The Mel Robbins PodcastThe #1 Menopause Doctor: How to Lose Belly Fat, Sleep Better, & Stop Suffering Now
EVERY SPOKEN WORD
135 min read · 27,233 words- 0:00 – 6:10
Intro
- MRMel Robbins
(gasps) Hey, I'm so glad you're here. I promised you I'd be in the studio today. Shay Hall Day, she's here too. You can't see Maddie, but she's right behind you. So we are about to have the amazing Dr. Mary Claire, uh, Haver jump in that seat. And I just wanna tell you, this is gonna be one of those episodes that's gonna change your life, and it will change the life of every girl and woman you know, so please share it, share it, share it, earth. You ready? You ready to start the Mel Robbins Podcast? I know you are. Me too. Don't forget to subscribe. Mwah. Let's do this.
- MHDr. Mary Claire Haver
We were living our lives, managing our stress, managing our weight, doing all the things-
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
... and then all of a sudden, you can't put your finger on it, but something's changed.
- MRMel Robbins
That's exactly what everybody says. And whether this is happening to you, or you've heard your sister, or your mother, or your partner say this, we start going, "My, my pants are not fitting. I am grouchy. Suddenly I feel like I have ADHD, or brain fog, or dementia."
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
"I don't feel like myself in my body."
- MHDr. Mary Claire Haver
You are every single patient who comes in my office, this exact same story.
- NANarrator
(instrumental music)
- MRMel Robbins
Hey, it's Mel, and I'm so glad that you're here today, whether you're listening for yourself or because someone that you loved shared this episode with you. I wanna 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 wanna start by acknowledging you for something. You could be listening or watching to 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 gonna 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 confusion, so much conflicting information about this subject. What am I talking about? Menopause. It is time that you feel informed about what's going on with your body, your brain, and your hormones. And if this is not impacting you personally, do not change this. Listen, because it is impacting someone you love. Oh, I have been dying to have this conversation about women's hormone health and menopause with you, because I gotta be honest with you, every single friend of mine has been texting and DMing each other. We are lighting up the group chats. I am no longer sending my friends memes and funny quotes right now. You know what I'm sending them? Articles about hormone changes, articles about supplements. I've been complaining to my poor husband, Chris, about how bloated, itchy, irritated I am. I'm confused about what to do. And you know what? This approach is not helping Chris to understand me. It's not helping me to understand the changes that I'm experiencing, and I'm sharing this with you because if you're overwhelmed by the topic of hormone changes or menopause, or you're experiencing challenges with your monthly cycle, or maybe you're just tired, you're tired of hearing your mother or your significant other 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. She has hopped on a plane from Texas, and this woman is so busy, I cannot believe she's taken time out to be with you and me here in our studios in Boston. She has come to share with you everything that the research says, and more importantly, the simple things that you can do. And there's a lot that is going to surprise you today. For example, didn't know perimenopause can start as early as the age of 35. And, you know, I know that hot flashes and belly fat are symptoms of hormone changes. It's probably just the symptoms that I complain about the most, but current research is finding that things like ringing in your ears, frozen shoulder, I didn't even know that was a thing, dry skin, dry mouth, body odor, anxiety, fatigue, lack of a sex drive, autoimmune diseases, and on and on, can all potentially be tied back to the changes your body is experiencing because of menopause. I am so honored for you to meet our expert today, because she's gonna simplify this topic so that you no longer feel overwhelmed and left behind by the medical community, but rather you feel empowered and excited about what you can do. So let me tell you a little bit about Dr. Mary Claire Haver. She is a board certified obstetrics and gynecology specialist. Dr. Haver is also a certified menopause practitioner from the Menopause Society, and you're gonna 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. And, this is really important, she has two kids. And just like me, she's 55. She's juggling a big career, a marriage, and motherhood, and she has so much to share with you today that you will be able to apply to your life as you're listening, as soon as you're done. And I wanna 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.
- MHDr. Mary Claire Haver
Thanks for having me.
- MRMel Robbins
Thank you.
- MHDr. Mary Claire Haver
So excited to be here and share all things menopause.
- MRMel Robbins
You
- 6:10 – 8:45
What’s wrong with our medical system when it comes to menopause.
- MRMel Robbins
are so passionate about this topic-
- MHDr. Mary Claire Haver
Yeah.
- MRMel Robbins
... and you even get very emotional about it when you think about it. Why are you so passionate about this?
- MHDr. Mary Claire Haver
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, uh, I have such a need to get out there and teach and share, because we are not teaching our medical students and residents in, you know, our nurse practitioners much about menopause care outside of the most cliché of symptoms and how to manage them. We're gonna live a third of our lives like this.
- MRMel Robbins
A third of our lives-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... like this? (laughs)
- MHDr. Mary Claire Haver
A third of your lives. And, you know, after reproductive options are, uh, taken off the table, it's almost like medicine leaves us behind. I want to be an 80-year-old climbing that mountain, kicking ass, having a career, healthy, and if I don't implement changes today, I'm gon- not going to be able to reach that goal.
- MRMel Robbins
So, why is it that there is so little information-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... about hormone changes and menopause? And you go to your doctor, and it's sort of like, "Oh, well, you're going to deal with this for about 10 years, and then, you know, that's just the way that it is." What- what is up with this?
- MHDr. Mary Claire Haver
So, if you go to PubMed, which is basically Google for healthcare professionals, um, 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 brain power, 10% of the research, for the last third of our lives. And, you know, we do live a little bit longer than men, but we're going to spend 20% of that in poor health, in decline, in disability, and this is avoidable.
- MRMel Robbins
I hear the word menopause and I think out to pasture.
- MHDr. Mary Claire Haver
Right.
- MRMel Robbins
You're done.
- MHDr. Mary Claire Haver
And I thought that for a long time too, and then... I'm Gen X. You know what? To hell with that.
- MRMel Robbins
(laughs)
- MHDr. Mary Claire Haver
I'm- I want to live a good life.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
I want to feel like I can go to the gym, I can play with grandbabies, I can roll on the floor, I can climb a mountain, I can run a company, I can do all these things, and I'm not- I'm refusing to just accept the medical definition of getting older for a woman, which is very different than a man. So when we're born, we have about a million, plus or minus, eggs. So from birth
- 8:45 – 9:44
By the age of 30, women have lost 90% of these.
- MHDr. Mary Claire Haver
until, you know, we die, we're slowly losing that egg count, and it starts accelerating as we get older. So by the time we're 30, we're down to about 10% of our egg supply.
- MRMel Robbins
Well, hold on a second. By the time you're 30-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... you've already lost 90% of the eggs that you were born with?
- MHDr. Mary Claire Haver
That's correct.
- MRMel Robbins
I don't know why I never knew that. I- I- I kind of feel sort of dumb that I've gone through 55 years of my life and I did not know that we're down to about 10%.
- MHDr. Mary Claire Haver
And at 40, 3%.
- MRMel Robbins
3% at 40?
- MHDr. Mary Claire Haver
3%, mm-hmm.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
Yeah.
- MRMel Robbins
And you lose your period because you have no more eggs, so there's no more need to go through that cycle.
- MHDr. Mary Claire Haver
You can't ovulate, so yeah. There's nothing left.
- MRMel Robbins
Holy cow.
- MHDr. Mary Claire Haver
But doesn't it make sense now?
- MRMel Robbins
Of course it makes sense.
- MHDr. Mary Claire Haver
Why it's harder to get pregnant when you're older, why you're more likely to have a chromosomal abnormality, you know, because the number and quality of your eggs is declining with age.
- 9:44 – 14:50
How the loss in sex hormones starts to affect your life.
- MHDr. Mary Claire Haver
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, okay? All of our estradiol, our progesterone, and about at least half of our testosterone is created in those ovaries every single month, every single day. However, when we get to perimenopause, things start changing, and when we get to full menopause, we have no eggs left. The ovaries decline. We're losing our ovaries at the average age of 51. They stop producing sex hormones, and we basically are forced to live the last third of our lives without the benefit of estrogen, progesterone, and about half of our testosterone.
- MRMel Robbins
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-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... and from the moment you start your menstrual cycle and the hormones are going up and down, there is a purpose associated with the design of your body, and once that stops, everything gets disrupted-
- MHDr. Mary Claire Haver
Correct.
- MRMel Robbins
... in your body. Oh, why has nobody studied this? What the hell?
- MHDr. Mary Claire Haver
People are studying it. Um, (sighs) you know, i- when we look at OBGYN, the residency-
- MRMel Robbins
Yeah, and that's what you are, right?
- MHDr. Mary Claire Haver
... you know, women's health. Yes.
- MRMel Robbins
So- so did-
- MHDr. Mary Claire Haver
I'm OBGYN women's health. Super proud of what I learned in my training.
- MRMel Robbins
Right.
- MHDr. Mary Claire Haver
Pediatric gyn- you know, o- gynecology, oncology, surgery, babies, fertility, all this stuff. Menopause got shoved in this tiny little box. Like, "She's gonna have a few hot flashes and maybe some vaginal dryness. Her bones might get a little weaker and, and that's it." Or, "We only want to give her estrogen, uh, if she can't tolerate anything else. If nothing else is working, then fine, give it to her, but, you know, you might kill her."
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
Our bodies thrived on this hormone-
- MRMel Robbins
Right.
- MHDr. Mary Claire Haver
... for 50 years, 51 years on average.
- MRMel Robbins
And by this hormone, you mean estrogen?
- MHDr. Mary Claire Haver
Estrogen.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
And testosterone and progesterone. You know, like, we were- we were living our lives managing our stress, managing our weight, doing all the things.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
And then all of a sudden, you can't put your finger on it, but something's changed.
- MRMel Robbins
That's exactly what everybody says. And whether this is happening to you, or you've heard your sister, or your mother, or your partner say this, we start going, "I'm doing the same stuff I've always done."
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
Like, my- my pants are not fitting. I am grouchy. Suddenly I feel like I have ADHD, or brain fog, or dementia.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
I don't feel like myself in my body.
- 14:50 – 19:15
Surprising symptoms you’d never think were related to menopause.
- MHDr. Mary Claire Haver
lack of estrogen is doing to each and every organ system. Each female has a unique expression of our menopause. So where you may have had palpitations, frozen shoulder, and dry vagina, I would've had hot flashes, night sweats, and horrible rage. And, you know, doctors like a checklist of symptoms-
- MRMel Robbins
Yeah.
- MHDr. Mary Claire Haver
... that's how we're trained, to recall, you know. But the, you know, we're trained to look for ducks. How does it, does it walk like a duck, talk like a duck? It's a duck. And everyone's duck's a little bit different.
- MRMel Robbins
You mentioned that every organ in a female body-
- MHDr. Mary Claire Haver
Yes.
- MRMel Robbins
... has-
- MHDr. Mary Claire Haver
Every organ system, yeah.
- MRMel Robbins
Every organ system has receptors or has what for estrogen?
- MHDr. Mary Claire Haver
That's where the research is really exciting right now, is that Duke University did this elegant study looking at frozen shoulder, which is adhesive capsulitis, so common in women, especially in menopause. And she, a woman, finally a woman head of a orthopedic surgery department talked to the woman head of an OBGYN department at a big university, and they're like, "Something they right." And they did the studies, and they showed that women on hormone therapy have a lower chance of frozen shoulder. They pulled all the data, they l- and they're like, "Why would that be?"
- MRMel Robbins
Why?
- MHDr. Mary Claire Haver
So then now they're going in and- 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 a, it's an anti-inflammatory hormone in the bones and joints, so we have arthralgias, joint pain, capsulitis, all of this stuff tremendously flares. And some of your listeners are like, "Oh, my God," right now, "I had frozen shoulder." So really-
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
... really common. Or hip pain, or joint pain, or you can't roll over in the bed it's so painful, and you have no injury.
- MRMel Robbins
Wait, I- I, I'm sitting here feeling th- one revelatory-
- MHDr. Mary Claire Haver
(laughs)
- MRMel Robbins
... "Oh, my God, oh, my God, oh, my God." Like, there are, there are times in bed where I am laying there, and I will go to roll over, and it's as if I have to pry myself over I'm so stiff. Wow.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
That makes so much sense, actually. So if the estrogen receptors are in your organ system, that then presumes that it's impacting liver function-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... kidney function-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... everything.
- MHDr. Mary Claire Haver
Lung function, heart function, brain function, genital/urinary function as we know, bones. Osteoporosis we've known forever, that's a, that's a no-brainer.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
And so 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 it is used to functioning with estrogen.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
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.
- MHDr. Mary Claire Haver
Mm-hmm. (swoosh)
- MRMel Robbins
Dr. Haver, I just am so grateful that you're here, and I wanna take a quick moment, we gotta hit the pause, uh, in menopause (laughs) and hear a word from our amazing sponsors. And please take a listen to our sponsors because they are allowing me to bring you Dr. Haver at zero cost, so take a listen. But don't you dare go anywhere, let me tell you why. Dr. Haver and I are gonna be waiting for you after this short break. Stay with us.Welcome back. It's your friend, Mel Robbins, and I am here with the remarkable Dr. Mary Claire Haver. Her new book is The New Menopause, and she is an expert in women's hormones health. So you've now got this estrogen deficiency.
- 19:15 – 20:45
How does estrogen help your body run in the most optimal way?
- MHDr. Mary Claire Haver
Okay. So the first, you know, half of our cycle... So you have a period, you know, the first day you bleed is day one of your cycle. So you're kind of, that's, you're shedding and starting over. So in those first 14 days, we call that the folicular phase. So that's when our follicles, which are the little sacks that our eggs sit in-
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
... start saying, "Okay, one of us is gonna win." So 100, 200 of them are like, "It's a race." The hormones are starting to, "Okay." You know, the brain's like, "Our estrogen's low. Let's go, let's go." Estrogen starts to rise and then that lining starts to thicken up again-
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
... getting ready for a potential baby. Then we hit about day 14-ish, depending on the cycle, and then the estrogen level's at its highest.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
The brain is like, "Okay, we need to ovulate." The LH surges, and that's, that's the thing that makes the egg pop and that one e- one or two eggs come out.
- MRMel Robbins
And then when the egg pops, the popping also creates a little surge of estrogen.
- MHDr. Mary Claire Haver
Right. Just a little bit more-
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
... and then progesterone starts being produced where that egg came out from.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
And that's a really efficient factory for creating progesterone. Then that progesterone starts rising and that second half, you're very slight, but it's there, kind of mimicking what's to come when we totally lose our estrogen.
- MRMel Robbins
And so in the second half of this month and the cycle, as the estrogen starts to decline, what happens in your body?
- MHDr. Mary Claire Haver
So we have, uh, some women suffer horribly from it, but we have premenstrual
- 20:45 – 21:00
What causes menstrual bloating and swelling?
- MHDr. Mary Claire Haver
dysphoric disorder, PMDD, bloating, swelling. Now, we think the bloating and swelling is from the really high progesterone levels. That drop of estrogen, our mental health changes.
- MRMel Robbins
How does it change our mental health when you have a decline in estrogen?
- MHDr. Mary Claire Haver
So there's
- 21:00 – 21:40
Why do women become depressed and anxious during their cycles?
- MHDr. Mary Claire Haver
a lot of research going on right now, but we know that tons of estrogen receptors in the brain and our serotonin is affected.
- MRMel Robbins
How does estrogen and serotonin play?
- MHDr. Mary Claire Haver
So it looks like when your estrogen levels are optimal, you know, at a nice healthy level, we have really efficient serotonin and norepinephrine. So those are two key hormones that we see in depression, right?
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
They're low in dep- in women who are depressed.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
And so for women who are sensitive to it, that we're seeing the PMS, the PMDD, you know, 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
- 21:40 – 22:15
Wait. Migraines can be caused by a change in hormones?!
- MHDr. Mary Claire Haver
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, um, squeeze, uh, in, in certain areas of the brain, which will trigger a migraine headache. And so-
- MRMel Robbins
Wait a minute. So migraine headaches?
- MHDr. Mary Claire Haver
There's menstrual migraines.
- MRMel Robbins
And you also can feel a slump in terms of depressive symptoms-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... or anxious symptoms-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... because of the decrease in estrogen?
- MHDr. Mary Claire Haver
That's what we think.
- MRMel Robbins
And I would imagine brain fog, ADHD, all of these other neurodivergent
- 22:15 – 24:00
You’re not crazy if you’re dealing with ADHD symptoms in your 30’s.
- MRMel Robbins
kind of issues that people might have also then see an impact from the decline in estrogen?
- MHDr. Mary Claire Haver
There's a definite pickup worsening with people with known ADHD through the menopause transition, perimenopause into menopause. And we don't really know if it's a new diagnosis of ADHD or she was kind of making it until perimenopause and then... 'Cause it's a spectrum.
- MRMel Robbins
Yeah.
- MHDr. Mary Claire Haver
And then all of a sudden her resilience against this has stopped because she's lost her estrogen, progesterone, testosterone, you know, however that fits in for her. And all of a sudden she's now so symptomatic, and at the time in her life that she needs those facilities to be functioning at, at all levels.
- MRMel Robbins
Mm-hmm. Mm-hmm.
- MHDr. Mary Claire Haver
You know, career women are having to leave their jobs. We're seeing, you know, massive economic impact from this in the workforce.
- MRMel Robbins
And, you know, 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-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... 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, and of course-
- MHDr. Mary Claire Haver
Your executive functioning tanks.
- MRMel Robbins
Yes. Of course, it makes sense. And now the system's going haywire and inflamed. It's not got the firepower to help you focus on the thing that you need to do right now.
- MHDr. Mary Claire Haver
Right.
- MRMel Robbins
Wow, that makes so much sense. I didn't understand the fact that when estrogen declines that all of the symptoms that I was feeling, that that has to do with hormone fluctuation. What's interesting is if you were to start tracking your cycle, which everybody should do-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... you would probably, over the course of several months, start to notice a correlation, if not a direct connection between that halfway
- 24:00 – 28:10
Another surprising symptom of low estrogen levels.
- MRMel Robbins
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 compassionate with yourself-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... because I think knowing this, it will probably put symptoms in the context of how estrogen helps you feel better-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... 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."
- MHDr. Mary Claire Haver
So, estrogen's an anti-inflammatory hormone.
- MRMel Robbins
When you doctors say anti-inflammatory, I really don't know what you mean.
- MHDr. Mary Claire Haver
Sure.
- MRMel Robbins
And it seems like everything is inflammatory these days, and so you have such a freaking unbelievably cool way of explaining things. How do y- how would you describe anti-inflammatory, inflammatory?
- MHDr. Mary Claire Haver
Sure. So it's easiest to think about it in terms of acute and chronic inflammation, okay?
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
Acute inflammation, everybody knows. You got a virus, you twisted your ankle, you stepped on a nail, you... You know, it's the-
- MRMel Robbins
I don't know what that means.
- MHDr. Mary Claire Haver
... body's response-
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
... to an acute injury. So what happens? You, you breach some barrier in your body. A virus breaches it, you know, a nail, you twist your ankle, you have some orthopedic injury, you break a bone.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
Immediately, your immune system goes on alert.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
"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.
- MRMel Robbins
Mm.
- MHDr. Mary Claire Haver
Your white blood cells, which are in- in- infection fighters and, and inflammation, those are all in- pro-inflammatory cells in our bodies, so that-
- MRMel Robbins
So is inflammation a code word in medicine for your body is in an alarm state trying to address something?
- MHDr. Mary Claire Haver
Yes.
- MRMel Robbins
Okay. I think I got it now.
- MHDr. Mary Claire Haver
Right, and it's-
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
... all the little biological processes that make that happen.
- MRMel Robbins
Okay. Yep.
- MHDr. Mary Claire Haver
So that's acute inflammation, right?
- 28:10 – 29:10
What does estrogen have to do with your heart health?
- MHDr. Mary Claire Haver
we get to this, like, hyperinflammatory state, we see palpitations. That sinoatrial node. So there's a little node, there's a little, 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. It likes it, keeps it calm and, like, beating in a nice thing. You take estrogen away, all of a sudden some women will start having palpitations out of nowhere.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
And they go to the cardiologist, they get their million dollar workup, and they're like, "Hmm, don't know what's going on." And we're not training the cardiologists to say, "This might be part, part of her menopausal picture."
- MRMel Robbins
And you wanna know something else that I'm just, like, actually, as my brain is churning and all this is starting to go click, click, click, is that if there's not comprehensive training, and if there's not advocacy for what these symptoms are, then there's also no health insurance code-
- MHDr. Mary Claire Haver
Exactly.
- MRMel Robbins
... to cover the cost
- 29:10 – 29:55
How women are being treated unfairly by the health insurance industry.
- MRMel Robbins
of a lot of the diagnostic stuff that actually points to what is causing this.
- MHDr. Mary Claire Haver
Medicare does not pay for a menopause visit.
- MRMel Robbins
That's insane.
- MHDr. Mary Claire Haver
Right.
- MRMel Robbins
What?
- MHDr. Mary Claire Haver
Yeah. Your well woman exam, that has devolved into screening for breast and cervical cancer. That's it. You know, that 15 minutes with your legs in stirrups is not the time to, like, do a comprehensive menopause visit. So you need to schedule another visit, you know, go in with, you're armed with questions, go in with your family history and all of these symptoms.
- MRMel Robbins
And it sounds like don't call it a menopause visit. Say, "I'm having lots of symptoms," but don't call it so it gets covered.
- MHDr. Mary Claire Haver
Exactly.
- MRMel Robbins
Wow. Wow. Okay. So the heart, the lungs. How does estrogen
- 29:55 – 30:15
Asthma is another unexpected symptom of menopause.
- MRMel Robbins
impact your-
- MHDr. Mary Claire Haver
Asthma. Inflammatory disease.
- MRMel Robbins
What?
- MHDr. Mary Claire Haver
We see an increase in asthma, and actually asthma that doesn't respond as well to the typical, um, bronchodilators.
- MRMel Robbins
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.
- MHDr. Mary Claire Haver
Yep.
- MRMel Robbins
Wow. What about, like, your digestive
- 30:15 – 30:30
Estrogen impacts your gut health.
- MRMel Robbins
tract? How-
- MHDr. Mary Claire Haver
So the, the gut, you know, the gut health changes dramatically, and when the gut health changes and the gut microbiome changes, how we kind of reprocess our estrogen changes a bit as well, the, kinda the metabolism part of it. And so, you know, lots
- 30:30 – 33:40
Despite what you’ve been told, osteoporosis IS preventable.
- MHDr. Mary Claire Haver
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.
- MRMel Robbins
So just for somebody who's listening that doesn't know what that word means-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... could you-
- MHDr. Mary Claire Haver
Sure.
- MRMel Robbins
Is that like fragile bones, bone density?
- MHDr. Mary Claire Haver
Weak bones.
- MRMel Robbins
What does that mean?
- MHDr. Mary Claire Haver
So bone, so our bones' density maxes out the den- like how thick and strong our bones are. The thicker, the stronger, the more resilient to fracture they are, okay, in general. When... And we're constantly remodeling our bones, which is why when we, and I'll say wh- I'll explain that in a minute, which is why when we break them, they fix themselves if you line them up.
- MRMel Robbins
Hmm. Interesting.
- MHDr. Mary Claire Haver
So, we are constantly chewing up bone like Pac-Man and then pooping out new bone behind it, you know.
- MRMel Robbins
Really?
- MHDr. Mary Claire Haver
Yes. And so we're always r- the bones you were born with were not the bones you had at 10, are not the bones you have at 20. We have totally-
- MRMel Robbins
What?
- MHDr. Mary Claire Haver
... chewed up and laid down all new bone.
- MRMel Robbins
Wait, what?
- MHDr. Mary Claire Haver
What happens in menopause or in women with chronic suppression of ovulation, chronic low, you know, postpartum, multiple babies, we start chewing up more bone faster than we can lay it down, and that accelerates in menopause. So we end up with this porous bone with holes in it basically that is a lot easier to fracture. Now if you fracture your hip, so if you're 65 plus, and that is 10 years away from us, and we fall climbing up a ladder, chasing a grand baby hopefully maybe one day, no pressure to my children, um, and we trip, we d- and we, we take out a hip, even with surgical repair, we have a 29% chance of death in that first year, and if we-
- MRMel Robbins
Ho- hold on.
- MHDr. Mary Claire Haver
... survive-
- MRMel Robbins
Ho- 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.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
And-
- MHDr. Mary Claire Haver
And aging.
- MRMel Robbins
And aging, and that makes you more fragile and prone to having a broken bone. And she is also saying this is preventable.
- MHDr. Mary Claire Haver
Mm-hmm, for most women.
- MRMel Robbins
For most women, but if you fall and break a hip at the age of 65, 29% of you will die.
- MHDr. Mary Claire Haver
In the first year.
- MRMel Robbins
In the first year.
- MHDr. Mary Claire Haver
With surgery. Without surgery, it's like 79%. So they're all getting surgery. Yeah.
- MRMel Robbins
Wow.
- 33:40 – 42:00
How is a woman’s vagina impacted by loss of estrogen?
- MHDr. Mary Claire Haver
a big mouthful. It used to be called senile vagina.
- MRMel Robbins
(laughs) Sounds ugly.
- MHDr. Mary Claire Haver
That was the medical term. Senile-
- MRMel Robbins
Senile vagina-
- MHDr. Mary Claire Haver
Senile vagina.
- MRMel Robbins
... was a medical term?
- MHDr. Mary Claire Haver
Mm-hmm. Yeah, and they-
- MRMel Robbins
It sounds like a guys, a bunch of guys got around, got really wasted-
- MHDr. Mary Claire Haver
Welcome to Western medicine-
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
... in the 1950s. Then they changed it because it was so offensive to atrophic vaginitis. Again, doesn't sound much better.
- MRMel Robbins
No.
- MHDr. Mary Claire Haver
So our genital urinary system, the bladder, the vagina, the vulva-
- MRMel Robbins
Yes.
- MHDr. Mary Claire Haver
... that whole space from your pubic bone to your, to the end of your tailbone, just-
- MRMel Robbins
Yes.
- MHDr. Mary Claire Haver
... all of that area is highly sensitive and highly estrogenized. And when that estrogen level drops, we lose elasticity, we lose the stretchability of the vagina, which might be helpful on occasion, you know.
- MRMel Robbins
Is that why sex is painful sometimes?
- MHDr. Mary Claire Haver
For most women, they have atro- atrophic area, so they've lost their elasticity.
- MRMel Robbins
Yeah.
- MHDr. Mary Claire Haver
They can't make mucus anymore. The tissue is thin. If you look at a biopsy of pre-menopausal vagina, it's this thick, velvety, elastic, beautiful, like bring it, baby.
- MRMel Robbins
Yes.
- MHDr. Mary Claire Haver
And then this post-menopausal woman who's never been treated, it looks like the Sahara Desert. You know, you've lost layers and layers and layers of tissue. It's very dry. It's very small there, and she's just gritting her teeth through, through sex, and-
- MRMel Robbins
And that is because that entire-
- MHDr. Mary Claire Haver
... it's horribly uncomfortable. I'm a hiker, and so I've got to use hol- e- even with, you know, systemic estrogen, if I don't make sure that area is, is well-moisturized-
- MRMel Robbins
Right.
- MHDr. Mary Claire Haver
... things might... And now, and now our also the architecture changes a little bit, so things are hanging at different levels. And so I love to hike, and so I'm going to have some chafing and things that I never had before.
- MRMel Robbins
Right.
- MHDr. Mary Claire Haver
I need to make sure I'm getting lubrication in that area-
- MRMel Robbins
Right, and, and-
- 42:00 – 43:20
Once officially in menopause, a woman should never have these again.
- MRMel Robbins
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
And are you still in a monthly cycle? Like, what is happening when you're in menopause?
- MHDr. Mary Claire Haver
No. So once those ovaries fail, and I know that term is harsh, but you know, once the ovarian, once the eggs are gone, no more periods. You will, any vaginal bleeding after menopause needs to be evaluated by a gynecologist. There might be something wrong. Okay? You should never have another period again.
- MRMel Robbins
'Kay.
- MHDr. Mary Claire Haver
So your periods stop, or the, first they become s- shorter, longer. It's really, it could be anything, but eventually they just kinda stop.Some women will wake up and never have another period. Others will have this kind of skipping, months and months between, until they finally end.
- MRMel Robbins
Mine was like Chucky, just kind of kept popping up.
- MHDr. Mary Claire Haver
(laughs)
- MRMel Robbins
You know, rrr, rrr, you know? Like, "Oh, I thought you were gone."
- MHDr. Mary Claire Haver
Yeah, and-
- MRMel Robbins
That's-
- MHDr. Mary Claire Haver
... here you are again.
- MRMel Robbins
Yes.
- MHDr. Mary Claire Haver
So once you've gone a year, then most scientists agree that you're done. Okay?
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
If you're over the age of 45 and you hadn't had a period for a year, you are a post-menopausal woman. That's the clinical definition.
- MRMel Robbins
And what is the technical definition of when you've moved from peri-menopause to menopause?
- MHDr. Mary Claire Haver
So peri to men- menopause is that one day where, like, yep, it- it signifies your ovarian failure. You will never have another egg that's able to be fertilized again.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
The end. There's no more left.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
So, and then for the rest of your life, you're post-menopausal. Now some of the symptoms you experience
- 43:20 – 44:25
Will you have these menopause symptoms for the rest of your life?
- MHDr. Mary Claire Haver
get better. It might take several years. Like, the hot flashes do tend to go away. The sleep disruptions, if they're related to hot flashes and night sweats, do tend to get better. Might take 7 to 10 years.
- MRMel Robbins
7 to 10 years?
- MHDr. Mary Claire Haver
So forever-
- MRMel Robbins
I thought you said go away, like...
- MHDr. Mary Claire Haver
(laughs)
- MRMel Robbins
I'm thinking, like, a couple weeks.
- MHDr. Mary Claire Haver
It might take shorter, but I- I want to give people a very clear picture. And so a lot of women are like, "Well, I went through my menopause. Like, I'm done with that." And I'm like, "Your bones are still deteriorating. Your risk of cardiovascular disease is still increased." Like, those, your genital urinary system without support is failing. And, you know, these are the things that don't go away in your post-menopause.
- MRMel Robbins
I just realized I'm talking about it wrong, 'cause I always say I'm in menopause, I'm going through menopause, I've hit menopause, and you're saying once you actually get to that date where you've had not, you haven't had a period for a year, it ain't coming back, that's menopause. But technically now, I'm in post-menopause.
- MHDr. Mary Claire Haver
Forever.
- MRMel Robbins
Wow. So when you are post-menopausal-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... do you have any estrogen at all?
- 44:25 – 46:26
Your body makes 4 types of estrogen.
- MRMel Robbins
- MHDr. Mary Claire Haver
So 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, and that's what's mostly created in our ovaries.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
Testosterone can be peripherally converted at a very small rate to some estradiol or estrone. So estrone is what's created in our fat cells. So the heavier, the more subcutaneous fat you are, the higher your estrone level is, which is why heavier women are more likely to have endometrial cancer and other estrogen-related cancers.
- MRMel Robbins
Is this also why one of the symptoms when estrogen starts to decline is that your arms get flabby and you start to gain weight around your stomach, because your body, once it's signaling there's not enough estrogen being created in your ovaries, your body starts to try to create and hold onto it in your fat?
- MHDr. Mary Claire Haver
So there are theories around that. The anthropologists are, are scratching their heads because there's only five mammals that go through menopause and four of them live underwater. Beluga whales and a few ki- one of the killer whales. Yeah.
- MRMel Robbins
Really?
- MHDr. Mary Claire Haver
So yeah, no other mammals on land, really, that we can figure out. Maybe one giraffe. They're looking at one particular giraffe. Go- we are, like, really unique in that we have a menopause and we think because we've just artificially extended our life past our evolution with modern health and-
- MRMel Robbins
Yeah.
- MHDr. Mary Claire Haver
... sanitation and all the things that keep us alive.
- MRMel Robbins
That's wild.
- MHDr. Mary Claire Haver
We weren't designed to live this long. So we have estradiol.
- MRMel Robbins
Yeah.
- MHDr. Mary Claire Haver
That's gone.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
The ovaries can't make that anymore. Maybe a tiny bit, but really not clinically significant. Estrone, really weak estrogen.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
Estriol, which is created in our placentas when we're pregnant, but pharmacologists have been able to recreate it and it's used in, like, one or two formulations of hormone therapy. It's not one of my favorites. And then there's this other one called estriol, very fancy, that the fetuses, that are, when we're in the womb, that's another one that we make with fetal cells, and that one has also been synthesized and is used in a couple of, one, hormone replacement therapy. Um, that's not one of my favorites.
- MRMel Robbins
No, but I mean, in your body.
- MHDr. Mary Claire Haver
So your estrogen level is not zero,
- 46:26 – 47:40
How much estrogen you have at 25 vs. postmenopause.
- MHDr. Mary Claire Haver
but your estradiol... But it's less than 1% of it was when you were 25.
- MRMel Robbins
And-
- MHDr. Mary Claire Haver
So let me give it to you that way.
- MRMel Robbins
Got it. Less than 1%-
- MHDr. Mary Claire Haver
Yeah.
- MRMel Robbins
... of what it was when you were 25.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
Holy smokes.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
And your body needs it.
- MHDr. Mary Claire Haver
It will function better with it.
- MRMel Robbins
And-
- MHDr. Mary Claire Haver
You will not die without it, you'll just die faster and less healthy.
- MRMel Robbins
And more, and miserable.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
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-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... when-
- MHDr. Mary Claire Haver
Of estradiol, yeah.
- MRMel Robbins
... you are post-menopausal and the only sources for your body to create it are ovaries or-
- MHDr. Mary Claire Haver
And a little bit in the periphery, you know-
- MRMel Robbins
And that's-
- MHDr. Mary Claire Haver
... in other cells, you know?
- MRMel Robbins
... it.
- MHDr. Mary Claire Haver
That's it.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
And our march to death begins.
- MRMel Robbins
Blows raspberries ]
- MHDr. Mary Claire Haver
(laughs)
- MRMel Robbins
Not anymore, Dr. Haver-
- 47:40 – 48:20
The postmenopause toolkit you need to start feeling better.
- MRMel Robbins
Now that we know, what do we do?
- MHDr. Mary Claire Haver
Great question. So when I'm, have patients come to me in clinic and we talk about menopause care, I do it in the form of a toolkit.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
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, or if she's not a candidate, then other options for her based on her symptoms.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
We also talk about supplements that might be helpful.
- MRMel Robbins
So let's take these one at a time.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
Who is not a candidate for-
- MHDr. Mary Claire Haver
Okay.
- MRMel Robbins
... hormone replacement therapy?
- MHDr. Mary Claire Haver
Very few people, actually. There's a lot of misunderstanding and misconception around who can and can't take
- 48:20 – 53:12
What you need to know about hormone replacement therapy.
- MHDr. Mary Claire Haver
hormone therapy. Absolute contraindications, undiagnosed vaginal bleeding.... you need to go see your gynecologist. You might need an ultrasound or biopsy. Like, 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-
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
... 'cause it might be a tumor that is estrogen fed.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
So we need to work on that. Um, active breast cancer, shouldn't be on estrogen therapy. Active blood clot, active stroke, you know, once those six-month markers and- and the workup for those things have happened, it's a possibility.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
It's a nuanced conversation, but not an absolute contraindication. Neither is breast cancer.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
There are certain breast cancers that, after treatment, you- you-
- MRMel Robbins
You know, could be a candidate.
- MHDr. Mary Claire Haver
... you could be a candidate. Now, again, nuanced conversation, risks and benefits coming back and forth.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
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 gonna increase your clotting risk.
- MRMel Robbins
You're saying that even if you have a history of breast cancer, that does not...
- MHDr. Mary Claire Haver
100% preclude you from having the option.
- MRMel Robbins
Gotcha. There are ways for you, with the counsel of your physician-
- MHDr. Mary Claire Haver
Right.
- MRMel Robbins
... to explore hormone replacement therapy-
- MHDr. Mary Claire Haver
You-
- MRMel Robbins
... even if you have...
- MHDr. Mary Claire Haver
So, w- the thing that a woman with breast cancer is most likely to die from-
- MRMel Robbins
Yes.
- MHDr. Mary Claire Haver
... is cardiovascular disease, not breast cancer. She has a 90% survival cure rate. And when we go through menopause, we see a dramatic uptick in our risk of cardiovascular disease. Actually, women on hormone therapy, if given at that really, that, we have a wi- a juicy window of opportunity, the first 10 years of your menopause, estrogen is protective. And women on HRT between 50 and 59 age group within those first 10 years have a lower all-caused mortality, a lower cardiovascular disease death rate, and a lower cardiovascular disease at all, like, death from cardiovascular disease or- or an- or heart attack.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
And let me tell you something else-
- MRMel Robbins
Tell me.
- MHDr. Mary Claire Haver
... that'll blow your mind. So, primary prevention strategies for cardiovascular disease. So women are given statins all the time for high cholesterol. Has never been shown to decrease your risk of cardiovascular death. Th- yes in a man, but not in a woman. ACE inhibitors, then 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 heart attack, only in men. Yet we're recommending this stuff to women all the time, and we've taken from many women the conversation or the option of hormone therapy is off the table when that is the one thing that is gonna decrease her risk, besides lifestyle, of course.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
Yeah. That's when I get mad.
- MRMel Robbins
I can tell. An-
- 53:12 – 55:10
3 types of food ALL women should include in their diets.
- MHDr. Mary Claire Haver
at that historical reporting were walked back. There's only one that still stands and it's still controversial.
- MRMel Robbins
And this is recently. Like, recently, they have literally said, "That wasn't really accurate. It's not really true." And so the reason why it's important to say this is because there is this murmur out there that-
- MHDr. Mary Claire Haver
Still-
- MRMel Robbins
... hormone replacement therapy is-
- MHDr. Mary Claire Haver
Causes cancer.
- MRMel Robbins
... causes cancer.
- MHDr. Mary Claire Haver
Causes heart disease.
- MRMel Robbins
Is super dangerous. Blah-biddy-blah-biddy-blah-biddy-blah. And you're saying there are certain categories where you should not be on-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... but for the vast majority of the women in your life, this is an option you need to be exploring.
- MHDr. Mary Claire Haver
Yes.
- MRMel Robbins
And it's not only safe, it actually increases your health outco- outcomes. So, the majority of us are a safe candidate for hormone replacement therapy. What about supplements? Like, what are the supplements that we need to take?
- MHDr. Mary Claire Haver
We really should try to get most of our nutrients from food and we only supplement where there's a gap or you have an allergy and intolerance, and then we go in from there. There are a few supplements that are non, like, essential nutrients that might be helpful, like turmeric, right? That's not anything we have to eat to survive, but it has some pretty powerful antioxidant, anti-inflammatory properties and that someone might find helpful. But when we're talking about the vital things, if I had my, like, top three things I would recommend to everyone-
- MRMel Robbins
Yes.
- MHDr. Mary Claire Haver
... 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.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
That's its food.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
So that's the prebiotic.
- MRMel Robbins
Give me example of what, like, fiber is.
- MHDr. Mary Claire Haver
Legumes.
- MRMel Robbins
Who?
- MHDr. Mary Claire Haver
Berry... Oh, legumes. So, uh, nu- um, (laughs) beans. (laughs)
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
Beans. So it's a class of, of beans. Peanuts are actually legumes as well. Typically, really high in fiber.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
Um, berries, really high in fiber. Seeds and nuts, really high in fiber. Those are kind of... Avocado, or, you know, that's my go-to to make sure I'm, like, getting my fiber goal every day.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
Also has healthy fats and other vitamins and minerals and nutrients. Mag, magnesium.
- 55:10 – 56:56
What type of magnesium supplement should you take?
- MHDr. Mary Claire Haver
- MRMel Robbins
And this confuses me, because I'm not quite sure what type of magnesium to take.
- MHDr. Mary Claire Haver
Oh, great question. Your glycinates, your tarates, your citrates, um, and L-threonates are good, because they're readily absorbed into the bloodstream. So now we have nice magnesium levels in our blood. There's also benefit, some of them are better than others, about crossing that blood-brain barrier. So the brain protects itself. There's a membrane around the brain that it doesn't have this 100% free flow of nutrients back and forth. It's really selective about what it lets in.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
So mag L-threonate, which MAGtein or Neuromag are the brand names, has been studied in, like, SSRI-resistant depression. So antidepressant dep- you know, resistant depression in patients. They've added in this, it seemed to be helpful at... And my patients, you know, followers, it's so helpful for sleep, anxiety, so I'm often recommending that one at night.
- MRMel Robbins
And what one was that one?
- MHDr. Mary Claire Haver
Magnesium L-threonate.
- MRMel Robbins
Okay, so you're saying fiber's number one. Magnesium is number two.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
How do you get magnesium naturally?
- MHDr. Mary Claire Haver
So pumpkin seeds, um, spinach, you know, green, leafy greens are rich in mag generally.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
I have a lot of lists on my website where we list all this stuff.
- MRMel Robbins
Great. We will link to all this.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
And what's the third thing?
- MHDr. Mary Claire Haver
So I'm always looking at omega-3 fatty acids. Um, omegas are usually found in fatty fish, also in flax. Um, one of my favorite ways, I'll do this little yogurt, and I'll have flax, hemp, and chia seeds. So I'm just hitting all my antioxidants, my anti-inflammatory, my fiber all in one. Um, 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 gonna be your salmon, your mackerel, your tuna, your fatty fish.
- MRMel Robbins
Mm-hmm. Mm-hmm.
- MHDr. Mary Claire Haver
Your cold water fish. Um, and then I check
- 56:56 – 57:52
Why you have to take a vitamin D supplement.
- MHDr. Mary Claire Haver
a vitamin D level on every woman who'll let me stick a needle in her. Um, 80% of my patients, not, 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, you know, which is another place, and we're not really creating it in our skin as fast as we used to.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
So... And vitamin D is a hormone that has a million, you know, 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."
- MRMel Robbins
A lot of us, I've noticed in my, uh, 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-
- MHDr. Mary Claire Haver
Mm-hmm. (laughs)
- MRMel Robbins
... vitamin B deficiency-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... vitamin D deficiency, and heightened cholesterol.
- MHDr. Mary Claire Haver
Yes. So
- 57:52 – 58:45
Why do so many women have higher cholesterol?
- MHDr. Mary Claire Haver
a- again, about 70, 80% of my patients have an, an unexplained, no changes in diet or exercise, rise in cholesterol, absolutely secondary to estrogen deficiency. And again, rushing to put her on a statin is not... will make her, her cholesterol go down, but is not gonna decrease her risk of cardiovascular disease. And women who are on HRT have higher HDLs and lower LDLs than women who are not, when you compare the two groups. So just being menopausal is an independent risk factor for an un- unhealthy cholesterol profile.
- MRMel Robbins
So if you are eating the fiber, and the magnesia- uh, magnesium-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... and the omega-3s, and you're also taking the vitamin, uh, D supplement-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
... how do you make sure that your body can actually absorb it, or that your gut health is okay? Like, do you also recommend that people take a probiotic?
- 58:45 – 1:00:12
Should women take probiotic supplements?
- MRMel Robbins
- MHDr. Mary Claire Haver
So I do. They've done some studies looking at probiotic supplementation in women with obesity and hypertension who are also post-menopausal.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
And there were some really positive results of, you know... It's hard to measure gut health, you know?
- MRMel Robbins
Yes.
- MHDr. Mary Claire Haver
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, you know, there are things we can do, workarounds. But the loss of estrogen will change your gut microbiome to the profile of a man's.
- MRMel Robbins
Is that why we get a belly? (laughs)
- MHDr. Mary Claire Haver
Part of it. (laughs) That's part of it. Um, so we know that an independent risk factor for visceral fat deposition, what we call belly fat, in layman's terms.
- MRMel Robbins
Yeah.
- MHDr. Mary Claire Haver
Visceral fat means inside the or- wrapping around the organs, you know, inside the abdomen. That fat is very different than the curvy fat, than subcutaneous fat. That visceral fat is a marker for cardiovascular disease, diabetes, stroke. And so women who were on the probiotic versus placebo-
- MRMel Robbins
Yeah.
- MHDr. Mary Claire Haver
... had lower blood pressure and lower visceral fat. Weights didn't change. You know, 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.
- MRMel Robbins
Gotcha. Talk to us about
- 1:00:12 – 1:01:30
What type of exercise should postmenopausal women do?
- MRMel Robbins
exercise.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
So what kind of exercise is critical?
- MHDr. Mary Claire Haver
So I'm a... I grew up in the '80s, and I was the cardio queen.
- MRMel Robbins
(laughs)
- MHDr. Mary Claire Haver
I did so many step aerobics classes. I taught them. It would make your head spin. I did not-
- MRMel Robbins
I can actually see that. I could-
- MHDr. Mary Claire Haver
I did not-
- MRMel Robbins
I would take a step aerobics class with you.
- MHDr. Mary Claire Haver
It... I d- all of my exercise was to be thin-
- MRMel Robbins
Yep.
- MHDr. Mary Claire Haver
... and to maintain a certain body shape that was part of my social currency.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
And if I could go back and talk to my... What I tell my children all the time, "We need to w- 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 w- which we are going to desperately need as we age, especially if you're built like me.
- MRMel Robbins
Yeah.
- MHDr. Mary Claire Haver
And I didn't pick up weights until I was well into my 40s, and there's never too late. Anybody listening at any age can start weight training, and you should. So I think that getting people to let go of this notion that thin is the way to be and that you're way better off having a little more curves and a lot more muscle is going to serve you in these menopausal years so much better than just being skinny.
- MRMel Robbins
I have followed all this advice, and I have switched up the entire way I approach exercise. I now resistance train three days a
- 1:01:30 – 1:03:20
How can you sleep better?
- MRMel Robbins
week. Um, and if you're having a hard time sleeping, what do you recommend?
- MHDr. Mary Claire Haver
Right. So we have to look at why you're having a hard time.
- MRMel Robbins
Hmm.
- MHDr. Mary Claire Haver
Um, progesterone goes a long way to helping us sleep. And so estrogen leads to hot flashes and night sweats, which are completely s- sleep disruptive. I mean, even with hormone therapy, I still have a thermometer leg that I have to throw out occasionally.
- MRMel Robbins
A thermometer leg. Oh, my.
- MHDr. Mary Claire Haver
So-
- MRMel Robbins
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."
- MHDr. Mary Claire Haver
Yeah. (laughs)
- MRMel Robbins
And then just throw it back in, throw it out. Yeah.
- MHDr. Mary Claire Haver
Throw it back in. So I'm like, "Okay, let's get you on some estrogen."
- MRMel Robbins
'Kay.
- MHDr. Mary Claire Haver
You know, and so say she's had a hysterectomy and she doesn't have to have progesterone.
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
Progesterone's an option. So I'm like, you know, people sleep deeper, it has an anxiolytic effect.
- MRMel Robbins
What does that word mean?
- MHDr. Mary Claire Haver
So anti-anxiety.
- MRMel Robbins
Anti, anxiolytic effect?
- MHDr. Mary Claire Haver
So if... Anti, yeah, sorry. (laughs)
- MRMel Robbins
Wow, that's a big one.
- MHDr. Mary Claire Haver
Anti-anxiety effect.
- MRMel Robbins
Okay.
- MHDr. Mary Claire Haver
So if your sleep disruption is also h- you're having racing thoughts at night-
- MRMel Robbins
Yes.
- MHDr. Mary Claire Haver
...you can't shut that brain off-
- MRMel Robbins
Yes, yes. This is my daughter.
- MHDr. Mary Claire Haver
...progesterone is beautiful for these women, especially in perimenopause when we're skipping ovulations and we're not given that monthly surge of progesterone.
- MRMel Robbins
Is this an option for somebody who's even before perimenopause?
- MHDr. Mary Claire Haver
Perimenopause, you could, yeah.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
Yeah, you can safely take progesterone every day, even if you're premenopausal.
- 1:03:20 – 1:09:45
Estrogen dips impact how your body processes alcohol.
- MHDr. Mary Claire Haver
I zero in on with my patients.
- MRMel Robbins
What do we need to know about alcohol?
- MHDr. Mary Claire Haver
Whew. 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, like, I have to go on my personal experience, if I'm choosing to have a drink, I am choosing not to sleep. I'm gonna be up at 3:00, 2:32, 3:31, whatever it is, and it is like a bomb going off, even one glass. And I have to make that choice. I can't drink like I used to, thank God. You know, those college days... Most of the women in my practice and on social media are commenting, every time I talk about it, they're like, "Yep, gave it up."
- MRMel Robbins
That's-
- MHDr. Mary Claire Haver
"It's not worth it."
- MRMel Robbins
If you're choosing to drink, you're choosing not to sleep. It really is that simple.
- MHDr. Mary Claire Haver
Yeah.
- MRMel Robbins
Wow.
- MHDr. Mary Claire Haver
So women, you know, I've said this before, we are living longer, but we're living in poorer health. I- I don't want the longer lifespan if I'm gonna be decrepit and I'm gonna be disabled and, I'm, and my children are gonna worry about me every day. I think that, you know, as my, 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 gonna keep that lifespan, but we're gonna improve our health span-
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
...and make those choices that can lead to us having healthier lives.
- MRMel Robbins
Well, I think that's, like, 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-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
...and you're constantly complaining about the symptoms.
- MHDr. Mary Claire Haver
Your doctor didn't even understand. Yeah.
- MRMel Robbins
Yeah. You're constantly complaining about the symptoms with your, 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, uh, 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-
- MHDr. Mary Claire Haver
Yeah.
- MRMel Robbins
...over that lifespan, and 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-
- MHDr. Mary Claire Haver
That's correct.
- MRMel Robbins
...actually have found each other.
- MHDr. Mary Claire Haver
Yeah.
- MRMel Robbins
And have started collectively saying, "What's going on with my weight? What's going on with my joint pain? What's going on with my brain fog?" And you don't feel alone. Of course I knew that the hot flash-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
...was from menopause. I had no idea that the brain fog was menopausal. I had no idea that, uh, some of the joint pain was an issue.
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
And I certainly knew that the sex drive lowering was part of what was going on, but I'll tell you, it was really when the belly fat-
- MHDr. Mary Claire Haver
Mm-hmm.
- MRMel Robbins
...and the back fat that I started to gain, and I was so demoralized-
- MHDr. Mary Claire Haver
Yeah.
- MRMel Robbins
...because I'm the kind of person that exercises six days a week. I was doing everything I thought I was supposed to be doing.
- 1:09:45 – 1:10:55
How do you find a doctor and how do you prepare for your visit?
- MHDr. Mary Claire Haver
you could just march into your PCP or your OBGYN even-
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
... 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?
- MRMel Robbins
Mm-hmm.
- MHDr. Mary Claire Haver
I have a list on my website of testimonials from my followers who have found great people. So, that's one place. The Menopause Society, of which I've become certified, is an independent organization of people who care about menopause, do research in menopause, and they have a certification and training program. And so you can find, um, 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 test if you need them, and give you the hormone therapy you so desperately need.
- MRMel Robbins
I will link to absolutely everything that you've recommended, including how to find you, find the book, uh, and reach out to you, and all the resources for this show.
- MHDr. Mary Claire Haver
Awesome.
- MRMel Robbins
Do you have any final words of wisdom to the-
- MHDr. Mary Claire Haver
Oh.
- MRMel Robbins
... person listening?
- MHDr. Mary Claire Haver
You know, you're not crazy.
- MRMel Robbins
(laughs)
- 1:10:55 – 1:14:32
What else can you do to manage your experience?
- MRMel Robbins
.
- MHDr. Mary Claire Haver
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, 'cause it, they're most likely gonna mimic what you've gone through. Menopause is inevitable. It's not a bad thing. It is a natural process, but you don't have to suffer. What I love about menopause is women find this power to put themselves first for the first time in their adult lives. Their give-a-shit factor goes away.
- MRMel Robbins
(laughs)
- MHDr. Mary Claire Haver
They don't care anymore. They are embracing who they are, and I love that about us. You know? I am more successful. I never could have done this in my 30s, you know, that, what I've been able to build. And I just love that about this age, but I wanna keep that going.
- MRMel Robbins
Dr. Haver, I, I just wanna tell you, you are a gift. I am so thrilled that you took the time to be here. I do think you are changing and saving people's lives. I hope as you've listened to her that you've not only learned a lot about your own body, but that you feel more empowered and that you have a few very simple things that you can start doing immediately. And I hope one of the things that you do is that you take a moment to share this with every woman that you know. And I'm not just talking the women that are peri or post-menopausal. I'm talking every woman in your life, because the information today was about the design of the female body, and about how estrogen and estrogen decline and deficiency impacts her profoundly. And so this really could change somebody that you care about. It sh- could change your life.
- MHDr. Mary Claire Haver
Yes.
- MRMel Robbins
Um, so thank you, thank you, thank you for taking the time to be with us. And I wanna thank you for taking the time for yourself and taking the time to listen to something that could help you improve your life. And I wanna make sure to tell you, in case nobody else does, that I love you, I believe in you, and learning more about your body and your brain and your hormones and how to optimize your overall health is one of the most important things that you can do to improve your life. So, I know you feel empowered to do that after the conversation today, and I'll talk to you in a few days. Oh my god. Dr. Mary Clark. (clapping and cheering) You outdid wonderful. I would recommend every woman and young woman that I know. You were incredible.
- MHDr. Mary Claire Haver
Thank you. Thank you for giving me a platform.
- MRMel Robbins
Oh my gosh, thank you for everything you do. (clapping and cheering) And to you, um, thank you so much for being here with me on YouTube, for real. Uh, aren't you so empowered? Don't you want to send this to absolutely every single girl and woman that you know? Please, please, please share this widely. This is life-changing information. And one more thing. Please hit subscribe, because it allows me to continue to bring you world-class experts at zero cost, every single day new videos, here on YouTube. And I know what you're thinking. You're thinking, "Okay, I- I- I wanna know more, I wanna know more." So, I'm gonna introduce you to the amazing Dr. Amy Shaw. She is going to teach you how to optimize your health and your hormones and to sleep better, and you're gonna love, love, love Dr. Shaw and this video too.
Episode duration: 1:14:32
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