Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. I'm so glad that you're here today, whether you're listening for yourself or because someone that you love shared this episode with you. I want to welcome you to the Mel Robbins podcast family. And thank you. Thank you for making this podcast one of the most popular podcasts in the entire world. It is an absolute honor to be able to spend some time with you today. And I want to start by acknowledging you for something. You could be listening or watching do a bazillion things right now, but you chose to take some time for yourself and listen to something that can help you create a better life. And today, holy cow, is that going to happen? Because we are digging into a topic that is impacting nearly 1.2 billion people. It also happens to be one of the most requested subjects that you've been asking me to cover. And one of the reasons why you want me to cover it is because there is so much conflicting information about this subject. What am I talking about? Menopause. It is time that you feel informed about what's going on with your body, your brain, and your hormones.

If this is not impacting you personally, do not change this. Listen, because it is impacting someone you love. I've been dying to have this conversation about women It ends hormone health and menopause with you because if you're overwhelmed by the topic of hormone changes or menopause, or maybe you're just tired. You're tired of hearing your mother or your significant other complain about the changes in her body. Boy, oh, boy, Are you about to learn a lot? One of the reasons why so many of you feel so powerless about your hormones is because your doctor is probably not informed about this topic either. So you're not getting the answers, the information, and the simple things that you can do that you deserve. Well, that changes today because your friend Mel Robbins has tracked down one of the leading specialists on menopause and estrogen deficiency. So let me tell you a little bit about Dr. Mary Claire Haver. She is a board-certified obstetrics and gynecology specialist. Dr. Haver is also a certified menopause practitioner from the Menopause Society. You're going to learn why that's actually a very big deal a little bit later in our conversation. She's also a certified culinary medicine specialist from Tulane University, a best-selling author, and author of the incredible brand new book, The New Menopause.

She's the founder of the Mary Claire Wellness Clinic, which is dedicated to the care of menopausal patients. This is really important. She has two kids. Just like me, she's 55. She's juggling a big career, a marriage and motherhood. She has so much to share with you today that you will be be able to apply to your life. I want to remind you, this is not just for you. Please share this with every single woman that you know, because what you are about to hear will change your life and hers. Without further ado, please help me welcome Dr. Haver to the Mel Robbins podcast.

Thanks for having me.

You are so passionate about this topic, and you even get very emotional about it when you think about it. Why are you so passionate about this?

Because in my own journey of going through menopause and realizing what a gap there was in my own training and how I really wasn't the best menopause provider for a long time, I have such a need to get out there and teach and share because we are not teaching our medical students and residents in our nurse practitioners, much about menopause care outside of the most cliché of symptoms and how to manage them. Menopause and estrogen decline is inevitable the way that we're created as humans. But suffering through it and having to just put up with it or dismissing it as a sign of aging is not. There are lots of things that we can do. We're going to live a third of our lives like this.

A third of our lives like this?

A third of your lives. After reproductive options are taken off the table, it's almost like medicine leaves us behind. I want to be an 80-year-old climbing that mountain, kicking ass, having a career, healthy. If I don't implement changes today, I'm not going to be able to reach that goal.

Why is it that there is so little information about hormone changes and menopause? You go to your doctor and it's like, Oh, well, you're going to deal with this for about 10 years, and then that's just the way that it is. What is up with this?

If you go to PubMed, which is basically Google for health care professionals, which is where it's like a repository of medical studies, and you put in the word pregnancy, you'll get about 1.1 million articles. All important. Great stuff, right? It's important that we have healthy pregnancies and we deliver children in a healthy way and et cetera. When you put in the word menopause, We get 94,000 articles. We only get 10% of the funding. That means 10% of the brainpower, 10% of the research for the last third of our lives. We do live a little bit longer than men, but we're going to spend 20% of that in poor health, in decline, in disability. This is avoidable.

I hear the word menopause, and I think out to pasture. Right. You're done.

I thought that for a long time, too. Then I'm Gen X. You know what? To hell with that. I want to live a good life. I'm refusing to just accept the medical definition of getting older for a woman, which is very different than a man. When we're born, we have about a million plus or minus eggs. From birth until we die, we're slowly losing that egg count, and it starts accelerating as we get older. By the time we're 30, we're down to about 10% of our egg supply.

Well, hold on a second. By the time you're 30, you've already lost 90% of the eggs that you were born with? That's correct. I don't know why I never knew that. I feel dumb that I've gone through 55 years of my life, and I did not know that we're down to about 10%.

At 40, 3%.

3% at 40?

3%, yeah.

Wow. You lose your period because you have no more eggs, so there's no more need to go through that cycle.

You can't ovulate. Yeah, there's nothing left. Holy cow. It doesn't make sense now?

Of course it makes sense.

Why it's harder to get pregnant when you're older, why you're more likely to have a chromosomal abnormality, because the number and quality of your eggs is declining with age. What What happens for females is that our endocrine system, especially the ovaries, age at twice as fast a rate than the rest of our body. The endocrine system is where our hormones are created. All of our estradiol, our progesterone, and about at least half of our testosterone is created in those ovaries every single month, every single day. However, when we get to perimenopause, things start changing. When we get to full menopause, we have no eggs left. The ovaries decline. We're losing our ovaries at the average age of 51. They stop producing sex hormones. We basically are forced to live the last third of our lives without the benefit of estrogen, progesterone, and about half of our testosterone.

I get this at a level that I've never understood this before. Because when you really just put it in the context of you're born with a million eggs, and from the moment you start your menstrual cycle and the hormones are going up and down, there is a purpose associated with the design of your body. Once that stops, everything gets disrupted in your body. Why has nobody studied this? What the hell?

People are studying it. When we look at OB/GYN, the residency. That's what you are, right? Yes, I'm OB/GYN, women's health. Super proud of what I learned in my training. Pediatric, gynecology, oncology, surgery, babies, fertility, all this stuff. Menopause got shoved in this tiny little box. She's going to have a few hot flashes and maybe some vaginal dryness. Her bones might get a little weaker, and that's it. We only want to give her estrogen. If she can't tolerate anything else, if nothing else is working, then fine, give it to her, but you might kill her.

Wow.

Our body thrived on this hormone for 50 years, 51 years on average.

And by this hormone, you mean estrogen?

Estrogen, and testosterone, and progesterone. We were living our lives managing our stress, managing our way, doing all the things. Then all of a sudden, you can't put your finger on it, but something's changed.

That's exactly what everybody says. Whether this is happening to you or you've heard your sister or your mother or your partner say this, we start going, I'm doing the same stuff I've always done. My pants are not fitting. I am grouchy. Suddenly, I feel like I have ADHD or brain fog or dementia. I don't feel like myself in my body. You are every single patient who comes to my office.

This exact same story.

What would you, as a gynecologist, do when a woman would come in, as they did for years and years and years before you became one of the world's leading experts in this? What would you do as a doctor?

I'll tell you a story from my training. We had gynecology clinic in residency, and I was an intern. We had OBS divided into two sections. In gynecology We had the surgical cases coming in. All the residents would line up, like six or seven of us, and the upper levels would run for the surgery cases because they want to operate. Us, interns, will be left with whatever was left. They'd be like, Oh, you got a WW.

A WW?

A WW in Room 12. Good luck with that. A WW, this wasn't written in the chart. My professors never said this. This was lure handed down from an upper-level resident. You can do it with a Texas accent because that's where I trained. These guys in cowboy boots walking up and down the hall, Hey, you got a WW in Room 12. Good luck with that. It meant whiny woman. Here was this woman coming in, and this was a public health hospital. She's desperate. She can't sleep. She's gaining weight. She's not happy. She's having maybe headaches. Just this laundry list of very vague complaints. But she was still having periods. Maybe irregular, maybe heavier, maybe lighter, maybe You were like, It's just part of aging. If she came in complaining of libido, I was a deer in the headlights. I didn't know what to tell her. We were taught nothing about the female sexual response or medications that might help or go out and have some wine, relax, get a new boyfriend. All the other complaints, I would start sending her to other specialists. Let's go see a cardiologist for the palpitations and a neurologist for your headaches and When she'd walk out of my office with six referrals and I didn't know enough to say, Let's try some hormone therapy and see if these things get better.

I'll do some blood work. Let's make sure it's not autoimmune disease or hypothyroidism. I was doing that. I just think back on that and that we can do so much better. We got to do a better job training every single health care professional in all specialties about how special menopause is and what the lack of estrogen is doing to each and every organ system. Each female has a unique expression of our menopause. Where you may have had palpitations, frozen shoulder, and dry vagina, I would have had hot flashes, night sweats, and horrible rage. Doctors like a checklist of symptoms. It's how we're Recall. But we're trained to look for ducks. How does it? Is it walk like a duck, talk like a duck? It's a duck. Everyone's duck is a little bit different.

You mentioned that every organ in a female body- Yes.

Every organ system, yeah.

Every organ system has what for estrogen?

That's where the research is really exciting right now. Duke University did this elegant study looking at frozen shoulder, which is adhesive capsulitis, so common in women, especially in menopause. Finally, a woman, head of an orthopedic surgery department, talked to the woman head of an OB/GYN department at a big university, and they're like, Something may write. They did the studies and they showed that women on hormone therapy have a lower chance of frozen shoulder. They pulled all the data and they're like, Why would that be? Why? So then now they're going in and doing biopsies of all these joints and saying, there's tons of estrogen receptors here. And when we lose that estrogen, we're seeing mass. It's an anti-inflammatory hormone in the bones and joints. So we have arthralgia, joint pain, capsulitis, all of this stuff tremendously flares. And some of your listeners are like, oh, my God, right now, I had frozen shoulder. So really, really common or hip pain or joint pain or you can't roll over in the bed. It's so painful. You have no injury.

I'm sitting here feeling one revelatory, Oh, my God, oh, my God, oh, my God. There are times in bed where I am laying there and I will go to roll over and it's as if I have to prime myself over I'm so stiff. Wow. That makes so much sense, actually.

If the estrogen receptors are in your organ system, that then presumes that it's impacting liver function, kidney function, everything. Lung function, heart function, brain function, genital urinary function, as we know, bones, osteoporosis we've known forever. That's a no-brainer. Wow.

I want you, as you're listening, to Dr. Haver, to just really think about this for a second. That every single aspect of your organ system, from your brain to every organ to your muscles, all of is used to functioning with estrogen. Thinking about menopause and perimenopause and even issues related to your ability to ovulate, your ability to get and remain pregnant, all of these issues, these are all issues related to estrogen and hormones? Yeah. It makes so much sense. If you take out one of the main ingredients to the female body's optimal health, Of course, everything is going to go haywire. Wow. That is so empowering to know. Dr. Haver, we got to hit the pause in menopause and hear a word from our amazing sponsors. Please take a listen to our sponsors because they are allowing me to bring you Dr. Haver at zero cost. So take a listen. Dr. Haver and I are going to be waiting for you after this short break. Stay with us. Welcome back. It's your friend Mel Robbins, and I am here with the remarkable Dr. Marie Claire Haver. Her new book is The New Menopause, and she is an expert in women's hormones health.

So, Dr. Haver, you've now got this estrogen deficiency.

Well, not zero. Menopause is zero.

But still, it's a lot lower. But I'm saying it's still. So I want you to Pay attention to what Dr. Haver is about to explain to you, because your body has been experiencing mild symptoms of this for your entire life. You just probably thought it was whatever, but this is the symptoms of a drop of estrogen. How is estrogen helping your body and your organ system run in the most optimal way?

The first half of our cycle, so you have a period, the first day you bleed is day one of your cycle. That's your shedding and starting over. So in those first 14 days, we call that the follicular phase. So that's when our follicles, which are the little sacs that our eggs sit in, start saying, Okay, one of us is going to win. So 100, 200 of them are like, It's a race. The brain's like, Our estrogen's low. Let's go, let's go. Now that uterine lining is starting to thicken up under the influence of the estrogen level that's rising, getting ready for a potential baby. Then we hit about day 14-ish, depending on the cycle, and then the estrogen level is at its highest. The brain is like, Okay, we need to ovulate. The LH surges, and that's the thing that makes the egg pop, and that one or two eggs come out.

Then when the egg pops, the popping also creates a little surge of estrogen, right?

There's a little bit more. Then progesterone starts being produced where where that egg came out from. That's a really efficient factory for creating progesterone. Then that progesterone starts rising. In that second half, you are very slight, but it's there, mimicking what's to come when we totally lose our estrogen.

In the second half of this month and this cycle, as the estrogen starts to decline, what happens in your body?

Some women suffer horribly from it, but we have premenstrual dysphoric disorder, PMDD, bloating, swelling. Now, we think the bloating and swelling is from the really high progesterone levels. In menopause or in that second half, that drop of estrogen, our mental health changes.

How does it change our mental health when you have a decline in estrogen?

There's a lot We're doing a lot of research going on right now, but we know that tons of estrogen receptors in the brain and our serotonin is affected.

How does estrogen and serotonin play?

It looks like when your estrogen levels are optimal, At a nice healthy level, we have really efficient serotonin and noreponephrin. Those are two key hormones that we see in depression. They're low in women who are depressed. For women who are sensitive to it, that we're seeing the PMS, the PMDD, those women tend to do okay on a SSRI for a short term. They only take it two weeks out of the month, or some of them like to take it every month. But it really is from that estrogen decline. We see menstrual migraine headaches. Some women with a declining estrogen, the blood vessels will slightly squeeze in certain areas of the brain, which will trigger a migraine headache.

Wait a minute. Migraine headaches.

There's menstrual migraines.

You also can feel a slump in terms of depressive symptoms or anxious symptoms because of the decrease in estrogen. That's what we think. I would imagine brain fog, ADHD, all of these other neurodiversions divergent issues that people might have also then see an impact from the decline in estrogen.

There's a definite pickup worsening with people with known ADHD through the menopause transition, perimenopause into menopause. We don't really know if it's a new diagnosis of ADHD or she was making it until perimenopause because it's a spectrum. Then all of a sudden, her resilience against this has stopped because she's lost her estrogen, her gesterone, her testosterone, however that fits in for her. All of a sudden, she's now so symptomatic. At the time in her life that she needs those facilities to be functioning at all levels. Career women are having to leave their jobs. We're seeing massive economic impact from this in the workforce.

What I love about the fact that people are researching this is that knowing that it's a neurodivergent condition and that there are estrogen receptors in the brain, whether you're talking about the second half of the monthly cycle or you're talking about the period in your life where estrogen declines, that of course- Your executive functioning tanks. Yes, of course it makes sense. Now the system is going haywire and inflamed, it's not got the firepower to help you focus on the thing that you need to do right now. Wow, that makes so much sense. I did not understand the fact that when estrogen declines at all of the symptoms that I was feeling, that that has to do with hormone fluctuation. What's interesting is if you were to start tracking your cycle, which everybody should do, you would probably, over the course of several months, start to notice a correlation, if not a direct connection, between that halfway marker of the month and when you start to feel a little foggier, when you start to feel more irritable, when you start to feel more bloated, you might notice more headaches, you might notice... Which then allows you to be more competitive passionate with yourself.

Because I think knowing this, it will probably put symptoms in the context of how estrogen helps you feel better and what it feels like when your health is more optimal versus these symptoms that come up. Because when you feel the symptoms, you think, something's very wrong with me.

So estrogen is an anti-inflammatory hormone.

When you doctors say anti-inflammatory, I really don't know what you mean. Sure. It seems like everything is inflammatory these days. You have such a freaking unbelievably cool way of explaining things. How would you describe Anti-inflammatory, inflammatory. Sure.

It's easiest to think about it in terms of acute and chronic inflammation. Acute inflammation, everybody knows. You got a virus, you twisted your ankle, you stepped on a nail. I don't know what that means. Body's response to an acute injury. So what happens? You breach some barrier in your body. A virus breaches it, a nail, you twist your ankle, you have some orthopedic injury, you break a bone. Immediately, your immune system goes on alert. Okay. Make this stop. We need to fix it. So it rushes blood flow so things get red and swollen. It pumps fluid in the area to try to wall off whatever this invader is. Your white blood cells, which are infection fighters and inflammation, those are all in pro-inflammatory cells in our body.

Is inflammation a code word in medicine for your body is in an alarm state trying to address something? Yes. Okay, I think I got it.

It's all the little biological processes that make that happen. That's acute inflammation. Got it. We need that to stay alive.

Break a bone, boom, get to work. Inflame, go, go, go.

It hurts for a while, but then you're healed. Okay. Chronic inflammation is when that system gets turned on a little bit, it's something's not right, but it won't shut off. You have this chronic state of things being chewed up and laid down and And an estrogen calms that process down.

I think I just got this. Let me see if I can explain this back to you. Chronic inflammation, which you said is just like something's a little off, is that feeling where you're just like, something's not right in my body. I just don't feel comfortable in my body, but I don't know what it is.

It can affect a joint, your whole body, your gut, your head, your whatever. Autoimmune disease is basically nonstop chronic and acute inflammation, and it can calm down a little bit. But what that inflammatory process does is chips away at our organ systems.

Well, what I'm also wondering is if the female body and intelligent design of the month is designed based on cycles of estrogen in particular, and estrogen gets removed either because of menopause or PCOS or changing or surgery or whatever, that something to your body's natural process every month is wrong.

Of shutting down that inflammation.

And now your whole body's like, something's wrong. Because we need some estrogen down on there and the body doesn't respond. The ovaries can't do it again.

They're done.

It's like your whole body's like, whoa, broken bones. Something's wrong. What are we doing? And it races everywhere.

In the joints, we see- Arthralgia. Just this- What is that? Arthralgia is pain in the joint.

That sounds like an ugly version of arthritis. Arthralgia. It sounds like something that you would get in one of these fantasy novels. Pain in the joints. The Arthralgia comes over the hill.

In the heart, let's talk about the heart. When we get to this hyperinflammatory state, we see palpitations, that sinoatrial node. There's a little node, there's a little part of the heart where it sends out a signal to control our heartbeat. It's called the SA node, sinoatrial node. That thing is super responsive to estrogen and likes estrogen and likes it, keeps it calm and beating in a night. You take estrogen away, all of a sudden, some women will start having palpitations out of nowhere.

Wow.

They go to the cardiologist, they get their million-dollar workup, and they're like, don't know what's going on. We're not training the cardiologist to say this might be part of her menopausal picture.

You want to know something else? I'm just like, actually, as my brain is churning and all this is starting to go click, click, click, is that if there's not comprehensive training and if there's not advocacy for what these symptoms are, then there's also no health insurance code to cover the cost of a lot of the diagnostic stuff that actually points to what is causing this.

Medicare does not pay for a menopause visit. That's insane.

What?

Yeah. Your well-women exam. That is devolved into screening for breasts for breasts and cervical cancer. That's it. That 15 minutes with your legs and stirrups is not the time to do a comprehensive menopause visit. You need to schedule another visit. Go in with your arm with questions. Go in with your family history and all the symptoms.

It sounds like Don't call it a menopause visit. Say, I'm having lots of symptoms, but don't call it so it gets covered.

Exactly. Wow.

Okay, so the heart, the lungs, how does estrogen impact your- Asthma, inflammatory disease.

We see an increase in asthma. Actually, asthma that doesn't respond as well to the typical bronchodilators.

Well, that makes sense because it's like an internal system functioning thing where the oil and the gas is no longer in the engine. Yeah. Wow. What about your digestive track?

The gut health changes dramatically. When the gut health changes and the gut microbiome changes, how we reprocess our estrogen changes a bit as well, the metabolism part of it. Lots of research going on in that area right now. Our bones, we've known forever osteoporosis. Now, what your listeners may not realize is that osteoporosis is completely preventable for most women, and they don't know how. We're not diagnosing osteoporosis, usually until you have a fracture. And 50% of women before they die, will have an osteoporotic fracture.

Just for somebody who's listening that doesn't know what that word means, is that fragile bones, bones density?

What does that mean? Our bone density maxes out how thick and strong our bones are. The thicker, the stronger, the more resilient to fracture they are, in in general. We're constantly remodeling our bones, which is why when we, and I'll explain that in a minute, which is why when we break them, they fix themselves if you wind them up.

Interesting.

We are constantly chewing up bone like Pac-Man and then pooping out new bone behind it. Really? Yes. The bones you were born with were not the bones you had at 10 or not the bones you have at 20. We have totally chewed up and laid down all new bone. What happens in menopause or in women with chronic suppression of ovulation, chronic low postpartum, multiple babies, we start chewing up more bone faster than we can lay it down. And that accelerates in menopause. So we end up with this porous bone with holes in it, basically. That is a lot easier to fracture. Now, if you fracture your hip, so if you're 65 plus, and that is 10 years away from us, and we fall, climbing up the ladder, chasing a grand baby, hopefully, maybe one day, no pressure to my children. We trip and we trip, We take out a hip. Even with surgical repair, we have a 29% chance of death in that first year.

Hold on. I need everybody to hear that. This is really serious. She's basically saying bone density starts to decrease based on the decrease in estrogen. And aging. And aging. And that makes you more fragile and prone to having a broken bone. She is also saying this is preventable. For most women. For most women. But if you fall and break a hip at the age of 65, 29% of you will die.

In the first year.

In the first year. With surgery.

Without surgery, it's like 79%. So they're all getting surgery. Yeah. Wow. So say you survive, the rest of your life is marked with chronic disability, not being able to take care of yourself, which is... My patients don't come in saying, I want to rock a bikini. They're looking at their mothers, they're looking at their aunts, and they're like, Get me off of this path. I don't want this. Or they're looking at a really healthy mom who's running around and is not for real, not decrepitating care of herself. They're like, Make sure I stay on this path. That's where the work begins.

Wow. All right, we've covered bones. What else?

Genital urinary syndrome of menopause. Okay, what is that? That's a big mouthful. It used to be called senile vagina. That was a medical term. That sounds ugly.

Senile vagina? Senile vagina.

Was a medical term?

Yeah. It sounds like a bunch of guys got around, got really wasted.

Welcome to Western medicine. Wow. In the 1950s. Then They changed it because it was so offensive to atrophic vaginitis. Again, doesn't sound much better.

No.

Our genital urinary system, the bladder, the vagina, the vulva, that whole space from your pubic bone to the end of your tailbone, just all of that area. Is highly sensitive and highly estrogenized. When that estrogen level drops, we lose elasticity, we lose stretchability of the vagina, which might be helpful on occasion.

Is that why sex is painful?

Sometimes For most women, they have atrophic area, so they've lost their elasticity. They can't make mucus anymore. The tissue is thin. If you look at a biopsy, a premenopausal vagina, it's this thick, velvety, elastic, beautiful. Like, bring it, baby. And then this postmenopausal woman who's never been treated, it looks like the Sahara Desert. You've lost layers and layers and layers of tissue. It's very dry. It's very small. And she's just gritting her teeth through sex.

And that is because that entire- It's horrible uncomfortable. I'm a hiker.

I've got to use... Even with systemic estrogen, if I don't make sure that area is well moisturized, things might... Also, the architecture changes a little bit, so things are hanging at different levels. I I love to hike. I'm going to have some chafing and things that I never had before. I need to make sure I'm getting lubrication in that area. I can hike comfortably besides everything else I want to do in that area.

This is...

Preventable. Preventable. Yeah. Now, let's talk about how it can kill you. Recurrent UTIs. The bladder health, the urethra health, besides incontinence, the number one treatment for recurrent UTIs in a postmenopausal woman, the most effective treatment is vaginal estrogen, not chronic antibiotics. I'm going to save someone's life by this podcast because I'm going to keep someone from dying from Eurocepsis because she got vaginal estrogen after listening to this podcast.

This is amazing. Yeah. Here's what I love about it. It makes so much sense. If you take out one of the main ingredients to the female body's optimal health, Of course, everything is going to go haywire. It makes perfect sense. I love how you have explained this to us. I also love the fact that because you've explained it this way and because we've put it in the context of the month and we've put it in the context of your intelligent design and the way that you've always been running, and we've all had periods where it hasn't been running optimally, that you can also take the information that you're learning right now where we're focused on menopause, but you can also go, Oh, I can take this information. I can share it with my sister, my girlfriend, my roommates, so that they understand that the second half of their cycle, you're starting to experience baby symptoms or maybe they're bigger symptoms, but that this is all the same- Might be a precursor to what the bigger picture is.

Yes.

I am going to send this episode to every single woman I know. I hope as you're listening to Dr. Haver, you're not only feeling I know you're feeling inspired and empowered and informed, but you're like, Oh, my gosh, everybody needs to hear this. So as we take a quick pause, hear a word from our sponsors, take a moment and share this to people, because I want this information out to absolutely everyone, because every single woman On the planet, every girl needs to understand what is going on in her body and the role that estrogen plays in her overall health. You never know. You could truly not only improve somebody's life, you might actually save somebody's life. So we're going to be waiting for you after a short break. We're going deeper into the solutions, including the three things that Dr. Haver says all of you need to be adding into your diet right now. Stay with us. Welcome back. It's your friend, Mel. I am here with the remarkable Dr. Haver. Thank you for sharing this with everybody. I know it's making a huge difference to have this information. Now, let's talk about what Perry menopause is and when it begins.

Sure. And what are the symptoms?

There's a lot of misconception around terminology. Medically, and I think this is a problem, menopause is defined as one day in your life, one year after your last menstrual cycle.

Yes. Okay.

Most women know that. Everything after that is postmenopause. So what's perimenopause? So perimenopause, the best I can define it, is remember, we're losing ovarian function our lives from the day we're born. However, there's a point in time when your body notices.

You said that we have only 10% of our eggs left by 30. By 30. Is that when it starts noticing?

It depends on your body. It's when your body is like, something's not right. It could be mental challenges, it could be gut challenges, it could be inflammation in your joints, it could be irregular periods, heavy periods, light period, no period. It's really variable how it presents, but something has changed. Nothing in your world has changed. Something inside of you has changed. Okay. And so perimenopause is often defined by irregular periods, like in the medical journals, but it's a lot more than that. It's 7 to 10 years before your period stops. So do the math. So 35 to 45, perimenopause is going to begin. You're going to start noticing something's not right. It could be the cliché symptoms of hot flashes. You know why hot flashes define menopause? No. Because you can't blame it on anything else. Oh, that's true. Unless it's tuberculosis. Nothing else causes a hot flash, pretty much, unless you have a fever, then menopause. So that's why it's the bell ringer of menopause.

But what other symptoms might you be experiencing Brain fog, arthralgias, frozen shoulder, joint pain, constipation, diarrhea.

You name the organ system. Asthma flares, new asthma, new autoimmune disease, dry skin, dry eyes, dry vagina, dry mouth. It goes on and on and on.

It would seem, based on the science here, that anytime a woman goes to the doctor and has any complaint like that in terms of the symptom, that one of the standard procedures should be test your freaking hormones.

That's another problem. The brain is pumping hormones as hard as it can. In that perimenopause, I call it the zone of chaos. You're squicken an egg out now and then, but you're having massive surges of it. We'll see estrogen levels like you were pregnant with triplets. Three, four, hundred. They're temporary because you had to work so hard to get that egg out. Then it just plummets down to nothing.

Is this why our emotions are all over the place during the month?

That's what we think.

That makes perfect sense. Because if your system is in chaos, regardless of your age, by the way, but if your system is in chaos because it's having work so hard to just do the thing that it's supposed to do.

To try to do the basic biologic function.

No wonder you start to feel all sorts of things go haywire. Do the same things that you would recommend for a woman who is officially in menopause, are those the same things that you should be doing if it's perimenopause or it is the estrogen-deficient symptoms that you experience in the second half of the month?

This is where the art and the science come in in perimenopause because Some women will do well with just some progesterone support. Some women will need estrogen and progesterone support. We don't have a lot of great studies on the best way to support a woman's hormones in perimenopause, so it's a little bit of the Wild West. Also, we're not teaching our residents, medical students, trainees, how to recognize it, how to diagnose it. I don't need blood tests to diagnose perimenopause. I just listen to the patient and believe her.

I'm sitting here reacting to everything that you're saying because I'm thinking, I don't even really remember anybody Talking about perimenopause is anything other than your period might get irregular? But none of these other symptoms. I mean, this is very illuminating, and I feel bad that I didn't know that because I had no clue what was happening. I would love to now focus on menopause. Are you still in a monthly cycle? What is happening when you're in menopause?

Once those ovaries fail, and I know that term is harsh, but once the ovarian Once the eggs are gone, no more periods. Any vaginal bleeding after menopause needs to be evaluated by a gynecologist. There might be something wrong. You should never have another period again. So your periods stop. First, they become shorter, longer. It could be anything. But eventually, they just stop. Some women will wake up and never have another period. Others will have this skipping months and months between until they finally end.

Mine was like Chucky. Just kept popping up. Like, Oh, I thought you were gone.

Yeah, and here you are again. Yes. Once you've gone a year, then most scientists agree that you're done. If you're over the age of 45 and you hadn't had a period for a year, you are a postmenopausal woman. That's the clinical definition.

What is the technical definition of when you've moved from perimenopause to menopause?

Perimenopause is that one day we're like, Yep, it signifies your ovarian failure. You will never have another egg that's able to be fertilized again. At the end, there's no more left. Then for the rest of your life, you're postmenopausal. Now, some of the symptoms you experience get better. It might take several years. Like the hot flashes do tend to go away. If the sleep disruptions, if they're related to hot flashes and night sweats, do tend to get better. Might take 7-10 years. Seven to 10 years?

I thought you said go away like...

I'm thinking like a couple of weeks. It might take shorter, but I want to give people a very clear picture. A lot of women are like, Well, I I went through my menopause, I'm done with that. I'm like, your bones are still deteriorating. Your risk of cardiovascular disease has still increased. Your genital urinary system without support is failing. These are the things that don't go away in your postmenopause.

I just realized I'm talking about it wrong because I always say I'm in menopause, I'm going through menopause, I've hit menopause. You're saying once you actually get to that date where you've If you haven't had a period for a year, it ain't coming back. That's menopause. But technically now, I'm in postmenopause. Forever. Wow. When you are postmenopausal, do you have any estrogen at all?

There are four estrogens that our body can make. The number one heavy hitter, most biologically active, does the bulk of the work is estradiol. That's what's mostly created in our ovaries. Testosterone can be peripherially converted a very small rate to some estradiol or estrone. So estrone is what's created in our fat cells. So the more subcutaneous fat you are, the higher your estrone level is, which is why heavier women are more likely to have an imetrial cancer and other estrogen-related cancers.

Is this also why one of the symptoms when estrogen starts to decline is that your arms get flabby and you start to gain weight around your stomach because your body, once it's signaling there's not enough estrogen being created in your ovaries, your body starts to try to create and hold on to it in your fat?

There are theories around that. The anthropologists are scratching their heads because there's only five mammals that go through menopause, and four of them live underwater. And so, beluga whales and a One of the killer whales. Really? No other mammals on land, really, that we can figure out. Maybe one giraffe. They're looking at one particular giraffe. We are really unique in that we have a menopause. We think because we've just artificially extended our life past our evolution with modern health and sanitation and all the things that keep us alive. That's wild. We weren't designed to live this long. We have estradiol. That's gone. The ovaries can't make that anymore. Maybe a tiny bit, but really not clinically significant. Estrone, really weak estrogen. Esteriol, which is created in our placentas when we're pregnant, but pharmacologists have been able to recreate it, and it's used in one or two formulations of hormone therapy. It's not one of my favorites. Then there's this other one called Esterotrol. Very fancy. When we're in the womb, that's another one that we make with fetal cells. That one has also been synthesized and is used in a couple of... One, hormone replacement therapy.

That's not one of my favorites.

No, but I mean, in your body.

So your estrogen level is not zero, but your estrogen, but it's less than 1% of it was when you were 25. Let me give it to you that way.

Got it. Less than 1% of what it was when you were 25. Holy smokes. It will. And your body needs it.

It will function better with it. You will not die without it. You'll just die faster and less healthy.

And miserable. Wow. I'm trying to digest this stat. I want to make sure you didn't miss this. When you think about the estrogen levels that you have at the age of 25, you only have 1% of that when- Of estradiol, yeah. You are post-menopausal, and the only sources for your body to create it are ovaries or- A little bit in the periphery, in other cells. It.

That's it.

Wow.

Our march to death begins.

Not anymore, Dr. Haver, because You are here to make sure that does not happen because we are capable of doing simple things to optimize our health and live a long and happy, juicy, amazing life. Vibrant. Dr. Haver, as a medical doctor, as a woman who is going through this right now, what do we do? Now that we know, what do we do?

Great question. When I have patients come to me in clinic and we talk about menopause care, I do it in the form of a toolkit. We start with nutrition. We talk about movement and exercise. We talk about stress reduction, sleep optimization. Then we talk about pharmacologic options like hormone therapy, or if she's not a candidate, then other options for her based on her symptoms. We also talk about supplements that might be helpful.

Let's take these one at a time. Who is not a candidate for hormone replacement therapy?

Very few people, actually. There's a lot of misunderstanding and misconception around who can and can't take hormone therapy. Absolute contraindications, undiagnosed vaginal bleeding. You need to go see your gynecologist. You might need an ultrasound or biopsy. If you're having undiagnosed, we don't know why you're not bleeding normally, please go get that evaluated before we start hormone therapy because it might be a tumor that is estrogen-fed, so we need to work on that. Active breast cancer shouldn't be on estrogen therapy. Active blood clot, active stroke. Once those six-month markers and the workup for those things that happen, it's a possibility. It's a nuanced conversation, but not an absolute contraindication. Neither is breast cancer. Wow. There are certain breast cancers that after treatment, you could be You could be a candidate. Now, again, nuanced conversation, risks and benefits coming back and forth. Those are really the main ones. A family history of breast cancer, not a contraindication. A family history of a blood clot or a history that you have of MTHFR or some of the blood clotting, high-risk blood clots. As long as you avoid oral estrogen, we're not going to increase your clotting risk.

You're saying that even if you have a history of breast cancer, that does not-100% preclude you from having the option. Got you. There are ways for you with the counsel of your physician to explore hormone replacement therapy, even if you You have.

The thing that a woman with breast cancer is most likely to die from is cardiovascular disease, not breast cancer. She's a 90% survival cure rate. When we go through menopause, we see a dramatic uptick in our risk of cardiovascular disease. Actually, women on hormone therapy, if given at that, really, that we have a juicy window of opportunity, the first 10 years of your menopause, estrogen is protective. Women on HRT between 50 and 59 ish or within those first 10 years have a lower all-cause mortality, a lower cardiovascular disease death rate, and a lower cardiovascular disease at all, like death from cardiovascular disease or a new heart attack.

Wow.

Let me tell you something else. Tell me. It'll blow your mind. Primary prevention strategies for cardiovascular disease. Women are given statins all the time for high cholesterol. Has never been shown to decrease her risk of cardiovascular death. Yes, in a man, but not in a woman. Ace inhibitors, a blood pressure medication, is often recommended as primary prevention. Never been shown to be helpful in a woman, only in men. Aspirin, baby Aspirin, never been shown to be primary preventative for a heart attack, only in men. Yet we're recommending this stuff to women all the time, and we've taken for many women, the conversation or the option of hormone therapy is off the table when that is the one thing that is going to decrease her risk besides lifestyle, of course.

Wow. Yeah.

That's when I get mad.

I can tell. What are we doing? I'm glad you're doing something, and I'm glad that you're here because when you say it like that, it's outrageous. It makes you feel like we're guinea pigs.

We are more than our breasts. We are more than our breasts. You deserve the conversation. You deserve the option. For each woman, it is a risk to benefit ratio. I don't think every woman is going to choose hormone therapy, but I think every woman deserves the conversation. Based on modern medicine and what we know now.

Can you just quickly say why there is such a- Hysteria? Yes. Yeah. Around hormone replacement therapy.

I'll tell you why. A beautiful study. There's a A little bit flawed in the way they set it up because the average age in the study was 62, not 50, 51 when most women will go through menopause. They did a study that was looking at just one particular type of hormone therapy, primarin, which is CEE, conjugated equine estrogens, meant to show that, yes, hormone therapy is absolutely protective for cardiovascular disease. They had two groups, women who have a uterus, women who have don't. Then the women with the uterus got estrogen plus a progestogen. Then the women without a uterus got estrogen only. There was a placebo group in each set. Then they started them on hormone therapy, average age of 62, and then followed them.

So they were outside the window?

The When the hormone therapy- When the most women would really start. When they went back and stratified the data and looked at it, what they said was, Well, it doesn't really help cardiovascular disease. Well, no, because by the time you're 62, and they had women in their 70s in the study, they probably They already had it.

Is the bottom line that there was the biggest study that was written about, the study itself was flawed, and then the reporting became hysterical? Yes. The lure- Many of their findings at that hysterical reporting were walked back.

There's only one that still stands, and it's still controversial.

This is recently. Recently, they have literally said that wasn't really accurate, it's not really true. The reason why it's important to say this is because there is this murmur out there that hormone replacement therapy causes cancer, causes heart disease. Causes cancer, is super dangerous. Blah, blah, blah, blah, blah, beyond. But for the vast majority of the women in your life, this is an option you need to be exploring. Yes. It's not only safe, it actually increases your health outcomes. The majority of us are a safe candidate for hormone replacement therapy. What about supplements? What are the supplements that we need to take?

We really should try to get most of our nutrients from food, and we only supplement where there's a gap or you have an allergy and an intolerance, and then we go in from there. There are a few supplements that are non-essential nutrients that might be helpful, like turmeric. That's not anything we have to eat to survive, but it has some pretty powerful antioxidant, anti-inflammatory properties that someone might find helpful. When we're talking about the vital things, if I had my top three things I would recommend to everyone. Fiber. Track your fiber for a couple of weeks. Get a nutrition tracker. See where you're at. Fiber does so much in our bodies. Number one, feeds the gut microbiome. That's its food. That's the prebiotic.

Give me an example of what fiber is.

Légumes. Who? Berry. Légumes. Beans. It's a class of beans. Peanuts are actually legumes as well. Typically, really high in fiber. Okay. Berries, really high in fiber. Seeds and nuts, really high in fiber. Those are avocado. That's my go-to to make sure I'm getting my fiber goal. Okay. Also has healthy fats and other vitamins and minerals and nutrients. Mag, magnesium.

This confuses me because I'm not quite sure what type of magnesium to take.

Oh, great question. Your glycinates, your tarrates, your citrates, and l-theranates are good because they're readily absorbed into the bloodstream. Now we have nice magnesium levels in our blood. There's also benefit, some of them are better than others, about crossing that blood-brain barrier. So the brain protects itself. There's a membrane around the brain that it doesn't have this 100% free flow of nutrients back and forth. It's really selective about what it lets in. So Magl thurinate, which Magteen or Neuromag or the brand names, has been studied in SSRI-resistant depression. So any resistant depression in patients, they've added It seemed to be helpful. My patients, followers, it's so helpful for sleep, anxiety. I'm often recommending that one at night.

And what one was that one?

Magnesium L-3-N-8.

Okay, so you're saying fiber is number one, magnesium is Number two, how do you get magnesium naturally?

So pumpkin seeds, spinach, leafy greens are rich in mag, generally. I have a lot of lists on my website where we list all this stuff.

We will link to all this. What's the third thing?

I'm always looking at omega-3 fatty acids. Omegas are usually found in fatty fish, also in flax. One of my favorite ways, I'll do this little yogurt, and I'll have flax, hemp, and chia seeds. I'm just hitting all my antioxidants, my anti-inflammatory, my fiber, all in one. So omega-3s, if you can't get a good source of that, that's a very reasonable thing to supplement every day. One of the richest sources of that is going to be your salmon, your mackrel, your tuna, your fatty fish, your cold water fish. Then I check a vitamin D level on every woman who will let me stick a needle in her. Eighty % of my patients, not just low, I mean, deficient. And there's a million reasons for this. We don't absorb it very well because our gut health declines. We're protecting our skin from the sun, which is another place, and we're not really creating it in our skin as fast as we used to. And vitamin D is a hormone that has a million processes in the body. So I'm like, let's start here and get those vitamin D levels up because you're just not working as efficiently as you could.

A lot of us, I've noticed in my group chats with my girlfriends, that when we finally get in to see somebody who knows what they're doing and you do a blood draw and you get your panels back, almost all of us have magnesium deficiency, vitamin B deficiency, vitamin D deficiency, and heightened cholesterol. Yes.

Again, about 70, 80% of my patients have an unexplained, no changes in diet or exercise, rise in cholesterol, absolutely secondary to estrogen deficiency. Again, rushing to put her on a statin will make her cholesterol go down, but is not going to decrease her risk of cardiovascular disease. Women who are on HRT have higher HDLs and lower LDLs than women who are not when you compare the two groups. Just being menopausal is an independent risk factor for an unhealthy cholesterol profile.

If you are eating the fiber and the magnesium and the omega-3s, and you're also taking the vitamin D supplement, how do you make sure that your body can actually absorb it or that your gut health is okay? Do you also recommend that people take a probiotic?

I do. They've done some studies looking at probiotic supplementation in women with obesity and hypertension who are also postmenopausal. There were some really positive results. It's hard to measure gut health. We don't walk around with stool samples and they're counting the microbes in it, but you know when you're bloated, you know when you're having regular bowel movements, you know how you feel. When we go through menopause and lose our estrogen, the gut microbiome loses diversity. No matter how many probiotics you take or there are things we can do, workarounds. But the loss of estrogen will change your gut microbiome to the profile of a man's.

Is that why we get a belly?

Part of it. That's part of it. We know that an independent risk factor for visceral fat deposition, what we call belly fat in layman's terms, visceral fat means wrapping around the organs inside the abdomen. That fat is Very different than the curvy fat, than subcutaneous fat. That visceral fat is a marker for cardiovascular disease, diabetes, stroke. I can discuss visceral fat and muscle mass with my patients because it's so important for their ongoing health. So women who were on the probiotic versus placebo had lower blood pressure and lower visceral fat. Weights didn't change. Calories are still important, but they're not the only thing. But their visceral fat levels went down. So for that reason, I'm like, eat something rich in a probiotic every day, yogurt, miso, kimchi, whatever floats your boat. If you can't tolerate that, then you want to consider supplementing.

Got you. So talk to us about exercise. So what exercise is critical?

I grew up in the '80s, and I was the cardio queen. I did so many step aerobics classes. I taught them. It would make your head spin.

I did not- I can actually see that. I would take a step aerobics class with you.

All of my exercise was to be thin and to maintain a certain body shape that was part of my social currency. If I could go back and talk to what I tell my children all the time, we need to move our bodies to be strong, not skinny, and that we are chipping away this constant caloric restriction and all this cardio is chipping away at our bone and muscle strength, which we are going to desperately need as we age, especially if you're built like me. I didn't pick up weights until I was well into my 40s. There's never too late. Anybody listening at any age can start weight training, and you should. I think that getting people to let go of this notion that thin is the way to be, having a little more curves and a lot more muscle is going to serve you in these menopausal years so much better than just being skinny.

I have followed all this advice, and I have switched up the entire way I approach exercise. I now resistance train three days a week, zone 2 cardio, and that's all that I do. For those of you, you're like, What are you talking about? It's like the walk that you take where you're walking quickly, but you can still talk. You've got an elevated heart rate, but you're not just going completely Basically all out. Yes. I have noticed by increasing resistance training, and you can find all kinds of classes online. We've got sponsors of this podcast like Peloton that have online courses that you can follow. I do a ton of stuff on YouTube, too. There's all kinds of amazing things by simply doing resistance training. It can even be against your own body weight, like doing planks and doing pushups and all those kinds of things that I have noticed I'm more energized. I definitely feel that I'm clearer in terms of the brain fog being gone. I've absolutely noticed a decrease in the belly fat, in the flabby arms, and it's working. If you're having a hard time sleeping, what do you recommend?

We have to look at why you're having a hard time. Progesterone goes a long way to helping us sleep. And so estrogen leads to hot flashes and night sweats, which are completely sleep disruptive. I mean, even with hormone therapy, I still have a thermometer leg that I have to throw out occasionally.

A thermometer leg. I was just talking to a friend this morning. She's like, Oh, well, I just stick my leg out and the fan hits it, and that's how I cool myself down.

And then you just throw it back in, throw it out, throw it back in. Hot flashes are disruptive. Hot flashes. I'm like, Okay, let's get you on some estrogen. Say she's had a hysterectomy and she doesn't have to have progesterone. Progesterone is an option. I'm like, People sleep deeper. It has an anexiolytic effect.

What does that word mean?

So anti-anxiety.

Anti-anxiolytic effect?

Yeah, sorry. Wow, that was a big one. Anti-anxiety effect. Okay. If your sleep disruption is also you're having racing thoughts at night, you can't shut that brain off.

Yes, this is my daughter.

Progesterone is beautiful for these women, especially in perimenopause when we're skipping ovulations and we're not given that monthly surge of progesterone.

Is this an option for somebody who's even before perimenopause?

Perimenopause, you could. Yeah. Yeah, you can safely take progesterone every day, even if you're premenopausal. Wow. It can be really helpful.

Wow.

All right. So estrogen, progesterone. But also sleep hygiene. We can't negate the fact that we're on our phones too much at night. Blue light, not setting up an environment for good sleep, a snoring partner, especially some of us. All the things we need to do to set ourselves up for success for sleep. Then when you sprinkle in the hormone changes, it's a disaster for some women. That's really something I zero in on with my patients.

What do we need to know about alcohol?

I don't know any woman who's in her menopausal journey who is processing alcohol the way she used to. The tolerance seems to be going down. I'm excited to see some more research come out about this. But in my world, I have to go in my personal experience. If I'm choosing to have a drink, I am choosing not to sleep. I'm going to be up at 3:00, 2:32, 3:31, whatever it is, and it is like a bomb going off, even one glass. I have to make that choice. I can't drink like I used to, thank God, those college days. But most of the women in my practice and on social media are commenting. Every time I talk about it, they're like, Yeah, gave it up.

It's not worth it. If you're choosing to drink, you're choosing not to sleep. It really is that simple. Yeah. Wow.

So women, I've said this before, we're We're living longer, but we're living in poorer health. I don't want the longer lifespan if I'm going to be decrepit and I'm going to be disabled and my children are going to worry about me every day. I think that as this next gen, our daughters come up through this and they have their options and they know what's happening in their bodies and they understand it, we're going to keep that lifespan, but we're going to improve our health span and make those choices that can lead to us having healthier lives.

Well, I think that's the really exciting thing of this, because when you don't understand what's happening, you get stuck in this cycle of feeling overwhelmed and that there's something wrong with you and you're constantly complaining about the symptoms.

Your doctor didn't even understand.

Yeah, you're constantly complaining about the symptoms with your girlfriends and with your significant other or complaining to your kids. But what you're also saying is not only can you get relief from the symptoms and feel like yourself again and really optimize your health, but that when you do so, it increases the quality of your life and it increases your lifespan and it increases your vitality over that lifespan. That's why this is so important. You know one of the greatest things about social media? Is that this is the first time in history that women in our age group actually have found each other. I started collectively saying, What's going on with my weight? What's going on with my joint pain? What's going on with my brain fog? You don't feel alone. Of course, I knew that the hot flash was from menopause. I had no idea that the brain fog was menopausal. I had no idea that some of the joint pain was an issue. I certainly knew that the sex drive lowering was part of what was going on. But I'll tell you, it was really when the belly fat and the back fat that I started to gain, and I was so demoralized because I'm the person that exercises six days a week.

I was doing everything I thought I was supposed to be doing. Even more so, I had stopped drinking during the week, so I had lowered my drinking significantly, and nothing was doing anything. My pants were not fitting, and it was so weird because I felt swollen all the time. It's almost like certain parts of my body didn't change, but I just had this tire around my center. People would be like, Oh, but you're still really thin. I'm like, But that's not the point.

That is where I put my toe in the water of all this menopause stuff. You were me. That is my exact story.

Yes. I literally I literally hated the way my body looked. I was self-conscious around my husband of 28 years. I didn't want him to see me naked because I literally was like, I have rolls in my back. When I put my underwear on, I've got my skin hanging out over it. I do not know what to do. From a pure vanity and confidence, and I just want to feel like myself, and this doesn't feel fair standpoint, I started to get whack-a-doodle about it. Yes. Do I have to stop eating? Do I have to exercise like crazy? What do I need to do? What is happening? And discovering that it was menopause, it only went, okay, great. But then when I went to my doctor and they're like, oh, seven years. Workout more, eat less. Yeah.

Like, what the hell? Yeah. Exact same thing happened to me. The same feelings. I was weighing myself. You had to pee in the middle of the night because menopause I would weigh myself. In the middle of the night?

In the middle of the night. No wonder you weren't going back to sleep.

Oh my God. What is this? Constantly grabbing my belly. Yes. My husband was like, he was going on a trip. And I said, When you get back, you're going to have the wife you deserve. I'm going to get this fat under control. And he was like, I love you. I think you're beautiful. Your girls are watching this behavior. And he said, You're a smart girl. Figure this out. You're a scientist. And he got on the plane and I took that as, I'm going I'm trying to figure this out. I called the PhD Nutritionist at the university I was employed at. I was like, What the hell is going on in menopause? Because my patients can't lose it. I'm struggling. I'm starving myself. I'm working it all the time. They're like, Yeah, there's something going on in menopause. We think it has to do with inflammation. Read all these articles. And hence began the rabbit trail for me of going down, well, the rabbit hole. I was like, Well, inflammation, estrogen, visceral fat. What is this visceral fat thing? No one ever taught me that in school. My Diabetes risk. Let me check my cholesterol. Holy shit, it's elevated.

Oh, my God. Then that's why I wrote the book, to put it all together.

For the person listening, I know what they're now thinking. Okay, great. I got to get the book, but how do I find my own Dr. Haver? I'm dead serious about this. How do you prepare yourself to go in to your doctor? And how do you find somebody who has been studying menopause?

In a perfect world, you could just march into your PCP or your OB/GYN even, and they would be like, Absolutely, let's go. We're probably a generation away from this becoming normal. So what can you do now? I have a list on my website of testimonials from I have followers who have found great people. That's one place. The Menopause Society, of which I've become certified, is an independent organization of people who care about menopause, do research in menopause, and they have a certification and training program. You can find at the Menopause Society or menopause. Org, go on there and find a certified provider. That's another place to start. Some of the new telemedicine companies coming out are built to serve the menopausal woman. I don't love it as much as an in-person visit because I do in-person visits. But my God, that's all they do is sit there, listen to your symptoms, believe you, order a test if you need them, and give you the hormone therapy you so desperately need.

I will link to absolutely everything that you've recommended, including how to find you, find the book, and reach out to you in all the resources for this show.

Awesome.

Do you have any final words of wisdom to the person listening?

You're not crazy. It's okay. Find a community, talk about this, share this with everyone. We need to normalize this before we can optimize it. And that don't let your daughters suffer. Tell them about your own experience because they're most likely going to mimic what you've gone through. And But remember that menopause is inevitable. It's not a bad thing. It is a natural process, but you don't have to suffer. What I love about menopause is women find this power to put themselves first for the first time in their adult lives. Their give a shit factor goes away. They don't care anymore. They are embracing who they are. I love that about us. I'm more successful, more powerful. I have more... I never could have done this in my 30s, what I've been able to build. I just love that about this age, but I want to keep that going.

Dr. Haver, I just want to tell you, you are a gift. I am so thrilled that you took the time to be here. I do think you are changing and saving people's lives. I hope as you've listened to her, that you've not only learned a lot about your own body, but that you feel more empowered and that you have a few very simple things that you can start doing immediately. I hope one of the things that you do is that you take a moment to share this with every woman that you know. I'm talking every woman in your life because the information today was about the design of the female body and about how estrogen decline and deficiency impacts her profoundly. This really could change somebody that you care about. It could change her life. Yeah. Thank you, thank you, thank you for taking the time to be with us. I want to thank you for taking the time for yourself and taking the time to listen to something that could help you improve your life. I want to make sure to tell you, in case nobody else does, that I love you, I believe in you, and learning more about your body and your brain and your hormones and how to optimize your overall health is one of the most important things that you can do to improve your life.

I know you feel empowered to do that after the conversation today. I'll talk to you in a few days. Awesome. Thank you. All right, here we go. Fabulous. I love that. Okay, that's fantastic. You're right. I call it neuroadrenaline. Because I can't say the nephroreferine. Nephroreferine. Yes, I can't say that. What is... I'll wait till you. I'll take some water.

Let me hit my lips, too. We could say that.

A little snarky. Good? Okay, great. God, I do need some lunch. You guys need lunch, too. You haven't eaten either. How are we not bitching at each other? All right, better? Good. We're in the pocket now. Okay, great. Okay, hold on. Let me try that one more time. But it's good, right? Yeah.

You are- I can't believe we just did that.

Awesome.

I feel like I'm levitating. Okay. All right.

Oh, and one more thing. No, this is not a blooper. This is the legal language. You know what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode.

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