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If you don’t understand what’s happening to your body during menopause, you’re not alone! Dr. Mary Claire Haver is a Certified Menopause Practitioner and joins Reshma to answer all her questions about what the heck is going on with her body during midlife. They tackle everything from sleep issues, weight gain, depression and anxiety, nutrition, frequent urination – nothing is off-limits in this incredible conversation!

Follow Dr. Mary Claire Haver on Instagram @drmaryclaire.

You can follow our host Reshma Saujani @reshmasaujani on Instagram.

Let us know how you’re doing in midlife! You can submit your story to be included in this show at speakpipe.com/midlife

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Transcript

SPEAKERS

Reshma Saujani, Dr. Mary Claire Haver, Speaker 1

Reshma Saujani  00:32

Welcome to My So Called Midlife, a podcast where we figure out how to stop just getting through it and start actually living it. I’m Reshma Saujani.

 

Speaker 1  02:40

I don’t know about you, but this perimenopause thing, it has been a bitch. It has totally uprooted my life, and I get it. Why Women quit their jobs, leave their marriages, run away, because life just feels like an absolute mess. Nothing, nothing feels good anymore. Nothing is working anymore. For example, getting a good night’s sleep, it’s like an impossible thing. I like dream about how it used to feel to like, put your head on a pill and actually sleep through the night for seven hours, because that doesn’t happen for me anymore. And the anxiety, I mean, I’ll be sitting in some random hotel room because I’m flown in to give a speech the next day, and all I want to do is go to sleep, but I can’t, because I am so anxious, and my heart is just like thumping, thumping, thumping, and I think I’m about to have a panic attack. And so sleeping, I just lay there and do breathing exercises, or all the bizarre things that are happening to my body, like the sudden onset of allergies and anaphylaxis and histamine intolerance. And here’s the thing, all these things are happening, and I feel like I got no one to talk to about it. I mean, the people I love, like my husband, they know that it’s impacting my life, but he doesn’t know how to help me. And when I go to doctors to talk about my allergies or talk about the fact that I’ve had a period for three weeks, their best advice is like, sorry, take an antidepressant or just wait it out until this phase is done. So the point is, is that, like, I’ve had menopause in my mind for a long time now, pretty much since 45 when shit hit the fan for me. So I was, like, beyond excited to have this conversation with Dr. Mary Claire Haver, because she is literally the Beyonce of menopause. She is OG on menopause, she’s prolific, she is smart, she is compassionate. She’s a board certified OBGYN specialist, a menopause society certified practitioner, a certified culinary medicine specialist. Wow, and just a passionate entrepreneur and best selling author whose life focus is women’s health, and for the first time, she just made me feel seen. It was like having a conversation with a friend who was just way smarter than me about menopause, who just kind of broke it down like I was a three year old, she gave me some real good tips. She made me understand just why things are happening in my body. And she’s had some real lasting effects on me, like I take fiber now, like it’s my job. So all you mid lifers, I know you’re struggling with so much of the same things. I know the list of things I just talked about, the anxiety, the depression, the not being able to sleep, the the pooch around your belly that just came out of nowhere doesn’t want to go anywhere. Like I know that, like, you got all the same problems, and you are also just looking to be seen. So this episode is my gift to you, and I truly hope you get as much out of it as I did, because for me, meeting Dr. Mary Claire Haver, it was a game changer for me, and it set some real lasting impact on my life, and I can’t wait for you to listen.

 

Reshma Saujani  06:16

Hey, Dr. Haver, we’re so excited to have you on the show.

 

Dr. Mary Claire Haver  06:19

Thanks for having me super excited to be here.

 

Speaker 1  06:22

So Dr. Haver, on this show, we love to talk about midlife mindset. So that means, like, you feeling good, thumbs up, as my son would say, or thumbs down. What is your midlife mindset?

 

Dr. Mary Claire Haver  06:33

Oh, my God, thumbs all the way up. I am 56 years old, and I am living my best life. I have better sex, better relationships, better boundaries. I’m putting myself first. I’m doing what I want to do. I’ve learned to put boundaries around people that I love that were taking away my energy. You know, that was the gift of menopause for me, was I had to prioritize my own needs for the first time, or I wasn’t going to make it right. And so I mean, HRT has fixed the hot flashes and the brain fog and, you know, But Lord, I am not giving those boundaries back.

 

Reshma Saujani  07:14

All my listeners are all mid lifers, and they’re all like, Okay, how do I get there? I want to know how I get there. Like, did you go from like, okay, at 40, this fucking sucks. And then something happened, and you made it like, what? Tell me what unlocked this.

 

Dr. Mary Claire Haver  07:29

Okay, so I was high functioning type A, I had it. You know, my husband’s working overseas. I got teenage daughters. I had it. I was absolutely rocking the game. This was the life I built. And then all of a sudden, I couldn’t put my finger on it, but I started to lose resilience. Things were bothering me more. I started to not sleep as well. I started to, you know, depend on alcohol more to take the edge off, but I couldn’t really, you know, put my finger on it. Then I had a couple of big life event, and I completely lost it, where I would have bounced back probably at 35 My brother died suddenly, and that was, like a, kind of a big wake up call. And at the same time, I had gotten off of birth control pills. I was about 48 and I didn’t realize it, but I was fully menopausal, like I kind of masked most of perimenopause stuff, you know, it was starting to creep up. But, you know, being on pills, you know, was, I was treating it at least three weeks out of the month. And then when I got off, you know, I’m grieving my brother, I’m doubling down at work, I’m gaining weight. That was the other thing I was always had thin privilege, always, always, always, you know, and all of a sudden, what in the hell is happening to my abdomen and my midsection? You’re like, what is that pouch on my stomach? Right, and I’m like, all my patients had shook theirs at me during their womb woman exams. And I’d be like, workout more, eat less. Come on, girl, you got this, you know? And then all of a sudden, it was me, and I’m doubling down at the gym. I’m, you know, starving myself. I’m going to these crazy fad diet. What did I do? Some lemon juice and cayenne think I was.

 

Reshma Saujani  09:09

Oh, I’ve done that. I’ve done that. I think it was like the Beyonce diet. And I was like, I could, I could do that, yeah.

 

Dr. Mary Claire Haver  09:15

So where, kind of I started, like, medically, was, I was terrified of hormone therapy because I thought I’d get breast cancer, right? And I have a terrible family history of cancer, lost two brothers to cancer, and I’m a walking miracle that I’m even here. So I’m like, How can I fix this belly fat? My husband’s like, you’re obsessed. I had teenage girls. He’s like, they’re watching you. I’m negative self talk. I’m fat, you know. And he’s like, Honey, you know? And I was like, okay, I’m type A I’m gonna fix this.

 

Reshma Saujani  09:45

And do you know at this point that it’s menopause? Are you just like, I’m getting because, you know, people always say, like, the older you get, your metabolism just slows down. And oftentimes we don’t even connect that to menopause. So what are you thinking at that time?

 

Dr. Mary Claire Haver  09:58

I’m thinking I’m not working hard enough. I’m not trying hard enough, obviously, because all these things that I’ve told patients for 20 years have to work, otherwise I’m a liar, okay? And I’ve told them the wrong thing until it just would not work for me. You know, the starvation, the multiple workouts, I’d lose a little bit it come right back. Like, all the little tricks that I could get, the 10 pounds off real fast gone.

 

Reshma Saujani  10:19

You could tell a patient be like, well, they just don’t have the discipline. I’m telling them to do it. Yeah, they’re just, they’re eating the Oreos, and they’re really not going to the gym. But for you know you’re doing it’s disgusting.

 

Dr. Mary Claire Haver  10:29

The stuff that came out of my mouth. But I realized there’s much more going on with menopause, this body composition change. I’m like, What is body composition? I remember googling that. Like I did not even know what body composition was. I lived and died by the scale. I told my patients to live and die by the scale. I had no idea the significance of muscle mass and what that meant and how that would help you age.

 

Reshma Saujani  10:49

And Dr. Haver, I think one of the things so you talk about how like, like, You crushed medical school, right? Like you were, like, you crush it top of your game, but when you went through school, they had no education around women’s health and menopause.

 

Dr. Mary Claire Haver  11:03

Well, in menopause, so I think in medical school. So I went to a, you know, Louisiana State University, great school, super proud of my education. But when I look back, I think we had maybe in four years one lecture, there were no menopause clinics in our OB GYN rotations, there was no clinics focused on the health of women after reproduction. And then I did a residency in OBGYN, another fantastic program. Over 50% of my training, probably 55 60% was obstetrics, getting pregnant, staying pregnant, problems with pregnancy after birth. You know, all of that important stuff, like I am not knocking what I learned. Then there’s gynecology, which menopause would fall under. But we’re spending half the time in the or important stuff, learning the surgical procedures, all the different things because we’re doing, you know, uterus, ovaries, vagina, vulva. And in my second year, I had a six week block of REI, which usually is fertility, right? But that’s where menopause falls. That falls under. So in that six weeks, one hour a week, I had a lecture from a menopausal woman, from one of our professors, about menopause. That was it.

 

Reshma Saujani  12:10

One of the things you said is you learned only about hot flashes in school.

 

Dr. Mary Claire Haver  12:15

So for decades, the most recognizable symptom of menopause was the vasomotor symptom, usually in the form of a hot flash, hot flush, if you’re in Europe, and that the ensuing sleep disruption from that the sweating. Other symptoms, like the mental health, changes the weight, the body composition, you know, the visceral fat gain, the musculo skeletal changes the increase in autoimmune disease, the insulin resistant cholesterol changes. Everyone just attributed that to aging, and no one was looking at it. So when we look at the studies around the treatment of menopause, it’s all for hot flashes, because you can’t blame a hot flash on anything else. That’s right. But now the research is going this way. So we know not from the Australian data, and Martha Hickey was on it, and so they see a 50% increase across the menopause transition of mental health disorders. Wow, 50% okay. It’s not like we all collectively decide in perimenopause, let’s become depressed or anxious or, you know, yeah. And so what’s happening is now the researchers are recognizing that zone of chaos in perimenopause. So I thought during perimenopause, that transition where you’re reaching that critical egg threshold level, that estrogen levels would just gently decline right until they bottomed out. No, what’s happening? It’s a roller coaster this crazy, going up and down, up and down, up and down, higher than you’ve ever had in your life, and plummeting to like these very rapid rise and falls. And progesterone is not keeping up, right? It’s, it’s starting to kind of putter out as well.

 

Speaker 1  13:56

You know, we talk about menopause in the show, but we don’t. We haven’t really talked about perimenopause. What is perimenopause? When does it start? Great. Let’s start there.

 

Dr. Mary Claire Haver  14:05

So to define perimenopause, let’s define menopause. Okay, so menopause, medically, and it’s a horrible definition, is one year after the final menstrual period. That is medically. How we define it, natural menstrual period. Well, what if it’s leap year? Do you have to wait 366 days? What if you’ve had a hysterectomy or an ablation, or you have a marine IUD and your periods are suppressed, or you have polycystic ovarian syndrome? Do you not get to be menopausal? What it represents is the end of ovarian function and the end of the ovaries ability to produce estradiol and progesterone. That is really what it is. Defining it by an arbitrary symptom is a mistake, but here we are, so all your eggs are done, gone. Yeah, so let’s go to normal, normal cycles, right? Normal reproductive years. We’re not a steady state. And when I talk about, when I see people talk about hormone balance, I want to jump off a roof, okay? Because they obviously don’t understand endocrinology. We are never balanced in a healthy female who is ovulating regularly.

 

Speaker 1  15:04

And what are the hormones that every female has? I mean, we have dangerous but the big one, you’re the big four.

 

Dr. Mary Claire Haver  15:08

So when we talk about sex hormones coming from the ovary and everything involved, we have testosterone that we make it in other places, but half of our testosterone comes from the ovary, fairly steady state, okay? Estradiol, progesterone and from the brain. Remember, ovulation starts in the brain, LH and FSH from the pituitary gland that speak directly to the ovary, without LH and FSH, we do not ovulate. Okay, so in a healthy, normal menstrual cycle, in a in a woman at 25 our hypothalamus in the brain is constantly sensing for estradiol levels. When they naturally get low in your cycle, it sends a signal to the pituitary through something called GnRH, gonadotropin releasing hormone. Hey, bro, we’re running low on estrogen. Wake up the ovary, tell it to start doing its job, sends out LH and FSH to do that binds to these follicular cells around the eggs, those cells start converting testosterone to estradiol, […] blah, boom. We ovulate. You get a spike of estrogen, and the progesterone forms. Everything sloughs off, and we start all over again. Okay? Perimenopause, what happens? We reach a critical egg threshold where the signals coming from the brain, the the ovaries become resistant to those sick.

 

Reshma Saujani  16:20

What do you know what? What threshold is that?

 

Dr. Mary Claire Haver  16:22

So we don’t know. It depends from woman to woman. There’s some level of egg supply where the same levels of LH and FSH, which always work to secure an ovulation, no longer work. So the brain goes, whoa. What’s going on? Here’s my estrogen, right and there. And the territory is like, boss, I sent the signal. He’s like, send it again. Send more. So we get these bigger, harder pulses to force these ovulations to happen. So they’re delayed. Sometimes we get two eggs. That’s why we see a higher incidence of twins as we actually get older. You know, it’s a we see these women will go in and get their hormones checked. They’ll see levels of estradiol, three, four or 500 because we get these loop ovulations very, very chaotic on the way down.

 

Speaker 1  17:05

So it’s not like a poo. And typically that’s happening at 35, 36?

 

Dr. Mary Claire Haver  17:10

Yeah, so talk about timing again, very inter the genetic variation is huge. The ethnic variation is huge. Okay, so for a someone who’s from the Indian continent, right.

 

Reshma Saujani  17:24

South Asian woman like me.

 

Dr. Mary Claire Haver  17:25

What happened South Asian 46 is the average Asian woman. 51 like the average white woman like me. Okay, so we got to back it up five years.

 

Reshma Saujani  17:32

That sounds about right for me.

 

Dr. Mary Claire Haver  17:34

Okay, so in the US, we quote 51 because studies were done on me, people who look like me. So seven to 10 years is tends to be that transition. So do the math. So we’re looking at 45 you know, average age of 51 we’re looking at 41.

 

Speaker 1  22:02

Average age 51 that you begin perimenopause, or menopause.

 

Dr. Mary Claire Haver  22:19

Menopause so seven to 10 years behind that. Okay, so now we’re talking, you know, 41 to 43 that the perimenopause would begin for me, for South Asian women, it’s much younger, late 30s. And trust me, these, this disruption from the brain to ovary begins well before your cycles become irregular.

 

Speaker 1  22:59

Talk about what the common symptoms are, and I want to talk about some symptoms that I symptoms that I had, okay, and I want to know what’s going on. So, like, you right? I had the weight gain all of a sudden, had that little fold over on my underwear, you know, I mean, and I think for me, I already had the bulge, but the bulge got bigger, and I couldn’t, I couldn’t sit up my way out of it, why?

 

Dr. Mary Claire Haver  24:01

Yeah, okay, so when our estrogen levels begin to decline and become erratic, we see a shift happening. Of we see inflammation go up. So it’s the chicken and the egg. So estrogen is an incredible anti inflammatory hormone that is incredibly productive of our liver, of our endothelium, of our levels of visceral fat when we lose that protection, okay, we are insulin resistance rises with no changes in diet and exercise. When the insulin resistance rises, inflammatory markers start to go up. So when we have higher levels of inflammation, we shunt more fat to the intra abdominal cavity, doing nothing else. Got it. So what we see is, if we, if you had a twin sister, okay, and I took the ovaries out of her, all right, a pre menopausal woman, age matched, has a most of we look at her total body fat, about 8% is visceral, and that’s, that’s a roughly healthy level, okay, that goes up to 23% through menopause. Got. It just take out our ovaries and you shot that much more to the avenue.

 

Speaker 1  25:03

Okay, so that’s why I’m getting away sleep like I used to sleep like a baby. Now it’s like, I need a fan, I need a white light. I need two CBD, I need three magnesium, and I’m still waking up three to four times. Why can’t I sleep? Let’s talk about it.

 

Dr. Mary Claire Haver  25:23

I used to just lay my head on the pillow, and now it’s like an hour of sage and smoke and mirrors and medication and all the things I get it. Okay, so why is this happening? Two reasons probably more, but we have a thermo regulatory center in our brain. It’s in the hypothalamus, same organ, right, and it controls our temperature, so it goes absolutely hog wild when our estrogen levels start declining and going cattywampus. So it’s more to do with estrogen decline than the chaos. The chaos is more the mental health changes and the so restoring those estrogen levels tends to stabilize the vasomotor control center in the brain. Okay, so we’re waking up with hot flashes. The hot flashes will wake us up. Some people’s vasomotor symptoms are actually palpitations, rather than the thermo regulatory center. So we have kind of this a broader range. So that’s waking us up. Progesterone, so we lose the ability to make progesterone, that levels our body is used to, we see less GABA, which is a hormone very important for sleep and relaxation, produced in the brain, which directly affects our sleep. Most of my patients, you know, we can stop the hot flashes and get them to go to bed, but adding in progesterone, you know, estrogen is great for hot flashes, progesterone is better for that, good quality sleep. Wonderful studies right now being done with aura, looking at sleep disruption. You were pointing to our ring, yeah, sleep disruptions through the menopause transition. And you may there. You know women are wearing them, and they’re reporting their menstrual history.

 

Speaker 1  26:58

Oh, and I have latency every day, latency, you have too many wake ups. You’re too unrestful. That’s why aura is telling me. Because I don’t, I’ve intermittent sleep is essentially what happens.

 

Dr. Mary Claire Haver  27:08

So progesterone, especially early perimenopause, you know, when they’re not really needing estrogen quite yet again, it’s, it’s very nuanced conversation. Okay, progesterone is magical for sleep. L theanine is really helpful, and magnesium. L therinate. Wonderful study just came out this week on l thermnate.

 

Speaker 1  27:24

That’s what the magnesium has really helped. Okay, third question, why do I have to go to the bathroom all the time? I am constantly, constantly pink, like constantly pink.

 

Dr. Mary Claire Haver  27:34

Okay so, GSM, genital urinary syndrome of menopause. GSM, estrogen receptors are all over our body. Okay, it’s not just hot flashes. It is everything. So in the specifically the bladder, the bladder neck, the urethra, the vagina, tons of estrogen receptors, all of that tissue together, vagina, vulva, bladder, bladder neck, the whole apparatus, hugely sensitive to estrogen levels. When they decline, we lose elasticity, we lose mucus production, we lose the ability of our body to fight inflammation and bacteria so recurrent UTIs, incontinence, irritation, what we thought was interstitial cystitis, especially in that age group, is probably untreated genital urinary syndrome and menopause. I’m going to blow some of your listeners minds. Vaginal estrogen is the key, right now, I’ll put you on vaginal estrogen if you were my patient, to see how it worked.

 

Reshma Saujani  28:29

Just see how it works. See if I pee less. Okay, why do I feel depressed and anxious? Because, right? Like the littlest things set me off.

 

Dr. Mary Claire Haver  28:39

So.

 

Reshma Saujani  28:40

And that’s new, is this new for you, right?

 

Dr. Mary Claire Haver  28:42

Yeah, I’m a pretty, I’m a pretty, like, standard, you know, like, I don’t get too excited, I don’t get too sad. I’m just kind of study betty. The perimenopause transition is an incredible window of vulnerability for a female’s mental health. Why? Because our neurotransmitters, especially dopamine, serotonin, norepinephrine, are directly related to levels of those hormones in our brain. And when those hormones go crazy or start declining or stop becoming predictable, the brain hates it, and so brain fog mental health changes, and the studies are coming out left and right now, lots of people are looking at the mental health changes and that, guess what? Estrogen replacement or estrogen therapy is more effective in perimenopause than SSRIs, then the standard antidepressant medications. It’s absolutely phenomenal.

 

Speaker 1  29:37

So I have noticed Dr. Haver that a lot of these symptoms get real intense midway through my cycle. Why is that so?

 

Dr. Mary Claire Haver  29:46

Like we talked about the chaos zone, we see kind of a bump because we don’t have that predictability. What the kind of thought process is, is that we’re seeing worse. Meaning PMDD, premenstrual dysphoric disorder, or the, you know, we’ve known about this forever. This happens in little bits. When I talk about the chaos and what happens in the brain. For some women, they’re super susceptible and have really bad PMS or PMDD all their whole reproductive life, but we see this sudden surge of it in perimenopause, yeah, you know. And so women who had it, I’m like, get ready. We need to be on the lookout and get really aggressive about treatment. But it’s very common that I will see patients who never had issues before suddenly having debilitating PMS, you know, rage, anger, anxiety, depression, cannot function for 2, 3, 4, days, and then it kind of calms down, and it’s, you know, very much tied to their cycles.

 

Reshma Saujani  30:43

So I want to talk about my situation.

 

Dr. Mary Claire Haver  30:44

Okay, now I can’t practice medicine in the state of New York. I could just give general advice.

 

Speaker 1  30:50

I’m going to tell you what my doctor said. I just, I mean, I thought it was really interesting. It was enlightened me. I actually want to share this with the viewers. So I didn’t realize how much menopause was connected to the same fertility challenges that I was having. So I had recurrent miscarriages. You know more than I can count. And when I you know, and oftentimes, similarly, I would go into the doctor like, oh, you’re just you’re 38 you’re 38 your eggs are old. And my sister’s an OBGYN. And she started looking at my records, and she’s like, no, this isn’t right. And she said, you know, I’m seeing some autoimmune issues. I want you to get it checked out. And what I discovered then was that I had APS right in a heightened immune system, a ton of killer T cells. And every time I got pregnant around 10, 11, weeks, my body would attack the fetus, right? And so once I figured it out, I had a concoction of like heparin and blood thinners and a bunch of stuff, right? And I was able to kind of carry my first son. So I go through this, right? And I’m thinking, as I’m in menopause, well, none of this is relevant to when I start having my menopause. And I’m like, do I take HRT? What do I do? And finally, the third doctor says, wait, wait a minute here. And oftentimes, the symptoms I was having not just are the ones I described, but I had intense itching. I would randomly break out in an allergic reaction out of like nowhere, in hives, because the histamine and so this incredible Doctor kind of put it all together for me, of like, no, this is related to this.

 

Dr. Mary Claire Haver  32:28

I mean, we’ve known this correlation forever, that there’s certain autoimmune disease clusters that spike in perimenopause. Again, estrogen is our friend, and estrogen is an anti inflammatory and when we have lower inflammation levels, we have lower autoimmune disease. And so when we take away that protection, we see, you know, in females, a surge of these very female specific types of autoimmune disease, like hypothyroidism.

 

Reshma Saujani  32:55

Wow.

 

Dr. Mary Claire Haver  32:55

So, yeah, so.

 

Reshma Saujani  32:57

I want to ask you something I and I, actually, I’ve asked several people have come here and talked about menopause, about this, and maybe I’m like, Okay, I haven’t exactly gotten it. How do I know, right, that this is, like, menopause, or perimenopause, or, How do I know it’s not something else.

 

Dr. Mary Claire Haver  33:12

Sure, great question.

 

Reshma Saujani  33:14

Because I now tend to fall in this, right? This thing of, ah, it’s my menopause. That’s why I snapped at you today, or that’s why my hair is itching, or that’s why I can’t sleep where it could be, a whole host of other things.

 

Dr. Mary Claire Haver  33:27

So when I have a patient come to clinic, post menopause is easy to diagnose. I don’t have periods anymore. You know, we have a great blood test for post menopause. We do not have a good blood test for perimenopause. So I can diagnose perimenopause by talking to the patient and believing her. I do a ton of blood work though. Okay, so she comes in, she’s got her list of symptoms. First of all, I believe her.  I don’t automatically dismiss it to your stress, you need more water, you need more sleep, you need more look, I was taught. It was taught to us that women tend to somaticize their symptoms, that we take something biological and we give it a psychological cost, not for men, only for women. It’s all in her head.

 

Reshma Saujani  34:11

What was the term you used? They used to call them WW?

 

Dr. Mary Claire Haver  34:14

Yeah, the whiny woman. Um, I’ve talked, you know, I go, I’ve spoken at American College of OB GYN, and there I heard whiny guy knees. I’ve heard Madame Delores in New York. I’ve heard TBD total body, DeLorean, Miami, where they, you know, where there’s a lot of Spanish, or if she was white, www, whiny white woman. And so my upper level is telling me this so and now I look back, I mean, it took like, 10 years for me to go, Wait a minute, I’m a whim woman. I’m her, you know, but I’m not. This is real. This is real. So the first thing I do is acknowledge what she what is happening is real. Second thing I do is I get a lot of blood work to see. So it could be, is it autoimmune disease? Is this overlapping? Is this also a nutritional deficiency? What is her? You know, I check inflammation. Patient markers. I mean, we are going all in with our patients to see, you know, I don’t want to miss I’ve picked up lupus. I’ve picked up lots of things. And, you know, is she anemic? Is she, you know, is this part of it? Then we talk about therapy, you know, we talk about everything from pharmacology to supplements to and then we just give her a try. I’m like, let’s try hormone therapy for three months and see what gets better.

 

Reshma Saujani  35:25

Right.

 

Dr. Mary Claire Haver  35:26

And you cannot believe the quality of life we can give back a woman by giving her back her hormones.

 

Speaker 1  37:50

I want to talk about the intersection of nutrition and menopause, yeah, what should we be eating and focusing on during this time period?

 

Dr. Mary Claire Haver  40:51

Good question. You know, more than ever with age and with menopause, because they kind of compound on each other. We can get away with a lot when we’re younger. Okay, look at the diets of our college kids. So menopause takes away the ability to get a freebie, you know, for most of us, and you should be focusing on protein. And I’m talking about so when I when my patients come into clinic, we focus on the immediate things that are keeping her from functioning on a day to day basis. Is it hot flashes? It night sweats? Is it brain fog? Is it depression? Is it, you know, whatever we fix that. Okay, then I feel great. I’m back to me now. We talk about her parents, her aunts, the elders in her family and their what diseases have plagued them with older age? What are we trying to avoid? Because I don’t know about you, but I’m in the sandwich generation, and I am dealing with three sets of parents in laws who are not doing well in old age, yeah, and it’s a lot and so and so my husband and I are constantly like, what can we do to try to avoid most of that? I don’t want to negate what they did, or they’re lovely people, and we love them so much, but it is a lot of suffering.

 

Speaker 1  42:02

Oh, my father ate a ton of Indian food, drank a whiskey every night, and he’s got diabetes and a heart attack at 56 I’m with you, right? And all I’m doing is, how do I not? Because I truly live a highly stressed life, how do I not end up there, right?

 

Dr. Mary Claire Haver  42:17

So there’s a lot of genetic variation. Look at your family history, you know, I’ll have people come in with perfect labs. They have no visceral fat, but they’re having, you know, life, crushing depression. We focus on that, you know, I’m like, keep eating what you’re eating. You’re you know, how do we prevent a metabolic free fall, if, if that is going to be your path, how do we prevent sarcopenia, osteoporosis or dementia? What do we know? And usually it’s the same stuff, adequate protein, about 1.6 grams for every kilogram of lean body mass. For a woman, I don’t look at men’s studies, I just look at us. Okay, so most women are getting maybe half that on a day to day basis, right? Because they were always taught to be thin and calorically restrict, and protein kind of goes out the window plants and protein. So we focus on plants and protein. There is a theoretical place where a woman would never need a supplement, because she could get everything from her diet. It’s possible, but it’s very hard. Okay, in clinical practice, it is really, really hard. So supplements are there to fill in the gaps plants and protein and then avoiding the processed foods. Not to say, Never you will go to parties. Things happen, but watching your added sugars less than 25 grams a day, at least 25 if not 35 grams of fiber per day. Those are the two core things on my patient. You know we talk about, we know that works for everyone.

 

Speaker 1  43:34

Yeah, I just started taking a fiber supplement. Why is fiber important during menopause? And I started taking it because I just got my cholesterols and my LDLs and my HDLs were like off the charts, right, which is because of the estrogen drop.

 

Dr. Mary Claire Haver  43:49

So fiber does several things. It slows down the absorption of sugars. So when you eat a meal that has carbs and fiber together, right? And a lot of carbs have fiber. Natural fruits and veggies have fiber. It slows down the absorption of the sugar, so you don’t get the insulin spikes, IGF receptors, the insulin growth factor receptors, you know, all of that on the liver will. You know, those insulin spikes are going to help to drive cholesterol levels. It really is less about your you know, saturated fats. We look at a two to one unsaturated to saturated fat ratio, and that seems to really help move the needle. But fiber slows absorption of blood glucose, feeds the gut microbiome. It is the prebiotic. So keeps your gut microbiome well fed and happy. We’re also adding in probiotic supplements a lot of times like that.

 

Reshma Saujani  44:41

Ask you, do you need a probiotic and a fiber supplement or just one or the other?

 

Dr. Mary Claire Haver  44:45

You should do both. So if you’re eating something rich in probiotics, if you’re doing plain Greek yogurt every day, you know a three fourths of a cup, that should be enough probiotic, but it’s usually just lactobacillus. So I tell my patients, when you’re going to a Whole Foods or wherever, to pick out your supplement. But you want something that has lots and lots of strains, so like billions, and you want as many strains as possible, right? You want to fill the pond with as much variety as possible, because our gut microbiome changes to that of a man. Great studies done through Zoe looking at the gut microbiome health like they got stool samples all the way through prairie menopause and menopause, and looked at how the gut changed through the menopause transition.

 

Reshma Saujani  45:23

So you’ve recommended a nutrition program called the Galveston diet, right?

 

Dr. Mary Claire Haver  45:27

I wrote that book yeah..

 

Reshma Saujani  45:28

Yeah that’s right. You wrote that book. Tell me about it. And because you okay, because one of the things like, I listen to these conversations and I’m like, okay, you know, I mean protein and, like, no saturated fats. But sometimes I’m like, tell me what I should eat for breakfast. Tell me what I should eat for lunch, for lunch, and tell me what I see for dinner. And I’m just gonna do that every day. So can you do that for me?

 

Dr. Mary Claire Haver  45:47

So kind of, when I, you know, first got into studying nutrition, so I actually got certified in culinary medicine in 2019 from the American College of culinary medicine. So like 18 month program, took all the labs. Had to go to San Antonio, New Orleans, work in kitchens. It was awesome. So I learned a lot, because we, again, in medical school, zero on nutrition, you know, like at the actual functional nutrition. So I took what I learned there, and I was looking at studies on inflammation. I wanted to lower inflammation in menopausal women, knowing that there was a big connection with visceral fat and weight gain and so there were, there’s good studies done on fasting with inflammation. Now I’ve kind of backed off on, like, being very rigid about fasting now, because it’s hard to get your protein in in a tiny window, right, right?

 

Reshma Saujani  46:35

So you don’t recommend intermittent fasting in the same way.

 

Dr. Mary Claire Haver  46:38

I still do it kind you know, I talk about it, I talk about the risks, the benefits, but I tell patients not to sacrifice nutrition to be able to fit in an eating window, you know? And that if you’re trying to build muscle, you should invest so Galveston diet had anti inflammatory portion, a fasting portion, and then what we call a fuel refocus portion, where we were looking at macros, what I’ve done differently now. So that was 2015 when it was weight loss, weight loss, weight loss, right? So I got into the weight loss space. Well, then as I kept learning and reading and researching, I’m like, this is less about weight loss and more about body composition. Yeah, this diet, you’ll lose weight, but wait a minute, are we going to gain muscle and lose fat? Like, are we just losing a whole lot of muscle? You know, so if I ever wrote a book again on nutrition, it would be more protein centric, less rigid about fasting, and more about body composition. More like celebrating your curves, your shape and muscle. I’m now trying to have a bigger body, you know. I’m constantly fighting to have more muscles. So much more fun place to be than constantly thinking about, I can’t eat this, or I can’t.

 

Speaker 1  47:43

Yeah, I love you say that, like we need to move away from thinness being a sign of health, right? Can you elaborate why being thin is not the same as being healthy, strong and healthy?

 

Dr. Mary Claire Haver  47:56

Yeah, so, you know, forever I was taught calories in, calories out thin is healthy. You know, you could look at a patient and tell her what your cardiometabolic status is, and then you start seeing these younger patients who are thin, falling out and having horrible cholesterol and horrible you know. And so BMI is now, you know, the World Health Organization and American College of Cardiology. You know, all the big societies are stepping in and saying, We are rethinking BMI as a measure of the risk of chronic disease. The waist up ratio, or an abdominal circumference, is more important than the BMI, because you’re discounting muscle when you talk about BMI, and that is a more clinically relevant indicator of the risk of chronic disease, plus you say they’re obese if they have a waist to ratio for a woman greater than one plus one risk factor like hypertension, insulin resistance, etc, so that now qualifies for obesity.

 

Reshma Saujani  48:51

How does GLP? One fit into this?

 

Dr. Mary Claire Haver  48:54

So I use them in my clinic, and I can tell you for my patients who’ve lifelong struggled with with, you know, being over fat and under, you know, it is a miracle. For the first time, the food, noise, inflammation goes down, they’ve never seen a more motivated. They’re absolutely sticking to the, you know, plans that we put with them. They’re able to do it like the mindset part is really there for them. And really, we’re seeing good results for menopausal weight gain as well. So women who really had normal weights and didn’t have to worry about their weight until menopause, you know, we start with HRT typically, if they’re menopausal and, you know, get their symptoms under control. We give them a nutrition plan, then we see them back in three months, and if they’re still struggling. And so Rocio Salazu and my good friend. She’s in New York. She’s an endocrinologist, and has does incredible work. Taught me so much about GOP ones. She said, you know, there’s all this talk about, you know, vanity, weight loss. She said, If a woman is maintaining her weight, but it is taking 90% of her day to do it, and it is, you know, the thought process, the the, you know. It is making her unhealthy in every other part of her life. Why would you not try it right to see if you could take that angst away from her and allow that beautiful brain of hers to go think about her things like making the world better, building her position at work, you know, whatever. Yeah, anything. But am I eating? Am I not eating? How much I want to work out? So she says, it’s worth it.

 

Speaker 1  50:22

Yeah, tell that voice to be quiet so you can focus on other things. So you’ve been doing this work for a while, and you are, like, one of the, I mean, you’re just, you’re sage, like you are like, you break it down in a way that, like no one else does, I guess. I want to ask you, like, what’s the thing that surprised you? And what do you think? The thing is that we still have to, we still have to work on.

 

Dr. Mary Claire Haver  50:46

Everything, I mean, what surprised me, how much I didn’t know, how much every day I’m surprised, how much I, if I open my mind and listen, if I, if I treat to heal, if healing a person is my goal, rather than taking a random set of of guidelines of fixing a sick person, but if I’m here to promote health, it absolutely has blown my mind. And here’s one of the most disappointing things, the people, the institutions, the organizations, who have been in control of women’s health after reproduction are not happy about this movement. They are horribly, horribly disappointed. They have built careers and lives off of a very narrow definition of menopausal symptoms, you know, and how we’re supposed to treat them. You know, there’s society saying we should be doing cognitive behavioral therapy as first line treatment of menopause. Wow, it’s outrageous. It’s outrageous not to say I love CBT. I’ve had CBT for traumatic, you know, things that have happened in my life. But to think that I would use that to manage a hot flash, I just, I’ll think a hot flash. I’m like, why are you assigning a psychological, you know, treatment for a biological condition, I, you know, so that has been really disappointing. Here I am thinking, oh, good, all these societies are going to be so excited, and, you know, really see, like women are galvanizing or interested in their health care, and really want to ask him more questions, and ask him more questions, and the pushback. Now, let me, let me be clear about this. Remember, I was that doctor. I was a great OB, GYN. I delivered babies. I did wonderful pap smears. I was a good surgeon. I was, you know, high risk OB. I did it all. I was terrible, terrible, terrible, menopause provider. I will tell you this straight out, and I dismissed and I, you know, I didn’t know what I didn’t know, and it wasn’t my fault, because no one taught me. It was not part of my required training, and no one since my graduation put articles in front of me on a regular basis as part of my CME to say, this is important, and this is how you should be taking care of these women once they’re done having babies, okay, once their ovaries shut down. So we have some OB gyns who aren’t happy with this menopause movement either, because it’s making their job harder, because harder because they weren’t taught and they’re having 15 minutes, you know, I have an hour with my patient. That is a privilege. Yeah, that’s a privilege. I could never have run this kind of practice I have now in the old traditional, you know, it’s Fee for Service Insurance. The current guidelines do not promote the health of a woman after reproduction ends. I know that’s controversial, but I’m saying it loud and proud.

 

Speaker 1  53:27

And you’re building a movement. Listen, you’re building a movement that’s going to change the structure. So anyway, I want to get to that. I want to, you know, close out here, and just because I think you have so much like, again, sage advice to give, like for women entering perimenopause, what’s the first step they should take?

 

Dr. Mary Claire Haver  53:45

Educate yourself, and realize that this, this change is coming, and probably the things that you’ve been doing for your diet, your nutrition, your sleep, for most of you, not all, are going you’re going to struggle to maintain homeostasis. It’s going to get harder, either your mental health, your musculo skeletal health, your gut health, your you know, and could be all of them, but there’s usually kind of one thing, and there’s a really interesting gut study called not feeling like myself in Flm, and it’s usually the first sign of perimenopause, like the symptoms, like everyone says, hot flashes. Well, that’s the most recognizable symptom. The most common symptom is fatigue.

 

Reshma Saujani  54:26

So wait, where’s the study? Where can they read it?

 

Dr. Mary Claire Haver  54:29

So if you Google not feeling like myself, scholarly, it’ll come up.

 

Reshma Saujani  54:33

Okay? We’ll put in the show notes.

 

Dr. Mary Claire Haver  54:34

Okay, so read that article, yeah. And you’ll be like, what? You know? And so these online menopause companies, MIDI alloy and ever now, my three favorite they do not pay me, you know, but I’ve vetted them. You know, a lot of people are struggling to find an in person menopause provider like educate yourself. Get the new menopause. That was my book. You know, there’s other great books out there.

 

Speaker 1  54:57

So read the new menopause. Read the scholarly art and. Maybe sign up for a session with one of these companies, right that can give you like give you a counselor. I did that right and said, I’m going through this. What do I do? And it was enormously helpful.

 

Dr. Mary Claire Haver  55:09

And because you really can’t rely on your poor, busy, lovely OBGYN to be able to keep up with this, it’s moving too fast, and they are still doing great care in what they were taught to do. And it’s a really special OB GYN who has been able to step outside of their training to be able to do really good menopause care.

 

Speaker 1  55:27

No, it’s true. I experienced that too. Also. It’s like you lose that. Like, the last time I went to my OBGYN was like when I was struggling with fertility issues, and then you kind of, you know, you don’t have that same relationship. Okay, well, this was so amazing. Thank you. Dr. Haver, when’s your new book coming out?

 

Dr. Mary Claire Haver  55:43

Not till 2026 the New Perimenopause.

 

Speaker 1  55:45

Yeah, all right, we’ll be looking out for it. Okay? Thank you so much.

 

Speaker 1  56:03

Dr. Mary Claire Haver is the author of two best selling books, The Galveston Diet and The New Menopause. I truly cannot thank her enough for taking the time with me with all of you mid lifers, because I know you learned as much as I did. So here’s one last thing, thank you so much for listening to My So Called Good Life. If you haven’t yet, now is a great time to subscribe to Lemonada Premium. You’ll get bonus content like me and Tamron all talking about raising suns and being aware of the way that society just treats them differently than girls. Just hit the subscribe button on Apple podcast or for all the other podcast apps, head to lemonadapremium.com to subscribe, that’s lemonadapremium.com. Thanks, y’all be back next week.

 

CREDITS 56:48

I’m your host, Reshma Saujani. Our associate producer is Isaura Aceves, and our senior producer is Kryssy Pease.   This series is Sound Design by Ivan Kuraev. Ivan also composed our theme music and performed it with Ryan Jewell and Karen Waltuck.   Our VP of new content is Rachel Neel.   Special thanks to our development team, Hoja Lopez, Jamela Zarha Williams and Alex McOwen. Executive Producers include me, Reshma Saujani, Stephanie Whittle Wachs and Jessica Cordova Kramer. Series consulting and production support from Katie Cordova. Help others find our show by leaving a rating and writing a review and let us know how you’re doing in midlife. You can submit your story to be included in this show at speakpipe.com/midlife. Follow My So Called Midlife, wherever you get your podcast, or listen ad free on Amazon music with your Prime membership, thanks so much for listening. See you next week, bye.