The Dr Louise Newson Podcast - 249 - Dr Mary Claire Haver: on a mission to demystify menopause

Episode Date: March 26, 2024

In this week’s podcast Dr Louise is joined by Dr Mary Claire Haver, an obstetrics and gynaecology doctor and a menopause specialist in the US. Dr Louise and Dr Mary Claire discuss the challenges of ensuring all women have access to evidence-based information and treatment, and their hopes for change. Dr Mary Claire shares her three tips to help menopausal women improve their health: Really focus on your nutrition. Make sure you're getting adequate fibre in your diet every day. Fibre-rich goods are good for you gut microbiome, help you stay full for longer, and are good sources of vitamins, minerals and nutrients. Limit added sugars – those that are added in cooking and processing - to less than 25g per day. Women who do that consistently have less visceral fat. Visceral fat is tied to increased risk of chronic inflammatory diseases. Don't just focus on cardio for your movement. You really need to keep your muscles strong so at least two days a week pick up some weights. Multiple studies in menopausal women show much better outcomes for osteoporosis with resistance training. You can follow Dr Mary Claire on Instagram at @drmaryclaire Click here to find out more about Newson Health Pre-order the revised and updated paperback edition of Dr Louise’s Sunday Times bestseller The Definitive Guide to the Perimenopause and Menopause here   References to studies discussed in this week's episode J Gen Intern Med 2006; 21:363–6 J Gen Intern Med 2004;19:791–804 Am J Med 2009;122:1016 – 22 JAMA 2004; 291:2243 – 52 Int J Cardiol 2010;138:25 – 31 Urology 2024; Jan 29:S0090-4295(24)00006-2

Hello, I'm Dr Louise Newsom. I'm a GP and menopause specialist and I'm also the founder of the Newsom Health Menopause and Wellbeing Centre here in Stratford-Pon-Avon. I'm also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research,

bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newsome Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on my podcast, I've got another clinician who is in US and really excited, actually. I've been stalking her for a while. We've been sharing each other's post sometimes and it's great because we can.

think the same in the way that we work, the way we practice and the way that we educate people globally as well. So she's a quite well-known, getting more well-known, Dr. Mary Claire Haver, and she is an obsciney person, OBGYN, and she's also got qualification in nutrition as well. And she's like me, really, on a mission to demystify and simplify the noise that's been going on over the last couple of decades. Would that be fair to say, Mary Claire? Absolutely. Removing the shrouds of secrecy and shame and misinformation around the menopause. Yeah, it's really interesting actually. So about, well, eight years ago now, when the International Menopause Society produced their guidance and nice over in the UK to produce their menopause guidance, I went to the International Menopause Society Conference. And all these people were talking about menopause and the health risks and the problems and how safe HRT is.

and I sat in this auditorium thinking, what can I do? How can I help women? Like, I'm only seeing 20, 30 women a day. I was a GP then, and I was busy, and I thought, I'm never going to make a big difference. So what can I do? And I thought, why, I'm going to play with media and social media, because technology is the only way we can reach people. And so since then, I've just been posting and I've been educating people because I've been a medical writer for many years as well. And it's been really empowering. But it's a really incredible space that, you know, 30 years ago we couldn't have educated in this way.

No. I am shocked about my own growth on social media. You know, I knew I was a good communicator. I knew I could talk to patients in a way and breaking down complicated medical information into something a layperson without my background and training can understand. I'd done it for years, you know, talking about risk benefits of medications and surgeries. et cetera in my practice. And then learning how to translate those skills onto social media has been such a wonderful kind of surprise for me. And it's just the feedback that I'm getting from my

followers about you've changed my life. You gave me tools to advocate for myself. You've given me hope. You know, I thought I was crazy. I was gaslit. I was dismissed. And now I feel like I have, you know, a set of skills that I didn't have before that I can take to make my health better moving forward. And that to me is everything. It's incredible, isn't it? Because I'm sure you like me went to medical school because we wanted to help people feel better, but also we wanted to reduce the risk of diseases. And there's very little in medicine where you can really do that. You know, I've held diabetes clinics and I've run asthma clinics and it's still quite difficult because people don't get completely well or they're not taking the medication

properly or they get side effects of their medication or whatever. Whereas my menopause clinic is just transformational medicine. But actually to hear the stories where your people that you don't know, you're never going to meet, you're never going to make any money from them, it's not a commercial situation. Those are the people where, you know, people say to me, thank you, you've got my life back, my family back, my job back, I can't thank you enough. It's amazing.

it's also really frustrating. You know, we've always been told, well, it's flushed sweats, it's just something that happens. And then I go to lectures and people say, well, the symptoms only last five to ten years. Only, I don't understand. Do you let people suffer? It doesn't really make sense. And then when I sort of explain to people how important our hormones are biologically, how they help with mitochondrial function, how they reduce oxidative stress, how they're anti-inflammatory, how they work in our brain, and our brain produces these hormones. You can see the gynecologist going, what's she talking about? The menopause is just about a few symptoms. And so when there's this big debate about medicalising the menopause with HRT and it should be a natural transition,

I find it quite difficult to think that women, the majority of women globally, are being refused this evidence-based treatment or not allowed to have it or don't know it's available. there's obviously different reasons why people don't take it. Right. But it's not usually because women don't want it. It's just they can't access it. They can't, yeah. There's definitely barriers to access.

In the U.S., you know, if you're fortunate enough to have traditional medical insurance, you know, but we have a huge percentage of our population that does not have access to what would make it easier for most people. But even if you do have it, you walk into your clinician's office and there's barrier after barrier after barrier, and probably one of the biggest barriers is just lack of education and training around menopause and not only symptom relief,

but the potential preventative aspects of hormone therapy. And those are just being completely dismissed and ignored. And why do you think they are being dismissed and ignored? Because there's good evidence and it makes sense as well. So it's really important when we look at studies, we don't interpret them in isolation, because obviously you can skew data, you can have different trial population that don't translate to real world data. But actually, we know our hormones are very anti-inflammatory.

So when we think about heart disease risk reduction, we know estradiol is anti-inflammatory on the endothelium. It helps relax the blood vessels. It helps lower blood pressure. It helps the way our kidneys work. So all that fluid balance and everything else as well. And we know it reduces arthroma, and reduces cholesterol. So it makes sense that when people have HRT, it lowers their risk of heart disease. And we've got studies that show that. But I know, like over in the US and over here, a lot of the societies will say there isn't enough evidence. So then people then get scared. But actually, there's better evidence at giving HLT for primary prevention of heart disease than there is compared to a statin or a blood pressure lowering drug. Right. But even so, there's still

this antagonism saying, no, there isn't, no, there isn't. And I don't understand. why we have to try and not have this professional curiosity and look at the data and look at the common sense as well? I think it makes it harder. There's so many, you know, boxes to check. And a lot of doctors across the world kind of stop learning once they get out of their training programs. And they kind of stick by what they learned in school and maybe pick up a few things over time, but at least in like the OB-Gen literature for our continuing medical education from my board certification, there is rarely a menopause-focused article. Last year, they did present the American Heart Association article that came out in 2020, looking at the menopause

transition and risk of heart disease. And just a week ago, AHA, just American Heart Association in circulation, again, just presented more data, really, really fascinating. But by and large, it just seems like that information is not being picked up and disseminated. I think honestly, Dr. Newsom, we are a generation away from a woman being able to walk into her health care provider's office and getting an informed conversation about menopause. Yeah, I think the times are changing. I mean, on Wednesday I was chairing a women's health education event, and there were thousands of doctors there because there were lots and lots of other things going on.

there was heart disease and various other streams. But it was the first time they'd had a menopause education sort of tent, if you like, lecture theatre. And the organisers, I did try and warn them that it would be busy. But they literally couldn't fit everyone in the lecture theatre. And it was like the first day of the sales. There were so many people wanting to know, which was wonderful. Like a few years ago, no one, the tent would have been empty.

No one would have been interested. And there are some fantastic healthcare professionals who have this curiosity, who are understanding, but also a lot of them say to me, gosh, since I've been prescribing HRT, the women aren't coming back every week. They're not having all these symptoms. They're able to reduce their blood pressure treatment. They're coming off their antidepressants. And this really is amazing.

And in medicine, when you learn and you do something, then you learn more and then you apply it and hopefully teach your colleagues. So this ripple effect is definitely happening. But there are still certain doctors and clinicians, not just doctors who, are very resistant to change and it's really difficult making a change, isn't it? It is. You know, and it's like you say, it's the doctors who are approaching new data with curiosity and those are hard to find. I think because in both of our healthcare systems, doctors are overwhelmed. Yes. You know, the burden of so many patients to see in a day in order to pay your,

you know, reimbursements are going down in the United States. You're having to do more ancillary care. And it takes a long time to take a woman with 19 symptoms and tease out all of the important information to determine, is this really perimenopause or is this hypothyroidism? Is it both? Is it autoimmune disease? Is it, you know, primary hypertension? And without that good baseline of training and knowing how to recognize these things, it's just hard. And, you know, we have a long way to go. You know, I think this is not just an OBGYN thing. You're a GP. You're a GP. this is an all medicine thing. This is all specialties need to include menopause. Like female health care, I don't want to call it menopause. This is women's health. I totally agree. And it's actually,

I was thinking the other day it's more health of women rather than women's health. And there is a subtle difference in that when we say women's health, it's always about contraception. It's about fertility. It's about periods. And I don't want to be defined by my fertility status or whether I have periods or not. I'm 53, like, forget it. But actually, I don't even want to be called menopausal. I just want really good health. And so when you talk about health of women, then you're including cardiovascular health, you're including brain health, you're including, and I think that's where we've got to put the change. And I don't want to see myself as a menopause specialist, because I actually see a lot of perimenopausal women or a lot of women with PMS and PMD. So it's the hormonal changes, but it's

not, like you say, there's so many other hormones as well. We just, this is just block when it comes to these three hormones that we all need. And men need too, of course. I'm writing that down, the health of women. I love that so much. I think that is the change that needs to happen. And I talk a lot about this on social is, you know, and I'm stealing the phrase from Dr. Stacey Sims, who's an exercise physiologist who looks at muscle strength, training and health in regards to females very different than males. And she says over and over again, we are not little men. Yeah, absolutely. So there's a lot of historical context around medicine that a lot of the tests, the drugs, the pharmacology, were done on the average 30-year-old white male. And all of that,

you know, data gets extrapolated to other cultures, other races, and other genders. And it's just not how we work, you know. And then when you layer on estrogen deprivation and hormone, and the fluctuations in our cycles, free menopausal, and then the loss of them postmenopausal, we're very different medical beings. And for the health of women, I think we need half of all of the research budgets, half. Absolutely.

I totally agree, because otherwise it gets fragmented. There's a little budget for women's health, and then it gets fragmented quite rightly. Yeah, fragmented quite a bit. Into conditions like endometriosis and fertility, which is really important. But, you know, when I speak to cardiologists and say, do you prescribe hormone replacement therapy? Oh no.

But do you see women with palpitations? Oh yeah, lots of women in their 40s and 50s. Would you ever give it? Oh, and then psychiatrists, no, no, no, we don't. But then that doesn't help. And then so many people say to me, do you know what, we're so bored of listening to the menopause, it's gone on for so long.

And then when I say, actually, only 14% of women in the UK who are menopals or take HRT, it's a real shock. But, you know, you're going to shock. the audience by saying how many, what was the percentage of women in the US? It's four. Four percent. Four. And pre-WHA, it was about 30 percent, wasn't it? Here it was about 40. 40. So 40 percent, and it was on the increase, wasn't it? Yeah. It was. So this was before the study that was the biggest car crash for women's health. And actually, the study, even when you look at it in the worst eyes, it's not that bad a study. It still shows benefits of hormone or replacement

therapy. Right. And it showed wonderful like information on protein intake and frailty. And I mean, there's good information that came from it. Yeah, it was a good study. And now we've just nail on the coffin for HRT. And from 40 to 4 percent, and I know your heart disease figures, rates have really increased. And of course it's not just hormones. Right. Nutrition's got worse. Obesity's got worse. But actually, I don't know about you, but it's really hard to have as good nutrition and as good exercise when you're menopause and I'm really struggling with symptoms. It's difficult, isn't it? Yes, definitely. The mental health load is just incredible. And, you know, why aren't the psychiatrists recommending hormone therapy? Why aren't the cardiologist? The neuroscientists think you

should be doing it. You know, the PhDs think you should be. The, you know, people in the labs who are writing these articles and doing the research are really pro-HRT, but, you know, the people. It's it's just not translating to the rest of the medical subspecialties. The orthopedic surgeons should be recommending it routinely. Cool, they should. For musculoskeletal syndrome of menopause and osteoporosis prevention. Yes, and it's licensed in the UK. It's certainly licensed as a treatment for osteoporosis.

So anyone who has an osteoporic fragility fracture should be thinking about having HRT. And certainly rheumatologists, you know, the people with muscle and joint pains. And the urologists, I've done some training with this. Association of neurological surgeons. They are a lot better with vaginal estrogens. Absolutely. But then we've got introsa, which obviously helps with testosterone. But they don't prescribe systemic hormones. And as good as vaginal hormones are, they just don't get absorbed systematically. That's why they're good, obviously, for women who've had breast cancer as well. But a lot of women still have urinary symptoms because they need systemic hormones. But they're still a bit,

oh, not sure, Louise, not really sure. But they prescribe. other drugs. They prescribe drugs for overactive bladder, which have all sorts of side effects. They prescribe anti-musculinics, which increase risk of dementia and probably heart disease as well. So it's how do we get that shift where people can be confident? And I know there's a real scare of litigation, isn't there, in the US and here. Yes. For us, there's a huge scare of litigation. There was a paper, a follower sent to me. And it was a full sheet completely tight. of a consent for hormone therapy. Like before they would, the physician's practice would give them the prescription,

they had to sign this paper. And it was basically all four of the findings that have been rescinded from the WHOI. And the only benefits listed were relief of hot flashes and osteoporosis prevention. That was it. You know, and the patient was like, can you believe this? And I'm like, this is rescinded data, rescinded. You know, I can show you the studies where these were rescinded points. on the risk of breast cancer and, you know, all the things.

But it is just, it was the original viral, you know. But it's very difficult. You know, I actually, it was awful. Last night I was feeling a bit overwhelmed with life and tired and a bit emotional. And then this morning I was in the shower, I thought, oh, I haven't, I took my patches off and I forgot to put them back on. So I'd had like 15 hours without any estrogen. And of course I'd still have some.

But as you know, it declines quite quickly without. So I opened a new package. packet of my patches and I always put it in recycling because in that box is this MHRA risk of death, risk of breast cancer, risk of heart disease. And it's so wrong because actually it's linked to our prescribing as well. I don't know what it's like in the US, but if I prescribe a patch comes up with a warning of risk of breast cancer which increases after a year. And so then I'm thinking, well, no wonder doctors don't prescribe it. No wonder women are scared because they go home and read this horrific insert and your FDA is to say. And so why is it that it's so hard for women who want it to get

HRT, but it's so easy for men who want it to get Viagra, for example, which has more risks actually for a lot of people than when I'm just talking about transdermal Easterdial. It doesn't seem fair. It doesn't. And I think it's kind of the built-in misogyny in medicine and fraternalism and, you know, just it's a stark example of how men, you know, males are treated medically versus how females are treated medically. And where did informed consent go? Where did shared decision making go? Doctors feel like they are in control of a woman's health.

And we're not seeing the same amount of shared decision making. You know, women aren't given the option. You see, I think this is really interesting because we know there are health risks of being overweight and smoking. Of course we do. But I would never refuse treatment of any treatment. You know, I'm not talking about hormones, any treatment. I wouldn't say to someone, you've got raised blood pressure, you're overweight and you smoke, I'm not going to give you any treatment because, you know, your lifestyle increases your risk. Whereas women are being told there might be a small risk of breast cancer, but we're not going to give you this treatment.

but if they were overweight, their risk of breast cancer would be more, but they still have allowed to have treatment for other conditions. But they're allowed to choose what they eat. And the same with medication. We can choose if we're consenting adults whether to accept or refuse certain treatments. We do that in every aspect of medicine. And as you know, if you do surgery, this is what the consent process is about. Right.

Whereas somehow women are not allowed to choose. They have to adapt and have this manifest. transition where they take a second-rate job or they give up their job, they have to accommodate to the weather if they're having flashes. I was listening yesterday, there's a clinic in Manchester where they have a memory and concentration clinic for women who are menopausal. It's like, what about giving them some hormones and saying if they want it? And my problem is, is that a lot of people tell me that we're pushing HLT, the social media doctors are pushing and it's terrible and all this misinformation. But actually, I've said, I don't mind the percentage. If it's 4% for you and 14% of

us of women who take HRT, and that's all the people that want it, that's fine. But what I really want to keep working for is that 100% of women who want to take HRT can easily get it. And whether that's 4 or 40% is irrelevant really. And it sounds like you're getting the same horrendous stories that I am every day from women who are just refused it. What's not happening in the is women aren't given informed conversations. Like, I don't think every woman should choose HRT or that's the magic bullet for everything, but women are being denied the conversation. I think 100% of women deserve the conversation of her particular risk and benefits.

I totally agree. That's not happening. No. And that's the same. I think, you know, I'm as a family physician, really holistic. Everybody should have a conversation about nutrition, about exercise, about lifestyle, and actually how I would talk to a teenager about their nutrition is quite different to a menopausal woman or an athlete.

We adapt and we change and it's really important. And women, when their menopausal, should have individualized consultations which don't just look at hormones. They look at everything together. And they might choose one thing first, whether it's, they might decide, well, I'm going to sort my nutrition out first, Dr. Newsom, because that's really important. And then I'm going to think about hormones. Or they might say, I'm going to do everything together.

everyone's different. You know, we dress differently, we talk differently, we're allowed health choices differently as well, but they have to be controlled by the patient. Really is so important, isn't it? Agreed. Agree. And it's not happening. It's not happening. No. We have no nutrition training in the United States for medical health care providers unless you happen to, like me, go back to school and learn or happen to have an undergraduate degree in nutrition science. My daughter, who's a first-year medical student here, her undergraduate degree, is nutrition science and I'm like, oh. Amazing.

That's so good. It's so important. So it is looking at everything to improve health because you're the same as us over here, but globally the commonest cause of death is cardiovascular disease and dementia, but all these inflammatory diseases. And I know like me, you're very interested in diseases of inflammation. And we know increasingly, which is good,

people know about inflammatory foods and processed foods and everything else, and how exercise can reduce inflammation, good sleep can. But we've known for decades, way before WHOHI study, how anti-inflammatory our hormones are as well, haven't we? Right. All the observational studies before clearly pointed this out, you know, and although WHO was originally thought to do was going to confirm these things, but they started too late.

You know, all we did was confirm that estrogen is better at prevention than cure. So moving forward, we've got a lot to do in it. And, you know, the platform that you have, you've got your book that's coming out, which is great. And it may actually, you're very open about your own experience and your own strengths and weaknesses as well, which I think is really good for people to listen to. I know some medical professions over here really don't like it when I talk about my own experience. They've told me off. But actually, I think it's good for people to know that we are. are human. We have some days that are better than others and we've made choices that are right for us.

They're not necessarily right for everybody. But I think showing that you're so motivated with your own health has got to be a good thing. I think transparency is everything. And I think trying to create this false narrative of you're not human and you don't have good days and bad days. And it's all about moving that needle towards a better health for women. And that's going to incorporate nutrition, exercise, stress reduction. And you know, you're not going to check every box every day, but we all can be healthier. And there's multiple paths to get there. Absolutely. And it doesn't happen overnight as well, I think, is the other thing. It's so easy to look at people and think, wow, but you have to chip away at things. And not do it alone, I think is really important, isn't

that? So in my clinic, my patients are not coming in wanting to look great. in a bikini. I mean, that would be nice, but that is not their motivation. They're looking at their mothers. They're looking at their aunts. They're looking at older women and their generation and seeing the frailty, seeing the dementia, seeing the heart disease, seeing that 10 years of chronic disease and that long slog till death. And they know women live longer than men, but we live 20% of our lives in poorer health than men. And they're like, I don't want that. And one of the biggest motivators for me, after dealing with my parents and my older brothers, I have, don't want to burden my children with the pain of my chronic illness as much as I can do to

avoid that. And that is really a big motivator for most of my patients is they don't want their children to disrupt their lives to come home to take care of them. You know, they want their children to be living their best life and for them to be living with them, you know, in a way that is supportive and not the children taking care of the parents or for as little as possible. Yeah. And that is so important because, you know, we are generally living longer and it's not the age we die, it's the journey to that age and how we can keep as well as possible. Because I want to be independent. I don't want to be cooped up in a nursing. I want to be able to think as well. You know, my mother is really mentally active and reads a lot and is interested in life. And I want to do that. It's not the age that I die. It's how I keep going. and you have to invest now for the future.

And sometimes if you don't, it's never too late, but the earlier you realise that simple hacks in your life can make a difference. It's really important. But knowledge is power, actually. And I think what we're both doing between us and there's some great people across the world, there's some really good healthcare professionals who are joining our little group is enabling people to have access to data that they couldn't have before. And, you know, like me, you're very evidence-based.

You read papers and then you share, like, top line. And I think that's crucial because in the past, patients haven't been allowed this information. And I know some doctors still don't like it. But I think it's wonderful to be able to educate people, don't you? I do. I do. I think that's everything. That's my favorite thing to do.

I get so excited every morning I read articles. and I can't wait to share the things that I find. Yeah, I think so. And I think, you know, I've said to many people, I'm just a messenger. Like, don't shoot the messenger. I'm just regurgitating evidence. And sorry if it's evidence that you don't like or it feels uncomfortable, but actually I think we deserve to know and increase our knowledge, don't we?

Agreed. So lots to do. We've done a huge amount, but it still doesn't feel enough. I don't know about you, but I feel inadequate every day and think about all the things I need to do, not the things I've done. But what we're doing is definitely making a difference. People are listening and people are very grateful, and that's really important. So before I end, Mary Clow, always ask for three tips.

And so three things that you think globally would make the biggest and quickest difference to improve the health of men orples or women. One is really focused on your nutrition. Make sure you're getting adequate fiber in your diet per day. most women in the U.S., at least in probably UK, are only probably getting around 12 grams of fiber per day, and we really should have 25 or more. That hits multiple, that's insulin resistance, gut microbiome health, staying full longer, you know, in those fiber-rich foods are also other vitamins, minerals, nutrients.

So that's one. Two is make sure that you are limiting your added sugars. So sugars added in cooking and processing, not fruits and vegetables, you know, or dairy. two, less than 25 grams per day. Women who do that consistently have less visceral fat. Visceral fat is tied to increased risk of all the chronic inflammatory diseases. And three, don't just focus on cardio for your movement. We really need to be trying to keep our muscles strong. We have an accelerated muscle mass loss, which leads to increasing bone loss. So multiple studies in menopausal women showing much better outcomes for osteoporosis with resistance training. So, you know, at least two days a week,

picking up some weights to try to keep those bones and muscle strong. Great advice that everybody can learn from. Actually, you don't even have to be menopausal for a lot of that advice. So thank you so much for your time. It's been wonderful. You're so welcome. You can find out more about Newsome Health Group by visiting www.newsonhealth.com.uk. And you can download the free balance app on the app store or Google Play.