Today, I am thrilled to reconnect with a previous guest, Dr. Mary Claire Haver.
Dr. Haver is a board-certified OBGYN, a certified menopause provider, and the founder of Mary Claire Wellness, a private medical practice focusing on women in midlife. Her best-selling book, the Galveston Diet, and her latest New York Times best-seller, The New Menopause, are fabulous resources for middle-aged women.
In our discussion today, we dive into various aspects of perimenopause, looking at the associated challenges. We discuss factors accelerating ovarian aging, the role of contraception, mental health shifts, and the often delayed diagnosis of premature ovarian insufficiency. We examine the differences between hormone replacement therapy and oral contraceptives, discussing the importance of advocacy for women's health and the benefits of vaginal estrogen. We explore the disparity in federal funding for women's health research, the impact of the Women's Health Initiative, body composition changes, the estrabolome, the 30 Plant Challenge, and the advantages of HRT. Dr. Haver also talks about her preferred supplements.
I'm sure you will find this conversation a valuable resource that you will likely revisit several times.
IN THIS EPISODE YOU WILL LEARN:
Why perimenopause is so fraught with chaos
Some of the factors that hasten ovarian aging
How perimenopause causes significant changes in neurotransmitters, leading to cognitive changes
The differences between HRT and oral contraceptives
How estrogen loss during menopause affects vaginal tissue
The benefits of vaginal estrogen for symptoms of menopause
How women's health research funding prioritizes reproduction over menopause and perimenopause
How HRT can help with fat loss and muscle mass in postmenopausal women
The emergence of eating-disordered behaviors in menopausal women
Some of the lesser-known symptoms of menopause and ways to overcome them
How HRT could impact the longevity and cognitive health of women
Bio:
Dr. Mary Claire Haver is a board-certified OB-GYN who has devoted her adult life to women's health. When she began to experience the changes of menopause and mid-life weight gain, she created her online program, The Galveston Diet, which currently has over 80,000 students. The Galveston Diet is the first and only nutrition program in the world created by a female OB-GYN, designed for women in menopause.
As part of her ongoing research, she became certified in Culinary Medicine in 2019, specializing in medical nutrition. In 2021, Dr. Haver opened Mary Claire Wellness; the clinic was born out of repeated requests from the Galveston Diet students and Dr. Haver's social media followers for personal guidance.
Dr. Haver lives with her husband and two daughters in Galveston, Texas. She is the author of The Galveston Diet (Rodale; January 10th, 2023).
“In perimenopause, the stimulating hormone signals that come from the brain don't work as well and we become resistant to them."
-Dr. Mary Claire Haver
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Submit your questions to support@cynthiathurlow.com
Connect with Dr. Mary Claire Haver
On the Mary Claire Wellness website
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of reconnecting with Dr. Mary Claire Haver. She has been a previous guest, and she is a board-certified OBGYN, a certified menopause provider and the founder of Mary Claire Wellness, a private medical practice that focuses on women in midlife. Her best-selling book, The Galveston Diet, and her New York Times bestselling book, The New Menopause, are incredible resources for middle-aged women.
[00:00:55] Today, we spoke at length about the zone of chaos of perimenopause, what hastens ovarian aging, the role of contraception in perimenopause, mental status changes, the impact of premature ovarian insufficiency and the delays in diagnosis, differences between hormone replacement therapy and oral contraceptives, the role of advocacy for women's health, genitourinary symptoms of menopause and the role of vaginal estrogen, how the NIH advocates $5 billion in federal funds for women's health and only $15 million for menopause, which is less than half a percent.
[00:01:37] The impact of the Women's Health Initiative, the role of body composition, the estrobolome and the 30-plant challenge, benefits of HRT, and lastly, her thoughts on her favorite supplements. I know you will find this to be an invaluable conversation and one that you will listen to multiple times.
[00:01:59] Well, Dr. Haver, it's such a pleasure to have you back on the podcast. I've really been looking forward to this conversation.
Dr. Mary Claire Haver: [00:02:04] Same. So glad to be back here.
Cynthia Thurlow: [00:02:06] Absolutely. So, I'd love to start the conversation around some of the terminology that you've utilized about perimenopause. I think for a lot of listeners that have not yet made that transition into menopause, and you coin it properly, talk about this zone of chaos. Why is perimenopause fraught with chaos?
Dr. Mary Claire Haver: [00:02:27] The best I can explain it is to do some basic endocrinology, so people can understand. So, human females are born with all of our eggs. We have a finite supply, and menopause really represents when we run out of them, okay? So, in a normal, healthy reproductive cycle, which is probably 85% of women, we have ovulation each month. The rise and fall of our hormones is dependent on the rise and fall of stimulating hormones coming from the brain.
[00:02:58] So, let's back it up. The hypothalamus is a big gland in our brain, well, medium like walnut size, and it's constantly sampling our blood supply for estrogen. When those estrogen levels naturally get low in the certain times of our cycle, it sends a signal to the pituitary, another gland in our brain, to say, “Hey, make the stimulating hormones, so that the ovary can ovulate an egg, and we'll get our estrogen levels back up.” This is a very predictable EKG like curve each month. So, we know what, for certain women on day 12, she's going to do this. On day 18, she's going to do that. We're going to have these levels that are very predictable each month. The brain loves predictability.
[00:03:38] So, what happens in perimenopause is wherever that is for you, each female reaches a critical threshold of egg supply. And also our eggs are aging with us, so there's also dysfunction within the egg itself because it's old, for lack of a better explanation. So, the same signals that come from the brain don't work as well. We become resistant to those stimulating hormones. So, normal signals get sent down, the ovary can't quite get the egg out, can't quite get those estrogen levels up. The hypothalamus gets mad and says, “Hey, where's the estrogen I was looking for?” And the pituitary is like, “I sent a signal.”
[laughter]
[00:04:18] Hypothalamus says, “Send more.” So, the pituitary ends up getting a bigger burst of this LSH and FSH in order to get the ovulation going. And so, we end up with maybe two eggs ovulating that month. We get much higher estrogen levels typically than we would have in our normal reproductive years. And then we have this crash of estrogen, much lower than we would have in our regular reproductive years. And then progesterone, in that second half, never quite gets up to where it was. So, what used to be this very predictable EKG like month to month to month to month suddenly becomes a zone of chaos, where we can't predict at any point in the cycle when your estrogen is going to peak, how high it's going to be, how low it's going to dip and when progesterone is going to come into play.
[00:05:05] And so, what that looks like in laboratory testing, well, it just depends on the day. And so, it's chaotic. And so, we don't have a great blood test to be able to clearly predict if a woman is perimenopausal. You might catch it, but really, it's talking to the patient, believing her. I do a lot of blood work to rule out overlapping symptoms, like hypothyroidism and autoimmune disease, inflammation disorders, etc., nutrition disorders. But I'm not doing a lot of hormone tests, because I can usually use her symptoms to guide me into her diagnosis. Hopefully, that's not too long [chuckles] answer for a very complicated process.
Cynthia Thurlow: [00:05:43] No, it's perfect. I think the one thing that it hearkens back to me is this is where the history is so critically important. So, when we're having conversations with our patients, or we ourselves are patients talking to our healthcare team, this is why it's so important to share as much as you can, because it gives a sense of where you might be on this trajectory.
[00:06:04] Now, some people may not know that our ovaries are as old as we are. But what are some of the more common things that you see that will hasten ovarian aging? Because I think for some people, they may not be cognizant of these.
Dr. Mary Claire Haver: [00:06:18] So, we all have a genetically predetermined shelf life of our ovaries, but we can certainly speed that up. So, genetics does play a part. If your mother went through early or premature menopause, you are more likely-- It's not 100% correlation nothing is in genetics, but it does tend to-- Genetics plays a very big factor here. Lifestyle is humongous here. Oh, gosh, it just breaks my heart. But when we look at trauma and stress in females-- So, one of the greatest studies ever done on this was looking at women who were sexually abused as children, who had children, who were then sexually abused. They happened to look at the age of menopause for these women. They lost nine years off of the life of their ovaries. Nine years.
[00:07:05] So, we know that stress and trauma plays into it. We know that exposure to radiation plays into it. We know that nutrition, most likely, to some degree, plays into it. We know that smoking, you lose about two years on the ovary. We know that with a hysterectomy where your ovaries are left behind because we're cutting off a little bit of the blood flow to the ovaries, we lose four years.
[00:07:28] I did not know this until I started doing a deeper dive outside of the box of what was taught to me, and I cannot believe I did hysterectomies for 20 years without counseling patients that she would go through menopause four years sooner. You have one ovary out, you lose about a year and a half, depending on the age of when that happens. You have your tubes tied, you lose about a year, year and a half.
[00:07:52] Genetics as far as your race, Asian women tend to go through a little bit later, whereas African, American women tend to go through sooner compared to Caucasian patients. So, lots of nuances here in when that age of the ovary. We don't know things that are going to reliably extend the life of the ovary, because we don't test for those things. But we do know the things that can hasten your menopause well.
Cynthia Thurlow: [00:08:16] Well, and I think for a lot of people, understanding some of these things are outside our control and some of them are not. I too, until I read your book, did not know that a partial hysterectomy would hasten by four years,-
Dr. Mary Claire Haver: [00:08:29] I know.
Cynthia Thurlow: [00:08:30] -because I can think of how many friends who were looking for relief, they were done having children and
Dr. Mary Claire Haver: [00:08:36] Mm-hmm. Medically indicated
Cynthia Thurlow: [00:08:36] they had menstrual cycles, and they had tried every other-- IUD's, oral contraceptives, and they were just tired of the heavy cycles and went directly to a partial hysterectomy, not realizing that. To your point until you now, now now we know, but it's such an important distinction and understanding for women to think about.
[00:08:57] Now, you mentioned tubal ligation. So, I think for a lot of women, this is their main focus in terms of having some control over their reproduction when they're done having the finality of a tubal ligation. What are some of your favorite forms of contraception for women in perimenopause, who may be,
Dr. Mary Claire Haver: [00:09:18] Right.
Cynthia Thurlow: [00:09:18] -let's be honest, not every husband is signing up to get a vasectomy.
Dr. Mary Claire Haver: [00:09:21] Vasectomy. Yeah. My number one favorite is, “Take it out of her hands and give it to him.”
Cynthia Thurlow: [00:09:25] Yes, exactly.
Dr. Mary Claire Haver: [00:09:26] So, if the patient is having heavy, heavy period and she needs contraception, I love a progestin containing IUD, because it's going to concentrate progesterone in the lining of the uterus, thin that lining out to where her periods become not a life disrupting factor. Not enough progesterone escapes that IUD to get into our blood to make a significant impact on our menopause symptoms like sleep and those types of things. But for just contraception and heavy periods, the IUD can be a wonderful form of contraception.
[00:10:01] I used to be a fan of tubal ligation, especially if he was having a C-section. She knew she was done with childbearing. This is so easy. Just with the caveat, I would now say, “We're going to lose about a year, year and a half off the shelf life of your ovary. We're going to need to monitor you a little bit closer as we get to those ages, and pay attention to that.” So, I still really like it, because it's non hormonal. I'm in there, anyway, doing a surgery. To do a tubal ligation on someone who is otherwise healthy and normal, again, it's a nuanced conversation. If this is what she wants and then she's absolutely-- I don't care what age she is, or how many kids she has. That is her decision. But I'm going to talk about all the options with her and let her make a decision.
Cynthia Thurlow: [00:10:44] Yeah. I think it's so important, because many of us, again, may not be aware of these limitations to some of these options. Now, one of the most common symptoms that I see in women in perimenopause, and so many of my clinical cardiology patients were on antidepressants, antianxiety agents, largely because of these fluctuating levels of progesterone.
Dr. Mary Claire Haver: [00:11:08] Yes.
Cynthia Thurlow: [00:11:10] Let's talk a little bit about mental status changes, because there's so much interplay between our sex hormones, and these neurotransmitters and how this can show up in perimenopause in particular.
Dr. Mary Claire Haver: [00:11:22] So, this is one of the most poorly understood faction, probably one of the most important factions of perimenopause. I just went in a couple months ago, I went to a conference in Chicago, and they had a whole--We had four sections. Dr. Sharon Malone and I did HRT. There was a whole section on cognition and psychiatric changes. There were two neuroscientists and a couple of menopause specialists. I just was floored, plummet-- They really did a deep dive into the data.
[00:11:49] So, what we know is that our neurotransmitters, these are the chemicals where the nerves in our brains talk to each other, serotonin, dopamine, GABA, norepinephrine, epinephrine, all of them are really, really affected by the changes in our sex hormones. So, estrogens rise and fall. There's one thing about estrogen plummeting. That's post-menopause. But you go into chaos in perimenopause and the brain hates chaos. That is leading to the cognition changes in brain fog, that sudden increase in brain fog, memory, can't remember your keys. Women are quitting their jobs, surgeons are quitting because they're terrified they're going to hurt a patient.
[00:12:31] Sleep disruption is huge, with progesterone disruption and the mental health changes. So, the data coming out of Australia looking at the mental health changes across the menopause transition. So, we double the rate of SSRI use, so antidepressants from 10% to 20% across the menopause transition. So, one in five women after menopause will be on antidepressant. These are important medications. I use them. But they are being used as a panacea for menopausely mental health changes.
[00:13:03] The data is now clear that in a perimenopausal patient, treating her with hormone therapy is more effective and more efficacious than treating her with the traditional anti-anxiety antidepressant medication. It is going to be a while before every practitioner who treats the female patient understands this. So, you're spreading the message. We're all trying to spread the message. Those of us who are educated, so that patients can get the greatest benefit, because it's more effective than these SSRIs.
Cynthia Thurlow: [00:13:29] Yeah. It's interesting to me just how many women I saw in their late 30s, early 40s that were on multidrug therapy.
Dr. Mary Claire Haver: [00:13:38] Yes.
Cynthia Thurlow: [00:13:38] Really what they probably needed was some progesterone to help with sleep, to help with cognition. Something else that I see emerging-- I'm not on TikTok all the time. [Dr. Mary laughs] But when I am on TikTok, something that I find interesting is seeing younger women. So, let's talk about average age of menopause, 51, 52, premature menopause versus this premature-
Dr. Mary Claire Haver: [00:14:02] POI
Cynthia Thurlow: [00:14:03] -failure or POI, which is the new term. I'm seeing 20- and 30-year-olds that are still-
Dr. Mary Claire Haver: [00:14:08] Oh, yeah.
Cynthia Thurlow: [00:14:09] -haven't had a period in years. They're not contraceptives. So, let's talk about this, because it's not benign. It's not a benign entity.
Dr. Mary Claire Haver: [00:14:17] It's not benign at all. The earlier you are when you lose your ovarian function as in menopause, regardless of the title we put on it, early premature, whatever, the more risk you have, the longer your body is forced to live without the benefit of your natural estrogen, the less healthy you're going to be. You accelerate mental health, you accelerate cardiovascular disease, you accelerate insulin resistance, you accelerate obesity, all of it goes up. And so, these women who are having earlier menopauses and not being counseled appropriately and not being offered appropriate treatment-- Because if you're early, you don't need menopause hormone therapy dosing. You need to be dosed as a premenopausal woman.
[00:15:01] You don't need to be treated like a 60-year-old. You need to be treated like a 30-year-old and give her back those levels, which are higher. These poor women are being shelved, not diagnosed adequately, not being treated adequately. It's heartbreaking to me, because I know that their cardio metabolic function is going to be much harder than the age match person who went through menopause 20 years later, 10 years later, would have had. I think it's a travesty, and I think it's malpractice.
Cynthia Thurlow: [00:15:28] Do you think that there's a lack of awareness of the fact that-- They're just looking at primary amenorrhea or the loss of your menstrual cycle as being like, “Oh, you're too thin, or maybe you've over dieted or maybe you've got an underlying autoimmune condition that might be driving some of this.” In your clinical experience, where do you think there's this nebulous lack of understanding about putting these pieces together?
Dr. Mary Claire Haver: [00:15:53] I think just looking at the time it takes for these women to get diagnosed is so horrible. By the time they get to me, they've made the diagnosis. They're coming to me for, “Am I getting optimal treatment, or I can't get treatment or they're scaring me, and I don't understand all the risk and benefits.” But it took them six months, a year, two years.
[00:16:13] Especially in POI, you don't just wake up. Most women don't wake up in their menopausal. Most women have this protracted-- They went through perimenopause just much, much younger. No one had their hat on thinking or a red flag raised or anything other than them dismissing it as, “Oh, you're stressed out. Oh, you're too thin. Oh, you need more water. Oh, this happens to women at this age. You're an athlete,” whatever, and not really doing a deeper dive, and we're leaving these women behind.
Cynthia Thurlow: [00:16:39] Yeah. It's so interesting. You are a younger individual. We do have people listening to this podcast who are in their 20s and early 30s. Your menstrual cycle really is a vital sign. I do think about it that way. It is as important as your blood pressure, your pulse, your temperature, etc. And so, if you are struggling in this area, please look out for appropriate practitioners. If you live in Texas, you have Dr. Mary Claire that you can [Dr. Mary laughs] go see.
[00:17:06] One of the more common questions we get across social media is women will reach out. They're in perimenopause or menopause, and they'll say, “Oh, Cynthia, I have a new doctor. I have a new Nurse Practitioner. I'm now on HRT.” They'll go on to share with me what they're taking. And it turns out they are on oral contraceptives. And so, I think in a lot of ways, it's this lack of education around. There's oral contraceptive dosing, which is very different than hormone replacement therapy for two different reasons. But help listeners understand what are the key differentiators for you when you're talking about this.
Dr. Mary Claire Haver: [00:17:43] Okay. Talk about why the medications were formulated. So, hormonal contraception uses estrogens and progestogens to stop ovulation. No ovulation, no eggs, no baby, okay? That's how it works. Very, very nutshell answer. Menopausal hormone therapy was developed to stop a hot flash. No other reason. They haven't done much squeaking with it. The biggest difference between the two is dose. So, much higher dose-- Well, double to triple the doses are needed to stop ovulation versus to stop a hot flash. All the hot flash has to do is MHT developed to do is to bind to thermoregulatory center in the brain, much like the new VEOZAH doing, and calm that system down. Then they're like, “You're successful.” Because for decades, we defined menopause care and treatment as the bothersome hot flashes and getting rid of those. It turns out HRT, hormone therapy, estrogen does a whole lot more in our body, but that's why it was developed.
[00:18:40] Now, formulation does tend to differ as well. The traditional birth control pills are ethanol estradiol, which is synthetic. I was on it for years, used them for years for contraception and to control my PCOS. I was as thin as I could get. There's nothing left I could do in my diet. I did try metformin and all the things and have fertility to get pregnant. And thank God, I have two kids. And then the modern menopause providers who like us keep up with the latest and read the studies are using estradiol typically and progesterone typically and testosterone typically. Those are, what we call, body identical, which can be a little bit of a marketing term.
[00:19:20] But what it means is most like what your body used to make. I'm trying to give you back the water you were drinking, what your receptors are used to, what your brain is used to and not have to go through some complicated-- Things have to be further metabolized sometimes to bind. So, I'm just going to give you back exactly what your body used to have, so that it's just an easier process for you. That is not typically what is in the birth control pills.
Cynthia Thurlow: [00:19:43] Yeah. I think this is an important distinction, also helping women understand. My philosophy is to keep it as simple as possible. I think there are some well-meaning people out there. Maybe they've tried conventional therapies. Maybe they haven't worked well for them. But things like estrogen patch, traditional micronized progesterone are very inexpensive, covered by insurance. And if that works, that's great.
Dr. Mary Claire Haver: [00:20:08] That's my go to, really. That's where we start. I'm glad we have options of other things. It doesn't work for everyone. There's nuances in the discussion, but that is my absolute get to.
Cynthia Thurlow: [00:20:18] Yeah, it's my hope. I know certainly with the menopausey and these providers and clinicians that are trying to amplify this message, do you think in the next 5,10 years, we're going to see an FDA approved form of testosterone specific to women? Because right now, it needs to be compounded, or I have some colleagues that are doing those AndroGel packs, but that's really challenging to work with because they're teeny-tiny little doses.
Dr. Mary Claire Haver: [00:20:42] Right. Getting the doses right on that is it can be a challenge. They're better at when women need higher doses, because they squeeze a pea sized amount out. But that being said, so the ISSWSH, which is the International Society of Sexual Wellness, is doing some incredible work. Number one, they're now testifying in front of Congress to get the black box label taken off of vaginal estrogen. Because right now, vaginal estrogen carries the same warnings as systemic estrogen, and it's ridiculous. So, the next phase is getting in front of Congress to testify on the safety and efficacy of physiologic dosing of testosterone for females.
[00:21:20] We have the studies. We know it works. We know it helps with HSDD. Most likely, it's helping with osteoporotic fracture and sarcopenia, as long as you do all the other things, eat the protein and lift the weights. But there's some great papers on mental health and things. We know it works. But again, the reluctance because testosterone is controlled substance, because a certain subset of people abused it, usually in the weightlifting space, causing void rage, and very negative side effects. So, they put a controlled substance label on it. So, we have to get that taken off and then have it approved for women. We're 10,15 years out from that, I think. FDA moves very slowly on that stuff, especially in women's health. [chuckles] Sorry.
Cynthia Thurlow: [00:22:01] No, it's unfortunate, because I think about how many elderly patients were on chronic antibiotic therapy.
Dr. Mary Claire Haver: [00:22:10] Oh, my God.
Cynthia Thurlow: [00:22:11] Because they had chronic urinary tract infections. For anyone listening, elderly men and women are really at risk for, not just urinary tract infections but also the sequelae like urosepsis, which can be-
Dr. Mary Claire Haver: [00:22:23] Urosepsis
Cynthia Thurlow: [00:22:23] -catastrophic. I saw plenty of my patients in the ICUs that were really sick. And yet, the easiest thing to address chronic UTIs is vaginal estrogen.
Dr. Mary Claire Haver: [00:22:35] Estrogen. Yeah. It is the best treatment course. I have friends who are now putting their mothers on it in their 80s and 90s who are having recurrent UTIs. It's so easy, it's so simple, it's so safe and it will keep that tissue healthy and able to fight off naturally, the bacteria that just live on our skin. We can't keep that area sterilized. But just giving someone recurrent antibiotics, you disrupt their gut microbiome, they become resistant. It is not the best thing. And then they end up with urosepsis, and then we can't find antibiotic to treat them because they're resistant to everything.
[00:23:07] Some of my urology friends have looked at the data and said, “If we put all menopausal women prophylactically on vaginal estrogen once or twice a week, we would prevent 50% of admissions for urosepsis.” And that would save, I don't know, $24 billion or something in Medicare dollars. So, if you frame it that way to the FDA, [laughs] they pay more attention.
Cynthia Thurlow: [00:23:28] No. And to me, it's such a simple thing. I even have colleagues and friends who are cancer survivors, and they are now working with clinicians that are giving them vaginal estrogen because it is just localized to the vagina. It is not systemic estrogen. And for me, I think when I started reading about genitourinary symptoms of menopause, understanding that by the age of 60, most, if not all menopausal women will have those symptoms. So, maybe in the early stages of menopause, you're not. But at some point, there will be friability, there will be chronic UTIs, there'll be painful sex, just symptoms that I don't think any woman needs to live with when we have feasible, inexpensive, easy to use products that we know work so effectively.
Dr. Mary Claire Haver: [00:24:16] And it's okay. A lot of people get question, even pharmacists, that can we use both systemic and vaginal? Absolutely, you can use both. So, for myself, I was on hormone therapy. I went basically from birth control pills, got off immediately with menopausal somewhere in the background. I went through menopause-
[laughter]
[00:24:36] -and woke up fully menopausal. So, it took about six months for me to stop gaslighting myself to get treated. I really had a short course without hormones, and went immediately on systemic and was doing great. Seven- or eight-years then, something was feeling different down there. I was having difficulty with sexual function, physiologic things, feeling a little itchy, just not getting better. I was telling Corinne Menn, another of the menopausey, I was like, “What do you think is going on?” She's like, “Are you [unintelligible [00:25:06] estrogen?” And I was like, “No.” And she goes, “Mary Haver.”
[laughter]
[00:25:13] It's time.” I would have hesitated to offer it to my patient, but I just wasn't thinking because I was on systemic. So, for me, it took about eight years, but it eventually got to the point where I needed a little extra in the area to keep that tissue healthy.
Cynthia Thurlow: [00:25:25] Yeah. It's interesting. When I talk to patients about what changes in the vaginal microbiome, so we have a gut microbiome, we have an oral microbiome, we have a vaginal microbiome. Let's talk about what's happening behind the scenes as we're losing estrogen in the vagina, that helps explain the changes in pH and the lubrication, how they all interplay with this loss of estrogen.
Dr. Mary Claire Haver: [00:25:49] So, the best way I can explain it, if you biopsy a premenopausal vagina, you have the gorgeous, thick mucosa multiple layers, that is interspersed with all of these beautiful mucous glands that are just pumping out mucus for lubrication and to keep everything moving and healthy in the area. The tissue is thick, thick, thick. That tissue goes from the pubic bone all the way to the sacrum. So, our urethra, which is the tube that drains the bladder, the entire bladder wall, is part of this complex. All of it has estrogen receptors that are pro-health.
[00:26:20] Take estrogen away. What happens? Now we're going to biopsy for a couple of years after menopause. What was like? This thick under microscope is now looks like a desert. It's little tiny layers of thin, thin, thin tissue. The mucous glands are gone. And so, we end up with thin, friable, loss of elasticity, loss of accommodation, inability to create mucus. We lose the diameter, the ability to accommodate a penis or whatever you want to put there. All of that gets worse and worse and worse. And so, you're much more likely to get injured with usual normal sexual activity that never bothered you before. You're much more likely to develop a urinary tract infection. Your vaginal microbiome changes. You're much more likely to get bacterial vaginosis and other infections. Just by giving you back vaginal estrogen in the area, you can go back to basically a premenopausal vagina and enjoy all of the health and benefits and that [chuckles] you have before.
Cynthia Thurlow: [00:27:13] No, it's like a magic formula. For anyone that's listening, if they're 10 plus years into menopause, the concerns about vaginal estrogen are not the concerns that might be of issue with other types of hormone replacement therapy. I jokingly said to my 78-year-old mom, who was talking to me about symptoms, I said, “Please talk to your provider about vaginal estrogen. You do not need to suffer in silence.” Unfortunately, I think in many circumstances, women sometimes get uncomfortable with these conversations. They end up not having them, and yet, it's such a simple fix.
[00:27:43] Now, when I think about research dollars allocated for women's health, when I think about research dollars advocated for middle-aged women, it is paltry. Let's talk about the NIH, and how little money they actually allocate for women's health issues and specifically perimenopause and menopause.
Dr. Mary Claire Haver: [00:28:06] Because there's no NIH tags for perimenopause or menopause, those are tougher to track. But we just look at women's health, diseases specific to women, to females. Let alone how women interact differently in diseases that affect a sex. That's a whole other conversation, which is just deplorable. But if we just look at things specific to women's health, we have less than 10% of the budget. The lion's share of that goes to reproduction. And then what's not goes to reproduction, it goes to gynecologic cancer and breast cancer. And so, that is where it stands. Menopause just gets this little, tiny, tiny sliver.
[00:28:49] So, let's just look at women's health. I go to PubMed, which we know, but for your listeners is kind of a Google database for scientific research articles, the highest tier, the best research articles out there that are peer reviewed. I type in the word menopause as a search term. Now, let's do pregnancy first to give you a comparison. Right now, 1.1 million articles pop up for pregnancy. Great. We need healthy pregnancies. It's important. Lots of research dollars for women's health going there. I type in the word menopause, and right now it's 9,700, so less than 10 to 1. So, that's the last third of our lives which is getting just a snippet of that money represents brain power, interest, what is important in women's health. So, it's reproduction, by and large. Then I type in the word perimenopause. 6,700 articles as of yesterday.
Cynthia Thurlow: [00:29:44] Wow.
Dr. Mary Claire Haver: [00:29:45] That's it.
Cynthia Thurlow: [00:29:46] Wow.
Dr. Mary Claire Haver: [00:29:46] So, what did I learn about menopause in my training in all those years? It is the transition to menopause. That's it. No nuances of diagnosis, treatment, training. I happen to have a professor, I think, whose wife went through a rough parry, who taught me a little bit more on the back end. But nothing formal, just stuff we learned in clinic and women coming in with, “I learned everything I know about perimenopause and menopause.” Really, that is clinically significant outside of severe hot flashes and osteoporosis.
[00:30:16] I learned by stepping out of the box of my traditional training, of which I'm super proud of. There were just gaps. And so, all of this is represented by most, even OBGYN residents, coming out have not received any clinically significant menopause training or feel comfortable or confident in treating the menopausal patient.
Cynthia Thurlow: [00:30:37] Well, and it's interesting to me because I was reflecting as I was going into perimenopause and didn't yet realize it, and wasn't fully mentally or physically prepared for what was happening. [Dr. Mary laughs] I went back to some of my books and I said, “We literally might have gotten four senses.” It was like menopause, you fall off a cliff, we worry about you later. It's like an afterthought. And yet, as you appropriately stated, we spend a third of our lifetime in menopause. It should be something that we have clinicians that are specifically trained to be able to be attuned to these changes that occur for women.
[00:31:14] Now, when we talk about some of the changes that are happening in menopause, I think that certainly on this podcast, we talk a lot about loss of muscle, sarcopenia, loss of insulin sensitivity. What do you think are some of the lesser-known changes that maybe most women are surprised to hear are occurring behind the scenes or maybe don't show up until a little bit later?
Dr. Mary Claire Haver: [00:31:36] So, certainly, when we look at cardio metabolic risk, these things go up with aging. So, there's that. We're all getting older. But when we look at age matched women, because we all go through menopause at different ages, so fortunately, people have looked at this and they take like 50-year-olds, because half of us will be menopausal, and the other half weren't because the average age is like 51. They match them for everything other than menopausal status. They look at insulin resistance, triglycerides, cholesterol levels, diabetes and hypertension. It is astounding, [chuckles] the changes that are happening simply from the loss of hormones. So, that's what shocks a lot of women when I blow up the internet, when I talk about cholesterol and what I'm seeing with my patients. Vitamin D levels plummeting. Multiple reasons for that. But really having to function without a normal, healthy vitamin D level.
[00:32:26] And then what's also happening is the loss of bone, which accelerates-- it happens with aging. We reach our maximum bone density, about 35. It starts trending down and then really plummets across the menopause transition. As a medical community, we are doing a terrible job at helping women understand the impact of this and diagnosing it early enough to make a real significant impact. And so, palpitations, these poor women are showing up in the ER with sweating-- night sweats, so they come in sweating, they come in with pounding heart rate, they get an appropriate workup for menopause.
[laughter]
[00:33:01] And so, they're ruling out all these catastrophic things, which, “Okay, you're in the ER. That's what they do.” But no one, at the end of the day, they're saying, “Okay. Your normal. Go home.” But no one is suggesting that all of this constellation of symptoms could be your menopause. It's not the clinician's fault. It's the fault of the medical system that we're not training all these clinicians. Not just OBGYN like me. Why should it be dumped in my lap? I'm busy doing C-sections and Pap smears in my former life. This should be, any clinician who touches a female patient should have a breadth of knowledge about how unique she is and how her health needs change with menopause.
Cynthia Thurlow: [00:33:37] Yeah. I think it's interesting, because even working in cardiology and how many patients had atrial fibrillation? So, I had many, many menopausal patients that had atrial fibrillation. Understanding that interrelationship between estrogen and this propensity for atrial arrhythmias bothersome, they can cause strokes, they’re not nearly as problematic as ventricular arrhythmias. But still, how many patients came in with chronic palpitations? We’d put monitors on them and we’d see couple premature beats and we’d say, “Oh, everything fine. If it’s really symptomatic, we’ll give you a beta blocker.” And then that created another constellation of symptoms that they then dealt with, which it's with good intent. But you're absolutely right. If we had some awareness, we could at least counsel patients. Maybe it's time to go back and see-- [crosstalk]
Dr. Mary Claire Haver: [00:34:22] Let's do a trial of hormones and see if it gets better.
Cynthia Thurlow: [00:34:25] Exactly. Such a benign way of addressing things. What are your thoughts surrounding body composition changes as we're navigating this transition? Because I think many women, as they're navigating, they'll say, “I'm still doing the same exercise. I've changed how I'm eating. My sleep is dialed in. My stress is dialed in. And yet, I seem to have more body fat and less muscle mass.” What is the way that you like to evaluate this? Because I know there are people that will remain nameless across social media that will talk [Dr. Mary chuckles] a lot about MRIs, and that's great. If you can afford that, that's fantastic.
Dr. Mary Claire Haver: [00:34:56] Oh, an MRI for muscle? Yeah, who can afford that? [crosstalk]
Cynthia Thurlow: [00:34:58] Exactly. No, no, I had a guest on recently, and he was talking about that. I was like, “Well, that's great.” Most people probably can't afford that. But what are some of the ways that you like to evaluate fat mass to muscle mass?
Dr. Mary Claire Haver: [00:35:10] So, for visceral fat, it's not perfect, but it's much better than your weight or your BMI is doing some kind of a waist-hip ratio or looking at waist circumference. That's a really nice way to track your efforts to see if the waist versus your hips is getting smaller. It's a reasonable marker for visceral fat. Again, if you have a diastasis, there's a million different things you want to do in the morning when you're not bloated, etc. But that is clinically something that is super easy for people to use. I took it a step further in my clinic, and I have an electrical impedance scanner. The InBody scan is the brand that I use. I have the highest grade with the most electrodes on it. It basically runs a current through your body that bounces off, for lack of a better word, different compartments. So, muscle, fat, water, eta, and it's able to give me a reasonable estimation of visceral fat versus subcutaneous fat, and then her muscle mass as well.
[00:36:02] So, when I'm individually counseling patients about what are our risks moving forward, quite often my obese patients have wonderful muscle mass. It turns out they've been wearing a weighted vest their whole life. They have to work harder just to go to the bathroom and do things. And so, I'm, first of all, giving them high five for having wonderful muscle mass, and then we direct the conversation around fat loss and what that's going to look like for her. What we know is that women on hormone therapy have lower-- We can attenuate their visceral fat accumulation across the menopause transition with HRP. Again, you still have to eat the things. You still have to move. You can't get around the whole package of, what, body composition. But hormone therapy can be a tool in that toolkit that is going to make your efforts easier.
[00:36:48] So, we make sure she's getting adequate protein based on her muscle mass, and we're trying to build, say, she's skinny fat, someone like me who's low-- [chuckles] I'm trying getting there. Genetically low in muscle mass, but went through menopause and had the fat. So, what nutritional things can we do to help with that? We talk about fiber limiting added sugars, magnesium, vitamin D, utilizing foods rich in those things. We talk about ZOE. Do you ever follow ZOE nutrition.
Cynthia Thurlow: [00:37:14] Mm-hmm.
Dr. Mary Claire Haver: [00:37:15] I really love them. And so, they have a little challenge where they do 30 plants a week, like different plants. And so, that's a fun thing I'll do with patients, like a challenge to them to try to get 30 different sources of plants in their diet per week. That's super easy. It's not restrictive. It's really motivating. They're texting me or sending me a message, “Oh, I tried pumpkin seeds this week or something, so they could get an extra plant in.” So, seeds, nuts, fruits, veggies, those are all different plants. It really just changes this restrictive diet mentality to adding things to your nutrition. So, there’s no room for a lot of the other stuff that is problematic.
Cynthia Thurlow: [00:37:53] Yeah, I love that, because I think we want to make nutrition fun. We don’t want it to be perceived as restrictive. Unfortunately, I feel like sometimes the nutritional dogma can get very polarizing and problematic, and then you have people fighting and I’m like, “Listen, if going carnivore-ish works for you, great. If you go from a standard American diet to vegan for a couple months to get a break from all the processes foods--"
Dr. Mary Claire Haver: [00:38:18] You probably going to be -- Yeah, you're probably going to be healthier.
Cynthia Thurlow: [00:38:20] Right. You're probably going to better off. I think for a lot of patients, they perceive there's a lot of restriction and not a lot of flexibility. So, I love that you do the 30 plants challenge. What I've started seeing is some emerging eating disordered behavior in menopausal women. I think largely, maybe they had a latent disorder when they were younger or things have quieted down, but now they’re feeling like they’re weight loss resistant, they’re frustrated. They’re like, “Everything I used to do, used to work, no longer does.” Are you seeing a great deal of this in your practice where women are starting to get, whether it’s over fasting, maybe it’s under restriction or not enough-
Dr. Mary Claire Haver: [00:38:58] All of it.
Cynthia Thurlow: [00:38:59] -protein macros?
Dr. Mary Claire Haver: [00:39:01] By the time they get to me, and that’s one of the biggest pain points in my clinic, especially in a post-menopausal patient, is especially in the patient, especially in athletes who really maintained the homeostasis and they were super happy until menopause, and then they've done nothing different. In their world, they feel like their world is rock. Then they start doubling down on behaviors that used to work to get the 5,10 pounds off in a punch after a baby or something, and then they're not working anymore. So, then I did it myself. I was doubling down at the gym. I was calorically restricting Cynthia, it was embarrassing, like 500 calories.
[00:39:39] The funny thing is I'm 10 years in now, and I am healthier, happier, wealthier, healthy, all of it, than I've ever been. I want that for everyone. I'm also heavier on the scale than I was when I started Galveston Diet. And so, but what that represents is I have more muscle. [laughs] And thank God for the body scanner, because then I feel like a failure. So, I just changed my body composition, and I don't worry so much about whatever little curves that I have, because I'm doing this for my old lady body and just shifting the conversation around, what are our goals as we age? What do you want? Because thin doesn't always mean healthy. That's relentless pursuit of skinny over healthy. Thin isn't always healthy. Helping them reframe that, looking at their body composition, understanding the psychological drive to look a certain way, that's understandable. We all have it. Our society raised us this way.
[00:40:34] But really focusing on what is going to get her, keep her out of a nursing home. And it's not caloric restriction and relentless cardio. And so, it's going to be adequate protein intake, lifting weights and readjusting her brain to, “I'm banking muscle for my old lady body.” [laughs]
Cynthia Thurlow: [00:40:52] I love that. And thank you for your-- [crosstalk]
Dr. Mary Claire Haver: [00:40:53] So, I don't end up frail.
Cynthia Thurlow: [00:40:55] Yeah. No, and thank you for your transparency, because I think sometimes on social media, we only see the perfection. And yet, it's so reassuring to know that even you have struggled with a lot of things that many women struggled. I certainly am guilty of it myself. Sometimes you get in that mentality of, “Oh, I just need to fast more. I just need to restrict my food more.” Actually, what I've come to find over the last, probably, three to five years is that by having a wider feeding window, having three meals a day, more protein. I'm actually leaner this way than I was when I was doing. I never did OMAD, but when I was eating less food and not realizing how little I was eating until I started making myself more accountable.
[00:41:37] Now, when we think about symptoms around menopause, some of them are obvious, like vasomotor symptoms, mood changes. But some of them are less common. And so, I think a lot about vertigo, tinnitus, dry skin.
Dr. Mary Claire Haver: [00:41:53] Vertigo, tinnitus, dry skin. I don't want to get this wrong ever now. Or, Midi, one of the two telemedicine companies, and I can't remember which one. Did a review of symptoms with their patients or with their people who were inquiring. So, they have thousands of women. Thousands and thousands and thousands and said, “Tell us what your symptoms were like.” And of course, hot flashes were up there, but they were number five. Sleep disturbances, mood disturbances, weight gain were the top three. Those were almost universal. 80% to 85%, 90% of women were complaining of the same things. It's just we were only able to blame hot flash on menopause.
[00:42:35] Outside of tuberculosis, women don't have alcohol, and that's easy to rule out with a skin test. But now that we have to broaden the definition of what menopause symptoms look like, we're learning so much more. And so, yeah, tinnitus and vertigo blow up the internet because women are like, “Wait, what?” I did one the other day on Chronic Talk. Yeah, because of the estrogen, such a powerful anti-inflammatory, we see this resurgence of atypical asthma, which is probably menopausal asthma, typical for menopausal woman.
[laughter]
[00:43:08] She doesn't respond to the typical inhalers. [crosstalk] She needs estrogen and probably some anti-inflammatory till the estrogen catches up, but she doesn't respond to atropine-- I forget all the names. I don't do [unintelligible [00:43:21] anymore. But outside, yeah, I don't do pregnancy, and that's when we were treating Aspen pregnancy.
Cynthia Thurlow: [00:43:26] Yeah.
Dr. Mary Claire Haver: [00:43:27] So, yeah, every time I turn around, the one that really kills people is frozen shoulders. So, the musculoskeletal syndrome of menopause. That's another one that's in the top five. 80% of us will have it. And for 20% of us, it is the most debilitating symptom. Forever, it's like, “Oh, get an X-ray. It's not broken.” “Okay.” “Oh, get an MRI,” da, da, da. It's literally loss of the pro-inflammatory effects, anti-inflammatory effects of estrogen. And now we pulled that blanket out, and you're naked, and so you're seeing the residual effects of that.
Cynthia Thurlow: [00:43:59] Well, and it's so interesting because I follow Vonda Wright, and she'll be a podcast guest in a few weeks. I had more questions come in around knee pain, shoulder pain, ankle pain, foot pain. Just one thing after another and people saying, like, “I've been X rayed. My X-ray I didn't break the bone. I don't know what else is going on.” And so, if you're listening and you're one of these individuals, it could very well be a manifestation of this low estrogen state that is driving the degree of inflammation you're experiencing.
[00:44:27] Now, one thing that I find really fascinating, is that as women are navigating perimenopause and menopause, there's a profound net change in the gut microbiome. I know there's been a lot of emerging research around this. Let's talk about some of the things that you're seeing with your patients that's relevant to this community, because it can explain why we're at greater risk for opportunistic infections.
Dr. Mary Claire Haver: [00:44:51] Sure. So, I think ZOE's done the best work here. The ZOE nutrition study, they actually tracked the gut microbiome through the menopause transition with about hundreds of women, and they saw lack of diversity and more overgrowth of the bad bacteria. Our nutrition needs change through menopause. We can't deny that. And so, again, the 30-plant challenge can be huge here. So, I talked to the patient. What's also changing is the estrobolome, which is how the gut microbiome is also responsible for some of the ways that we metabolize estrogen. So, it starts in the liver, and then it gets excreted into the biliary tract, and then out into the poop and then the gut. But the gut microbiome has its own little factory where it's recirculating estrogen levels a little bit. And so, the full impact of that, we're not sure. We need more studies. We know there is an impact, especially in perimenopause, when our estrogen levels are fluctuating so much.
[00:45:49] And so, a healthy gut is always best maintained with healthy nutrition, with eating the plants and eating the things. The more colors, we used to call it eat the rainbow and Galveston Diet, or the more variety of those plants, the better off your gut microbiome is going to be. And of course, probiotics refeeding the pond. And so, the body always prefers, we get that stuff naturally through food. But if you can't tolerate yogurt or you don't eat kimchi or miso or other things that are Chinese pickles that are rich in natural probiotics, it's reasonable that decent studies looking at a probiotic supplement.
Cynthia Thurlow: [00:46:26] Yeah. It's so interesting how it really does start with nutrition. And yet, as a culture, we like novelty, we love supplements and I'm like, “Okay, there's a place and a time for a lot of these things, but this is really where it becomes very, very important.” I want to make sure we at least touch on-- There was a study that you talk about in the book that said, “The Journal of Menopause reported that women that used estradiol or estrogen at age 50 could expect to live up to two years longer-”
Dr. Mary Claire Haver: [00:46:58] Yup.
Cynthia Thurlow: [00:46:58] -and a 20% to 50% decrease in dying from any cause.”
Dr. Mary Claire Haver: [00:47:03] Per year. Yeah. So, the all-cause mortality in a woman is lower, significantly on a woman, with hormone therapy than without. That was published. That comes out of the Women's Health Initiative data. So, they were on Premarin. Two of the medications are so antiquated, we barely use them. Premarin and medroxyprogesterone acetate. Premarin only arm and the combined arm show decrease [chuckles] of all-cause mortality year per year. I think we have better products now we're giving our patients. It's just no one's really studying us right now because of the drama of the WHI, and everyone's terrified. But when you go back and look at that data, it is clear we're going to live longer.
[00:47:48] At the end of the day, women are living longer than men. Here's what I want to see. Women are living longer than men, three to four years. Okay, fine. But that tradeoff is that they're living not just those three to four years, but 20% to 25% of their lives in poorer health than their male counterparts. So, we are much more likely to have a longer, protracted course of debilitating disease than our male counterparts. Men live fairly functional, then die quickly. Women have a long slog, in general, to decline cognition deficits. They end up in long-term care facilities, because they can't move and they can't think and they can't take care of themselves. And so, hormone therapy seems to attenuate that significantly. Significantly. I'd like to see, as a more women are getting brave like myself, staying on hormone therapy well outside of the 10-year range, what that's going to look like for my longevity and my health moving forward.
Cynthia Thurlow: [00:48:51] I think it's really important. I have a family member that was just moved into memory care has end stage Alzheimer's, was not on HRT because she fell into that WHI timeframe. I had a conversation with her on Saturday and yesterday, and she said, “I know my brain's not working right. Why is this happening?” It's heartbreaking. Absolutely heartbreaking. When I looked around the room of individuals that are in this memory care, easily 95% are women.
Dr. Mary Claire Haver: [00:49:21] Yeah.
Cynthia Thurlow: [00:49:22] And all in the same situation and circumstances and had a really-- She's getting excellent care, but it's something that is so profoundly preventable, and that, to me, is heartbreaking.
Dr. Mary Claire Haver: [00:49:35] So, there's a beautiful book written about this. There's two books she wrote. Lisa Mosconi wrote The Menopause Brain, and she also wrote The XX Brain. For anyone who was worried about this, especially if you have a family history, please pick up those books. Because she doesn't just address the role of estrogen in the brain, which is humongous, [chuckles] because Alzheimer's is a disease with symptoms and old age that begins in midlife, now is the time for us to start making these interventions. She talks about nutrition, exercise and how all of that is going to play into the risk of you developing Alzheimer's with the APOE forging. So, just incredible data there for those of you listeners that are concerned about this area. I touch on it in, The New Menopause, but she really-- There's a whole book written on this.
Cynthia Thurlow: [00:50:23] Well, I know when I read The XX Brain, it was the first time that I felt like a little switch went off in my brain, and I thought, “This changes everything,” understanding what's happening physiologically in the brain. Now, before we wrap up today, I know you touched on some of your favorite supplements or equipment. Let's give your, Mary Claire's top five. If someone's listening, these are the game changers. These are the things you recommend most frequently to your patients.
Dr. Mary Claire Haver: [00:50:51] So, again, full disclosure. I do self-supplements. So, go buy them wherever you feel like you-- but always try to get nutrition from food, however. Vitamin D, really hard for us to keep our levels up. 80% of my patients are not just low, deficient in vitamin D, probably because of the gut, they can't absorb it. Their guts aren't as healthy. We're protecting our skin against the sun for good reasons. That's just leading to low vitamin D level. So, if you're struggling to maintain vitamin D level 60 or above, you want to consider a vitamin D supplement. In the ones I have, I add vitamin K, and I add some omega-3 fatty acids, because they play well together on vitamin K, increases absorption. So, one recommendation.
[00:51:33] Number two. Get a nutrition tracker free one, MyFitnessPal. I use Cronometer. Get the free one. Track what you eat for two or three weeks. Eat healthy, and then look to see where your deficiencies are. Are you getting enough RDA magnesium? Are you getting enough calcium? I don't routinely recommend a calcium supplement. I recommend you getting calcium for food. Calcium supplements have never been shown to decrease your risk of osteoporotic fracture. And the cardiologists hate it. They think that it increases the risk of pacification of your atherosclerotic plaques. Also increase your risk of kidney stones. So, get your calcium from food. There's not a good substitute for that.
[00:52:08] Fiber, great studies on fiber and cognition. They looked at the dietary fiber, plus a supplement. This was in 60, 70, 80-year-olds who were in long-term care facilities. And so, the higher level your fiber up to 30, 35 grams for female, the higher your cognition scores. Fiber feeds the gut microbiome. Fiber speeds up transitive stool through the colon. Fiber decreases the rate at which we absorb sugars into our bloodstream. There's nothing bad I can say about fiber. Most of it should come from food. If you have to supplement, we have supplements out there.
[00:52:44] And number three-- Oh, magnesium. I love magnesium. I use it for sleep. [chuckles] So, I like the Magnesium L Threonate for sleep. It has pretty good studies showing it crosses the blood brain barrier. There's lots of great magnesium’s out there that do get your levels up. We have a hard time nutritionally getting magnesium up. You try to get it from food, because foods that are rich in fiber, food that are rich in mag, foods that are rich in calcium, also they're in a package with a lot of other healthy stock. So, with a spinach leaf, you can hit so many birds with one stone. Using food to figure out those nutrients, I think is going to be key.
[00:53:21] Turmeric, I don't recommend for everyone. But if you're struggling with arthritic pain, it does seem to be pretty helpful. In some patients, they did see a decrease in visceral fat, probably from the anti-inflammatory benefits. Not a menopause cure. I don't sell menopause cures. I'm selling ways to support your nutrition, which is struggling through the menopause transition.
Cynthia Thurlow: [00:53:43] Okay. I have to ask that.
Dr. Mary Claire Haver: [00:53:44] Oh, and then collagen. I like collagen.
Cynthia Thurlow: [00:53:45] [laughs] I have to ask. So, for you, as a menopause expert, as someone that is so well respected and really helping to change the narrative, how do you feel when you see predatory advertising for women at this stage of our existence?
Dr. Mary Claire Haver: [00:54:04] It just makes me so sad, because these people send them to me all the time. You have to go down these rabbit holes. They're promising you miracle cures, get your sexy back, you'll feel like you're 25 again, all of these things. Women are so desperate, and they've been dismissed and they've been-- It really, really is predatory for such a vulnerable population who have struggling to get their voices heard. It just kills me. So, I try to take them down as much as I can, but again, it's like whack-a-mole. You hit one over the head and then 10 more pop-up. So, to your listeners, buyer beware. There really isn't a great menopause cures out there. There are certain supplements that might help your body as it's adjusting to the loss of estrogen, but nothing's going to replace the estrogen in your body.
[00:54:52] Now you can be healthy without hormone therapy. It's just harder. I like to stack the deck in my favor, and my patients are coming to me for that same thing. It's not required for you to live a healthy, happy life. It just may make your life a lot easier.
Cynthia Thurlow: [00:55:06] Such a good point. Thank you so much for your time. It really has been a pleasure. Please let listeners know how to connect with you on social media. If they're under a rock and they aren't already [Dr. Mary laughs] following you, how to get access to your new books, your website or to work with you personally.
Dr. Mary Claire Haver: [00:55:20] So, the book is, The New Menopause. It's available everywhere that you buy books. The websites are Dr Mary Claire on all the sites. If you just google me, you'll find this stuff. We're really active on Instagram. That's really my fastest growing platform. I've got TikTok, some on Facebook, YouTube, all the things.
Cynthia Thurlow: [00:55:38] Well, thank you again for your time today. It's a pleasure.
Dr. Mary Claire Haver: [00:55:40] Thanks for having me.
Cynthia Thurlow: [00:55:43] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
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