Dr. Mary Claire Haver
Appearances
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Average of two kids, nine months each.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So men have a slow decline from like 18 or 19 down till they die. But for most, it's still detectable. Now, you might function better at a higher level and no one's going to deny that to you. It would be as if your testicles shriveled up and died at the average age of 51 and your empty ball sack is flapping in the breeze for the next 30 years.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Good luck to you, dude. Yeah, exactly.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So here's a sleeping pill. Here's something to improve your libido, maybe. Here's a palpitation medicine. Here's an antidepressant. Yeah, it's just like get through the rest of your life. They're talking about over-medicalizing menopause. The critics, and I'm like, bitch. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I'm giving her six drugs or I can wipe the whole thing out with just replacing her estrogen that's gone missing. Right.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
You'll actually have real results. It is the longevity drug for females. Nothing's going to work better than that. Wow. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Now you can raw dog menopause. No one's making you go on it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
When you look at why menopause hormone therapy was developed, it was to treat a hot flash. And forever, the pathognomonic, the poster child symptom was hot flashes, what we call medicine vasomotor symptoms. What was never taught to me ever, and I learned like three years ago, was we have estrogen receptors in every single organ system in this body.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And what I also was taught is in perimenopause, it's a slow, gentle decline. That's all I learned, one sentence. Decline until full menopause when you lose function. It is a rocking rollercoaster. And your worst symptoms tend to be the mental challenges, the brain fog, the cognitive disorders, the frozen shoulder. All of it is peri and late peri and early menopause.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We were born with all of our eggs.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So one to two million at birth. One to two million eggs.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yes. When your grandmother was pregnant with your mother, the egg that made you was inside of your mother, inside of your grandmother. In some ways, women have always existed. So there's all this knowledge, wisdom, and trauma that they think that this imprinting that goes on through a traumatic pregnancy. Yeah. Okay, a million to two million eggs. So one to two million in birth.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We lose eggs two ways. One, and from the minute they form, we start losing it through atresia, which is like an aging process. And it's kind of survival of the fittest because not all eggs are good eggs that you want to fertilize. So we want to leave the healthy ones behind to catch the sperm. So atresia is happening. Boom, boom, boom. And it accelerates at 35. We see a big drop off.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And then just from ovulating, we lose about 10,000 to get one to like pop off. Every ovulation cycle. Every ovulation.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
They just kind of dissolve. So when one egg pops out, the fallopian tube picks it up and it gets swept like a chimney through the fallopian tube. And it's fertilized or not in the fallopian tube. And then it goes into the uterine cavity. And sometimes they can pick it up in the mints, you know, when they've done studies. But sometimes it just kind of dissolves. But it's tiny, tiny microscopic.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Okay, so at 40, most women, and this is different for you, and I'm going to explain why. Don't shoot the messenger. She already knew. Most women are down to 3%. This is for people who look like me. This is the average American white girl. Are you Indian or Southeast Asian? Okay. Average age of menopause is 46.5. For me, it is 51. Thank you. So that's average.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
The window 41 is still normal for an Indian descent. And then that goes up to 51. You start younger. And then perimenopause back it up seven to 10 years before that. Am I in it? Maybe.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I don't, oh God, okay. Well, how would I know? That's a great question. Certainly if your cycles were starting to become irregular and if you had hot flashes, if you had the kind of cliche symptoms, but those are usually late in the game in parallel. I don't have that.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
The most common symptoms actually, now that these online telemedicine companies have developed for menopause and they are doing scoring systems on hundreds of thousands of women because everybody goes to their website, Am I in Menopause? And we have all these quizzes and things you can take. Fatigue, out of the ordinary. Nothing has changed. Your diet hasn't changed. Your stresses haven't changed.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
New onset mental health changes. We have a 40% increase in depression and anxiety across the menopause transition with no real environmental changes. We We have weight gain. So it's a steady state weight gain. But what's happening in the background with body composition is we have this acceleration of muscle mass loss and an acceleration of body fat gain, typically in the viscera.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So the intra-abdominal fat. So my patients used to come in and grab their tummies and their little paper gowns and be like, what the fuck is this? Mary Claire, I worked in a small town and then we all went to church together. What is this? I knew her. I worked out with her. We ran together. I know this woman. I know what she eats.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
That's when I was like, I are all my friends and now me gaining weight in weird places. None of us have gone off the deep end. We're not secretly eating bonbons at night. Yeah. And then bone density is another key thing. So we're seeing acceleration of bone loss. And so I'm telling my patients, let's get early bone densities. Let's not wait till 65. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Especially if you're programmed to go through younger than what's expected. Okay, can you get pregnant? You absolutely can get pregnant. During perimenopause. It's just a little harder. Because your supply and the quality of the egg goes down, which you knew. You know, the older you are.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Towards the end of perimenia, you're getting close to exhausting the whole deal.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
That's specific to who you're working with. Brain fog. You know, suddenly you lose your words. We all do it from time to time, but this is consistent. Get in the car and you're like, where am I going? You walk into a room, what was I doing here? You know, everybody does that from time to time.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
There's a pod of certain whales that do it and elephants are very matriarchal. But when you look at like the anthropologists and they're like, why do women go through menopause? So from a survival standpoint, it behooves a woman to not keep being pregnant over and over again. You kind of have your batch of children and then you have better survival rates if you stop.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
The anthropologists also think that women served as the source of wisdom for the tribe. They were the passers-on of knowledge. The dudes tended to die younger because they were getting killed by saber-toothed tigers. The grandma stayed back. Now, remember, these people were still very young compared to when we think of a grandmother now. We also died a lot sooner.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Things that don't take people out now, like vaccines and childhood diseases, we have a reason why we live longer. You're right.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We've industrialized our way out of it. We've evolved past our genetics.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So we're saying the reason that human women didn't die is because of their... Well, those who kind of ran the gauntlet of disease and being killed by accidents, if they survived, they seem to take on these very wisdom-creating, teaching the next generation. You know, if you look at whales, they're teaching the babies to hunt while the moms are hunting, gathering with the dads.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah, it's harder to do and it's harder to stay healthy doing it. In general, we would lose more women to cardiovascular issues, hypertension, preeclampsia, that kind of stuff. Before modern medicine, we had medications to help manage those conditions, diabetes.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So let's talk about what you're going through right now. A healthy woman who has a regular menstrual cycle, nothing is ever steady state. It's an EKG-like ebb and flow of some key hormones. And ovulation starts in the brain, not in the ovary. In order to ovulate, the brain registers that our estrogen level is low. So you have your period, your estrogen, progesterone drop off.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So they hosted my book launch, my big New York, one of the deals. And she made this for me.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
The brain gets that signal. Whoa, we're low. The hypothalamus is testing. It says, all right. It's time. Sends a signal to the pituitary, next gland underneath. And pituitary is like, all right, boss, I got it. The pituitary then sends LH and FSH. So if you've done any fertility treatments or you know these words or had the shots, you know, I did all that too.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So those two hormones go down and bind to the ovaries to stimulate the ovulation. Around each egg are a set of cells, follicular and granulosa cells, and then produce our sex hormones. Estrogen in the first half of the cycle, which peaks at ovulation. After ovulation, we see progesterone rise. And that cycle...
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
is unbelievable and goes month after month after month in perfection, unless you're ill or you're pregnant.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
There are things that we can do to mess it up, but for the average woman, the cave woman, this worked very well month after month after month.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
It's the one steady state that we have. It might mildly fluctuate, but really testosterone starts high in our 20s and 30s and then just like a man.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
When you're ovulating, but we just don't really see that. Female-male drives are a little bit different. So then what happens in perimenopause, in the background, we're losing eggs, losing eggs, losing eggs. We reach a critical egg threshold level, which is different for every human, where... The signals coming from the brain no longer work.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We become resistant because the quality and the quantity of the cells around the eggs available are declining. So the brain's like, where is my estrogen? The pituitary is like, boss, I sent the signal. He's like, send more. You start pounding the ovary with the GnRH to the pituitary. Pituitary is like, fuck, all right. Shoots out FSH and LH.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We see the stimulating hormones start to rise much higher than they ever, ever were in a premenopausal woman.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
This is so nice. I feel left out because I do indeed. Hydra Magic. I love it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Right, and just take it in the ass. So we see delayed ovulation. So the period starts to become irregular. And then because you were just pounding that egg, we end up with higher estradiol levels than we ever had before. That's why twins are a little bit more common towards the end of your fertility. Oh, interesting.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah, than they were when you were younger because you're getting your self-made fertility drugs, basically. Right, right, right. To push that egg out. And then progesterone never quite gets to where it was before. So what used to look like this gorgeous EKG each month now is literally a zone of chaos.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So you have estrogen doing this. Progesterone's like, I'm trying to keep up. FSH and LH are all over the place. And that's why we don't have a great blood test for perimenopause. I can't do a one-time blood test and say, obviously. Now for post, when you run out of eggs, FSH and LH, the brain is always looking, always pushing, always trying.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And now we know we have FSH receptors in other areas of our body. We think the bone, we know the liver. So sometimes it's not just the loss of estrogen, but it's these high FSH levels that are leading to the cholesterol changes that we see.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
A new study just, just, just came out two weeks ago that was looking at using a specific cholesterol marker, LDL marker called super dense LDL as a marker for perimenopause. Like we don't have a good blood test, but would AMH be helpful, which is one of the fertility things that we check, which is an ovarian reserve hormone.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
It is. Yeah. And the colors are Wicked. Yeah. I'm going to a Mardi Gras ball that is Wizard of Oz Wicked themed. In New Orleans? In Galveston.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So that's a great question. People ask me all the time, okay, so if I'm going to replace my hormones in my menopausal journey, would it have been good for me to know my 30s where they were? I'm like, where in the month would you like me to check? Probably not the high because that's when we have the breast tenderness and we worry about stimulating the uterine lining too much. Right.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So one of the problems with menopause treatment is we've just titrated to get rid of hot flashes. Right. But now we know women absorb very differently and not everyone's therapeutic on our transdermal doses. So in my clinic, we're starting to check three months out. What are her levels? How is she absorbing?
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We know that women who start HRT in the first 10 years have a 50% per year lower risk of a new heart attack, cardiovascular disease, atherosclerosis. It's very protective of the endothelium. What we don't know is what were those levels? We just know she was on it or she wasn't. Right. Yeah. So should we be taking estrogen during perimenopause? I think so. Wow.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We can decrease your risk, but it's just how. Do we suppress and replace, like what's in a birth control pill? Or do we just support, give you just enough to calm the brain down and make your symptoms better, but allow the process to proceed in the background? Right. There's tons of debate in my world about what's better.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
There's like three people and he's one of them. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I wish that I could tell you, you could confidently walk into your OBGYN, your family medicine, your internal medicine doctor, and have a reasonable, logical conversation about your plan of care in perimenopause and menopause. That is not possible right now. It is not the fault of the individual doctor.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So that's going to be the Galvez more than likely. Okay.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
They may have been excellent in your birth and your pregnancy, every aspect, but because of the six hours, so right now they surveyed residents coming out three years ago, Only 30% felt barely adequately trained to treat menopause. It's awful. So at least they're honest. Call ahead.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Look on the Menopause Society website, which is menopause.org, and see who has passed the test and is certified there. It's not perfect. There's always people out there who aren't. great doctors who took the test, but it's somewhere to start. We crowdsourced with my followers. I've got thousands of testimonials and we organize them by country, city, and state to help people.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
They don't pay me just to go find a provider who might be able to help you. And right now it's pretty slick. There's some great telemedicine companies that have been developed, mostly female founded, who saw a gap in care and they saw a need and they developed these telemedicine companies. I have women calling me from New York, LA, London, the most well-connected you would think
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Who have the same basic questions and the same worries and the same fears and cannot find help as the woman sitting on the couch in Iowa. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I was shocked, and most of that was driven by questions I got on social. As my little social media platform was exploding, when 10,000 women ask you about frozen shoulder, palpitations, or vertigo, you're like, they can't all be lying. Then I'm digging, and I'm like, somebody did the study. There's clear data here.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So I go online, and I make a little video talking about the correlation between menopause and vertigo, or menopause and frozen shoulder, or menopause and palpitations, and the world goes crazy. Wow. I get 10,000 comments. Why didn't my doctor know? Again... were doing a terrible job of teaching, but I was literally learning alongside my followers. As I learned, I'd make a video and teach.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah, I grew up in Louisiana, went to undergrad. I was a raging Cajun, so I went USL. I'm dating myself. It's now ULL. They're fancy. And then I did grad school for a little bit, almost went the PhD geology route. Oh, my undergrads in geology. I went to work for an oil company, kind of had a change of heart and was like, what else can I do with the science degree?
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And that's what inspired me to write the book. And they were like, please write a book. I don't want to chase you all over social media. That's too complicated. Just put it all in one place. Frozen Children, that is scaring me. My mom had it. My grandmother had it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So this is a great story, and I hope I get the lore right. But the story goes... The first study on frozen shoulder and menopause, I know it came out of Duke University. I read the paper and it was the head of OB-GYN and the head of orthopedics who both happened to be women. And it was something like they were sitting in the doctor's lounge or in the cafeteria and just shooting the breeze over.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Can you believe all these women with frozen shoulder? You think there's a correlation? I don't know. Let's look into it. They started pulling charts and they were like, fuck me. Look at this. Women who are on HRT have a lower incidence of frozen shoulder and they do better. They're getting it, but they're getting it less than women who aren't, and they're having a better course.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So they go to get it published. They go to orthopedic journals first. Nobody would touch it. Nope, this can't be right. Nope, this is an artifact. Nope, nope, nope, nope. So one of the menopause journals published it. And so then I have a friend, Vonda Wright. She's an orthopedic surgeon. She does a ton of teaching, and she wrote the paper on the musculoskeletal syndrome of menopause.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Estrogen receptors and probably progesterone here as well are all over the musculoskeletal system. We know bones. We got bones down. We've known about osteoporosis since I was a resident. I know that one really well. But what wasn't understood was tendons, muscles, and the connections between bones and muscles and how that all works together. And frozen shoulder is adhesive capsulitis.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
There's a capsule around the ball joint and the shoulder that gets absolutely adhesed and frozen. And it's an inflammatory condition. You can't put your arm down. Yeah. You go to take a picture. Yeah. And it's very, very painful. You need early intervention. You need physical therapy. There's needling. They have to break it up.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And that we can delay the onset and the duration and probably prevent several cases for women on HRT. Because estrogen is protective. So it's an anti-inflammatory. But my mom, I've never heard her once say she had that because of menopause. Well, no, most women don't know. Most orthopedic surgeons don't know. We're working to change that. That paper was written a year and a half ago. Oh, wow.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah. Tinnitus, tinnitus, I still don't know how to say it correctly.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Maddening. Yeah. So again, this is an estrogen receptor problem. The vertigo is that the crystals break off quicker. It's basically osteoporosis in the ear. Oh. And the crystals break off and then float around and you're dizzy. But the tinnitus, the inflammation around the nerve and around some of the auricular bones that they feel like is leading to it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And that all these studies say age match women, premenopausal women definitely have it less than post and women on HRT are less likely to get it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah, in the skin and tegumentary skin and the paraphocles. I like tegumentary. I've never heard that word. That's nice. All the follicles and oil and sweat glands. It's the whole system. Largest organ in the body. It is. Most absorbent. So we lose 30% of our collagen. You don't have to tell a woman that. She knows. Okay.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
In the first five years of menopause, we can attenuate that with topical or systemic hormone therapy. Topical works better, actually, which is why I'm on my vanity cream. Is it a retinol? No, it's estrogen for the face. Wow. So it's compounded. Some people take the vaginal product and will mix it in their moisturizer and put some on their face. But you should talk to a doctor before you do.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
You shouldn't do that on your own. Don't do any compounding at home. So, yeah. Mix it up with a little mortar and pestle. You lose oil production in the skin. You lose thinness and the trans-epidermal water loss is much greater. So you're just losing all your barrier, your protection. So the skin is less healthy.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And I was moving towards a PhD and I'm like, I'm not going to do this PhD. I need to do something cool and big. Let me just take the MCAT and see what happens. So then LSU for med school, which was in Shreveport, North Louisiana. And then I did residency in Galveston and we've stayed in the Houston, Galveston area pretty much since then. Do people tell you you look like Courtney Cox? Yes. Yes.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Dry mouth, same thing. So mucus production, the salivary glands dry up. We have tremendous dry mouth. And dry eyes, dry mouth, it's the same.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Early in menopause, as the estrogen levels decline, something that's made in the liver called steroid hormone binding globulin, SHBG, which binds our sex hormones and carries them around the blood and renders them inactive until they let loose and then they bind to go do things.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
When we lose the binding hormone, the activity of our androgens increases, even though your total testosterone may not be different, but the free is higher.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah, so you had some, but they were bound and you couldn't use them. That's right. It's a balance because you can... eat certain things, take certain things, certain supplements to increase, decrease. But then sometimes you're robbing Peter to pay Paul. And so in women, when the activity of their androgens increases, we see male pattern baldness.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
They start getting chin hair and their odor changes. They smell like onions and it's a really kind of weird. Yeah, I hear the onion thing a lot. This is so awful. Monica. I am living my best life. You just stick with me.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I don't want to scare people. So many women just go blindly into the night and they have no idea. And so one of my critics have said, you're just fear mongering. You want to scare people, whatever. I'm like, no, I want to educate. You're not blindsided. Imagine the cortisol levels that will come down where they're like, oh. This is what's going on. This might be my menopause. Fine, whatever.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Okay, we got this. I'm not going crazy. Especially the cognitive changes in the mental health. The divorce rates, the suicide rates are all right in there at this age.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Peak suicide rates are 45 to 55 in women.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I made it. I'm going to lean into work. We're going to go off in the sunset here. No. Wow.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And is that hormonal too? The neurotransmitters in the brain are heavily influenced by estrogen, progesterone levels, and the brain doesn't like the chaos. So the real mental health that we see, the big, big problems are in Perry. Post things tend to calm down, both cognitively and mental health. You still may need your, you know, whatever, but we see this wild uptick. in Perry.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I learned this much about sex drive.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Holding up a zero, sorry. I get my little diploma and I graduate and I'm at the top of my class. I win lots of awards and off we go. I'm going to go be the best OB-GYN. So the pregnant people come and then these other people come. I'm like, ew. So, like, as you're walking out from the well-woman exam, I'm like, okay, we'll see you next year. She's like, can I ask you one more thing? Sure.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I have low libido. I don't want to have sex. It's really affecting my marriage. And I was just like, deer in the headlights. You're like, I don't know.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Especially back in the day. Yes. When she was on Friends, I was a resident and we would have Friends watch parties. And now it's kind of Tina Fey. Anyone with black hair and big glasses is me. Well, both are compliments. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Oh, please. So I go out in the hallway and I find my boss, who's our mentors when we first get out, keep us out of trouble in those first couple of years. I'm like, hey, so Ms. Smith, you know, everything's fine. She's healthy, but you know, there's sex. I can't even say it. You know, I'm deep South and taboo. And he's like, oh, tell her to have some wine. She just needs to relax.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And it'll be fine. Just pat her on the knee, but she's going to be okay.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Exactly. Women just go through this at this age. So many people were complaining over and over again. I started looking for resources and I read Venus and Mars in the bedroom. Like that was my Bible. That was the only thing I knew how to do. No one taught me. I was going back in my textbooks. Nothing was talking about sexual desire drive.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I didn't even know all the causes of female sexual dysfunction. It was never a lecture. No one ever talked about it. Here I am, the expert going, I'll be right back. Let me see what I can find. So I ended up making little handouts for my patients on what I could dig up on desire and herbs.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And I didn't know about, well, they came out later, but Addy and Vilisi and testosterone and all these things that might be helpful to a woman and counseling and therapy and looking for orgasmic disorders and arousal disorders and pain disorders and pelvic floor dysfunction.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
When we go through the menopause transition, 100% of us are going to lose the protective effect of estrogen in the vagina, the vulva, the bladder, that whole what we now call the genital urinary system, pubic bone all the way back and up to the bladder. We lose elasticity. we lose the ability to produce mucus.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So if you biopsy to pre and postmenopausal vagina, premenopausal, it's this thick velvety, full of mucus glands, very resilient. It'll take a beating and be fine. Baby comes through there. It's traumatic, but they'll make it. And then postmenopausal looks like a desert.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
You went from this gorgeous, thick, multi-layered tissue to six cells laying on top of each other with no mucus, no nothing, like a desert. All we have to do for those women is give them back estrogen in the vagina and all that tissue will grow back. Even at 70, you can absolutely prevent and reverse this condition. So I recommend lubricants for all of my patients on every sexual encounter.
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Mary Claire Haver (on menopause)
Just get used to it. Do it proactively. Normalize this. Yes. And then I'm advising not to wait until you start having symptoms to use vaginal estrogen. It's very safe. It's like skincare. It doesn't absorb much. There's very much risk-free. If you have active breast cancer, you can still use it. It will save your life. I mean, it prevents UTIs.
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Mary Claire Haver (on menopause)
The best treatment for recurrent UTIs for a menopausal person is vaginal estrogen, not recurrent antibiotics.
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Mary Claire Haver (on menopause)
They have creams, gels. They have a suppository. They have a ring. There's multiple ways, but generic and cheap. The cream works for most people.
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Mary Claire Haver (on menopause)
So when we look at female sexual function, we have five buckets where she may not be happy. First of all, it has to bother her. Some women are like, I don't care. I'm never going to care. And I'm like, okay, then you're good. Other women are like, I used to have it. I miss it. So you have to make sure she's not having pain. There's a pain disorder.
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Mary Claire Haver (on menopause)
She's not having a relationship disorder because no amount of testosterone is going to fix a bad relationship. Can she have an orgasm? Or is the plumbing still working if she puts her mind to it?
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Mary Claire Haver (on menopause)
You see arousal disorders, it's more of a blood flow issue. I kind of had that. I was having delayed orgasm, like, hello, everything's working, I'm ready. I was like, okay, fine, I need vaginal estrogen now. And it took about eight years of menopause because I was on systemic, but I wasn't quite getting enough and everything's fixed. Libido, which is desire.
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Mary Claire Haver (on menopause)
In medical, we say hypoactive sexual desire disorder, HSDD. That is a mood. It's totally in the brain. Everything's working down here, but it's the thought of it. And most women will come to say, once we get going, I'm fine. So if a female has an arousal disorder, vaginal Viagra might work for her.
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Mary Claire Haver (on menopause)
They weren't shy about it. I would walk into the parents, make it out in the corner. Really? So mom and dad were restaurateurs. Oh, yes. They owned a Cajun restaurant. Yeah. We just called it food. You would call it Cajun. And it was a little more upscale. It was steaks and seafood. And I grew up in a big restaurant family. My grandparents, my aunts and uncles, most of my siblings.
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Mary Claire Haver (on menopause)
Increases blood flow. Basal dilator. Specifically to the corpus spongiosum. So that's the squishy part that gets erect. We have exactly the same tissue in the clitoris.
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Mary Claire Haver (on menopause)
Same anatomy, except ours looks like Gumby and yours is like a little rocket. So we've ruled out all the things and she's like, I love him. I'm not going anywhere. I miss it. Please help me. So we have two classes of meds that we talk about. One is testosterone. It works great for these women. If it doesn't help her in three months, that's not the answer.
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Mary Claire Haver (on menopause)
So we don't have FDA approved option for women. So we're either having someone cook it up in a lab and get a compounded cream generally.
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Mary Claire Haver (on menopause)
Ridiculous. We have studies that prove the safety and efficacy and all the things. And she's so much happier. There is anecdotal evidence that also her stamina is better. Her mood is better. Muscle mass.
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Mary Claire Haver (on menopause)
So all that works together. So I don't want to say it's a chandelier. So I have low muscle mass genetically, and I'm doing the things, eating the protein, working out. It's a full-time job, wearing my weighted vest. And I was like, what if I tried some testosterone off-label for myself, did not have a libido issue, and no one was complaining, and then start some testosterone.
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Mary Claire Haver (on menopause)
And I see an uptick in the area. A little more interested. He's not cuter. He's not pissing me off less. He's not my poor husband. But I'm just like, okay, a little more often, or maybe I'm even initiating, which had not happened in a long time. And we've just reached a different level now. And I think I would miss it if it was gone. So I'm like telling my patients this.
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Mary Claire Haver (on menopause)
Certainly if you're distressed, let's go for it. But here's my experience. So that's a topical. You don't want to do oral. There's no form available in the U.S. that will not affect the liver. There's one they use in Australia, Unducanoid, but it's not available here. So you're going to look at a non-oral option. So some people are doing some compounded injectables.
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Mary Claire Haver (on menopause)
What we're doing in our clinic is either T-STEM gel or Androgel. So we're doing the FDA approved gels for men. We're just using them off label for women. Interesting. You can also get a capsule. So there's trochies that dissolve that are submucosal. So you put them under your tongue. Oh, you mean the pellets. The pellets. So pellets are commercially available. They're not FDA approved.
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Mary Claire Haver (on menopause)
There's a problem with pellets that we see kind of in the ethical realm. Two problems with pellets. If you go to a doctor and they are trying to talk you into pellets and they won't discuss any other form of hormone therapy, that is an ethical red flag because they are financially benefiting from the sale of the pellets. Got you.
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Mary Claire Haver (on menopause)
And I just think you can do better because pellets are very hard to manage. You have this rapid rise. And I've seen females with testosterone levels in the four and five hundreds. And I am not kidding. They never made a female level pellet. They just give females the low level and say, you're running 200. You're fine. You're not going to die.
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Mary Claire Haver (on menopause)
They're supposed to. I've never seen a decay curve. Have you? They don't publish them. They're not FDA approved. So they don't have the same regulation. So I'm like, listen, we don't need to be doing this. Yeah. And I can take it away tomorrow. If you have a pellet, you are stuck until it's gone.
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Mary Claire Haver (on menopause)
Generally. I think we can do better for our patients. I don't need to make money putting pellets in people. It's a cash cow for a lot of practices. And I'm just really hesitant. If your doctor is really railroading you, if they say, I only do pellets, I would probably bounce. Interesting. Okay.
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Mary Claire Haver (on menopause)
Injectable. You can do a cream. You just rub it.
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Mary Claire Haver (on menopause)
You could, so I'll tell patients to put it here. Oh, I'm teasing. Is that real? There's no hair follicles here. I was studied on the shoulders. Okay. We want to monitor them to see how they're absorbing, make sure we're not going over, checking their free and total testosterone levels, and just seeing how they're doing.
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Mary Claire Haver (on menopause)
Another option to think about would be to do the T-stem gel or the Androgel. It's in a pump. So a full pump is 20 grams. For women, we need 5 to 10 grams. So that's like a half pump or a pea-sized amount. I tell my patients to put it on their inner arm where there's no hair follicles so they can see the pee. And then you just rub it in. Do a little rub. Wow.
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Mary Claire Haver (on menopause)
Okay, so you're doing testosterone on your arm, estrogen on your vulva. What else? I think I replaced my hormones like five ways, you know. Yeah. For estrogen, there's oral and non-oral. And in non-oral, patches are what we usually prescribe in my clinic.
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Mary Claire Haver (on menopause)
Lots of naps. Work the lunch shift, come home nap. Nap quotes.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah. They're very inexpensive. We have multiple strains, so I have a lot of options for patients. But sometimes people have a reaction to the adhesive, tape allergies. So we have gels and creams. It's just the expense goes up. The vaginal ring is great because you get two for one. You get systemic and vaginal. But they're like $200, $300. They last for three months. It's nice.
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Mary Claire Haver (on menopause)
You just throw it up there and forget about it. Toss it in. Yeah, I get scared. Yeah, it's not for everyone.
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Mary Claire Haver (on menopause)
I have a real fear of it. As you should. It's scary as hell. It's scary and you die. And then there's local estrogen options for the face and or the vagina. And then your progesterone. So progesterone is typically given in the menopause. We're giving oral micronized progesterone. It's the safest option.
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Mary Claire Haver (on menopause)
So progesterone is mandatory if you have a uterus, if you're doing estrogen, because the inside lining of the uterus, the endometrium where the blood would be made each month, is sensitive to estrogen. If we let estrogen play in there and oppose with progesterone, you'll develop hyperplasia and potentially malignancy.
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Mary Claire Haver (on menopause)
Early days of hormone therapy and the like, get your wife back sexy movement with estrogen. They were doing just estrogen and women were getting endometrial cancer. So we learned that lesson. You give her a progestogen, you will negate that. So if she has a uterus without the Mirena IUD, which has progesterone in it, you must give progesterone to not potentially give her cancer.
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Mary Claire Haver (on menopause)
Turns out progesterone is amazing for sleep. It upregulates GABA in the brain and it is our sleep, sleep hormone. So when patients are coming in an early perimenopause, still having regular cycles, but they can't sleep. This is Monica. They're waking up at two or three in the morning. Progesterone might be your new best friend. It's fine to start with progesterone without estrogen.
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Mary Claire Haver (on menopause)
We do that in a lot of cases. Interesting. I have so many things to take. You need a hormone doctor immediately.
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Mary Claire Haver (on menopause)
Obstetrics, that is tricky. Obstetrics and gynecology. So in your third year in most traditional programs, first two years are just in classroom and you get a little taste of different things, but you're mostly just getting the basics down. And your last two years are out in the wards where you're in the hospital rotating and figuring out what you want to do.
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Mary Claire Haver (on menopause)
I need you. Anxiety thoughts. It's great for that 2 a.m. wake up. I'll just take an extra one if I still have that. I mainly have a hard time just falling asleep. I mean, it's worth a trial. It's not going to hurt you. It's a natural hormone.
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Mary Claire Haver (on menopause)
If you're in perimenopause, your chances of getting pregnant are lower. Yeah. But if you are trying to spontaneously get pregnant, you have to make sure you're giving low enough doses where you're not going to inhibit a standard ovulation. And menopause hormone therapy really was not high enough to suppress ovulation.
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Mary Claire Haver (on menopause)
So the biggest difference between birth control pills and menopause hormone therapy, you think about why they were created. Birth control was formed for contraception. We need a high enough dose to shut the signal down from the hypothalamus, to tell the hypothalamus, we're cool, we got enough estrogen, no signals. No signals, no ovulation.
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Mary Claire Haver (on menopause)
Menopause hormone therapy was developed to simply stop a hot flash. You don't need nearly as much. Got it. So it's lower. Formulation, though, is different because of big pharma. Formulation tends to be ethanol estradiol, which is cheap and easy to make, and it's 100 times as potent as estradiol. And that's why you have those little tiny birth control pills.
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Mary Claire Haver (on menopause)
Whereas estradiol in its natural form, which is body identical, it's much less potent than its cousin, ethanol estradiol, but it's got a great safety profile and you don't need much to stop the hot flash. Now, how much do we need to prevent cardiovascular disease? You don't need much to help your bones. They did study those numbers.
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Mary Claire Haver (on menopause)
So we're all kind of debating if we're going to check levels, what's therapeutic?
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Mary Claire Haver (on menopause)
How many doctors did you go to before they gave you testosterone?
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Mary Claire Haver (on menopause)
A woman on average has to go to six to eight doctors before her menopause is diagnosed. This is how bad the problem is.
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Mary Claire Haver (on menopause)
Yeah, and that's kind of the pellet. It's the bio-T, really, that got into, whoa, let's put these in women and see what happens, you know?
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Mary Claire Haver (on menopause)
They're like, I don't know why my hair is falling out of beard. And I took her level and it's 450. I'm like, I might have a clue.
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Mary Claire Haver (on menopause)
Yeah. So, you know, most of them come in and menopause 12, 15, 20, 25. Let's get you up. So I'm trying to titrate my patients 60 to 70. Let's overshoot a little bit and see if this is going to help with your libido. But There are two FDA approved medications for libido that are not testosterone.
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Mary Claire Haver (on menopause)
I remember I thought I wanted to be a pediatrician. I was president of the Peds Interest Group, but they called PIG. And I did Peds first and I realized quickly I love babies, but I don't love their parents. The whole dynamic. This is not my niche. So then you rotate through surgery. I really like aspects of surgery, but I didn't like surgeons. Yeah, they're very arrogant.
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Mary Claire Haver (on menopause)
One is Vilisi and it is an injection you give yourself 45 minutes before and it causes a massive dump of melanocortin that then stimulates dopamine. And when our dopamine levels are higher, it makes us want to do things. Yeah.
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Mary Claire Haver (on menopause)
So we want the unfortunately, most of my patients don't choose that because they're like there's a praying mantis on the other end of this waiting the 45 minutes going is working.
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Mary Claire Haver (on menopause)
The women who like it and can unlock that part of their brain, it's great. Is it a base dopamine? Like, don't give it to an addict. I've not seen those studies. I've not had a patient yet who was like, yes, please. Addie is another. So Addie was studied in mood and they saw an uptick. Tell us how Addie works because they're a sponsor. Addy works the same thing.
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Mary Claire Haver (on menopause)
It's going to increase your dopamine levels. And it's something you take every day. It was studied in Mood. It works by increasing happy sexual encounters a couple more times a month or however they measure it. So the detractors of Addy are like, well, that's not enough. And the women are okay with it. Right. Right, right, right. on to four. That's enormous. I'm like, let the patients decide.
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Mary Claire Haver (on menopause)
Most of my patients choose testosterone purely because of cost and potentially the other benefits for bone and muscle, even though we don't have great studies yet, but the anecdotal data is looking very positive in that area.
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Mary Claire Haver (on menopause)
The musculoskeletal unit works together. It's not like it works in isolation. So testosterone will help a little bit. We looked at one of the things from WHI when the Women's Health Initiative is they follow these women forever and they follow them into nursing homes and they looked at protein intake and frailty scores.
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Mary Claire Haver (on menopause)
And the women who ate the most protein, like 1.6 grams for every kilogram of lean body mass had much lower frailty scores. I'm drilling down. We're going to prevent your osteoporosis. We're going to consider hormone therapy and estrogen. We know we'll prevent 50% of fractures.
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Mary Claire Haver (on menopause)
So she's on HRT. We're going to work out heavy. We're going to lift heavy and we're going to eat the protein. We're going to give some creatine on board. So all of that works synergistically. I call it my nursing home prevention program because once I put out the fire for menopause and she's functional and she's your mom and me. Now we're like, I don't want to be my mom.
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Mary Claire Haver (on menopause)
My mother is in a nursing home with Alzheimer's and a broken hip. She just got out of rehab. She's not doing well. Right. It's going to take a long time
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Mary Claire Haver (on menopause)
AUNT was cool, but super competitive. I had the grades, turns out. But my last block was OB-GYN. And that first night I caught a baby. The block I happened to have first was labor and delivery. Wow. I have some awesome upper level resident who's like, we got this. Come on, get in there. And I was like, and I remember calling my mom like, I finally figured out what I want to do.
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Mary Claire Haver (on menopause)
Alzheimer's is not the natural course of an aging brain. There's 14 risk factors. So, of course, the easy stuff. Don't smoke. Eat a balanced diet. Stay away from processed foods. Don't get diabetes. Don't get insulin resistance. All of that. But then it's Social connection, keep your brain moving, thinking, working, do the puzzles.
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Mary Claire Haver (on menopause)
When my dad died, mama had lost Bob in 2015, one of my brothers, my second birth of esophageal cancer. The third one, they lost the one when he was 18. When I was nine, she'd lost two kids and a husband in five years. And she was like, I'm out. She locked herself in the house and started drinking. Which I can't blame her.
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Mary Claire Haver (on menopause)
What I've seen it do to her, the relationships with her kids and this long protracted course she's going to have until she goes and all the talking of the children on how to manage and who's doing what. I don't want that. Exactly. You know, I want to die like my dad. He was great until like the last month. And then he kind of slowed down.
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Mary Claire Haver (on menopause)
And then we all gathered around and we sang songs and told stories and were there and sang to him and he slipped into a coma and then it was over. Yeah, that sounds great. That's not what happens to women. We have this nursing home. She's frail and she breaks. Alzheimer's. Yeah. Yeah. Oh, yeah.
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Mary Claire Haver (on menopause)
My patients are not interested in option B. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Top nutrition tips for aging and longevity for women in menopause. Is she limiting added sugars? So the whole keto movement, sugars got demonized. But it turns out that sugars added to stuff are much worse than found naturally in fruits and vegetables because the sugar in a fruit is wrapped in a fruit, which has fiber and vitamins and minerals. And this is a doctor who sells supplements.
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Mary Claire Haver (on menopause)
But I think everyone should be able to get everything they need from food. That just doesn't happen. That would be amazing if it happened. Right.
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Mary Claire Haver (on menopause)
So I'm here to help you fill in the gaps where you need it. Fiber, vitamin D. 80% of my patients are deficient in vitamin D. We're checking everyone's levels. We're telling them to supplement. I'm giving prescription doses if they're super low. We're trying to give them loading doses. Magnesium is really great for a lot of patients. I've been taking magnesium.
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Mary Claire Haver (on menopause)
I have a specific collagen product that was studied in menopausal osteoporosis that seems to have some benefit. So we're talking about that. For movement, most of my patients are walking minimum. You have to meet her where she is. If she's sedentary, just walking 30 minutes a day will decrease her risk of diabetes by 50%. Yeah, wow. That's it. If she's walking, let's put on a weighted vest.
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Mary Claire Haver (on menopause)
If she's doing that, let's get in the gym. You have to meet them where they are. All the fluencers, they're lifting and all that. I'm like, that scares the shit out of most women.
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Mary Claire Haver (on menopause)
So we're easing them into it. I love to run these challenges for my followers. We'll get 100,000 people who are lifting weights for the first time and I'll have a fitness person in there. I didn't know either. I was injuring myself.
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Mary Claire Haver (on menopause)
So I will hire someone to come in and show my followers how to do a squat safely. You don't have to do a lot of different exercises. Just the really basic push, pull.
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Mary Claire Haver (on menopause)
Squats, lunges. For osteoporosis, good studies with walking with a weighted vest, doing yoga with a weighted vest, balance training with a weighted vest is super helpful. Vibratory plates, again, you're stimulating that musculoskeletal unit. I tell patients to brush their teeth on one foot because you're working on balance to always be decreasing your risk of fall with balance training.
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Mary Claire Haver (on menopause)
I want to deliver babies. I didn't want to have anything to do with menopause.
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Mary Claire Haver (on menopause)
And then lifting, they were putting 80-year-old ladies in the gym from nursing homes and they were seeing all these gains.
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Mary Claire Haver (on menopause)
So grip strength is a proxy for the rest of your body.
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Mary Claire Haver (on menopause)
So it's not the grip strength. That's an easy thing to measure. That's an indicator. I got it. That's an indicator.
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Mary Claire Haver (on menopause)
We do use them in our clinic and probably 20% of our patients end up on them. When they come to us, it's usually, hi, I'm in menopause, help me, I'm dying. Probably 50 to 60% of them now have a weight problem. I have either always had it or they have new weight gain.
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Mary Claire Haver (on menopause)
So the first thing we do is break down where their fat is, if they have it, because some patients come in, they're just muscular and they've been told they're obese their whole life and they're crying their eyes out because, oh my God, I'm healthy, what? If they have a visceral fat problem, I really don't care about subcutaneous fat. It's not metabolically that active. It's just storage.
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Mary Claire Haver (on menopause)
I still could cry. It never gets old being there for a birth.
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Mary Claire Haver (on menopause)
It's the intra-abdominal fat that'll kill you. And so we are working on that number. And what do we know works for that? Starvation, but that's not why they're there. High fiber diets, low added sugar, diets rich in probiotics or a probiotic supplement, zone two training, all of that works. So we're focusing on that and we get her started in HRT.
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Mary Claire Haver (on menopause)
Across the menopause transition, a woman will go from 8% of her total body fat being visceral to 23 on average. Just from becoming menopausal. No changes in diet and exercise. I have the unusual circumstance of most of these people follow me, have read the book. It's an investment to come and see me because I'm outside of the insurance model.
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Mary Claire Haver (on menopause)
So they've done their homework. They're dedicated. Yeah. So they're like, okay, let's do this. We start HRT. We bring them back in three months. If her cardiometabolic risk factors are still there and she's like, I want to give it a try. I'm like, let's go for it. A GLP-1 needs a lot of counseling to be done well.
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Mary Claire Haver (on menopause)
Yeah, that's three. So there's semaglutide, which had just the GLP-1, and then terzepatide, which is what we usually start with now, which has the GLP-1 and the glucagon agonist. And then this new one has, I forget what the third ingredient is, but I'm excited to see when it comes out.
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Mary Claire Haver (on menopause)
In our clinic, if the patients eat the protein and do the resistance training, we are seeing some muscle loss expected, but not this massive loss. And they are able to maintain. And then it's like that first three months, if they lose 20 pounds, maybe five is muscle, maybe 20%. But then that just levels out and it's all fat loss after that.
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Mary Claire Haver (on menopause)
It is absolutely the coolest thing to watch because we bring them back every six weeks to check their muscle mass. We stay on top of it. We're checking in with them. They're doing this not to look great in a bikini. I mean, maybe that'll happen and that'll be great. But they're doing this to decrease their risk of all these diseases they don't want to die from.
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Mary Claire Haver (on menopause)
And be happy during those. They're so motivated to avoid the diseases that plague their elders.
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Mary Claire Haver (on menopause)
There is a genetic component. So there's an ethnic genetic component. So I was telling Monica, for me, it's 51. As average for her, it's 46.7. African-Americans is about 18 months behind Caucasian. Asians get a little bit longer. Okay. Interesting. Does sexual activity impact that? Trauma does. So we know lots of things that speed it up.
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Mary Claire Haver (on menopause)
And I get to see them before you. Yeah, right. And I'm just like, come on. You know, it's never gets old. And it's a miracle. And I make a big production. We lay the baby on mom's tummy and I let the daddy cut the, I let, you know, he gets to cut the cord.
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Mary Claire Haver (on menopause)
You were born with X amount of eggs and they're going to go before you die if you live a normal lifespan. But what do we know speeds up the process of egg loss? Smoking, chemotherapy, radiation, abdominal surgery. You have a hysterectomy, leave the ovaries behind, but we've cut a significant blood supply to the ovary. We're going to lose average of four years off the life of the ovary.
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Mary Claire Haver (on menopause)
A lot of women undergoing necessary hysterectomy aren't getting that counseling. There's nothing they can do about it, but wouldn't that be nice to know? Yeah, I have a friend's friend who had to have a hysterectomy. She's like, I'm about to be in menopause.
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Mary Claire Haver (on menopause)
My mom had one after baby number eight. They were like, this is your Catholic birth control. Time for that uterus to come out. So does it instigate menopause? It cuts the blood flow. So you lose the shelf life of the ovary where you may have gone through a 51. Now you back that up four years on average. Okay. Okay.
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Mary Claire Haver (on menopause)
Exactly. So that's surgical menopause and we have premature menopause and early menopause. So those are a little bit different animals. Premature ovarian insufficiency is usually with an autoimmune condition. So it has its own set of risks. And in surgical menopause, you don't get a trial period. It's like, boom.
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Mary Claire Haver (on menopause)
So whenever I had to take out ovaries for medical reasons, I was putting a patch on them in the OR. Yeah, that's...
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Mary Claire Haver (on menopause)
So ethnic and then family history. You look at the women in your family, when did they go through it?
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Mary Claire Haver (on menopause)
Mom's side and sometimes dad's side. I mean, you're half genetically.
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Mary Claire Haver (on menopause)
So this isn't a chromosomal thing. Yeah, so it's not like that, right? It's more of a general health and kind of how things are going to go. Certain things. Tribes in Africa have a lot of twins or certain cultures are more prone to twins. That's more of a general than a chromosome thing.
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Mary Claire Haver (on menopause)
I'm literally on 79% of the chapter. First of all, I hate the protagonists. Okay. Yeah. So she's not my girl. Yeah. But I'm researching and writing the new perimenopause. It's not coming out till 2026. I'm in the middle of it. And so Gretchen, who's my co-writer, I write like an asshole. I am so clinical.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
My collaborator will take my disgusting prose and spin it into something that sounds digestible, like a human, not a normal person could read, not geek. And Gretchen's like, read it from the perspective. This is resonating. It And that just flipped the switch for me. I read for entertainment. I read about fairies and dragons and lots of sex. And my daughter reads all the dystopian novels.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Through the whole birth labor process, I'm hanging out. Where'd y'all meet? Let's talk. Because you don't get that connection in a 15 minute visit through the OB stuff. So I'm there for delivery. I'm not just rolling in to catch the baby. I'm there for the whole labor.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So I read to read with her and talk about stuff. And then I read medical journal articles. So to pick up a book that is outside of my usual and not have a 15 year old little girl who turns into a princess with magical powers was like hard. I'm trying to identify this. She says, stop trying to identify, read it and figure out why the hell the world is resonating. And then I'm like,
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Oh, so then the doctor in me is like, she's having palpitations. That's a panic attack. That's menopause. That's menopause. That's menopause. Now, have an affair and redo this room in this weird hotel. That's a whole nother thing, but I'm getting it now. It is so hard resonating. Movie rights are done. Oh, yeah. All my friends write them. Did you love it? I loved it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
That. So what I'm finding, and I think why the divorce rate is so high, is that women and myself included, and thank God my relationship is better than it's ever been. And we're working together. We have a small business through the supplement company and he's now running it. I've never liked him more. But yeah, she's getting to choose the last third of her life.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And so did I. I chose differently than her and that's okay. But women are circling the wagons around themselves. Menopause is fucking them so hard. They are giving themselves permission to put themselves first.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And now it's a survival thing. If I don't do this, for me, my journey was quit a job that didn't serve me, stop serving a system that was broken, absolutely get the hell out of Dodge, figure out what the fuck I wanted to do with my life, put my own oxygen mask on first. It's time for you. And I really didn't give a shit if the kids or my husband cared. But I had to do this.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Thank God it all worked out. And look where I am now. But that's what it is.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Too late to celebrate. Well, educate yourself as soon as possible. Yeah. That's part of my mission is just vomiting all over social media.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Where some of the hardcore old school menopause people are like, don't say prevent, they come in. After me, every time I talk, look, FDA approved for the prevention of osteoporosis and that is enough for me. But let me tell you, the U.S. Preventative Services Tax Force needs to get their shit together because you have a window of opportunity for cardiovascular disease prevention.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And the data coming out clearly for mental health, we can prevent the suicides, the job loss, the brain fog, unless you're on the dementia spectrum. With early and judicious hormone therapy, not allowing your body to withdraw and go through that chaos.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Why wait till your vagina's broken?
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
It's never been thought of like that. It's wait till you're miserable. And then it was severe symptoms only. A doctor's going to tell me if my symptoms are severe enough? What does that even mean? What does that even mean?
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Women have been taught to minimalize. Did you read the WW story?
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
The whiny woman. This is just what women go through. They tend to whine a lot.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
The woman with a laundry list of complaints, very vague, weight gain, brain fog, low libido. And they're like, check her thyroid, get these tests, make sure you're not missing anything, but you're not going to be able to help her.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
It's just one of those whiny women. So I've talked to other doctors across the country. And in California, they called it whiny-ginies. Oh, nice. And on the East Coast, around New York, it was TBD, total body dolor. And in Miami, it was Madame Dolores.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
This is like the opposite. Yeah. There's occasional bad outcomes and tragedies. And I'm trained for all the crazy stuff that could happen. But most of the time I just get to be there and it's just such a cool experience. So that's what I fell in love with. And I'm like, and I have to do surgery.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Like, she's got a lot of pain. Women who come in and complain a lot, kind of vague. Libido, go have some wine. You'll be okay. Yeah, yeah, yeah. Oh, my gosh. This is wild. I don't want to scare people. But women should know. No, it's good to know. We don't know anything. And your doctor, not their fault, may not know anything. None of us know.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Because it was never studied. Women in medicine have been treated as small men. So excluded from studies till 94 because of thalidomide and what happened. If there's a chance in hell she might be pregnant, we need to exclude her. And oh, we probably shouldn't study them anyway because hormones are hard. Yeah. They didn't even study female rats in the lab. Oh, really? Because they have estrus.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So they too will fuck up your study. It'll be confusing. The cardiovascular data. is awful for women. You go into the ER with a heart attack. If you're a woman, you have a 50% higher chance of dying than if you're a man because we have atypical chest pain. So men have the classic clutching their chest, going up their neck, sliding down their arm.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
You're an actor and they're like, pretend you're having a heart attack. I know exactly what you're going to do. A woman has fatigue, abdominal pain. It's very vague because men have the LAD, the widow maker, the very large vessels that immediately come out of the aorta to dive into the heart muscle, to feed that heart. That's where the plaques happen. Women, it's way down below that.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
It's the diffuse microvascular disease.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Oh, another way to speed up your menopause is trauma. So there was a study that looked at women who were sexually abused who then had kids who went on to be sexually abused, and they went through menopause nine years sooner. Wow.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
It's my little baby clinic in Galveston.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And I have to do this menopause thing and do gynecology, but it's a necessary evil to do this baby thing.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Just people need to know. People don't know anything. Well, I appreciate being on here. And actually, my kids now think I'm cool. Oh, wonderful. Two daughters? Two daughters, 21 and 24. Okay, cool.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Well, it's a little early for them. So Catherine's in med school. She's tough, man. She has guaranteed me she's not doing OBGYN. But talk about having someone hold a mirror up to you and keep you in line and double check your facts behind your back. Yeah. So I'm like sitting out studies and she is literally... Looking it up to make sure I am toe in the line. She's talked about it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So this menopause thing was a sector of it? Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
She's a little freaked out and wants to freeze her eggs now for the highest quality. I think that's the move. I kind of do too. So I did a talk. I was at Reese's event, Hello Sunshine. I was the emcee for the first time. That was fun. Of a panel. And one of the panelists started this where you go and you donate your eggs, but you get to keep some.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So it's a way for the younger women with these juicy, gorgeous eggs to afford.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
She gets to keep a few for herself.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I'm a terrible host because I forgot the name of the company, but you know, it was so cool. And so I went home and told Catherine about it because she's starting to think about that kind of stuff.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I have a friend in Telluride who gifted his daughter with egg retrieval. Yes.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Not even. In medical school, right, we do four years, two years on the books, two years in the wards. And we had one one-hour lecture in that first two years. This is menopause. It's a basic overview.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
My 21-year-old is not on the radar. She's just trying not to be pregnant and is living her best life.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
That girl. Gets to college. My oldest is by the book, straight A's, pre-med. I'm like, go to the party, have fun. Come on. I'm like so worried about her social life. My second one has rolled with 20 kids her whole life. She gets there within October. She's like, I'm out of money. Like she went with her summer money and her graduation money. I'm like, what? I check her account.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I'm like, bars, beer, clothes, fast food. I go, you have a meal ticket. She goes, I don't like it. So I'm like, you're out of money. You still have
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
in the lounge I'm not going to let you starve but she went and got a job and now she's a nanny oh that's great the funniest stories ever is her taking care of other people's kids these Baton Rouge moms that will definitely not get her to freeze her eggs nannying I will say that she's not at all worried yeah to any young people I just really encourage it I think a lot of people get a ton on your book it's wonderful the new menopause book and please follow you what's your handle on Instagram Dr. Mary Claire D-R-M-A-R-Y C-L-A-R-E
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Most no makeup. She's in her weight test all the time. I brought glam with me and I'm like, no one's going to recognize me.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
That 100% of women will go through. It's not optional.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah. But, you know, it wasn't put to me that way. This is just a transition and estrogen declines and off you go. And she might have some hot flashes. We've got medicine for that. Okay. Then in OB-GYN residency, which is women's health, probably 55, 60% of what we did was to do with OB, getting people pregnant, staying pregnant, un-pregnanting them. Right.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
All the trials and tribulations, important stuff. So proud of everything I learned. And then everything else gets shoved in the box of gynecology. And we have reproductive endocrinology, which is basically endocrine stuff that happens, weird chromosomal things, and getting people pregnant for fertility issues.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We have pediatric gynecology, how to take care of smaller people with the same organs who have issues and need help. We have general gynecologies, well, women exams. So menopause was part of our REI block. reproductive endocrinology, which we only did second year for six weeks. We had a one hour lecture each week.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So in eight years of medical training and education, I had seven hours of menopause. We had no menopause clinics. And then I was leashed onto the world. Go be free and practice. I didn't know anything. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I didn't know enough at the time to know that her palpitations, her frozen shoulder, her, you know, myriad. Frozen shoulder? Oh, girl, wait, we're going to get there. My mom? Oh, no. Oh, yeah. Laundry list of complaints. I'm the well woman examer and I got 15 minutes to get through this. So I'm like, we're going to send you to cardiology for your palpitations.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
We're going to go to the ortho for your shoulder. So I'm giving her six referrals.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah. And a nutritionist for your weight gain. And we're good. Your pap is normal. See you next year.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I was, you know, I had an endocrine condition. I didn't ovulate regularly. Why? I had fertility treatments for my kids. You had PCOS? PCOS. I had the two big kids, finally got that done. I don't want to go through another miscarriage. We're done. So I go on birth control pills to manage my condition, which I did great on. That was fine for me.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And then I get to about 48 and I'm like, OK, I think we're getting close to where we're going to be. And I'm totally suppressing my period. So I'm not taking the inactive pill. So I'm totally replaced all my hormones and shut it down. I felt better that way than PCOS. I was like, probably time to get off. See where we're at.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So I talked to my nurse practitioner who took care of me and was like, I'm gonna get off the pill. We're gonna get some blood work in a month and see where I'm at. She's like, cool. Very same time, my brother dies. So I have six brothers from the same parents. My oldest brother died when I was nine from leukemia. So I was a kid when that happened.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
And then my next brother, Bob, had HIV and hepatitis. The HIV is actually really under control, but it was his liver just tanking, tanking, tanking. So I've stopped the pill, see where Mary Claire's at, and I'm in the OR. The phone's ringing, ringing, ringing. I'm like, get the phone. And they put it to my ear, and they're like, Bob's in a coma. You probably should start heading home.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Eventually. I had sat the kids down and said, you know, Uncle Bob's getting sicker, but not like today.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah, I thought we had a year, two years. Anyway, my partner comes down, we get to a good part in the case, scrubs me out and I go and prepare to go home and figure all this out. So here I am grieving this horrible thing and I am in full on menopause, but I don't know it. I'm gaslighting myself. I'm attributing all the things to grief and certainly grief was a part of it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
But after like month six, I realized the grief is lifting. I'm not crying all the time on the way home. I'm like, when was your last period?
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I didn't like menopause. I was like, ew. Right. I was like Samantha on Sex and the City, not the menopause. And so I was like, Dora, I'm going to come get the blood work now. And so we did everything. And sure enough, I was fully, fully menopausal. And that's detectable. Yeah. Check your estrogen. Check something called FSH. One's high, one's low. That's it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah. Perimenopause, no, we don't have that. Okay, that's what I was going to ask because I think I'm in it.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I looked up all the stats for Southeast Asia. Oh, you did? Yes, I did. Thank you. Yeah, so we'll go over that. But I reluctantly go on hormone therapy because I'm like, I cannot live like this. I was still in the impression I would get breast cancer and die. It was going to kill me.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So the WHI study was a large multi-center trial. It was one of the biggest projects the NIH had ever taken on. And for the first time, they were studying women. We were so fucking happy. We knew from anecdotal evidence that women who were on HRT before the WHI- And that's hormone replacement therapy. Sorry, hormone replacement therapy. 40% of women were utilizing HRT and menopause.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So that was kind of the baseline rate. It was recommended by the American College of Physicians. I mean, it was like, everybody should consider this. We knew that women who chose it had lower heart disease, had lower certain risks, but that's not proof. That's an observational study. Yeah, correlation. So if you follow a TIA, you need a randomized, controlled, blinded.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So NIH, billion-dollar study. Wow. Let's study women. They got 37,000 women recruited. Half were placebo versus estrogen or estrogen and progesterone if they had a uterus.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
The particular estrogen that they were on was Primarin, which we don't use today very often. And then a very specific progesterone. It wasn't using modern HRT formulations. It was just looking at this one. But at the time in the 2000s, that was the most common formulations used. Nothing weird there.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Because they were looking for heart disease as the outcome, is this really protective for heart disease or are just wealthier, healthier women on HRT and we're getting an artifact? The average age was 63 in the study. A little late. We know it works for hot flashes. We know it'll take care of menopause symptoms, but does it really help with heart disease?
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So they wanted to start later because it's expensive to go 20 years. So if we start later, then we'll start seeing the heart attacks in a quicker timeframe. They did have younger and they had some women in their 70s start. They went up to 79. Off they go with the trial. The women on estrogen-only had a 30% decreased risk of breast cancer, and that was statistically significant.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
The women on the combo saw a slight increased risk, but it never reached statistical significance.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
So when you compare the two groups, whoa, this is really causing—it was four guys—
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I can't even pronounce their names. Yeah, they're rough names. And they still stand by. It's crazy.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
There were 17 centers involved in the study. There were multiple PIs, primary investigators. And these two or three guys wrote this paper and said, estrogen causes breast cancer. HRT causes breast cancer. And they called everybody in the room and said, take a look at it. You have one hour to make changes. They rejected all the changes. And then they went to the press. There's no peer review. Yeah.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Yeah, they just said it and it was like letting a genie out of a bottle. Flawed interpretation and hysteria. There was no viral for internet back then, but it was the number one medical news story of 2002. It was on the cover of every magazine. Nancy Snyderman is on ABC saying don't give anyone estrogen. I was a chief resident. I remember the day it came out, and we were like, what?
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
I was terrified to give people HRT. What I didn't know in the ensuing 20 years, being board certified, getting my recertification every year, reading every article they put in front of me, I was the straight-A student. They never walked it back to the OB-GYNs. And the guidelines have not been changed in American College of OB-GYNs since 2014, and they still say...
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
only for severe symptoms, smallest amount for the shortest time possible. Wow.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Wow. 4% of women who are eligible are receiving FDA approved. Now, there's probably more with compounded. It's hard to track that because they don't report. Right. So maybe seven, but still.
Armchair Expert with Dax Shepard
Mary Claire Haver (on menopause)
Do you know how much brain power we're talking about? How much NIH funding? How much private funding? How many labs? That's 10 to 1. And more women will go through menopause than bear children. Exactly. Yes.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
You're still going to age and die of something.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
But we're not going to see that acceleration, so women will just live a lot longer than they are right now, which is longer than men.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Right. And so taking that, you know, what it would do for women's mental health and their resilience and their ability to function and work, you know, through that, I think would be astounding.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
No, no, no. It's all experimental right now. But there's, Oviva is one of the company, Daisy Robinson, and then there's There's one, I can't think of the name of the company right now, but there's two I know because I've been on panels with them and I just sit there, oh my God, that's amazing. So like for my daughters who are 23 and 20. It might be possible. That might be possible.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
I mean, my 23 year old who's going to be a doctor, she's first year, well now second year med student. She's like, mom, menopause really should be an option. Like I should not go through all these things. You know, like I might get on hormone therapy and Perry and just skate on through.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
That I totally misjudged the women of our age. I totally bought into the line that this is the end and that, you know, I just wasn't going to be as much of a person. Menopause scared the hell out of me. And I felt when I finally realized it was menopausal, I felt old. I felt like it was the end. I felt, you know, and how wrong that was and how I am killing it right now.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
You know, I am like, let's go. And I'm bringing my daughters and I'm bringing other physicians and I'm, you know, I'm just trying. This, no, I'm saying no, I'm not accepting what the status quo, the old menopause, because this should be the best time of our lives.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
and how cardiovascular medications affect. So greatest example, statins, right? We use statins left and right to treat high cholesterol. Most women will have significant elevations of cholesterol through menopause. So here she goes through the change, boom, her cholesterol goes up, goes to her PCP, you need a statin.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Um, I just love my kids and my family, you know, that I don't worry about, um, like pay for college. And, you know, I'm not worried and now I can help out my nieces and nephews. Like that level of stability that I didn't grow up with. You know, my parents went bankrupt when I was a kid and just kind of living through that, which made me who I am. But I don't want to repeat that for my kids.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It's like, how do you create just enough hardship for your kids? Not give them just enough to be successful, but not enough to do nothing. So I'm always walking that line with them. And just really like celebrating my siblings. And I have lost three brothers, two to cancer, one to the HIV and hepatitis.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And just life is short and you got to smell the roses and do the things and climb the mountains and do the travel. And if I don't take care of myself, I'm not going to be able to
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
fulfill all those goals and there's so much cancer in my family like two brothers five aunts on one side you know like multiple multiple multiple cousins like I've got a gene there's something not okay and like it is my job to take care of myself and if I don't like eat the foods and do the work and live the life and do the stress reduction and you know then I'm not going to get that that option that I really really want
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So you lose them one at a time. So it's not like you wake up and they're gone. So I was a little girl. I was nine when Jeff died. And it really kind of redefined our family. Mom was pregnant with number seven. There's eight of us. And then she had another baby two years later. And then she had a hysterectomy. And there was no more kids. So, you know, watching them watch me grieve was really hard.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And because I was so close to my brother, Bob, when he died in 2015. And he was like, you know, he had the same partner for 35 years that he and Randy came for like every Mother's Day and Easter. And, you know, we decorate and he's just so talented. And so he'd do all these wonderful, special things with my daughters and, you know, dress them up and make them fancy things. And
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
and so that was a tough loss and then when jude died you know jude got sick right after bob died he got was diagnosed with cancer and you know it was covet and we were sneaking over the state line to go see him and try to take care of him and you know his travel was embargoed for good reasons but you know and just trying to like spend time with him and take care and then in the end i was able to do his end of life care too so um for the last week or so and
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Statins have never been shown in women to decrease the risk of a heart attack or decrease death from cardiovascular disease.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It just really, you know, they were older with Jude and watching them like celebrate the wins is really cool. And we have like a little thing in the kitchen where all the boys, we have the little church cards, you know, from their, with their pictures. And then my dad died like nine months after, but he was old and, you know, still, and he's, he had a broken heart.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So, so broken heart from, well, he buried three of his kids.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
You know, he just kind of like, once Jude died, I just saw him just kind of go quickly. And that was a blessing that he didn't have this long drawn out, you know, horrible thing. But, you know, now here's my mom. She's been alone without my dad since 2021. she's buried three kids. She's now has dementia and she just, it's really hard. It's hard for her. Yeah.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And so me just openly talking to my kids about my feelings about that and like what I'm doing in my life to try to prevent, not that you can't guarantee everything, but like, I'm just trying to limit their time of dealing with me like that.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Because it worked in men and we- Just do it. So there is no evidence to support that. It will lower cholesterol, will not decrease the risk of a heart attack. Because we develop disease differently and for different reasons. And it's, you know, this is published by the American Heart Association in Circulation Magazine. I didn't make this up. And so, yet... There's no studies right now.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So I didn't, I did it wrong the first time with Bob, you know, and I, I didn't give into the grief. I fought it. I would only cry on my drive home from work. I didn't get therapy or counseling. You know, I did everything wrong.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Right. I'll be fine. And then, um, then with Jude, I said the things to him, like Bob, it, I didn't have the closure. And so with Jude, I said the things. I said all the I love yous and I said the goodbyes and I said everything wonderful. And then I really leaned into it and I let myself be sad and I let the kids see it. But I didn't want to be overly dramatic about it.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
But it was such a different experience. I ate well. I knew it was coming. I worked out. I made myself do the things. So I was so much healthier through the process mentally and physically. I still grieved, but I just came out of it so much better.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
No, you've got to grieve. You've got to let yourself go there. But the days you can't get out of bed, that's okay. But the days you can, you need to go and eat the right things and go to the gym and keep those pillars of health going because you're just going to get through this so much easier.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Right.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
But now you can put words to it, right?
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah. And there's a thing happening and it's okay. We're going to get through this together.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It's not painful.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It's just that this is an inevitable process, but suffering through it is not. And it can be, and it hopefully for you, it's an entryway or your partner or your mother, whoever's listening, you know, whoever that you love in your life is going through this, that she is going to be okay. She might need some extra love and support.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
and things are changing for her and it's not her fault and be there for her and get her an appointment, help her find a menopause informed provider and help her get on the path to being okay.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So now it's like us fighting, getting NIH grants, getting Congress on board. What the menopause is doing is advocacy, is fighting on a legislative level to force these things to happen, force these American College of OB-GYN, American Board of OB-GYN. And why should all of women's health fall in the lap of the poor, busy OB-GYN who's trying to deliver babies and prevent cervical cancer, right?
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
I did that job. It's a hard job. This should be required in medical school. I got one hour of menopause in medical school. Every clinician who touches a woman should have required menopause training, not just hot flashes, night sweats, and what HRT may or may not do for you, but how our sex differs in disease and how we need to treat women differently.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
I mean, if you read Eleanor Cleghorn's The Unwell Woman and you look at The Invisible Woman just came out, Invisible Women, just looking at how in science women are just kind of ignored because we're harder. Harder to study. Yeah. And so we're not little men. We're more than just a man running, a short man running around with a breast and a uterus, you know, breast and uterus.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So we're actually, the way we present with disease, the way we're treated with disease is vastly different.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So what started out with like hot flashes and weight gain is actually a much bigger, bigger picture.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Are there higher risk factors for diseases like breast cancer or other types of- So menopause, you see the cardiovascular disease risk starts rapidly accelerating. Yeah. So that's because our insulin resistance goes up. and our cholesterol goes up. So the risk factors for heart disease go up once you go through menopause.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So you take two 50-year-old women, one is premenopausal, one is post, and she has like a 50% increased risk of cardiovascular disease once she's postmenopausal. Yeah, so estrogen is incredibly protective for the lining of those vessels in the heart where those plaques start building up.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So in being on HRT early, if you start early enough in menopause, it actually will decrease your risk of cardiovascular disease 50% per year if you start early enough.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And that's okay. So it's going to be harder, but it's not impossible. So you're going to have to double down on the other pillars of health. So your diet, your exercise, your stress reduction, really staying on top of the risk factors.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Right. But not holding the discussion around HRT, which most women aren't getting. So 85% of women will go and talk to their doctor and mention the cliche symptoms of menopause, right? Only 10% right now, as in 2023, be offered treatment. And it's usually an antidepressant.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Not HRT. Only 4% to 6% of women are on HRT, right?
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Who are menopausal.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So, well, if she's really depressed, sometimes her depression gets better. But again, everything has side effects, including HRT. So I don't want to like make like, you know, but her libido goes down. She can gain weight. It depends on the specific SSRI or SNRI. So there are side effects that can be pretty debilitating.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
But a woman is like four times more likely to be given an SSRI right now for the treatment of her menopause than hormone therapy, which is the gold standard. Certain SSRIs have been shown to somewhat decrease hot flashes, but they're not great. And they can help with depression symptoms, which can be severe in menopause.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
But yeah, but then there's side effects. So every discussion around medication with a patient is risk-benefit ratio and discussing possible side effects.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It doesn't mean it's like, okay, I can do this and now I don't. And now you're negating, you know, a trip to Wendy's though.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So, yeah. So it's like, it's not perfect. It's a tool in your toolbox. So when I approach menopause care with my patients, it's a toolbox and we have tools in here and they're all important.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It can. It can. So I'm on, I'll tell your followers, I'm on systemic estrogen replacement. And I do that with a patch. So that goes to my brain, my bones, you know, everywhere. But I still have extra estrogen locally. So I have top and bottom. So I have facial estrogen to help with thinning skin.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So we lose 30% of our collagen, which women know, every menopausal woman knows she has lost some collagen in her skin, especially her face. So I do a little topical estrogen here. And then I also use some in the general urinary area as well.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And then I have progesterone. So, and that really helps with sleep. So it's magic. I'm telling you, like if nothing else, especially in perimenopause, progesterone could save a woman's life. So if she's not sleeping, so love my progesterone at night. And then I do testosterone as well.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
They also died.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah. They died in their fifties, sixties. So we, you know, 150 years ago, the average life expectancy, they died before menopause was like a thing. Really? Yeah. And so we, you know, there was the occasional, but someone my age, 200 years ago was very rare to be alive.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And so sure, they had the occasional one, but the average life expectancy, you know, we are now because of modern medicine, modern plumbing, modern technology, are living 30 years outside of our menopause, way longer than most humans lived as females.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
I would have to agree with you. The medical system, I don't think the individual doctor goes out in the world and thinks, I'm going to fail a woman. I think the way we've built the system was for the basic white guy. at least in the US. And so all of the studies, women were not even required legally to be in studies until 1993 from the NIH. So we have an entire generation.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So the best office visits I have are when their partners come and they're there to help understand. And I do a lot. That's a long visit because I'm educating two people at once, right? Yeah. And so those are the couples where I know they're going to make it. He's really here for the right reason. He's bought in. He wants this to work and he wants to understand.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And so this is going to happen to 100% of us who live long enough. This is not optional and it is going to rock her world. So be aware. I mean, I think education is everything.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And so if not my book, there's other books out there, like pick up a book and educate yourself, you know, read the book together, get it on audio, whatever, you know, so that you have some grip and understanding, which will help you have more compassion.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And, and help you lean into this time for her so that, and help her navigate and help her get her to the doctor, you know, facilitate these things so that she can get on the path to going back to who she used to be.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
I think, you know, most of us go through, you know, we're not the same people we were 20 years ago. No one is, right? And so most relationships that stay together, you kind of ebb and flow and grow and change together. You're on this kind of tangential thing together.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
And what breaks up most marriages is, I think, in the early days is you grow apart and then all of a sudden she's doing this and you're still on your little path, right? And just understanding that it's like, how did you deal with teenagers, you know, and all of the hormone changes in puberty that you had to like go through with your kids. You love them. You're not getting rid of them.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
You're committed. You know, this will end. There are probably things you can do to facilitate, but that's going to look different for every couple.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It's happening.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It's happening.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah. And, you know, some women kind of, I mean, quietly tell me and they're kind of embarrassed, like, I'm actually fine. Like my period stopped and I'm okay. Now maybe they've had joint pain or some headaches, but like they kind of skated through the worst of it.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So when you look at, there's some data on cognitive behavioral therapy. But, man, that's hard to do and hard to access, at least in the U.S. But there are some studies in Great Britain looking at cognitive behavioral therapy and menopause. And those women did better and really felt like they had less symptomatology and were doing better.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
But I don't want to say that CBT is a replacement for hormone therapy or whatever. I think it's a tool in a toolkit, especially if you're having the mental issues. That can be very, very powerful and help address some other issues. Wow. Women who have good nutrition or healthier when they start the perimenopause journey do better.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Now, I don't want to shame any woman who's living in hell who had perfect nutrition and was working out, doing all the things.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Now that happened because thalidomide was being used in pregnant women
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
But overall, the healthier you are when you show up is how you'll kind of go through it.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Sure. So average 51 for menopause, period, stops. 45 to 55, still normal. Seven to 10 years. So let's back it up. So around 35, I really think patients should be screened for perimenopause and getting the education system going in their 30s. Like this is coming. These are the things to look for. Don't be scared. You know.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
To push it in the future to your 60s? So that is where the most exciting research is. So there's the occasional woman who will kind of go into her 60s.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
It's pretty rare. And have a child then? 95% of women will be, no, not without help because the quality is poor in the eggs. So they might get pregnant, but it doesn't survive.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
For nausea and ended up causing birth defects and that freaked everyone out understandably But they removed all women from studies after that just in case they might get pregnant then when you talk to researchers It's much more expensive and harder to study women because of their cycles or because of peri or postmenopause and men are just predictable so they just study mostly men and just take those things and infer them to women when we don't really understand the gender differences and the sex differences and
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So they miscarry.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah, but still having a period. It's pretty rare, but it'll happen. But 95% of women will be through by the age of 55. So then we have our stragglers. So we don't know what can push out the life of the ovary other than good health and nutrition. We know things that will cut years off the life of the ovary.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So chemotherapy, anything that'll like disrupt the ovary, you know, chemotherapy, radiation in the abdomen. Yes. Surgery. So hysterectomy, which a lot of women have. You lose four and you leave your ovaries behind, you're going to lose four years off the life of the ovary. Okay.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
In the book, we talked about a study that was done specifically looking at women who had childhood sexual abuse, whose children were then sexually abused. And for whatever reason, they looked at their age of menopause and it was nine years. Nine.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Earlier than the average.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah. So we know that stress, that that kind of stress will take off the shelf life if you're, you know, because you're inflamed and autoimmune, you know. We know that smokers, you go through earlier. African-American women tend to go through about a year, year and a half earlier. You know, genetics plays a huge part. Asian women tend to go through a little bit later. um, than, than Caucasian.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Then, um, we have, um, if you have a bilateral tubal ligation, so tubes tied from, you know, you lose a year and a half. Yeah. So anything that disrupts blood flow or the health of the abdominal cavity, ovaries, endometriosis, you go through sooner, you know, cause of all the inflammation in the abdomen. So there's lots of things that can lower the age of menopause, how many kids you have.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So if you are ovulating all the time, you lose more eggs each month. So women who've never had children and weren't on contraception go through a little bit sooner. Women who are on birth control for a long time get a few more months in. It's really interesting. But the best research, I love, love, love coming out right now.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
There's a couple of companies that are looking at AMH, which is a kind of bizarre hormone in our ovaries, that can extend the life of the ovary.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
So they're really looking at technology and pharmacology that will make menopause optional.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Yeah. You think it's possible? Mine are dead. They're gone. But you'd have to start young. But it would basically decrease the signals that are causing the atrophy and the atresia of the ovarian follicles.
The School of Greatness
Has The Medical System Betrayed Women? How To Take Back Control of Your Health
Well, like a man, you just age and die. I think we'd live longer. I think we'd have a longer health span. Interesting. But what these people are saying is that, what these researchers are saying, that it won't extend your ability to bear children much longer, but it will give you enough estrogen for protection. Interesting. To maintain that protection.