Episode: 157
The #1 Menopause Doctor: How to Lose Belly Fat, Sleep Better, & Stop Suffering Now
with Dr. Mary Claire Haver, MD
Learn about the surprising menopause symptoms like frozen shoulder, ear ringing, and body odor.
Know what to do about them and other symptoms of menopause.
Dr. Mary Clare Haver is a board certified obstetrics and gynecology specialist, a certified menopause practitioner from the Menopause Society, and her latest book is The New Menopause.
Dr. Haver will help you understand the latest research on menopause, and give you practical advice like: which supplements you need to take for better sleep, and the best exercises for weight loss and bone health.
Stop guessing about your health and gain the confidence to take control of your body and feel your best.
Listen on:
"I don’t just want a long life—
I want a strong, healthy, vibrant life.
And that starts with
understanding and supporting
our hormones."
Dr. Mary Claire Haver
Featured Clips
Transcript
Mel Robbins (00:00:00):
Hey, I'm so glad you're here. I promised you I'd be in the studio today, Shay, all day. She's here too. You can't see Maddie, but she's right behind you. So we are about to have the amazing Dr. Mary Claire aver jump in that seat. And I just want to tell you, this is going to be one of those episodes that's change your life and it'll change the life of every girl and woman you know. So please share it, share it, share it. You ready? You ready to start the Mel Robbins podcast? I know you are. Me too. Don't forget to subscribe. Let's do this.
Dr. Mary Claire Haver (00:00:30):
We were living our lives, managing our stress, managing our way, doing all the things, and then all of a sudden you can't put your finger on it, but something's changed.
Mel Robbins (00:00:40):
That's exactly what everybody says. And whether this is happening to you or you've heard your sister or your mother or your partner say this, we start going, my pants are not fitting. I am grouchy. Suddenly I feel like I have ADHD or brain fog or dementia. I don't feel like myself in my body.
Dr. Mary Claire Haver (00:00:58):
You are every single patient who comes to my office. This exact same story.
Mel Robbins (00:01:11):
Hey, it's Mel, and I'm so glad that you're here today. Whether you're listening for yourself or because someone that you loved shared this episode with you, I want to welcome you to the Mel Robbins podcast family and thank you. Thank you for making this podcast one of the most popular podcasts in the entire world. It is an absolute honor to be able to spend some time with you today. And I want to start by acknowledging you for something. You could be listening or watching, do a bazillion things right now, but you chose to take some time for yourself and listen to something that can help you create a better life. And today, holy cow, is that going to happen? Because we are digging into a topic that is impacting nearly 1.2 billion people. It also happens to be one of the most requested subjects that you've been asking me to cover.
(00:01:58):
And one of the reasons why you want me to cover it is because there is so much confusion, so much conflicting information about this subject. What am I talking about? Menopause. It is time that you feel informed about what's going on with your body, your brain, and your hormones. And if this is not impacting you personally, do not change this. Listen, because it is impacting someone you love. Oh, I have been dying to have this conversation about women's hormone health and menopause with you, because I got to be honest with you, every single friend of mine has been texting and DMing each other. We are lighting up the group chats. I am no longer sending my friends memes and funny quotes right now. You know what? I'm sending them articles about hormone changes, articles about supplements. I've been complaining to my poor husband, Chris, about how bloated, itchy, irritated I am.
(00:02:51):
I'm confused about what to do. And you know what? This approach is not helping Chris to understand me. It's not helping me to understand the changes that I'm experiencing. And I'm sharing this with you because if you're overwhelmed by the topic of hormone changes or menopause, or you're experiencing challenges with your monthly cycle, or maybe you're just tired, you're tired of hearing your mother or your significant other complaint about the changes in her body, boy oh boy, are you about to learn a lot. One of the reasons why so many of you feel so powerless about your hormones is because your doctor is probably not informed about this topic either. So you're not getting the answers, the information and the simple things that you can do that you deserve. Well, that changes today because your friend Mel Robbins has tracked down one of the leading specialists on menopause and estrogen deficiency.
(00:03:47):
She has hopped on a plane from Texas, and this woman is so busy, I cannot believe she's taken time out to be with you and me here in our studios in Boston. She has come to share with you everything that the research says, and more importantly, the simple things that you can do. And there's a lot that is going to surprise you today. For example, didn't know perimenopause can start as early as the age of 35. And I know that hot flashes and belly fat are symptoms of hormone changes. It's probably just the symptoms that I complain about the most. But current research is finding that things like ringing in your ears, frozen shoulder, I didn't even know that was a thing. Dry skin, dry mouth, body odor, anxiety, fatigue, lack of a sex drive, autoimmune diseases and on and on can all potentially be tied back to the changes your body is experiencing because of menopause.
(00:04:42):
I am so honored for you to meet our expert today because she's going to simplify this topic so that you no longer feel overwhelmed and left behind by the medical community, but rather you feel empowered and excited about what you can do. So let me tell you a little bit about Dr. Mary Claire Haver. She is a board certified obstetrics and gynecology specialist. Dr. Haver is also a certified menopause practitioner from the Menopause Society, and you're going to learn why that's actually a very big deal a little bit later in our conversation. She's also a certified culinary medicine specialist from Tulane University, a bestselling author and author of the incredible brand new book, the New Menopause. She's the founder of the Mary Claire Wellness Clinic, which is dedicated to the care of menopausal patients. And this is really important. She has two kids and just like me, she's 55, she's juggling a big career, a marriage and motherhood, and she has so much to share with you today that you will be able to apply to your life as you're listening, as soon as you're done. And I want to remind you, this is not just for you. Please share this with every single woman that you know because what you are about to hear will change your life and hers. Without further ado, please help me welcome Dr. Haver to the Mel Robbins Podcast.
Dr. Mary Claire Haver (00:06:03):
Thanks for having me.
Mel Robbins (00:06:04):
Thank you.
Dr. Mary Claire Haver (00:06:06):
So excited to be here and share all things menopause.
Mel Robbins (00:06:09):
You are so passionate about this topic and you even get very emotional about it when you think about it. Why are you so passionate about this?
Dr. Mary Claire Haver (00:06:17):
Because in my own journey of going through menopause and realizing what a gap there was in my own training and how I really wasn't the best menopause provider for a long time, I have such a need to get out there and teach and share because we are not teaching our medical students and residents in our nurse practitioners much about menopause care outside of the most cliche of symptoms and how to manage them. We're going to live a third of our lives like this, a third of our lives like this, a third of your lives. And after reproductive options are taken off the table, it's almost like medicine leaves us behind. I want to be an 80-year-old climbing that mountain kicking ass, having a career healthy. And if I don't implement changes today, I'm not going to be able to reach that goal.
Mel Robbins (00:07:10):
So why is it that there is so little information about hormone changes and menopause and you go to your doctor and it's sort of like, oh, well, you're going to deal with this for about 10 years and then that's just the way that it is. What is up with this?
Dr. Mary Claire Haver (00:07:30):
So if you go to PubMed, which is basically Google for healthcare professionals, which is where it's like a repository of medical studies and you put in the word pregnancy, you'll get about 1.1 million articles, all important great stuff, right? It's important that we have healthy pregnancies and we deliver children in a healthy way and et cetera. When you put in the word menopause, we get 94,000 articles. We only get 10% of the funding. That means 10% of the brainpower, 10% of the research for the last third of our lives. And we do live a little bit longer than men, but we're going to spend 20% of that in poor health, in decline in disability. And this is avoidable. I hear the word menopause and I think out to pasture, right? You're done. And I thought that for a long time too. And then I'm Gen X.
(00:08:21):
You know what? To hell with that. I want to live a good life. I want to feel like I can go to the gym, I can play with grand babies, I can roll on the floor, I can climb a mountain, I can run a company, I can do all these things, and I'm refusing to just accept the medical definition of getting older for a woman, which is very different than a man. So when we're born, we have about a million plus or minus eggs. So from birth, until we die, we're slowly losing that egg count and it starts accelerating as we get older. So by the time we're 30, we're down to about 10% of our egg supply. Well, hold on a second.
Mel Robbins (00:08:56):
By the time you're 30, you've already lost 90% of the eggs that you were born with. That's correct. I don't know why I never knew that. I kind of feel sort of dumb that I've gone through 55 years of my life and I did not know that We're down to about 10% and at 43%, 3% at 43%. Wow. And you lose your period because you have no more eggs. So there's no more need to go through that cycle. You can't
Dr. Mary Claire Haver (00:09:30):
Ovulate. So yeah, there's nothing left holy. But doesn't it make sense Now? Of course it makes sense why it's harder to get pregnant when you're older, why you're more likely to have a chromosomal abnormality because the number and quality of your eggs is declining with age.
Dr. Mary Claire Haver (00:09:44):
What happens for females is that our endocrine system, especially the ovaries age at twice as faster rate than the rest of our body. The endocrine system is where our hormones are created, okay? All of our estradiol, our progesterone, and about at least half of our testosterone is created in those ovaries every single month, every single day. However, when we get to perimenopause, things start changing. And when we get to full menopause, we have no eggs left. The ovaries decline. We're losing our ovaries at the average age of 51. They stop producing sex hormones, and we basically are forced to live the last third of our lives with without the benefit of estrogen progesterone in about half of our testosterone.
Mel Robbins (00:10:30):
I get this at a level, but I've never understood this before because when you really just put it in the context of you're born with a million eggs, and from the moment you start your menstrual cycle and the hormones are going up and down, there is a purpose associated with the design of your body. And once that stops, everything gets disrupted in your body. Oh, why is nobody studying this?
Dr. Mary Claire Haver (00:11:02):
What the hell? People are studying it. When we look at OB, GYN, the residency, that's you are right? Yes, I'm obgyn Women's Health, super proud of what I learned in my training, right? Pediatric gynecology, oncology, surgery, babies, fertility, all this stuff, menopause got shoved in this tiny little box. She's going to have a few hot flashes and maybe some vaginal dryness. Her bones might get a little weaker, and that's it. We only want to give her estrogen if she can't tolerate anything else, if nothing else is working, then fine, give it to her, but you might kill her.
Mel Robbins (00:11:43):
Wow.
Dr. Mary Claire Haver (00:11:45):
Wow. Our bodies thrived on this hormone for 50 years, 51 years on average. And by this hormone you mean estrogen? Estrogen and testosterone and progesterone. We were living our lives, managing our stress, managing our weight, doing all the things, and then all of a sudden you can't put your finger on it, but something's changed.
Mel Robbins (00:12:06):
That's exactly what everybody says. And whether this is happening to you or you've heard your sister or your mother or your partner say this, we start going, I'm doing the same stuff I've always done.
Mel Robbins (00:12:18):
My pants are not fitting. I am grouchy. Suddenly I feel like I have ADHD or brain fog or dementia. I don't feel like myself in my body.
Dr. Mary Claire Haver (00:12:28):
You are every single patient who comes to my office.
Mel Robbins (00:12:32):
This exact same story. What would you as a gynecologist do when a woman would come in as they did for years and years and years before you became one of the world's leading experts in this? What would you do as a doctor?
Dr. Mary Claire Haver (00:12:46):
I'll tell you a story from my training. So we had gynecology clinic and residency, and I was an intern. And so we had OBS divided into two sections. And so in gyne clinic, we had the surgical cases coming in. And so all the residents would line up like six or seven of us, and the upper levels would run for the surgery cases they want to operate, and US interns would be left with whatever was left and they'd be like, oh, you got a ww, a ww, a WW in room 12. Good luck with that. And a ww, this wasn't written in the chart. My professors never said this. This was kind of lore handed down from upper level resident, and you can do it with a Texas accent where I trained. So these guys in cowboy boots walking up and down the hall, you got a WW in room 12. Good luck with that. And it meant whiny woman. So here was this woman coming in, and this was a public health hospital. So she's desperate.
(00:13:42):
She can't sleep, she's gaining weight, she's not happy, she's having maybe headaches, I mean just this kind of laundry list of very vague complaints. But she was still having periods
(00:13:52):
Maybe irregular, maybe heavier, maybe lighter maybe. And you were like, Ugh, it's just part of aging. If she came in complaining of libido, I was a deer in the headlights. I didn't know what to tell her. We were taught nothing about the female sexual response or medications that might help or go out and have some wine, relax, get a new boyfriend, all the other complaints, I would start sending her to other specialists. Let's go see a cardiologist for the palpitations and the neurologist for your headaches. And she'd walk out of my office with six referrals, and I didn't know enough to say, let's try some hormone therapy and see if these things get better. I'll do some blood work. Let's make sure it's not autoimmune disease or hypothyroidism. I was doing that. I just think back on that and that we can do so much better.
(00:14:42):
We got to do a better job training every single healthcare professional in all specialties about how special menopause is and what the lack of estrogen is doing to each and every organ system.
Dr. Mary Claire Haver (00:14:53):
Each female has a unique expression of our menopause. So where you may have had palpitations, frozen shoulder and dry vagina, I would've had hot flashes, night sweats, and horrible rage and doctors like a checklist of symptoms. It's how we're trained recall, but we're trained to look for ducks. How does it, is it walk like a duck? Talk like a duck. It's a duck and everyone's ducks a little bit different.
Mel Robbins (00:15:18):
You mentioned that every organ in a female body,
Dr. Mary Claire Haver (00:15:22):
Yes, every organ system. Yeah,
Mel Robbins (00:15:24):
Every organ system has receptors or has what for estrogen?
Dr. Mary Claire Haver (00:15:28):
That's where the research is really exciting right now, is that Duke University did this elegant study looking at frozen shoulder, which is adhesive capsulitis, so common in women, especially in menopause. And a woman, finally a woman head of a orthopedic surgery department talked to the woman head of an OBGYN department at a big university, and they're like, some may write, and they did the studies and they showed that women on hormone therapy have a lower chance of frozen shoulder. They pulled all the data and they're like, why would that be? Why? So then now they're going in and doing biopsies of all these joints and saying, there's tons of estrogen receptors here. And when we lose that estrogen, we're seeing mass. It's an anti-inflammatory hormone in the bones and joints. So we have arthralgias, joint pain, capsulitis, all of this stuff, tremendously flares. And some of your listeners are like, oh my God, right now I had frozen shoulder. So really, really commodore hip pain or joint pain, or you can't roll over in the bed, it's so painful and you have no injury.
Mel Robbins (00:16:29):
I'm sitting here feeling one revelatory. Oh my God. Oh my God. Oh my god. There are times in bed where I am laying there and I will go to roll over and it's as if I have to pry myself over. I'm so stiff. Wow, that makes so much sense actually. So if the estrogen receptors are in your organ system, that then presumes that it's impacting liver function, kidney function, everything,
Dr. Mary Claire Haver (00:17:09):
Lung function, heart function, brain function, genital urinary function as we know, bones, osteoporosis, we'd known forever. That's a no brainer.
Mel Robbins (00:17:20):
Wow. And so I want you, as you're listening to Dr. Aver, to just really think about this for a second, that every single aspect of your organ system, from your brain to every organ to your muscles, all of it is used to functioning with estrogen. It makes so much sense. If you take out one of the main ingredients to the female body's optimal health, of course everything is going to go haywire.
(00:17:58):
Dr. Haver, I just am so grateful that you're here and I want to take a quick moment. We got to hit the pause in menopause and hear a word from our amazing sponsors, and please take a listen to our sponsors because they are allowing me to bring you Dr. Haver at zero costs. So take a listen, but don't you dare go anywhere. Lemme tell you why Dr. Haver and I are going to be waiting for you after this short break. Stay with us. Welcome back. It's your friend Mel Robbins, and I am here with the remarkable Dr. Mary Claire haver. Her new book is The New Menopause, and she is an expert in women's hormones health. So you've now got this estrogen deficiency.
Dr. Mary Claire Haver (00:18:39):
Well, low, not zero, menopause is zero,
Mel Robbins (00:18:42):
But still, but I'm saying a lot lower. So I want you to pay attention to what Dr. Haver is about to explain to you because your body has been experiencing mild symptoms of this for your entire life. You just probably thought it was whatever. But this is the symptoms of a drop of estrogen. How is estrogen helping your body and your organ system run in the most optimal
Dr. Mary Claire Haver (00:19:13):
Way, efficient manner? Okay, so the first half of our cycle, so you have a period, the first day you bleed is day one of your cycle. So that's shedding and starting over. So in those first 14 days, we call that the follicular phase. So that's when our follicles, which are the little sacks that our eggs sit in, start saying, okay, one of us is going to win. So a hundred, 200 of them are like, it's a race. The hormones are starting to okay, the brain's like our estrogens load. Let's go. Let's go. Estrogen starts to rise, and then that lining starts to thicken up again. We're getting ready for a potential baby. Then we hit about day 14 ish, depending on the cycle. And then the estrogen levels at its highest, the brain is like, okay, we need to ovulate the LH surges. And that's the thing that makes the egg pop and that one or two eggs come out. And then when the egg pops, the popping also creates a little surge of estrogen. It's a little bit
Mel Robbins (00:20:15):
More.
Dr. Mary Claire Haver (00:20:15):
And then progesterone starts being produced where that egg came out from. And that's a really efficient factory for creating progesterone. Then that progesterone starts rising in that second half. You are very slight, but it's there kind of mimicking what's to come when we totally lose our
Mel Robbins (00:20:30):
Estrogen. And so in the second half of this month and the cycle, as the estrogen starts to decline, what happens in your body?
Dr. Mary Claire Haver (00:20:39):
So we have some women suffer horribly from it, but we have premenstrual dysphoric disorder, PMDD, bloating, swelling. Now we think the bloating and swelling is from the really high progesterone levels that drop of estrogen are mental health changes. How does it change
Mel Robbins (00:20:56):
Our mental health when you have a decline in estrogen?
Dr. Mary Claire Haver (00:20:58):
So there's a lot of research going on right now, but we know that tons of estrogen receptors in the brain and our serotonin is affected. How does estrogen and serotonin play? So it looks like when your estrogen levels are optimal at a nice healthy level, we have really efficient serotonin and norepinephrine. So those are two key hormones that we see in depression, right? They're low in women who are depressed.
(00:21:27):
And so for women who are sensitive to it that we're seeing the PMS, the PMDD, those women tend to do okay on A-S-S-R-I for a short term. They only take it two weeks out of the month, or some of them like to take it every month. But it really is from that estrogen decline. We see menstrual migraine headaches. Some women with a declining estrogen, the blood vessels will slightly squeeze in certain areas of the brain, which will trigger a migraine headache. And so wait a minute. So migraine headaches, there's menstrual
Mel Robbins (00:21:57):
Migraines, and you also can feel a slump in terms of depressive symptoms or anxious symptoms because of the decrease in estrogen. That's what we think. And I would imagine brain fog, ADHD, all of these other neurodivergent kind of issues that people might have also then see an impact from the decline in estrogen. There's
Dr. Mary Claire Haver (00:22:22):
A definite pickup worsening with people with known ADHD through the menopause transition, perimenopause into menopause. And we don't really know if it's a new diagnosis of ADHD or she was kind of making it until perimenopause and then because a spectrum. And then all of a sudden her resilience against this has stopped because she's lost her estrogen, her progesterone, testosterone, however that fits in for her. And all of a sudden she's now so symptomatic and at the time in her life that she needs those facilities to be functioning at all levels. Career women are having to leave their jobs. We're seeing massive economic impact from this in the workforce.
Mel Robbins (00:23:03):
And what I love about the fact that people are researching this is that knowing that it's a neurodivergent condition and that there are estrogen receptors in the brain, whether you're talking about the second half of the monthly cycle or you're talking about the period in your life where estrogen declines, that of course
Dr. Mary Claire Haver (00:23:22):
Your executive functioning tanks,
Mel Robbins (00:23:24):
Yes, of course it makes sense. And now the system's going haywire and inflamed. It's not got the firepower to help you focus on the thing that you need to do right now. Wow, that makes so much sense. I didn't understand the fact that when estrogen declines that all of the symptoms that I was feeling that that has to do with hormone fluctuation. What's interesting is if you were to start tracking your cycle, which everybody should do, you would probably over the course of several months start to notice a correlation if not a direct connection between that halfway marker of the month.
Mel Robbins (00:24:02):
And when you start to feel a little foggier, when you start to feel more irritable, when you start to feel more bloated, you might notice more headaches you might notice, which then allows you to be more compassionate with yourself. Because I think knowing this, it will probably put symptoms in the context of how estrogen helps you feel better and what it feels like when your health is more optimal versus these symptoms that come up. Because when you feel the symptoms, you think something's very wrong with me.
Dr. Mary Claire Haver (00:24:38):
So estrogen's an anti-inflammatory hormone.
Mel Robbins (00:24:41):
When you doctors say anti-inflammatory, I really don't know what you mean. And it seems like everything is inflammatory these days. And so you have such a fricking, unbelievably cool way of explaining things. How would you describe anti-inflammatory? Inflammatory? Inflammatory?
Dr. Mary Claire Haver (00:24:59):
Sure. So it's easiest to think about it in terms of acute and chronic inflammation. Acute inflammation, everybody knows you got a virus, you twisted your ankle, you stepped on a nail. I don't know
Mel Robbins (00:25:12):
What that
Dr. Mary Claire Haver (00:25:12):
Means. Body's response to an acute injury. So what happens? You breach some barrier in your body. A virus breaches it a nail, you twist your ankle, you have some orthopedic injury, you break a bone immediately your immune system goes on alert, okay, make this stop. We need to fix it. So it rushes blood flow, so things get red and swollen. It pumps fluid in the area to try to wall off whatever this invader is. Your white blood cells, which are in infection fighters and inflammation, those are all in pro-inflammatory cells in our bodies. So inflammation,
Mel Robbins (00:25:54):
A code word in medicine for your body is in an alarm state trying to address something.
Dr. Mary Claire Haver (00:25:59):
Yes,
Mel Robbins (00:26:00):
Okay,
Dr. Mary Claire Haver (00:26:01):
I think I got it now. Right? And it's all the little biological processes that make that happen. So that's acute inflammation. We need that to stay, break a bone, boom, get to work, and flame inflamm, go, go, go. But then you're healed. Okay? Chronic inflammation is when that system gets turned on a little bit, it's kind of something's not right, but it won't shut off. So you have this chronic state of things being chewed up and laid down, and estrogen kind of calms that process down.
Mel Robbins (00:26:33):
I think I just got this, lemme see if I can explain this back to you. So chronic inflammation, which you said is a sort of like something's a little off, is that feeling where you're just like, something's not right in my body, I just don't feel comfortable in my body, but I don't know what it is.
Dr. Mary Claire Haver (00:26:52):
And it can affect a joint, your whole body, your gut, your head, your whatever. Autoimmune disease is basically nonstop chronic and acute inflammation, and it can calm down a little bit, but what that inflammatory process does is chips away at our organ systems.
Mel Robbins (00:27:09):
Well, what I'm also wondering is if the female body and intelligent design of the month is designed based on cycles of estrogen in particular, and estrogen gets removed either because of menopause or PCOS or changing issues or surgery, surgery or whatever, that something to your body's natural process every month of shutting
Dr. Mary Claire Haver (00:27:38):
Down that inflammation
Mel Robbins (00:27:39):
And now your whole body's like, something's wrong. We need some estrogen down there. And the body doesn't
Dr. Mary Claire Haver (00:27:45):
Respond, no race can't do it again, they're done.
Mel Robbins (00:27:47):
It's like your whole body's like, whoa, broken bones, something's wrong. What are we doing? And it races everywhere.
Dr. Mary Claire Haver (00:27:52):
So in the joints we see arthralgias just this, what is that? Arthralgia is pain in the joint. That
Mel Robbins (00:27:59):
Sounds like an ugly version of arthritis.
Dr. Mary Claire Haver (00:28:02):
It sounds like something that you would get in one of these fantasy novels. Novels. The arthralgias comes over the hill. So in the heart, let's talk about the heart. When
Dr. Mary Claire Haver (00:28:10):
We get to this hyper inflammatory state, we see palpitations that sino atrial notes. There's a little node, there's a little part of the heart where it sends out a signal to control our heartbeat. It's called the SA node. Sino atrial node. That thing is super responsive to estrogen and likes estrogen and likes it, keeps it calm and beating in a night thing. You take estrogen away, all of a sudden some women will start having palpitations out of nowhere and they go to the cardiologist, they get their million dollar workup and they're like, Hmm, dunno what's going on. And we're not training the cardiologist to say, this might be part of her menopausal picture. And you
Mel Robbins (00:28:45):
Want to know something else that I'm just like, actually as my brain is churning and all this is starting to go click, click, click is that if there's not comprehensive training and if there's not advocacy for what these symptoms are, then there's also no health insurance code to cover the cost of a lot of the diagnostic stuff that actually points to what is causing this.
Dr. Mary Claire Haver (00:29:15):
Medicare does not pay for a menopause visit.
Mel Robbins (00:29:18):
That's
Dr. Mary Claire Haver (00:29:19):
Insane, right? Yeah. Your well woman exam that is devolved into screening for breast and cervical cancer. That's it. That 15 minutes with your legs and stirrups is not the time to do a comprehensive menopause visit. So you need to schedule another visit, go in with your armed with questions in with your family history and all those
Mel Robbins (00:29:43):
Things. And it sounds like don't call it a menopause visit. Say I'm having lots of symptoms, but don't call it so it gets covered. Exactly. Wow. Wow. Okay. So the heart,
Dr. Mary Claire Haver (00:29:53):
The lungs, how does estrogen impact asthma? Asthma, inflammatory disease. We see an increase in asthma and actually asthma that doesn't respond as well to the typical bronchodilators.
Mel Robbins (00:30:06):
Well, that makes sense because it's like an internal system functioning thing where the oil and the gas is no longer in the engine. Yeah.
Dr. Mary Claire Haver (00:30:13):
Wow. What about your digestive track? So the gut health changes dramatically. And when the gut health changes and the gut microbiome changes, how we reprocess our estrogen changes a bit as well, the metabolism part of it.
Dr. Mary Claire Haver (00:30:28):
And so lots of research going on in that area right now. Our bones, we've known forever, osteoporosis. Now, what your listeners may not realize is that osteoporosis is completely preventable for most women and they don't know how. We're not diagnosing osteoporosis usually until you have a fracture and 50% of women before they die will have an osteoporotic fracture.
Mel Robbins (00:30:54):
So just for somebody who's listening that doesn't know what that word means, is that like fragile
Dr. Mary Claire Haver (00:31:02):
Bones, bones, density? What does that mean? So our bones density maxes out how thick and strong our bones are. The thicker, the stronger, the more resilient to fracture they are. Okay? In general when, and we're constantly remodeling our bones, which is why when we, and I'll explain that in a minute, which is why when we break them, they fix themselves if you wind 'em up. Interesting. So we are constantly chewing up bone like Pac-Man and then pooping out new bone behind it.
Mel Robbins (00:31:29):
Really?
Dr. Mary Claire Haver (00:31:30):
Yes. And so we're always, the bones you were born with were not the bones you had at 10 or not the bones you have at 20, we have totally chewed up and laid down all new bone. What happens in menopause or in women with chronic suppression of ovulation, chronic, low postpartum, multiple babies, we start chewing up more bone faster than we can lay it down. And that accelerates in menopause. So we end up with this porous bone with holes in it. Basically. That is a lot easier to fracture. Now if you fracture your hip, so if you're 65 plus, and that is 10 years away from us, and we fall climbing up a ladder, chasing a grand baby, hopefully maybe one day, no pressure to my children, and we trip and we take out a hip. Even with surgical repair, we have a 29% chance of death in that first year. And if we survive, hold on, I need
Mel Robbins (00:32:21):
Everybody to hear that this is really serious. She's basically saying bone density starts to decrease based on the decrease in estrogen and aging and aging, and that makes you more fragile and prone to having a broken bone. And she's also saying this is preventable
Dr. Mary Claire Haver (00:32:44):
For most
Mel Robbins (00:32:44):
Women, for most women. But if you fall and break a hip at the age of 65, 20 9% of you will die in
Dr. Mary Claire Haver (00:32:53):
The first year. In the first year with surgery. Without surgery, it's like 79%. So they're all getting surgery. Yeah. Wow. And so say you survive, the rest of your life is marked with chronic disability, not being able to take care of yourself, which is my patients don't come in saying, I want to rock a bikini. They're looking at their mothers, they're looking at their aunts and they're like, get me off of this path. I don't want this. Or they're looking at a really healthy mom who's running around and is not for real, not decrepit, taking care of herself. And they're like, make sure I stay on this path. And that's where the work begins.
Mel Robbins (00:33:32):
Wow.
Dr. Mary Claire Haver (00:33:33):
Alright. We've covered bones. What else? Genital urinary syndrome of menopause. Okay. What is that? So that is a big mouthful. It used to be called senile vagina. That was a medical term. Ugly sile. Senile
Mel Robbins (00:33:46):
Vagina.
Dr. Mary Claire Haver (00:33:47):
Senile vagina
Mel Robbins (00:33:48):
Was a medical
Dr. Mary Claire Haver (00:33:49):
Term. Yeah, it sounds like a bunch of guys got around, got really wasted. Welcome to Western medicine in the 1950s. Then they changed it because it was so offensive to a trophic. Vaginitis again, doesn't sound much better. No.
(00:34:03):
So our genital urinary system, the bladder, the vagina, the vulva, that whole space from your pubic bone to the end of your tailbone, just all of that area is highly sensitive and highly estrogenized. And when that estrogen level drops, we lose elasticity, we lose. So stretchability of the vagina, which might be helpful on occasion, is that why sex is painful sometimes for most women, they have atrophic area, so they've lost their elasticity. They can't make mucus anymore. The tissue is thin. If you look at a biopsy, a premenopausal vagina, it's this thick, velvety elastic, beautiful. Bring it baby. And then this postmenopausal woman who's never been treated, it looks like this Sarah desert. You've lost layers and layers and layers of tissue. It's very dry. It's very small, and she's just gritting her teeth through sex. And that is because that uncomfortable. I'm a hiker. And so I've got to use, even with systemic estrogen, if I don't make sure that area is well moisturized things. Also, the architecture changes a little bit. So things are hanging at different levels. And so I love to hike, and so I'm going to have some chafing in things that I never had before. I need to make sure I'm getting lubrication in that area so I can hike comfortably besides everything else I want to do in that area. And this is preventable.
Mel Robbins (00:35:27):
Preventable.
Dr. Mary Claire Haver (00:35:28):
Yeah. Now let's talk about how it could kill you recurrent UTIs, the bladder health, the urethra health, besides incontinence, the number one treatment for recurrent UTIs in a postmenopausal woman, the most effective treatment is vaginal estrogen, not chronic antibiotics. I'm going to save someone's life by this podcast because I'm going to keep someone from dying from urosepsis because she got vaginal estrogen after listening to this podcast.
Mel Robbins (00:35:58):
This is amazing.
(00:36:00):
And here's what I love about it. It makes so much sense. I love how you have explained this to us. And I also love the fact that because you've explained it this way and because we've put it in the context of the month, and we've put it in the context of your intelligent design and the way that you've always been running, and we've all had periods where it hasn't been running optimally, that you can also take the information that you're learning right now where we're focused on menopause. But you can also go, oh, I can take this information. I can share it with my sister, my girlfriend, my roommates, so that they understand that the second half of their cycle, you're starting to experience baby symptoms. Or maybe they're bigger symptoms, but that this is all the
Dr. Mary Claire Haver (00:36:47):
Same. Might be a precursor to thing what the bigger picture is coming.
Mel Robbins (00:36:50):
Yes, I am going to send this episode to every single woman I know. I am sending this to my daughters. So as we take a quick pause, hear a word from our sponsors, take a moment and share this to people because I want this information out to absolutely everyone. Because every single woman on the planet, every girl needs to understand what is going on in her body and the role that estrogen plays in her overall health. You never know, you could truly not only improve somebody's life, you might actually save somebody's life. So we're going to be waiting for you after a short break. We're going deeper into the solutions, including the three things that Dr. Haver says. All of you need to be adding into your diet right now. Stay with us. Welcome back. It's your friend Mel. I'm here with the remarkable Dr. Aver, thank you for sharing this with everybody. I know it's making a huge difference to have this information. Now let's talk about what perimenopause is and when
Dr. Mary Claire Haver (00:37:46):
It begins. Sure. So I like to start in the middle. There's a lot of misconception around terminology. So medically, and I think this is a problem, menopause is defined as one day in your life, one year after your last menstrual cycle. Yes. Most women know that everything after that is post menopause. So what's perimenopause? So perimenopause, the best I can define it is remember we're losing ovarian function our whole lives from the day we're born. However, there's a point in time when your body notices.
Mel Robbins (00:38:19):
So you said that we have only 10% of our eggs left by 30 by 30. So is that when it starts
Dr. Mary Claire Haver (00:38:27):
Noticing? So it depends on your body. It's when your body is like something's not right. It could be mental challenges, it could be gut challenges, it could be inflammation in your joints. It could be irregular periods, heavy periods, light. No period. It's really variable how it presents. But something has changed. Nothing in your world has changed. Something inside of you has changed. And so perimenopause is often defined by irregular periods like in the medical journals, but it's a lot more than that. It's seven to 10 years before your period stops. So 35 to 45 perimenopause is going to begin. You're going to start noticing something's not right. It could be the cliche symptoms of hot flashes. You know why hot flashes define menopause? No, because you can't blame it on anything else. Oh, that's true. Unless it's tuberculosis, nothing else causes a hot flash pretty much. Unless you have a fever, then menopause. So that's why it's the heart, the bell ringer of menopause. But what other symptoms might you be experiencing? Brain fog, arthralgias, frozen shoulder, joint pain, gut constipation, diarrhea. You name the organ system, asthma, flares, new asthma, new autoimmune disease. Dry skin, dry eyes, dry vagina, dry mouth. It goes on and on and on. So it would seem
Mel Robbins (00:39:47):
Based on the science here, that anytime a woman goes to the doctor and has any kind of complaint like that in terms of the symptom that one of the standard procedures should be test or freaking hormones.
Dr. Mary Claire Haver (00:40:01):
So that's another problem. The brain is pumping hormones as hard as it can. And so in that perimenopause, I call it the zone of chaos.
Mel Robbins (00:40:09):
Yes,
Dr. Mary Claire Haver (00:40:10):
You're squeaking an egg out now and then, but you're having massive surges of that. We'll see estrogen levels like you were pregnant with triplets, three, 400, they're temporary because you had to work so hard to get that egg out and then it just plummets down to nothing.
Mel Robbins (00:40:25):
Is this why our emotions are all over the place during the month? That's what we think. That makes perfect sense because if your system is in chaos, regardless of your age, by the way, but if your system is in chaos because it's having to work so hard to just do the thing, you're supposed to
Dr. Mary Claire Haver (00:40:43):
Try to do the basic biologic function.
Mel Robbins (00:40:45):
No wonder you start to feel all sorts of things go haywire. And so do the same things that you would recommend for a woman who is officially in menopause. Are those the same things that you should be doing if it's perimenopause or it is the estrogen deficient symptoms that you experience in the second half of the month?
Dr. Mary Claire Haver (00:41:07):
This is where the art and the science come in perimenopause, because some women will do well with just some progesterone support. Some women will need estrogen and progesterone support. We don't have a lot of great studies on the best way to support a woman's hormones in perimenopause. So it's a little bit of the wild west. We also, were not teaching our residents medical students trainees how to recognize it, how to diagnose it. You really, I don't need blood tests to diagnose. I just listened to the patient and believe her.
Mel Robbins (00:41:35):
I'm sitting here reacting to everything that you're saying because I'm thinking, I don't even really remember anybody talking about perimenopause as anything other than your period might get irregular, but none of these other symptoms. I mean this is very illuminating and I feel kind of bad that I didn't know that because I had no clue what was happening.
Mel Robbins (00:41:57):
I would love to now focus on menopause. And are you still in a monthly cycle? What is happening when you're in
Dr. Mary Claire Haver (00:42:05):
Menopause? So once those ovaries fail, and I know that's term is harsh, but once the ovarian and once the eggs are gone, no more periods, any vaginal bleeding after menopause needs to be evaluated by a gynecologist, there might be something wrong. You should never have another period again. So your stop or first they become shorter, longer. It's really, it could be anything, but eventually they just kind of stop. Some women will wake up and never have another period. Others will have this kind of skipping months and months between until they finally end.
Mel Robbins (00:42:39):
Mine was like Chucky just kind of kept popping up like, oh, I thought you were gone.
Dr. Mary Claire Haver (00:42:45):
Here you are again.
Mel Robbins (00:42:46):
Yes.
Dr. Mary Claire Haver (00:42:47):
So once you've gone a year, then most scientists agree that you're done. Okay. If you're over the age of 45 and you hadn't had a period for a year, you are a postmenopausal woman. That's the clinical definition.
Mel Robbins (00:42:58):
And what is the technical definition of when you've moved from perimenopause to menopause?
Dr. Mary Claire Haver (00:43:03):
So perimenopause is that one day we're like, yep, it signifies your ovarian failure. You will never have another egg that's able to be fertilized again. Then there's no more left. And then for the rest of your life, your postmenopausal. Now some of the symptoms you experience get better.
Dr. Mary Claire Haver (00:43:21):
It might take several years. Like the hot flashes do tend to go away, the sleep disruptions, if they're related to hot flashes and night sweats do tend to get better. Might take seven to 10 years.
Mel Robbins (00:43:31):
Seven to 10 years, forever
Dr. Mary Claire Haver (00:43:33):
Think should go away. I'm thinking like a couple weeks. It might take shorter, but I want to give people a very clear picture. And so a lot of women are like, well, I went through my menopause, I'm done with that. And I'm like, your bones are still deteriorating. Your risk of cardiovascular disease is still increased. Your genital urinary system without support is failing. And these are the things that don't go away in your post menopause.
Mel Robbins (00:43:58):
I just realized I'm talking about it wrong. I always say I'm in menopause. I'm going through menopause, I've hit menopause. And you're saying once you actually get to that date where you haven't had a period for a year, it ain't coming back. That's menopause. But technically now I'm in post menopause forever. Wow. So when you are post-menopausal, do you have any estrogen at all?
Dr. Mary Claire Haver (00:44:25):
So there are four estrogens that our body can make. The number one heavy hitter most biologically active does the bulk of the work as estradiol. And that's what's mostly created in our ovaries. Testosterone can be peripherally converted at a very small rate to some estradiol or estro. Soone is what's created in our fat cells. So the more subcutaneous fat you are, the higher your estro level is, which is why heavier women are more likely to have an endometrial cancer and other estrogen related cancers.
Mel Robbins (00:44:56):
Is this also why one of the symptoms when estrogen starts to decline is that your arms get flabby and you start to gain weight around your stomach because your body, once it's signaling, there's not enough estrogen being created in your ovaries. Your body starts to try to create and hold onto it in your fat.
Dr. Mary Claire Haver (00:45:13):
So there are theories around that. The anthropologists are scratching their heads because there's only five mammals that go through menopause and four of them live underwater. Beluga whales and a few, one of the killer whales. Yeah.
Mel Robbins (00:45:26):
Really.
Dr. Mary Claire Haver (00:45:26):
So yeah, no other mammals on land really that we can figure out maybe one giraffe. They're looking at one particular giraffe. We are really unique in that we have a menopause and we think because we've just artificially extended our life, past our evolution with modern health and sanitation and all the things that keep us alive. That's wild. We weren't designed to live this long. So we have estradiol that's gone. The ovaries can't make that anymore. Maybe a tiny bit, but really not clinically significant. Estro, really weak estrogen estriol, which is created in our placenta when we're pregnant. But pharmacologists have been able to recreate it. And it's used in one or two formulations of hormone therapy. It's not one of my favorites. And then there's this other one called rol, very fancy that the fetuses, when we're in the womb, that's another one that we make with fetal cells. And that one has also been synthesized and is used in a couple of one hormone replacement therapy. That's not one of my favorites. No, but I mean in your body.
Dr. Mary Claire Haver (00:46:24):
So your estrogen level is not zero, but your estro, but it's less than 1% of it was when you were 25. So lemme give it to you that way.
Mel Robbins (00:46:31):
Got it. Less than 1% of what it was when you were 25. Holy
Dr. Mary Claire Haver (00:46:37):
Smokes.
Mel Robbins (00:46:39):
And your body
Dr. Mary Claire Haver (00:46:40):
Needs it. It will function better with it. You will not die without it. You'll just die faster and less healthy
Mel Robbins (00:46:47):
And miserable. Wow. I'm trying to digest this stat. I want to make sure you didn't miss this. When you think about the estrogen levels that you have at the age of 25, you only have 1% of that. When of estradiol. Yeah. You are postmenopausal and the only sources for your body to create it are ovaries or,
Dr. Mary Claire Haver (00:47:08):
And a little bit in the periphery in other cells. It That's it. Wow. And our march to death begins.
Mel Robbins (00:47:19):
Not anymore Dr. Haber, because you are here to make sure that does not happen because we are capable of doing simple things to optimize health and live a long and happy, healthy life juicy, amazing
Dr. Mary Claire Haver (00:47:33):
Life vibrant.
Mel Robbins (00:47:33):
As a medical doctor, as a woman who is going through this right now, what do we do now that we know? What do we
Dr. Mary Claire Haver (00:47:41):
Do? Great question. So when I have patients come to me in clinic and we talk about menopause care, I do it in the form of a toolkit. We start with nutrition. We talk about movement and exercise, we talk about stress reduction, sleep optimization. Then we talk about pharmacologic options like hormone therapy or if she's not a candidate, then other options for her based on her symptoms. We also talk about supplements that might be helpful.
Mel Robbins (00:48:07):
So let's take these one at a time.
Mel Robbins (00:48:10):
Who is not a candidate for hormone replacement therapy?
Dr. Mary Claire Haver (00:48:13):
Very few people actually. There's a lot of misunderstanding and misconception around who can and can't take hormone therapy, absolute contraindications, undiagnosed vaginal bleeding. You need to go see your gynecologist. You might need an ultrasound or biopsy. If you're having undiagnosed, we don't know why you're not bleeding normally. Please go get that evaluated before we start hormone therapy. It might be a tumor that is estrogen fed, so we need to work on that. Active breast cancer shouldn't be on estrogen therapy, active blood clot, active stroke. Once those six month markers and the workup for those things have happened, it's a possibility. It's a nuanced conversation, but not an absolute contraindication. Neither is breast cancer. Wow. There are certain breast cancers that after treatment, you could be a candidate. You could be a candidate. Now again, nuanced conversation. Risks and benefits coming back and forth. A family history of breast cancer, not a contraindication, a family history of a blood clot or a history that you have of M-T-H-F-R or some of the blood clotting, high risk blood clots. As long as you avoid oral estrogen, we're not going to increase your clotting risk. You're saying
Mel Robbins (00:49:25):
That even if you have a history of breast cancer that does not a
Dr. Mary Claire Haver (00:49:33):
Hundred percent preclude you from having the option.
Mel Robbins (00:49:36):
Gotcha. There are ways for you with the counsel of your physician to explore hormone replacement therapy, even if you have,
Dr. Mary Claire Haver (00:49:46):
So the thing that a woman with breast cancer is most likely to die from
(00:49:52):
Is cardiovascular disease, not breast cancer. She's a 90% survival cure rate. And when we go through menopause, we see a dramatic uptick in our risk of cardiovascular disease. Actually women on hormone therapy if given at that really that we have a juicy window of opportunity. The first 10 years of your menopause estrogen is protective. And women on HRT between 50 and 59 ish or within those first 10 years, have a lower all cause mortality, a lower cardiovascular disease, death, and a lower cardiovascular disease at all like death from cardiovascular disease or heart attack. Wow. And lemme tell you something else. Tell that'll blow your mind. Tell me. So primary prevention strategies for cardiovascular disease. So women are given statins all the time for high cholesterol, has never been shown to decrease her risk of cardiovascular death. Yes, in a man, but not in a woman. ACE inhibitors and a blood pressure medication is often recommended as primary prevention never been shown to be helpful in a woman. Only in men aspirin. Baby aspirin never been shown to be primary preventative for a heart attack only in men. Yet we're recommending this stuff to women all the time. And we've taken from many women the conversation or the option of hormone therapy is off the table when that is the one thing that is going to decrease her risk besides lifestyle. Of course.
Mel Robbins (00:51:17):
Wow.
Dr. Mary Claire Haver (00:51:18):
Yeah. That's when I get mad.
Mel Robbins (00:51:20):
I can tell
Dr. Mary Claire Haver (00:51:20):
What are we doing?
Mel Robbins (00:51:21):
I'm glad you're doing something and I'm glad that you're here because when you say it like that, it's outrageous. It makes you feel, it makes like our Guinea pigs.
Dr. Mary Claire Haver (00:51:30):
We are more than our breasts. And you deserve the conversation. You deserve the option for each woman. It is a risk to benefit ratio. I don't think every woman is going to choose hormone therapy, but I think every woman deserves the conversation based on modern medicine and what we know now. Can you just quickly say why there is such
Mel Robbins (00:51:52):
A
Dr. Mary Claire Haver (00:51:53):
Hysteria? Yes. Yeah.
Mel Robbins (00:51:55):
Around hormone replacement therapy.
Dr. Mary Claire Haver (00:51:56):
I'll tell you why. A beautiful study, there's a little bit flawed in the way they set it up because the average age in the study was 62, not 50 51, when most women will go through menopause. So they did a study that was looking at just one particular type of hormone therapy, Premarin, which is CE e conjugated. Equine estrogens was meant to show that yes, hormone therapy is absolutely protective for cardiovascular disease. They had two groups, women who have a uterus, women who have don't, and then the women with uterus got estrogen plus a progestogen. And then the women without a uterus got estrogen only and there was a placebo group in each set. And then they started them on hormone therapy, average age of 62 and then followed them. And so they were outside the window in the hormone therapy When would really start? Yes. So when they went back and stratified the data and looked at it, so what they said was, well, it doesn't really help cardiovascular disease. Well no, because it's by the time you're 62 and they had women in their seventies in the study, they probably already had it.
Mel Robbins (00:52:59):
So is the bottom line that there was the biggest kind of study that was written about the study itself was flawed and then the reporting became hysterical?
Dr. Mary Claire Haver (00:53:07):
Yes.
Mel Robbins (00:53:08):
And the kind of lore,
Dr. Mary Claire Haver (00:53:10):
Many of their findings at that hysterical reporting were walked back. There's only one that still stands and it's still controversial.
Mel Robbins (00:53:17):
And this is recently, recently. They have literally said that wasn't really accurate. It's not really true. And so the reason why it's important to say this is because there is this murmur out there that hormone replacement therapy causes cancer, causes cancer is dangerous, blah, blah, blah. And you are saying there are certain categories where you should not be on, but for the vast majority of the women in your life, this is an option you need to be exploring.
Dr. Mary Claire Haver (00:53:48):
Yes.
Mel Robbins (00:53:48):
And it's not only safe, it actually increases your health outcomes. So the majority of us are a safe candidate for hormone replacement therapy. What about supplements? What are the supplements that
Dr. Mary Claire Haver (00:54:03):
We need to take? We really should try to get most of our nutrients from food and we only supplement where there's a gap or you have an allergy and intolerance and then we go in from there. There are a few supplements that are non essential nutrients that might be helpful, like turmeric, right? That's not anything we have to eat to survive, but it has some pretty powerful antioxidant, anti-inflammatory properties and that someone might find helpful. But when we're talking about the vital things, if I had my top three things, I would recommend to everyone, fiber, track your fiber for a couple of weeks, get a nutrition tracker, see where you're at. Fiber does so much in our bodies. Number one feeds the gut microbiome. That's its food. So that's the prebiotic.
Mel Robbins (00:54:41):
Give me an example of what fiber
Dr. Mary Claire Haver (00:54:43):
Is. Legumes who? Berry, legumes. Beans. Beans. So it's a class of beans. Peanuts are actually legumes as well. Typically really high in fiber.
Mel Robbins (00:54:55):
Okay.
Dr. Mary Claire Haver (00:54:57):
Berries really high in fiber. Seeds and nuts. Really high in fiber. Those are kind of avocado or that's my go-to to make sure I'm getting my fiber gold every day. Also has healthy fats and other vitamins and minerals and nutrients. Mag magnesium.
Mel Robbins (00:55:10):
And this confuses me. I'm not quite sure what type of magnesium to take.
Dr. Mary Claire Haver (00:55:15):
Oh, great question. Your glycinates, your tates, your citrates and elates are good because they're readily absorbed into the bloodstream. So now we have nice magnesium levels in our blood. There's also benefit, some of them are better than others about crossing that blood brain barrier. So the brain protects itself. There's a membrane around the brain that it doesn't have this a hundred percent free flow of nutrients back and forth. It's really selective about what it lets in. So mag urinate, which magine or NeuroMag are the brand names has been studied. And like SSRI resistant depression. So antidepressant resistant depression in patients. They've added in this, it seemed to be helpful. And my patients and followers, it's so helpful for sleep anxiety. So I'm often recommending that one at night.
Mel Robbins (00:56:04):
One was that one
Dr. Mary Claire Haver (00:56:06):
Magnesium L three eight.
Mel Robbins (00:56:08):
Okay. So you're saying fibers number one, magnesium is number two. How do you get magnesium naturally?
Dr. Mary Claire Haver (00:56:13):
So pumpkin seeds, spinach, green, leafy greens are rich in mag generally. I have a lot of lists on my website where we list all this stuff. We'll link to all this. And what's the third thing? So I'm always looking at omega fatty acids. Omegas are usually found in fatty fish, also in flax, one of my favorite ways, I'll do this little yogurt and I'll have flax, hemp and chia seeds. I'm just hitting all my antioxidants, my anti-inflammatory, my fiber all in one. So omega threes, if you can't get a good source of that, that's a very reasonable thing to supplement every day. One of the richest sources of that is going to be your salmon, your mackerel, your tuna, your fatty fish, your cold water fish.
Dr. Mary Claire Haver (00:56:54):
And then I check a vitamin D level on every woman who'll let me stick a needle in 80% of my patients. Not just low, I mean deficient. And there's a million reasons for this. We don't absorb it very well because our gut health declines. We're protecting our skin from the sun, which is another place, and we're not really creating it in our skin as fast as we used to. So, and vitamin D is a hormone that has a million processes in the body. So I'm like, let's start here and get those vitamin D levels up because you're just not working as efficiently as you could.
Mel Robbins (00:57:28):
A lot of us, I've noticed in my group chats with my girlfriends that when we finally get in to see somebody who knows what they're doing, and you do a blood draw and you get your panels back, almost all of us have magnesium deficiency, vitamin B deficiency, vitamin D deficiency, and heightened cholesterol.
Dr. Mary Claire Haver (00:57:50):
Yes. So again, about 70, 80% of my patients have an unexplained, no changes in diet or exercise, rise in cholesterol, absolutely secondary to estrogen deficiency. And again, rushing to put her on a statin will make her cholesterol go down, but is not going to decrease her risk of cardiovascular disease. And women who are on HRT have higher HDLs and lower LDLs than women who are, when you compare the two groups. So just being menopausal is an independent risk factor for an unhealthy cholesterol profile.
Mel Robbins (00:58:25):
So if you are eating the fiber and the magnes magnesium and the omega threes and you're also taking the vitamin D supplement, how do you make sure that your body can actually absorb it or that your gut health is okay? Do you also recommend that people take a probiotic?
Dr. Mary Claire Haver (00:58:45):
So I do. They've done some studies looking at probiotic supplementation in women with obesity and hypertension who were also postmenopausal. And there were some really positive results of, it's hard to measure gut health. We don't walk around with stool samples and they're counting the microbes in it. But you know, when you're bloated, you know when you're having regular bowel movements, you know how you feel. When we go through menopause and lose our estrogen, the gut microbiome loses diversity no matter how many probiotics you take. Or there are things we can do workarounds, but the loss of estrogen will change your gut microbiome to the profile of a man's.
Mel Robbins (00:59:22):
Is that why we get a belly
Dr. Mary Claire Haver (00:59:24):
Part of it? That's part of it. So we know that an independent risk factor for visceral fat deposition, what we call belly fat, in layman's terms, visceral fat means inside the wrapping around the organs inside the abdomen, that fat is very different than the curvy fat, than subcutaneous fat. That visceral fat is a marker for cardiovascular disease, diabetes, stroke. And so women who were on the probiotic versus placebo had lower blood pressure and lower visceral fat. Weights didn't change. Calories are still important, but they're not the only thing. But their visceral fat levels went down. So for that reason, I'm like, eat something rich in a probiotic every day. Yogurt, miso, kimchi, whatever floats your boat. If you can't tolerate that, then you want to consider supplementing.
Mel Robbins (01:00:10):
Gotcha. Talk to us about exercise.
Mel Robbins (01:00:13):
So what kind of exercise is critical?
Dr. Mary Claire Haver (01:00:16):
I grew up in the eighties and I was the cardio queen. I did so many step aerobics classes. I taught them it would make your head spin. I did not.
Mel Robbins (01:00:24):
I can actually see that I would take a step aerobics class with you.
Dr. Mary Claire Haver (01:00:28):
All of my exercise was to be thin and to maintain a certain body shape that was part of my social currency. And if I could go back and talk to my, what I tell my children all the time, we need to move our bodies to be strong, not skinny, and that we are chipping away this constant caloric restriction and all this cardio is chipping away at our bone and muscle strength, which we are going to desperately need as we age. Especially if you're built like me. And I didn't pick up weights until I was well into my forties, and there's never too late. Anybody listening at any age can start weight training and you should. So I think that getting people to let go of this notion that thin is the way to be and that you're way better off having a little more curves and a lot more muscle is going to serve you in these menopausal years so much better than just being skinny.
Mel Robbins (01:01:21):
I have followed all this advice and I have switched up the entire way. I approach exercise. I now resistance strain three days a week. And if you're having a hard time sleeping, what
Dr. Mary Claire Haver (01:01:35):
Do you recommend? So we have to look at why you're having a hard time. Progesterone goes a long way to helping us sleep. And so estrogen leads to hot flashes and night sweats, which are completely sleep disruptive. I mean, even with hormone therapy, I still have a thermometer leg that I have to throw out occasionally.
Mel Robbins (01:01:56):
Thermometer leg. I was just talking to a friend this morning, she's like, oh, well I just stick my leg out and the fan hits it and that's how I cool myself down. And then you
Dr. Mary Claire Haver (01:02:05):
Throw it back in. Throw it out. Yeah, throw it back in. So I'm like, okay, let's get you on some estrogen. And so say she's had a hysterectomy and she doesn't have to have progesterone progesterone's an option. So I'm like people deeper. It has anxiolytic effect. What does that word mean? So anti-anxiety, antiotic effect. Anti, yeah, sorry. Wow. That's a big anti-anxiety effect. Okay. So if your sleep disruption is also you're having racing thoughts at night, you can't shut that brain off. Yes, this is my daughter. GE is beautiful for these women, especially in perimenopause when we're skipping ovulations and we're not giving that monthly surge of progesterone. Is this an option for somebody who's even before perimenopause? Perimenopause? You could, yeah,
(01:02:51):
You can safely take progesterone every day, even if you're premenopausal. Wow. It can be really helpful. Wow. Alright. So estrogen, progesterone, but also sleep hygiene. We can't negate the fact that we're on our phones too much at night. The blue light not setting up an environment for good sleep, a snoring partner, especially some of, and all the things we need to do to set ourselves up for success for sleep. And then when you sprinkle in the hormone changes, it's a disaster for some women. And that's really something I zero in on with my patients.
Mel Robbins (01:03:21):
What do we need to know about alcohol?
Dr. Mary Claire Haver (01:03:23):
I don't know any woman who's in her menopausal journey who is processing alcohol the way she used to. The tolerance seems to be going down. I'm excited to see some more research come out about this, but in my world, I have to go in my personal experience, if I'm choosing to have a drink, I'm choosing not to sleep. I'm going to be up at 3, 2 30, 2, 3 31, whatever it is, and it is like a bomb going off even one glass. And I have to make that choice. I can't drink like I used to. Thank God, those college days, most of the women in my practice and on social media are commenting every time I talk about it, they're like, yep, gave it up. It's not worth it.
Mel Robbins (01:04:06):
If you're choosing to drink, you're choosing not to sleep. It really is that simple.
Dr. Mary Claire Haver (01:04:10):
Yeah.
Mel Robbins (01:04:11):
Wow.
Dr. Mary Claire Haver (01:04:12):
So women, I've said this before, we are living longer, but we're living in poorer health. I don't want the longer lifespan. If I'm going to be decrepit and I'm going to be disabled and my children are going to worry about me every day, I think that as this next gen, our daughters come up through this and they have their options and they know what's happening in their bodies and they understand it, we're going to keep that lifespan, but we're going to improve our health span and make those choices that can lead to us having healthier lives.
Mel Robbins (01:04:46):
Well, I think that's the really exciting thing of this because when you don't understand what's happening, you get stuck in this cycle of feeling overwhelmed and that there's something wrong with you and you're constantly, your
Dr. Mary Claire Haver (01:04:59):
Doctor, your doctor didn't even understand.
Mel Robbins (01:05:01):
Yeah. You're constantly complaining about the symptoms with your girlfriends and with your significant other or complaining to your kids. But what you're also saying is not only can you get relief from the symptoms and feel like yourself again and really optimize your health, but that when you do so, it increases the quality of your life and it increases your lifespan and it increases your vitality
(01:05:27):
Over that lifespan. And that's why this is so important. One of the greatest things about social media is that this is the first time in history that women in our age group actually have found each other. And I started collectively saying, what's going on with my weight? What's going on with my joint pain? What's going on with my brain fog? And you don't feel alone. Of course, I knew that the hot flash was from menopause. I had no idea that the brain fog was menopausal. I had no idea that some of the joint pain was an issue. And I certainly knew that the sex drive lowering was part of what was going on. But I'll tell you, it was really when the belly fat and the back fat that I started to gain, and I was so demoralized
(01:06:23):
Because I'm the kind of person that exercises six days a week. I was doing everything I thought I was supposed to be doing, and even more so I had stopped drinking during the week, so I had lowered my drinking significantly and nothing was doing anything. My pants were not fitting. And it was so weird because I felt swollen all the time and it's almost like certain parts of my body didn't change, but I just had this tire around my center and people would be like, well, but you're still really thin. I'm like, but that's not the point.
Dr. Mary Claire Haver (01:07:05):
That is where might put my toe in the water of all this menopause stuff. You were me. That is my exact story.
Mel Robbins (01:07:13):
I literally hated the way my body looked. I was self-conscious around my husband of 28 years. I didn't want him to see me naked because literally it was like, I have rolls in my back
(01:07:29):
When I put my underwear on, I've got my skin hanging out over it. I do not know what to do. And so from a pure vanity and confidence, and I just want to feel like myself, and this doesn't feel fair standpoint, I started to get wackadoodle about it. Do I have to stop eating? Do I have to exercise crazy? What do I need to do? What is happening? And discovering that it was menopause. It only kind of went, okay, great. But then when I went to my doctor and they're like got six or seven years less, yeah, what the hell?
Dr. Mary Claire Haver (01:08:09):
Yeah, exact same thing happened to me, the same feelings. I was weighing myself. You had to pee in the middle of the night because menopause, I would weigh myself
Mel Robbins (01:08:16):
In the middle of the night. In the middle of the night. No wonder you weren't going back to
Dr. Mary Claire Haver (01:08:18):
Sleep. You're like, oh my god. And what is this? Constantly grabbing my belly. Yes. So my husband was like, he was going on a trip. I said, when you get back, you're going to have the wife you deserve. I'm going to get this fat under control. And he was like, I love you. I think you're beautiful. Your girls are watching this behavior. And he said, you're a smart girl. Figure this out. You're a scientist. And he got on the plane. And I took that as, I'm going to figure this out. I called the PhD nutritionist at the university I was employed on. I was like, what the hell is going on in menopause? Because my patients can't lose it. I'm struggling. I'm starving myself. I'm working it all the time. They're like, yeah, there's something going on in menopause. We think it has to do with inflammation. Read all these articles. And hence began the rabbit trail for me of going down, well, the rabbit hole. And I was like, whoa, whoa. Inflammation, estrogen, visceral. What is this visceral fat thing? No one ever taught me that in school. Whoa, my diabetes risk. Lemme check my cholesterol. Holy shit. It's elevated. Oh my God. And then that's why I wrote the book to put it all together.
Mel Robbins (01:09:22):
So for the person listening, I know what they're now thinking. Okay, great. I got to get the book, but how do I find my own Dr. Aver? I'm dead serious about this. How do you prepare yourself to go into your doctor and how do you find somebody who has been studying menopause?
Dr. Mary Claire Haver (01:09:43):
Right? So in a perfect world, you could just march into your PCP or your ob gyn even and they would be like, absolutely, let's go. We're probably a generation away from this becoming normal. So what can you do? Now
(01:09:55):
I have a list on my website of testimonials from my followers who have found great people. So that's one place. The Menopause Society of which I've become certified is an independent organization of people who care about menopause, do research in menopause, and they have a certification and training program. And so you can find at the Menopause Society or menopause.org, go on there and find a certified provider. That's another place to start. Some of the new telemedicine companies coming out are built to serve the menopausal woman. I don't love it as much as an in-person visit because I do in-person visits, but my God, that's all they do is sit there, listen to your symptoms, believe you order a test if you need them, and give you the hormone therapy you so desperately need.
Mel Robbins (01:10:38):
I will link to absolutely everything that you've recommended, including how to find You, find the book, and reach out to you in all the resources for this show. Awesome. Do you have any final words of wisdom to the person listening,
Dr. Mary Claire Haver (01:10:53):
You're not crazy. It's okay. Find a community, talk about this, share this with everyone. We need to normalize this before we can optimize it and that don't let your daughters suffer. Tell them about your own experience. Most likely going to mimic what you've gone through. Menopause is inevitable. It's not a bad thing. It is a natural process, but you don't have to suffer. What I love about menopause is women find this power to put themselves first. For the first time in their adult lives, their give a shit factor goes away. They don't care anymore. They are embracing who they are. And I love that about us. I'm more successful. I never could have done this in my thirties, what I've been able to build. And I just love that about this age. But I want to keep that going. Dr. Haver, I just
Mel Robbins (01:11:44):
Want to tell you, you are a gift. I am so thrilled that you took the time to be here. I do think you are changing and saving people's lives. I hope as you've listened to her, that you've not only learned a lot about your own body, but that you feel more empowered and that you have a few very simple things that you can start doing immediately. And I hope one of the things that you do is that you take a moment to share this with every woman that you know. And I'm not just talking the women that are peri or postmenopausal. I'm talking every woman in your life because the information today was about the design of the female body and about how estrogen and estrogen decline in deficiency impacts her profoundly. And so this really could change somebody that you care about. It could change your life.
(01:12:37):
So thank you, thank you, thank you for taking the time to be with us. And I want to thank you for taking the time for yourself and taking the time to listen to something that could help you improve your life. And I want to make sure to tell you in case nobody else does that I love you. I believe in you. And learning more about your body and your brain and your hormones and how to optimize your overall health is one of the most important things that you can do to improve your life. So I know you feel empowered to do that after the conversation today, and I'll talk to you in a few days.
(01:13:15):
Oh my God, Dr. Mary, I'm looking forward that every woman and young woman that I know you are incredible.
Dr. Mary Claire Haver (01:13:38):
Thank you. Thank you for giving me a platform.
Mel Robbins (01:13:40):
Oh my gosh, thank you for everything you do.
(01:13:48):
And to you. Thank you so much for being here with me on YouTube for real. Aren't you so empowered? Don't you want to send this to absolutely every single girl and woman that you know? Please, please share this widely. This is life changing information. And one more thing, please hit subscribe because it allows me to continue to bring you world-class experts at zero costs every single day. New videos here on YouTube. And I know what you're thinking, you're thinking, okay, I want to know more. I want to know more. So I'm going to introduce you to the amazing Dr. Amy Shaw. She's going to teach you how to optimize your health and your hormones and to sleep better. And you're going to love, love Dr. Shaw in this video too.
Key takeaways
By the time you’re 30, you’ve lost 90% of the eggs you were born with, and by 43, you’re down to just 3%...and yes, that drop is wrecking your hormones.
Every single organ system in your body has estrogen receptors. So when estrogen disappears, it’s not just hot flashes, you also get joint pain, anxiety, migraines, insomnia, and other odd aches and pains.
Chronic inflammation ramps up as estrogen disappears, making you feel like “something’s wrong”. You feel fatigue, swelling, brain fog, even asthma and autoimmune flares.
Post-menopause, you’re left with less than 1% of the estrogen you had at 25, and your body is forced to run on empty unless you intervene on purpose.
The leading cause of death for women after menopause isn’t breast cancer, it’s cardiovascular disease. Hormone therapy has been shown to reduce that risk.
Guests appearing in this ep
Dr. Mary Claire Haver, MD
Dr. Mary Claire Haver is a board certified obstetrics and gynecology specialist and a certified menopause practitioner from the Menopause Society.
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Book: The New Menopause
Menopause is inevitable, but suffering through it is not! This is the empowering approach to self-advocacy that pioneering women’s health advocate Dr. Mary Claire Haver takes for women in the midst of hormonal change in The New Menopause.
Arming women with the power to secure vibrant health and well-being for the rest of their lives, The New Menopause is sure to become the bible of midlife wellness for present and future generations.
Resources
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Organization: The North American Menopause Society
Find a Menopause Practitioner for you!
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Organization: MIDI Health
MIDI Health is just one of many possible sources for menopause-focused telehealth care.
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Research > PubMed
Menopausal arthralgia: Fact or fiction?
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Article > Duke Obstetrics & GYN:
Hormone therapy appears to reduce shoulder pain.
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Article: The New York Times
How does menopause affect women of color?
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Article- Women's Health: Beyond hot flashes
Harvard Health
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Research: HRT may not be for you if you have heart disease.
American Heart Association
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Research: Women’s Health Report
The changes in your body composition during menopause
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How menopause changes the brain
The New York Times
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Organization: Breastcancer.org
Trusted guidance when you need us most. Because no one should face breast cancer alone.
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Research: Climacteric
Resistance training, 3x a week, improved quality of life.
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International Journal of Women’s Health
Finally putting a spotlight on your gut microbiome during menopause
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Dr. Mary Claire Haver
The Galveston Diet can help women lose stubborn weight
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The New York Times Podcasts
Menopause is having a moment
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Annals of Allergy, Asthma & Immunology
What is the asthma increase in menopausal women?
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Women’s Reproductive Health
Everything you should know about hormone disruptors and women’s health
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Endocrine Society
What you can do about hormone-disrupting chemicals
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Harvard Health
Taking aim at visceral (belly) fat
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Journal of Translational Research
Women in menopause have higher anxiety
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National Women’s Law Center
Insurance discrimination against women
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