablepractice you can do it.

(45:12):
Women need this care.
They are desperate for thiscare.
I now have patients flying fromall over the US to come and see
me because they can't findanyone near them who can do it.

I know.
That's why, before this podcast, I asked you, because I have a
lot of women asking me and Ihave trouble sending them
somewhere.

Yeah, Like you shouldn't fly it.
You have to fly it.
I mean I'm honored, but I meanmy God really I know, yeah, I
know For menopause.
So the Menopause Society has alist of certified providers on
their website.
That's a place to start.
They're not all perfect, but,you know, call ahead.
We have have a resource ofrecommended physicians on our

(45:52):
website, recommended by myfollowers.
So we have several hundred thatthey've written testimonials
for, and we've organized them bycity and state and country.
And then, um, there are greattelemedicine platforms out there
that are built specifically totake care of menopausal women.
I will leave off the ones Idon't love, so I'm going to talk
about MIDI health, alloy healthand ever now, ever now.
Uh, vetted all three.
Looked at their treatmentprotocols.

(46:12):
They're legit, um, and very,very reasonably priced.
Midi takes insurance, so theydo use the insurance model if
that's the route you want to go.
The other two are very, veryreasonable.
So there are options out thereif you can't find any one local
are those links on your websitefor me, yeah, so we have on our
website something called themenopause empowerment I'll put.

(46:33):
I'll put the link for theaudience on the 14 pages long
and it's like questions to askyour doctor, lab test to ask for
how to find a physician.
It has tons of links, basicnutritional recommendations, the
fiber, the calcium, the vitamind all the stuff that I would
recommend in menopause that'sall there and it's free.

So where do you see the signs of
menopause and women's healthgoing into the next decade?
I'm sure you're at theforefront of this, so you're
probably the best person to askthis.

So I feel like .
So I get reports from mydaughter, so she's just finished
second year.

Is she going to do OBGYN?

She says absolutely not.
Oh, okay, I think she'd love todo women's health.
She just doesn't want to sufferthrough obstetrics, right?
And so I don't know if shelikes psychiatry or internal
medicine.
We'll see.
She hasn't done her wards yet,so we'll see what she does.

Well, at least she went into medicine.
None of my kids are interestedin going it's like okay and
going it's like okay.
Well, my other baby's doing prand marketing, so nice, that's
exciting.

the other direction.

That's um yes so the next decade I feel
like it in.

It's probably a decade away from a woman being
able to confidently walk intoher clinician's office and
expect to have a reasonableconversation.
You know we just are going tohave a big train and lagging in
education.

Even with social media and AI.
You think it's going to take adecade.
That is so depressing.

To like get up to speed and reading and
understand.
I mean, you know, my book iswritten for lay people, not
clinicians.
The Menopause Society they onlycertify twice a year so it
takes about six months.
So like, who has that time whenwe're all busy clinicians, you
know.
But if you have a specialinterest and you want to carve
out the time, you have to gooutside of your training to be
able to do it.

So you think just the access to people
like you is going to be thelimiting factor, not the
information?

Right For right for now, yeah, just find
someone who's comfortable areyou serious?

yeah that is the most depressing news
I've heard.
I don't know there's.

You know the telemedicine platforms are
growing.
We have we're have stopgaps,you know, to get us through.
But we're gonna have to retrainour practicing clinicians or
give them.
It's gonna take months.
You know it's not.
It's not a weekend course yougo take in your menopause
certified.
It's hard what does?
Every organ system in our bodyyou know, some days I'm a
psychiatrist or an internist oran auto, you know or

(49:00):
rheumatologist so what aboutthese concierge practices, these
primary care medicinephysicians that have concierge
practices?

they, they spend a lot of time with
their patient.
I mean, I feel that should betheir purpose in a way, because
they have already the businessmodel, so knowledge can't be an
excuse for them.

Did they get the training?
Did they go outside?
You know, depending on whatthey learned in their residency,
they most likely have notreceived adequate clinical
training to take care ofmenopause oh my gosh.

Well, um, that is not very good news.
I did not expect that yeah, umso where do you see the role in
in men in this?
How can men support?
The women, um their wives,their spouses, um have you, you

(49:59):
know, thought about that and doyou involve men of the spouses?

I tell you my my best visits with patients are
when their partners come in.
So, um, and because the partnersare usually venture into a
gynecologist office, or they arebecause they care.
You know, no one wants to be inmy office with me to be there,
and so they are coming from sucha place of they love this
person, they want to understandthis person, they understand

(50:25):
that this person's been hijackedby this hormonal shit, by this
natural transition, and theywant to understand so that they
can be more supportive.
So the, you know, the bestpodcasts are going to be this
one.
You know, when I'm interviewedby men, it's a really different
vibe than when I'm interviewedby women, because you're coming
at it from a place ofunderstanding versus someone who
needs to share their story, andthere's nothing wrong with that

(50:47):
.
But I feel, like my you knowarmchair expert, steven god,
I've done so many with with justguys um, that those are better
for guys because they're askingthe dude questions, you know,
and it really helps get yourmind wrapped around what she's
going through and you know thereason.

And the reason why I'm asking is because
you know the part of menopause,the psychological and the
sexual aspect of menopause, thataffects couples and affects
relationships.
I mean, there's couples andmarriages where they love each
other.
But you know, psychologically,you know, or the women because

(51:34):
of the desire.
Mismatch, you know, as well asyou know depression, you know
atrophy.
You know, things aren't all ofthose will affect them the
frustration and then and thenthe men might not understand.
they might blame either, uh, thespouse or blame themselves,
because they don't understandwhat's going on right so, uh,

(51:58):
how do you?
I mean, it's almost like a sortof a couple's therapy that that
you have to sometimes do, don'tyou?
Sometimes um or you just referthat to the couple's therapist
and you just focus on themedical aspect they, if they're
coming into the office, they arecoming to learn.

They are coming.
I'm not, they're not coming infor me to be the referee, right?
They just want to understand.
And so it's less therapy for meand more education and like,
how can he help?
You know, and really it'scoming at it from a place of
understanding.
This is not her fault.
This, a lot of this, is fixable.
You know.
A lot of this is going to evokea change.

(52:39):
You know and can you adapt tothis?

yeah, I mean I think that that
mismatches what's in between alot of relationships and you
know the lack of understandingfrom the self-awareness from the
women's side, but then lack ofunderstanding from the men's
side, not understanding thatthese symptoms are not related
or as a result of you know thembeing the cause and the fault,
and rather a medical condition.

(53:04):
You know a physical, medical,physical, physical condition.
So any advice you want to sharefor women that are cynic, are
really set in their ways tobelieve their physicians.

(53:25):
That told them yeah.

Listen to your body.
You know that for the vastmajority of patients, menopause
hormone therapy is safe, but itdoesn't.
It's not in a vacuum.
Lifestyle is very important.
You know prioritizing yourself,your needs, your wants, your
sleep, limiting alcohol, makingsure you're getting up, exercise
, you know all of those thingsare are helpful.
But you know if you've beentold you can't take hormones,

(53:52):
they don't believe in hormones.
It's going to kill you.
I don't.
You know you need to.
It's okay to change doctors,even if it was a great doctor
who delivered your babies anddid great care.
There is definitely some biasthere that women tend to.
You know, I grew, I grew up inthe medical system where women,
where I was taught, I was taughtthat women tend to somaticize

(54:12):
psychological disorders.
This is never true.
This is not true.
Women are having very realphysiological symptoms due to
this complete overhaul of theirhormones, and just dismissing it
as aging or just you know she'sbeing annoying or this should
just be a whisper ofinconvenience and she's just
being dramatic is a mistake andyou deserve better.

Last question, Mary Claire, what
would you tell your own selfwhen you were a OBGYN resident
who just is about to graduatenext month and so excited about
taking on your new chapter, thenew chapter in your life and
practicing OBGYN and thinkingyou're going to help a lot of

(54:57):
women with their health?

I would tell her there are gaps in your
knowledge.
You've learned so much, so manybeautiful, wonderful things,
but you don't understand whathappens when the ovaries stop
working.
And this is something you'regoing to have to learn to
understand.
Or you're not going to helpyour patients Because I'll tell

(55:20):
you, I was a terrible menopausedoctor for most of my career.
To be absolutely honest, when Ithink of the words that came
out of my mouth, the things thatI mirrored and parroted from,
I'd heard from other cliniciansjust have wine, just relax, this
will pass.
Estrogen might hurt you.
You know we're only going togive you this if everything else
fails.

(55:40):
You know all the patients I puton Neurontin and Clonidine and
you know for their hot flashesbecause I was terrified of
estrogen.
I'm sorry, I didn't know what Ididn't know and I'm making it
my job in life to undo that harmthat I did to patients.

Wow, wow.
So I hope your colleagues arelistening and the freshly
graduating OBGYNs are listening,and I'm sure they are.
But that was Dr Mary ClaireHaver, and I hope this
conversation gave you more thaninformation.
I hope it gave you power.

(56:19):
If you're going throughmenopause, just know you're not
alone, you're not crazy andyou're definitely not invisible.
And be sure to pick up her bookcalled the new menopause, and
share this episode with a friend, your partner or even your
doctor, because you need tospread awareness, shift the

(56:41):
narrative for sure and bringwomen's health into the
spotlight, where it belongs.
And whether you are a plasticsurgeon dealing with women that
want to help them with theirtransformation, a health and
wellness doctor, a personaltrainer, a nutritionist, a

(57:04):
primary care or an OBGYN, Ithink we have a bigger
responsibility and it's our dutyto do our research, obtain the
knowledge so we can best helpthem, and rather than blaming
the system or throwing our armshelpless in the air and blaming
the patient for lack ofmotivation.

(57:27):
So thank you, mary Claire,truly honored to have you on the
podcast and keep, keep it going, please.

Okay, take care.

Thank you , take care, bye, bye.

All Episodes

Your Body Is Not Betraying You: Understanding the Science of Menopause - with Dr. Mary Claire Haver

Episode Transcript

Popular Podcasts

On Purpose with Jay Shetty

Dateline NBC

24/7 News: The Latest

.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Your Body Is Not Betraying You: Understanding the Science of Menopause - with Dr. Mary Claire Haver