Dr. Mary Claire Haver: Episode Link
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On this episode, we are speaking with renowned Board Certified Ob/gyn, menopause expert and author, Dr. Mary Claire Haver.
TRANSCRIPT:
Welcome back to Hot Flashes on Cool Topics. Today we have on Dr. Mary Claire Haver, who has been a previous guest of ours. And since we have seen you, you have just been very busy.
Welcome back to the show. Thanks for having me. Well, we appreciate you being here. It has been an absolute whirlwind to watch. watch you get just the conversation around menopause taking off and you and several other doctors and experts have really been on the forefront just in that front edge of making the conversation.
And we invited you to talk about your new book, The New Menopause, Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts. And wow, are there facts in this book?
We’ve a, you’re like, we’ve heard of menopausal toolkits. We even talk about our own toolkit, but half of the book is really talking about A to Z of every symptom. Not long.
And why did you decide now it’s time to write this book and how long did it take you? – So I started thinking about this book right when we were launching the Galveston diet because on social media,
I kind of put my toe in the water around how… how a woman should approach her nutrition in her menopause journey and how that could affect her outcomes. But as I began talking more and more about menopause,
like the questions were just exploding into multiple organ systems, not just cardiometabolic stuff. And so instead of just immediately saying, no, there’s no way that that’s associated with menopause,
I start digging. When 10 ,000 people ask you about frozen shoulder, or you’re like, hmm. okay, because remember, my clinical experience is just one on one with patients. And because of the way the medical system is,
the majority of my time was spent doing things to do with reproduction or getting pregnant or not getting pregnant, right? And a few mishaps of fibroids and tumors and whatnot, but I didn’t have any focused menopause care,
education. And so now that I had developed this platform, it’s just many questions are coming to me by the thousands, I was like, there needs to be a better conversation here.
And women are starting to like talk about it and they need a reliable source of information that is evidence -based because every coach, I mean, some coaches are fabulous,
but you know, like there’s a lot of misinformation out there and a lot of people are getting into this space who really don’t have any business being there. So I wanted to… get something out there that was based in science,
easy to read, available to everyone. And not only would support the person going through menopause or in her menopause journey, but the ones who were gonna get there and the people who love them.
So I started, oh God, it was 18 months of research, of reading, reading multiple medical journal articles, like thousands and compiling. compiling them,
extracting what I thought really putting it together. I had a great collaborator I worked with who was fantastic. And we were able to write it in about six months after about a year of research.
– Wow, I mean, it’s very evident when you read the book, how much research was put into it because it is so comprehensive. And one of the things that I found was just so refreshing,
relieving to have in the book. was the role of estrogen and how it plays such a big role in women’s lives. Can you talk about just, you can’t probably go into all the benefits.
You’ve got to read the book, but some of the benefits of estrogen in our body. – So estrogen in its natural form being pumped out of our ovaries day after day after day is incredibly protective.
It is why women have less heart disease and less heart disease. until menopause. It is why we have strong bones. It is why before menopause, it is why we have less,
we have normal cholesterol before menopause. It is why we have normal insulin resistance for those of us, you know, before menopause. It is why we don’t have musculoskeletal syndrome until menopause.
You know, it’s, it is just a lubricant and anti inflammatory hormone. So incredible. involved in multiple processes in our body, not just reproduction, which of course is an important face,
but it is literally linked to our cardiometabolic health. And when we naturally go through this transition and lose that estrogen, we see, independent of aging, those risks increase.
And I think that was the key message in the book was, listen, estrogen is more than just a pretty hormone that lets you have babies. I mean, this, this is cool. to us functioning at our optimum health as females.
– I really liked how you kind of cut the book into three parts. So part one is the story of menopause medicine. And it’s really important, I think, for women to understand the history behind what is menopause,
how it’s kind of really not coming to the forefront of conversation until recently. And then the second part is the story of menopause. the second part is getting to no menopause in that chapter Seven you get to know all you need to know about hormone therapy Which is wonderful because we get so many questions from listeners that’ll say I you know here are my symptoms Well,
your symptoms are different than this person’s symptoms and you really you know You’re all about number one find a good doctor, you know, that’s like it’s I love the fact that you really kind of it’s almost like You have a patient in front of you You and you’re giving them details.
And then the third part is symptoms and solutions. Why did you decide to divide it that way? And I know you talk a lot about the bad studies and obviously the early 2000s studies.
Why do you think it’s important for women to understand the history of menopause? – Because a lot of the questions and comments, why does my doctor say this? – Why can’t I?
I walk into my OBGYN and get good menopause care? Why, you know, so I felt like it was important from a historical perspective to understand the state of the state,
how we got where we are today. And it’s not just bad doctors. It’s a bad training system. It’s about, you know, the lack of an education, awareness and knowledge across all aspects of medicine and society.
How we view women, how we view women as they age, how we think about a way a woman presents medically versus how their male counterpart presents. All of this is wrapped up into our menopause experience.
So, I mean, I try to give credit to these amazing authors out there, Eleanor Clayhorn and others who have written these books about the history of women in medicine and kind of why is it that a woman waits 19 minutes longer for pain medicine in the ED or why is it that she’s more likely to die from a heart attack?
heart attack in the ED than a male? There are reasons for this and a lot to do with misogyny and paternalism and medicine and that’s got to stop. And so I wanted to arm women with some power to understand that this isn’t their fault.
I wanted to validate their experiences and make them understand why there’s a lot that we can do to change this for our children. Right, you know you always say too you’re not really trying to blame doctors.
You’re just saying it’s the system that they were taught by. I was that doctor. Yeah, right. Right. Because it’s easy. It’s easy for someone to get upset with their doctor. But then when you know,
well, this is what they were taught. But there is a section in the book that is so great about if your doctor says this, this to you, you need to get another doctor.
Can you share some of the things that you’ve heard from women? that they’ve heard from their doctors? – I don’t believe in menopause, like at Santa Claus or the Easter Bunny, like they don’t believe in it or they don’t believe in perimenopause,
not okay. It’s okay for a physician to say I haven’t had the time and I wasn’t trained. You shouldn’t come to me for menopause care. And I advise healthcare providers to remove menopause from their scope of practice if they are not willing to undergo additional treatment.
training. First, they have to recognize they’re not trained. And my book is not good enough. You know, like a lot of docs are gonna try to read my book and be like, “Okay, I’m a menopause provider.” No,
no, no, no, no. This is a step to realize what you’re missing. Now, you need to probably go get certified by the menopause society. Is it great? And start demanding from our academic institutions that we include a robust menopause curriculum.
across medical school and all training programs. – And you even talk about the fact that this is probably the first generation of medical trainees who are being introduced to the information out there.
And that maybe our daughters won’t have the same problems that we had accessing information in. And it’s great ’cause in the book you go into what to look for. Like if you’re trying to find a doctor,
look here. I mean, it really explains. to somebody everything they need to know in trying to find a menopause doctor, a certified doctor. And then in the second part,
you kind of go into menopause and like chapter seven is all about hormone therapy. And there’s some trigger words that I think women use, especially women who maybe are not as informed as others that they use that they don’t really understand.
understand. So can you talk about the first one is estrogen dominance. A lot of women use that term and I don’t think they really know what they’re saying. Can you explain what that is? Women have been suffering from menopause symptoms since the beginning of time.
As long as women live long enough to go through menopause, which is really on average only been in the last 150 years and that’s because of medical advancements and better water and clean, you know, plumbing and and you know,
die of cholera. cholera. So we’re living well past our ovarian capacity. And this is kind of new, you know, in this era.
Women have been suffering forever from this. And since 2002, most traditionally trained OB gens, providers who would have covered this level of care,
were taught that estrogen causes cancer and it’s dangerous and only give it a– she’s gonna commit suicide and you have no other option. So we have this whole generation. Women are still suffering. Women in history of the world will find solutions,
okay? They will go around barriers to healthcare and find a solution. This has happened, whether it’s safe or not. So this cottage industry of healthcare popped up.
It has multiple names, but basically people offering. offering solutions. Now evidence space, maybe not so much, you know, will they get hormone therapy?
Maybe will they promise the miracles with a bucket full of supplements? Absolutely. So terms have sprung up in popular culture in an attempt to explain some really complicated endocrinological events that happen in a woman’s life.
One of them is estrogen dominance. I would never in a million years sit across from a patient and tell her she has estrogen dominance. This is a marketing term, not a medical term, and it doesn’t address the root cause.
It basically means you’re not ovulating regularly. So you’re not balancing your estrogen with your progesterone. Each month, as we do on a very predictable and a healthy woman in her reproductive years, we have this very predictable EKG -like rise and fall of hormones month after month after month after month.
In policy, we have this very predictable EKG -like rise and fall of hormones month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after month after
month after month after month after month after month ovarian syndrome, thyroid disorder, inflammatory disorders, nutritional deficiencies, anorexia, perimenopause, that EKG starts going wonky,
okay? I want to know why that’s happening. I’m not calling an estrogen dominance and here, take this pill and it’s going to be magical or I’m going to balance your hormones. Those are, that is someone who’s probably trying their best to take a weekend course at some.
healthcare practitioner, you know, database thing, and they don’t truly understand the endocrinology. We need to find out why this is happening to her. Why is she not ovulating on a regular basis? What is going on?
So those are the terms that I use, but I think a lot of women in desperation find these clinicians who are just going to give them a Band -Aid and offer some solutions which really aren’t evidence -based.
I think we can do so much better. better. – Right, that is such an important part of your book that people need to know. And you talk about the different testing that’s involved. And it’s funny,
you brought up, or in your book, the homeless score, and that is the second time we’ve heard this, we had never heard it. Colleen and I, we interviewed– – My first score, yeah. – Yeah, someone last week that brought that up and Colleen and I were like,
“I’ve never heard that.” – The homeless score. So can you talk just about, you know, different tests because– you even say advocate, be an advocate for more testing that’s just your regular panel.
Can you talk about that? – So one of the things that I love to do is I go through the book and I go through the kind of standard testing that you would get at your regular well -women exam,
you know, your CBC, your CMP, whatever. And I’m like, hey, there are some add -ons and extras that probably are gonna be super helpful to you. And maybe, maybe insurance won’t cover it, but if you have symptoms,
they might. So make sure you discuss these with your doctor and ask for these tests. So one of them is like a hemoglobin A1c, which is a look back over the last six weeks of where your blood sugar has been.
Most of us get tested for that, okay? Then there’s the HOMA -IR score. This is a measure of insulin resistance and it’s based off of a calculation based off of a fasting glucose,
which most of us get and all they have to do is add a fasting insulin level, and then you can go to an online calculator and calculate what your score is. If it’s one or less, then the chances that you have insulin resistance are very low.
If it’s one to like two, you’re probably in early prediabetes and you have insulin resistance, even if it’s controlled with diet. You know that you’re at risk, you really have to focus on your diet. And above two,
2 .5, you were severely insulin resistant, and you… you need to, you know, this is a big red five morning sign. We are moving towards diabetes quickly unless you make those changes to try to reverse the process.
I am insulin resistant, very insulin resistant, which thank God with hormone therapy and diet I can control. – And that is something that also can happen as you’re going through metanopause.
– Right. So insulin resistance rises with the loss of estrogen, an independent reduction. factor, and nothing to do with aging. – Yeah. – Goes up with aging too, but you take two 50 -year -old women,
one who’s fully menopausal, one who’s not, she’s gonna have a three times higher rate of insulin resistance than an unmenopausal patient. – That’s one, wow. And women need to know that. – So,
you know, your risk of insulin resistance goes up three times. – What do you mean by that? – Insulin resistance and metabolic syndrome, sorry. And insulin resistance is a part of it. of that. So metabolic syndrome, which is visceral fat,
insulin resistance, hypertension, diabetes, three times higher just from being menopausal. – And women have no idea. – Well, they will now. – Well, they will,
yeah. We’re trying to get the word out because I didn’t know any of these things when I was paired with menopausal, nothing. – I didn’t either. – Yeah. – And now I’m like, wait a minute, this is my job now.
– My job. My job is to make sure as many women know about this as possible because they’re walking into their doctor’s office with new high cholesterol, new diabetes, new prediabetes, insulin resistance,
and they cannot change the thing in their lives. They haven’t changed their diet or their exercise and they’re blindsided and their physicians who aren’t trained are telling them, well, it must be your diet and your exercise. Here’s the statin.
Yeah. And then they feel worse. Then they’re just synthetic. that adds to the depression because they’re like, you know, look, I’m terrible, I’m a terrible person because this is happening to me. So it’s,
it’s just this big circle, but thank goodness for people like you and the other doctors that are getting out there and, and just trying to get this message out to women. And it’s also interesting in the book,
you say, you know, you had this kind of point in the road where you could not be the OBGYN and delivering babies and focus on menopausal health.
What made you decide to find, was it your own personal experience that said, no, I got to focus on menopause? Yes, it was my own personal experience. And also I was just completely dissatisfied with my job situation,
a job I’d been happy with for 20 years, you know, and really for a long time thought this would be my end game, you know, this would be my end game. be my, to my retirement, I would stay in this position. But the reality of the increasing burden from administrative affairs and,
you know, the institution was hiring multiple layers of pistol pushers and accountants and people who were trying to tell me how to do my job and make them more money with taking less care of patients, combined with,
I am a menopausal 55 year old woman. I do not need to be staying up every night to deliver a baby. It’s not possible for me. for me. I was sacrificing my own health, my own mental well -being,
my own resilience in order to do a job. And I had to come to the realization that if I don’t walk away from these hours, I am not going to live the longest, healthiest, happiest life that I can.
Right. And that’s another point, not sleeping well, which is a whole thing. Right. I was already having sleep deprivation. Now I’m having to stay up. Right. And I was not.
we should not be delivering babies or doing surgery or making clinical decisions when we’re up longer than 18 hours. It should be the most rare thing in the world, but it is literally commonplace and it is it’s killing the medical system.
And it’s all about money. They don’t want to hire more. The bottom line. Instead of women’s health and how I have this beautiful non insurance based menopause.
practice where I spend an hour with a new patient. I’ve fully reviewed. I’ve slept beautifully. I’m prepared for her. I’ve read through the pages of information she’s provided to me. I’m ready to have an open discussion about her needs,
her wants, and make a shared decision on what her best course of therapy is. I’m able to talk about nutrition. I’m able to talk about movement. I’m able to talk about stress reduction and sleep and give her a beautiful plan and comfort.
blood work to make sure that we’re not missing anything else and get her on a path to her best health in midlife and beyond. – Which I think every woman, 55, and well,
really, perimenopausal plus one is to be the healthiest and the happiest one. – I couldn’t do that with 15 minute visits and half of that, you’re in stirrups, you know? – This is a good point,
this is a very good point. – Yeah, with, when it comes to menopause, menopause hormone therapy, you break it down very clearly and you talk about synthetic versus bioidentical and I thought that might be a good place to start.
Can you explain the difference between synthetic hormones and bioidentical hormones? So remember all of the hormones that go into your body are made in a lab. So some are,
the starting thing is plants, okay? And that usually leads to the bioidenticals. bioidenticals. Others, the starting thing is chemicals at all, but they all go through the same chemical processing. So coming out of a lab,
so a lot of people think you just rub yams on yourself and that will be your hormone therapy. Stop buying yam cream, it does not work. There’s no clinical evidence to support it. Yams are often the starting bio botanical for,
and but you got to put in a lab and you got to add this chemical and do that and extract that and then do, you know, in order to get the estradiol. Body identical has a synthetic process to get to it.
Body identical means it is chemically identical at the end result to what your body made. Okay. And that’s estradiol, estriol, which is the pregnancy hormone made in the placenta,
and estrone, which is what is converted to or in our fat cells from the periphery. But the most biologically active, safest. safest and most what your body is needing to stay healthy is estradiol.
So that’s my go -to formulation. And that’s what I’m on, the patch. So that’s what I use. But you know, you also talk about, you talk about the different hormones and then you also talk about the people who can and shouldn’t use hormones.
And the big thing, the big scary was the breast cancer scare from the Women’s Health Initiative. But can you also talk about that it’s not necessarily a thing that you can’t have hormones if you had cancer?
Can you talk about those issues? – So it’s a very complicated nuance discussion. Now, certainly if you’ve had a stage one endometrial cancer,
no increased risk of recurrence with hormone therapy. therapy. If you’ve had vulvar vaginal cancer, no increased risk with hormone therapy. If you’ve had cervical cancer, no increased risk post -treatment with hormone therapy.
There’s so much misconceptions. Breast cancer is a very complicated nuanced discussion. Certainly, if you’re in your treatment window, you are not a candidate. If you’re on an anti -estrogen, you do not want to be taking estrogen unless it’s vaginal.
Vaginal estrogen is fine for every single human being. no matter where she is in her life or what cancer she has. You can use vaginal estrogen. I’m talking about systemic estrogen therapy.
But if you’re past your breast cancer treatment, you’re done. And now you’re looking to the next 30 to 40 years, the most likely thing you’re going to die of is heart disease. And if you’ve been on an anti estrogen, that risk is accelerated because estrogen is protective against heart disease.
So now begins the conversation, which is being denied. to the majority of menopausal patients who are post breast cancer treatment is the nuanced conversation of wood hormone therapy in whatever area be a good decision for you for your overall quality of life and your overall health,
not just your risk of breast cancer. So you really need to find an informed, now family history of breast cancer, no problem. If you have a… a genetic risk and we talk about the different genotypes that that might be,
again, nuanced conversation. Right. Because we hear so many women say, you know, they, they’ll ask us, no, we don’t, we don’t answer. We refer to the experts because we are not the experts,
but we do hear that. They immediately, I can’t have that. My sister had breast cancer. I can’t have that. Yes. Yeah. If you knew estrogen in the in the WHI,
the estrogen only arm had a 30 % decrease risk of breast cancer. The women who had the estrogen progesterone arm had a lower diagnosis was lower stage and better survival rate than women not on HRT.
So no one’s having these conversations with the patients and allowing her any ownership in this decision. They’re allowing her to suffer needlessly and not offering any other option of therapy non -hormonal They’re like go home be thankful you’re alive.
Bye. Bye. And it’s outrageous Right. I mean, I was personally denied the first time I asked because my mother had had a blood clot My mother had passed away not from the blood clot and I I couldn’t ask her was your blood clot from an injury was your blood clot What happened?
I didn’t know and She wouldn’t give me you know, I was like, no, go too bad. Good luck. You know, or actually, I was given no increase. Yeah, I was baseline’s increased because your mom had a blood clot,
right? Yeah. Yeah. And my mom, but I’m not going to worsen that risk with hormone therapy. I’m actually going to decrease your risk of a lot of other things. And actually, the data is supporting transdermal is actually anti inflammatory and make decrease your risk of a blood clot.
clot. Well, you know, it seems like some of the conversation is leading towards the proactive element of taking menopause hormone therapy as someone who is not on hormone therapy,
but I am about a year and a half post menopausal. I’m curious, you know, it seems like they keep saying improving, you know, I have osteopenia. It’s helpful for osteoporosis,
cardiovascular health. Is it going to? do you think it’s going into a point where we’re saying take it because it’ll keep you healthier? Like, well, I’m saying it loud and clear. That’s what I’m saying. But you have a window of opportunity.
It will always protect your bones. Let me say that. It will always protect your vagina, your bladder, the general urinary system. It’s all going to be beneficial, but as far as cardiovascular prevention of cardiovascular disease and prevention of cognitive neuro,
neurodementia, okay? okay? There is a window of opportunity that you might miss if you don’t get started now. The longer your body is away from estrogen, the more these chronic diseases start building up.
And estrogen can lower that curve. We’re still aging. Those disease risks are still there, but we go from this to this when we remove estrogen, okay, the acceleration.
We can get you back to here. Lifestyle is still important. All of those things are still important, but for cardiovascular disease, it’s the first 10 years of your menopause where you’re gonna hit that sweet spot of being able to decrease your risk.
We lose that benefit. Does not mean it’s harmful necessarily long term, but you wanna be in those first 10 years. Doesn’t mean you have to stop at 60. As long as the benefits outweigh the risk for you, you can continue. I might die with an astrodial patch on.
So, and that’s totally my choice. – I plan on it. – I plan on it. it. – I want to be crawling on the floor with my great grandchildren at 90 or grandchildren. I want to be functional.
I do not want to be my grandmother who spent the last five years of her life demented in a bed and basically immobile, drooling out the side of her mouth. My mother has been on a walker for 10 years due to musculoskeletal syndrome.
My mother is now going through dementia. I am fighting tooth and nail to stay clear, stay clear. of my genetics. And my other grandmother died of diabetes. I am insulin resistant,
you know, in her sixties. So these, this is my future if I just go with the status quo. And I think that’s what women, when they come to my office, that’s what they want to talk about their moms, their aunts,
what they see the future is and what can I do now to set up some new habits and decrease my risk so that I can age as healthy as possible. And that’s the interesting interesting part because there are women out there who are like,
well, my half ledges aren’t as bad and I can come, but is this going to help me in the long run? And you’re saying absolutely as long as, you know, you talk through your risks and everything with the doctor. And that’s important.
Women should be given that option. You know, maybe 50 plus, there should be a conversation in your yearly discussion saying, right now, only 10 % of women.
Now, let me say this. I. been that OBGEN I’ve been in the practice model do not expect to have that conversation at your well woman exam the well woman exam was designed to screen for breast and cervical cancer and a couple of blood tests that’s it okay make a problem visit for menopause discussion separate than your well woman exam there’s not enough time to get it done or do it justice your best bet go in with
your family history loaded go in knowing what you want, what you want to discuss. You know, go in, make the call before, is this doctor going to discuss my options of hormone therapy with me?
If they say no, he doesn’t do that or she doesn’t do that, do not make that appointment. So. Well, I just wanted to ask also in that particular chapter, you’re talking about DHEA.
And that’s something that I don’t think a lot of women know about. Can you explain what DHEA is? The DHEA is dihydroepiandestine diome, and it is a,
okay, so we start in the human body, we start with cholesterol, and that cholesterol molecule goes through several enzymatic changes to produce estradiol, progesterone,
and testosterone. And then testosterone gets converted to dihydrotestosterone, which is what binds to our skin, okay? So we have these, the estrogen pathway. the progesterone pathway, and the androgen pathway.
So DHEA is one of those steps along the process. So it is a precursor to oliver sex hormones, starting with cholesterol, and that process happens in the ovary,
in the females and in the adrenal gland, okay? There’s great studies with DHEA using that for vaginal cases. So, because it’s… it does seem to help with GSM,
and you end up getting both testosterone and estradiol in higher levels when we use DHEA suppositories in the vagina. So the sexual medicine doctors love it.
The breast cancer patients who are still freaked out about using anything with estrogen in the name, they love it ’cause they just, and fear for no reason because they’ve been taught wrong,
but that’s okay. okay. DHEA works. So oral DHEA is tougher. There is no FDA -approved option for oral DHEA. You must go with supplements, and supplements are only as good as who’s putting them in the bottle.
And so you can get sawdust, and they can slap DHEA on the level you really need. But there’s not enough studies for me yet to justify using DHEA as a treatment option for perimenopause.
I just get give them testosterone. So DHEA is a darling of the chiropractors because they don’t have prescriptive authority. Chiropractors cannot prescribe FDA approved medications. So they have to do supplements as all they can do.
There’s some great chiropractors out there. I love mine, but she knows, she stays with the endoscope of practice. I get really anxious when I see certain clinicians demonizing hormone therapy.
So you should take all these supplements with me. off into chronological tangents really not knowing what they’re talking about so right now I’m not recommending oral DHA for my patients if I feel like they need more testosterone I give them testosterone if I feel like they need more estradiol I give them that remember the ovarian production of your hormone stops because we lose our eggs they are gone so no amount of
DHA and post menopause is going to make your ovaries wake up and make more hormones they’re dead It’s not happening. Yeah. And so you’re, you’re bringing up testosterone, how you prescribe testosterone.
I take testosterone cream as well. And that is such an issue. You will have some doctors that won’t prescribe it. Some doctors train. Yeah.
I wasn’t trained. I was scared of it for a long time. Even early days, my menopause clinic until Kelly Casper said was like, you need to subscribe. esophageal disorder. And so I started experimenting with it with my patients and they’re like,
the best thing ever, I started it. Okay, I have low muscle mass, I mean, it’s better. Okay, but I’ve genetically just don’t have a lot of muscle.
I’ve always been kind of wimpy and thin -limbed. And I know I’ve got to hang on to my muscle to stay healthy as I age. It’s like critical. And so I’m doing the resistance training, eating the – taking the creatine.
And Kelly’s like, you should try some testosterone and see if that’ll help with your gains. I was like, okay, I never thought I had a libido issue. It is absolutely try true and tested for hypoactive sexual desire disorder,
which is in the brain, okay? For women, terrible thing that happens in menopause for the majority of us. I didn’t have any problems. I thought, okay, everybody was happy at my house, no one complained.
I was like, okay, I’m fine. So… start on the testosterone, do my workouts, and all of a sudden I’m like, yeah,
I didn’t think there was a problem, but I would certainly miss this if it went away again, like, yeah, so everyone’s happier at my house. And definitely an uptick in the area.
Yeah, wasn’t side effect was not the third, you know, the desired clinical outcome, but so I can personally attest, which is the worst thing for a doctor to do, but it’s so much fun.
Yeah. Yeah. The hard thing is getting it filled, getting the prescription filled, and is blood work necessary to, is a lot of blood work. That’s a great question.
So we don’t recommend routine testing for estrogen or progesterone because they fluctuate so much, especially in perimenopathy. Testosterone tends to have a steady state, but it’s not rising, falling as much,
nearly as clinically as much as our estrogen and progesterone does. So it’s a little, it’s a better monitor of how you’re doing overall. But postmenopausal, I never check it because I know it’s low. If she’s not making it,
she can’t out of her ovaries. So, but if you’re worried about toxicity, if you’re worried about, they’re not absorbing. If you’re worried about, treatment. treatment, it’s not working, I will check a level to see where she’s at,
you know? Or if she’s having tons of side effects, you know, hair growth, hair loss, I’m gonna check a level. But routine testing has not really been shown to be indicated,
having to go back every three months to have your levels tweaked and adjusted really isn’t good medicine. – Okay, it’s interesting in the third part of your book, you know? talk about the menopause toolkit And you really go into everything from acne all the way down and you talk about Yes,
you talk about medical treatments, but you also talk about holistic treatments and what you could do for your diet and your Exercise and you talk a lot about an anti -inflammatory diet. Why is that so important and what should women be considering when they do that?
that? So when I talk about the menopause toolkit, I’m looking at what things can we do in our pillars of health to decrease our risk of chronic disease and decrease our risk of frailty and dementia,
okay? Nutrition is key, key, key, key, key, key, key in that. And when we talk about nutrition, everything in my culinary medicine training is all about using food to lower inflammation.
So that’s eating foods. that fight inflammation naturally and that’s going to be things that are packed with things we call phytochemicals, anthocyanins, powerful antioxidant,
anti -inflammatory components found in fruits, vegetables, leafy greens, dairy probiotics,
all of that works together to promote our best health in multiple organ systems. across many aspects of metabolic disease and avoiding foods that promote inflammation,
additives, chemicals, things that disrupt your gut, et cetera. So I covered that, that was my first book, that was the Galveston diet. We went, we deep dove into all of that stuff, but it really holds true. It’s not gonna regenerate your ovaries,
it’s not gonna extend the life of your ovaries, right? We’re still gonna go through menopause, but the way our body reacts to the estrogen… loss is going to be much healthier if you eat an anti -inflammatory diet.
Well, one of my favorite things in your book, well, is all the examples as wealthy. And when you put that, you’ll say, here’s the foods for this, here’s the foods for that. But I love the list that you could have to ask your doctor’s questions,
because I think that is what so many women don’t even know what to say. Can you talk a little bit about how you include how to arm yourself with the right questions? – So knowing that your time is limited in this exam,
you’ve got 15, maybe 20 minutes tops that you go in prepared. So, you know, listening, that’s what patients wanted. This is what my followers wanted. Tell me what to say when I walk in the office and tell me what questions to ask.
And so I prepared, it’s too extensive to go through here, but it’s in the book. book you know how to prepare for your doctor’s appointment what time of the day to make an appointment go in the morning um go fasting blood work done right then you know just practical tips that like I know my patients are gonna have a better experience because they’re getting me fresh they’re fasted we can get blood work right away
there’s no wait time for that and then what questions that will make you seem like you know what you’re talking about you know that you’re prepared articles you can download and print out to hand to your doctor,
you know, you may be educating your physician quite likely. I’m sorry to dump this in your lap. This should not be happening. But this is the state of the state. And if you want to use insurance, here is the best way that you can get the biggest bang for your buck.
– Right. – Wow. And you also talk about intermittent fasting. And I know there’s been some research that’s coming, that’s come out recently about cardiovascular risk. Can you address that?
Peter or Tia addressed it the best, I think. And of course, I follow him as the rest of the world. I love a lot of what he says, but a lot of the data is just based on men. But I really like Stacey Sims as well.
As far as the musculoskeletal system, she’s a PhD physiologist and this woman only studies women. So I kind of pull from those two. She doesn’t love fasting for older women because it’s really hard to get your adequate nutrition in that window.
We need a lot more protein. And so she doesn’t feel like the benefits hold out on the far end. There’s so much other things that we could do. So that’s kind of one thing.
I’ve shortened my fasting window to about 14 hours. I used to go 16 and I’m kind of shortening it because I’ve increased my protein intake since I wrote Galveston time. based on Stacy’s research and Gabrielle Lyon who wrote “Strong Forever Strong” and then you know I really like how Dr.
Atia had really broke down that article. That article actually has not been presented yet it was just an abstract and so you know there it seems blown way out of proportion it doesn’t make any biological sense and so I’m waiting to see when the full article gets dropped,
when people are able to really dissect it, that it might not be the best science. – And that’s what, I’m sorry, but women just hear that. Like it’s a promo on a new spot.
And they’re like, okay, it’s really important to not just trust a little blurb of five seconds. – It was just a blurb. They went after the easy headlines and because people will click on it,
it’s gone. It’s clickbait. Right. And it’s just another example of misinformation because we spoke to a bariatric obesity doctor as well that said, you know, I don’t, I don’t really trust that or that.
She was waiting for more information. He was waiting for more information too, but she said it just doesn’t make sense to me how that, you know, could be an issue. So it’s, yeah,
and you’re the second you know, doctor that has studied this that is, you know, said the same thing. So that’s, that’s two that we spoke to personally. Yeah. What about supplements?
I, as a matter of fact, just ordered your Omega three supplements, which I’m waiting to receive. Well, because my LDL, HDLs were a little high low, whatever, it’s the bad one. So I was like,
you know, let me try them, you talk about them, I would supplements, like you said, are not all made the same. And Bridget and I are very cautious about taking them. Obviously, I would trust, you know, what you’re, you know,
the omega threes. But how can women get the benefit from supplements, but be careful not to kind of buy the wrong thing? So you have to ask yourself what you’re supplementing.
And, you know, supplements are never going to take the place of a healthy diet. You can’t swallow a handful of pills and then expect it to to negate for choices. That’s not how it works. Supplements are always meant to supplement good nutrition.
There are supplements that will shore up a deficiency. Okay, so that’s one way we use supplements. The other is there are some supplements that seem to have some medicinal benefits without a deficiency,
right? So we don’t need turmeric to survive. There’s no turmeric deficiency, but turmeric is a really powerful antioxidant anti -inflammatory. There’s no… omega -3 deficiency. We can make it in our own bodies,
but eating diets rich in things with omega -3 fatty acids is powerful anti -inflammatory versus magnesium or vitamin D, which you have deficiencies of because we don’t make it.
We must ingest it to stay healthy. Does that make sense? Yes. And so when I started Galveston diet and when I was constantly talking about nutrition, I was recommending supplements all the time. And so you should look at a fiber supplement,
you should look at an omega three supplement or vitamin D supplement. And I was struggling to find, you know, affordable, tested, you know, efficacious,
that were safe. And I knew what they said was in it because they’re not regulated by the Food and Drug Administration. You can put anything on a bottle and sell it. And so finally I got to the point where I was like,
why wouldn’t I just make my own. I’m constantly recommending these, these companies are calling me and saying, can you tell me when you’re gonna talk about my product ’cause we’re selling out? I was like, so then I was like my little entrepreneur self which full disclosure,
I sell supplements and I have a booming business. I was like, why wouldn’t I make high quality supplements for my patients and my followers and the students in the Galveston diet? So we just put a toe in the water and tried it and it’s ended up being a really lovely business.
We only have, well, we just have five now. So we have fiber. Okay. Women only get about half of the amount of fiber they should have in their diet per day. If you’re getting 25 or more naturally, you don’t even settle. Okay. We have an omega three vitamin D and vitamin K combo.
So I’m lazy. I like to combine things because it makes it easier for me that are, you know, vitamin D because 80 % of my patients are deficient in vitamin D. Most menopausal women are for women.
reasons. And then omega -3 for the added antioxidants. And then we have a collagen supplement that is good for bones and skin. And we have a creatine product that is great for,
you know, and my big thing is osteoporosis prevention. So there’s some great studies with creatine combined with muscle training and protein intake that have been shown and the weighted vest and all the things I recommend to avoid osteoporosis.
osteoporosis. And then we have a turmeric, which is great for musculoskeletal pain and menopause. – Yeah, I mean, yeah, I’d have seen your videos with your weighted vest on, not at Mr.
Graham. And I love that. And I wanted to, just to add for our listeners about pause life and what you, could you talk a little bit about that?
– So the pause life is our website in the name of our company. We… We started out as the name of the Galveston diet, and but I wanted the umbrella to be bigger and there’s a lot of negative connotation around the word diet.
And so I’m like, I’m bigger than a diet. I don’t wanna be known as the diet doc or just a weight loss doc. I wanna be known as a menopause doctor. So we came up with the pause life as a more inclusive umbrella that would cover not only nutritional wellness but sexual wellness and all of the things that we have.
So on our website, you have links. to the books you have links to blogs free information quizzes all kind of tools things you can download to take to your doctor you know like I try to provide as much education and information on our website as we can.
It’s very comprehensive and very helpful when you’re preparing for your doctor’s appointments because you do have a host of information there that women can take you know there we get so many questions all the time from women.
and we’re like, there’s resources out there, you just need to find them. So thank you so much for coming on and guys, check out the new menopause book by Dr. Mary Clara Haver. It’s awesome.
We highly recommend it and we thank you so much for what you’re doing for women and for your time today. So welcome. Thank you. Thank you. (upbeat music)