Live Like a Girl with Dr. Mindy Pelz - The Essential Menopausal Toolbox with Dr. Mary Claire Haver

Episode Date: July 8, 2024

Dr. Mary Claire Haver discusses the importance of education and empowerment for women during menopause. The conversation covers debunking myths about cognitive decline, embracing menopause as a period of strength, and making gradual lifestyle changes. This episode advocates for improved menopause education in medical training and better support for women's unique health needs as they age. To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visit https://drmindypelz.com/ep243 Dr. Mary Claire Haver is board-certified in Obstetrics and Gynecology and is a Certified Culinary Medicine Specialist from Tulane University. She is also a Certified Menopause Specialist through The Menopause Society. In 2021 Dr. Haver left traditional practice and opened Mary Claire Wellness, a clinic dedicated to caring for the menopausal patient. Dr. Haver has amassed over 5 million followers across social media by posting advice for women going through menopause.  Dr. Haver is the author of the New York Times #1 Bestselling Book, The New Menopause and the national bestselling book The Galveston Diet. Check out our fasting membership at resetacademy.drmindypelz.com. Please note our medical disclaimer.

On this episode of the Resetter podcast, I bring you the one and only Dr. Mary Claire Haver. Okay, you all had asked for this. I have received messages after messages asking to bring Dr. Haver on to the podcast. So many of you know her book, The New Menopause, has been just taking over the world and firing women up. And I have been waiting months for this interview because I respect her on so many levels. So if this is new, if Dr. Haver's work is new to you, let me just give you a little background on her and then let me tell you about what you're about to hear. So Dr. Mary Claire Haver is a board certified OBGYN. She's helped thousands of women going through perimenopause and menopause.

That's actually her specialty. And her goal is really, really to empower women through knowing how to talk to their doctors, knowing what type of medications are available to them, knowing lifestyle tools. She had a national bestselling book called The Galveston Diet, and then her new book, the New Menopause, New York Times bestselling book, was released a few months ago. She has not only an incredible educational background, but an incredible experience with menopausal women. And you'll hear in this conversation, what I really appreciate about her is her heart. And the way she delivers the message of menopause to women, it's about empowering you.

And that so lines up with everything that I stand for and are teaching you as well, is you have the right to speak up for amazing health. and that's what you're going to hear in this conversation. We went to a lot of places in this conversation that you, I hope have never heard before. I hope you'll walk out of this conversation with a tool set you didn't know you had. It was incredibly deep and the topics were vast. So let me give you an idea of a few. I wanted to talk about the new research that's out there right now.

A new study was put out by Lisa Mascone when I brought her on my, on this podcast, she talked about she had had some findings on the female brain. Those findings were released last week. Dr. Haber and I break that down. So what does it mean? What are the new findings on what's happening to estrogen receptor sites in the brain in the post-menopausal years? We talk about that. Then we talk about how do you decide if HRT's bioidenticals, how do you know if that's right for you. Then we moved into what are some of the key things you need to know about lifestyle. So really important that you understand where lifestyle fits into the menopausal picture. And then from there, we go into symptomatology. We talk about everything from hot flashes

to muscle loss, to visceral fat, to brain changes, and what resources do we have for all of that. This is definitely the most extensive conversation I have brought you on the perimenopause and menopausal journey. As you will hear, Dr. Haven and I line up on many of the lifestyle recommendations that we are both giving. It was just a beautiful conversation around how do we lift women up, how do we give women a voice, and how do we give women tools to navigate the menopausal process? And that's what you're about to hear. Welcome to the Resetter podcast. This podcast is all about empowering you to believe in yourself again.

If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. Okay, well, let me just start by welcoming you, Dr. Haber. Your work has inspired me. I have been watching you do your Facebook's lives. and all your videos and is somebody who puts out a lot of video content. I know how hard it is. I can feel your passion and I feel your heart for what you're trying to do for women. So I just want to welcome you to my podcast and say thank you. I can't wait to have this

conversation with you. I'm just so excited to be here because, again, I've been watching you, following you and just love your communication style and how effective you are at inspiring women to look at themselves, habits, changes so that they can live a healthier life and not accept the status quo. So yeah, let's do this. Yeah, let's do it. So I'm going to start this off with when I, over the last couple of days, I've been diving into your book. And I've got to tell you that one of the threads of thought that keeps coming to me is we needed this book, like I'm 54. I needed this book when I was 40. I know when I was in practice working with, lifestyle, with women, like this book was needed 20, 30 years ago.

And I'm so happy you wrote it now in the lens from which you wrote it from. But I also feel like there's this cracking open of a cultural conversation that's happening around menopause. There's like an empowered feeling that women are starting to embrace because of books like this. So what is it that's happening in this moment around the conversation of menopause that wasn't happening decades ago. You know, when I look at the options that our mothers and grandmothers had, and when they got to our age in their 50s, it was like, this is as good as it's

going to get. And they just calmly accepted what the world offered to them by and large, which ended up with them having 20% of their lives spent in poor health and their male counterparts, three to four times higher risk of Alzheimer's, much higher risks of fragility and ending up three to one meeting long-term care facilities for extended period of times more than their male counterparts. Our generation, the elder millennials and the gen Xers like us, because I'm 55, are saying absolutely not. Like, this is not okay.

Thank you. And how we approach, study, and conceptualize our menopause, which is from the last menstrual period, until we die, okay? They know that if we just stay on the path that has been laid out for us by society, by how medicine treats us as females as we age, is going to lead to these poor outcomes, and we're not willing to put up with it. And this is the exciting part of what I'm doing is, yes, I'm getting some pushback from the establishment.

You know what, that's okay. Take me out for it. I don't care, you know, because I know that we are. the menopausee, you know, the messages that we're giving women that are resonating with them are leading to change in their habits and health and options that are going to lead to better quality of life as they age. Yeah. Yeah. And I so agree with you that there's like I keep saying to many of the health people in the health world that are educating women, I keep saying, can you feel it? Do you feel it? Like there's something going on. There's something inside women

that we are now being like, no more. You can't treat me like this. You can't gas like me in an office. You can't give me an antidepressant for my menopausal symptoms. There's like this real rising up. And I call it, what I've been phrasing it is the patriarchal hex, that women have been under this sort of hex of accepting mediocrity in when it comes to our health care system.

And by patriarch, I always want to say it's power over. it's not men. I'm right. No. Some of the loudest voices that are the status quo are female. So I want to be very clear. This is nothing to do with men. You know, women are probably the worst at trying, you know, trying to continue a narrative,

at least in my world. And we're just not standing for it. Yeah. Yeah. Yeah. And so with that in mind, I really want to move into the, in this conversation, when you look at the symptoms of menopause, what I see that gets highlighted and profiled and media grabs onto, although that this is changing, is hot flashes.

Right. But I can tell you, as a 54-year-old woman, like hot flashes was, yeah, it was a thing, but can we talk about the mental changes that happened throughout the menopausal journey? Because those were the changes that were affecting every relationship in my life. So when I look at the research and about how these estrogen receptor sites are still very active in us post-menopausal through the, yeah, how do we, what is that telling us about menopause and how we need to do it different? Okay. So let's back up to the first part of your statement of, you know, forever it seemed like menopause treatment was defined by hot flashes. You were 100% right.

Hormone replacement therapy was devised. in the 40s, 50s, 50s, you know, through that pathway, simply to get rid of hot flashes. Forever, we defined menopause symptoms by the presence or absence of vaso motor symptoms. 85% of us have them. For 20, 25, 30% of us, they're severe and life disrupting. But that was it. There was no talk around the brain changes, which led to mental health and cognition changes, the musculoskeletal changes, which, you know, with your background, you probably know what better than

anyone with arthritis, oh my God, frozen shoulder, all of that. Besides the skin, hair, teeth, gut, you know, every single organ system in our body is affected. And the old guard, you know, who wrote the papers on face and motor symptoms, who really defined menopause, you know, and everything else that we are going through at this age was attributed to aging, nothing to do with hormone depletion. And that's where the new research is going. So the beautiful study that just got published in Nature magazine by our friend Dr. Lisa Mascone, who's a neuroscientist who in her entire career has studied the female brain and its relation to dementia and Alzheimer's. Okay, that is what she does. She PET scans brains left and right.

She's at Will Cornell. She's amazing. She is the first person in history. to look at the female brain by PET scan through the menopause transition, menopause brains, and looked at the activity of estrogen receptors. And what we thought was estrogen receptors kind of fall off and die as we go through menopause. No, they actually upregulate. The brain is starving for estrogen. It's creating its own estrogen through peripheral conversion, you know, of estrone to estradiol and some testosterone.

You know, it is dying for estrogen. And so the parts of the brain, the hypothalamus pituitary, the functioning, the cognition, the memory centers are lighting up like firecrackers in postmenopause because the estrogen receptors are like, help me, help me, we need estrogen. The old guard attributed the, we know that women are having cognition changes to menopause. They only attribute that to the loss of sleep from basal motor disturbance. Lisa proved them dead wrong. This is literally due to the loss of estrogen in the brain that lubricates and makes everything work better.

And we take that away and the brain stops dysfunctioning, all stops functioning normally. Also, we know great research coming out of Australia. We have a 40% increased risk of mental health disorders through the menopause transition. So in perimenopause, when the levels become chaotic before they plummet, you know, in postmenopause, that's when we see the biggest disruptions to our mental health. Yep. And forever, that got dismissed as this is a time in your life. You're stressed out.

Teenagers are driving you're crazy. Your parents are getting older. Your job is more demanding. You're not, you know, no, it is literally the disruption of neurotransmitters in our brain due to the chaotic fluctuations of our hormone levels. And here's the third thing that Lisa has discovered, and I've seen it also in the liver literature. FSAH, as we know, right, filicular stimulating hormone, which is made an opportunitary that makes it solubilate, basically, to simplify it. FSAH rises in perimenopause

and then gets really high in postmenopause and stays there for the rest of our life. New data is showing that those FSAH alone without the estrogen depletion is toxic to the liver and the brain, increases the rate of Alzheimer's plaques, yeah, in the brain. just the FSAH elevations. And if we can get those FSA levels down, those processes get easier. I mean, it's just explosive what's happening right now in the menopause world. I'm so excited. Yeah. So there's such a great explanation. So does that mean that everybody should go on hormone replacement therapy? No. That means that everyone deserves an informed conversation about the particular benefits of hormone replacement therapy and how it may affect her life. I don't think it's for

everyone know. It's a medication. You need a full discussion of the risk and benefits. But what's happening in modern medicine is that a woman walks in with hot flashes. So classic vasimotor symptoms, she has a 10% chance of getting the diagnosis of menopause put on her chart. No period. It's a diagnosis. Wait, I don't even, that seems like a fun. 10%. So if she's offered treatment, four to one, it's an antidepressant versus. is menopause hormone therapy. You know, only six to, depending on who you read, six to eight percent,

because we don't track the compounding pharmacies, right? So it's only the FDA-approved stuff. But right now it's 4 to 5 percent are getting FDA-approved H-R-T medications of women who are eligible. Yeah. So do I think all women need it or want it or whatever? No, but I think everyone deserves an informed conversation

not only about the risks and not only about hot flashes, but about the cardio protective and neuroprotected benefits. Yeah, I love that thought. And the way you phrased it is that every woman deserves an informed conversation, which is amazing. Now, I will tell you what I've seen not only in my clinical practice, but in our online community,

is that there's no one-size-fits-all when it comes to HRT. Right. And we can't, we can, and this is what I love about your books, is like, and this is the lens in which I see things, is we can't leave lifestyle. out of this conversation. So what I just want to make sure the women that are listening to this is as exciting as this is, it doesn't mean you put a patch on and life's going to be like how it was at 30. I wish. Right. I mean, I've had to completely overhaul my nutrition, my movement

strategies, my stress reduction, my boundaries, my, you know, I think I'm like you and that, you know, I'm 55, I'll be 56 in about a month. I literally am living my best life. I have better relationships, better intimacy, better health. I'm wealthier. I'm helping more women than I've ever helped in my life. Super proud of my past and everything I've done, but this, this is it. And I want everyone to feel that way, right, at my age and beyond. But had I not overhauled, how I eat, how I think, how I move my pharmacological choices, I wouldn't be here today. Yes, amen to that.

And here's what I love about my conversation with Lisa that's bleeding into this conversation is that as I was going through my perimenopausal years, I kept trying to figure out what's going on with my brain. And I brought guests on to my podcast, one of which was Dr. Amen, who I love. But when I asked him what's going on with the female brain, he said, well, it was because you weren't meant to live that long. And I thought, well, that's a horrible answer. I think I was meant, I want to live to 100. So that's a horrible answer. So when I brought Lisa on, she talked about how the brain changes and brought up this idea of the grandmother hypothesis and how our brain

actually becomes a more highly functioning brain postmenopausal years. That amygdala calms down. It starts to be more empathetic. We can see the big. picture. And when I saw that, my brain was like, so basically the brain changes that are happening in menopause are setting us up to be cultural leaders. That women in their postmenopausal years are their absolute best, to your point, living their best lives. But that's not the message that's getting sent down to women. No, it's like you're developing Alzheimer's at a higher rate because is you live longer, and that is not true. That is absolute false.

So if we were to take a woman at 40 and say, here's what's coming down the road, here's what I recommend you do so that you can land at 55 and 54 where I'm at, and we both are at, living your best life, what advice would you give? So I have a little talk that I do. That's like what I would tell my 35-year-old self, so roughly the same thing. nutrition over calories. You know, this whole cultural, I grew up with it. My whole life, I worked out to be thin and I ate to be thin. Those were my two goals because thin meant healthy, okay? Certainly being thin or is more healthy than being morbidly obese. My genetics was never

going to allow that to happen to me. It would be almost impossible, okay, to be morbidly obese. So I have been privileged for that. But I just focused on calorie counts. That's all they taught me in medical school. I knew about quasi-orcore and scurvy and severe vitamin deficiencies and stuff, but basic day-to-day nutrition, I went back to school at like 48 to learn about nutrition. And so, and then incorporate that into my practice, which, you know, then I wrote into a book. But so, you know, really focusing on nutrition over calories, are you getting enough fiber? So, like, I have a few tenants that I focus on. Foods rich in fiber also are rich in so many other things.

vitamins, minerals, nutrients. You know, so it's like you're killing multiple birds with one stone. But most women in the U.S. are really getting about 10 grams of fiber per day. Great studies coming out looking at cognition and fiber intake, you know, in elderly patients, looking at fiber intake and gut health. I mean, we all, you know, most of us know that now. And so women should be getting minimum 25. The health benefits for at least cognition seem to max out around 32 grams per day. That's three times what most women are getting. So nuts, seeds, legumes, crunchy vegetables, fiber, you know, berries, getting food rich in that, rather than just like, oh, locale, you know, like, how much fiber are you getting?

Yes. How much magnesium are you getting? What's your vitamin D level? You know, like looking at those things and the rest kind of falls into place. And then you go from a place of restriction to a place of, I got to eat more. Are you getting enough protein? Oh, my gosh. Like, I was not getting enough protein.

Yeah. For sure. What are your recommendations on protein? Because we've had some really deep discussions on this in my membership group. And people are struggling to get one gram of protein for every pound of body weight. So, again, there's a big mental shift that has to happen. It had to happen for me. But when we look at the, you know, the WHA, the Women's Self Initiative, which kind of threw out estrogen as, you know, optimal treatment.

It's just a data set. There's really good data that came out of there. For example, they looked at fragility schools. in menopausal women and protein intake. And the women who had the highest level of protein intake about 1.4 to 1.8 grams per kilogram of lean body mass. So just under just under one per pound. Had just looking at that had lower fragility scores, we are not eating enough protein to

counteract the sarcopenia of aging. And so up in your protein. So I'm recommending for my patients and I do it in kilogram. I have a body scanner in my office. I measure their muscle mass. I look at their visceral fat. And, you know, I'm really pushing closer to that one gram per pound, you know, a healthy body weight. And they, because they're usually about 50 or 60. So I'm like, don't think it's tomorrow. This is a transition. Okay. So we're going to, you know, don't think you have to fix everything today. You've been living this way. We're just going to get you. Let's make our goal by the end of the year. You know, we have like six months to a year. Let's get you up. And so every. Every month you're going to try to increase here, increase there. And, you know, protein supplements can be a great, like, segue way to get there. I always prefer you to get your proteins or food. You know, supplements are great, but they don't replace whole food and good nutrition.

Yeah. And so, you know, for my patients who are transitioning to get to these higher levels, sometimes a protein shake or sour to some of the bars can be a great way to help them until they figure out how to incorporate more of the protein-rich foods in their diet. What would you say to the vegan? It's tough. It's possible, but it's tough. You know, right? You can be healthy without HRT for the rest of your life. It's tough. It's harder. And so, you know, all of these are not absolutes, but if you choose to be vegan, it's definitely healthier than the Western diet. We know that. But you're going to struggle. It's going to be harder for you to get the recommended amount of protein to avoid the frailty as you get older. You know, the goal is not to be thin. The goal is to stay out of a nursing home. Oh my God, that's so, that you need to say that from the rooftops. That is what I talk to my patients all day long.

I'm like, let's get rid of the acute problems. Yes. Get rid of the hot flashes, the nights, what's the brain fog? You know, things that brought you here. And then we're going to set a course for the next 30 years. Okay. And what are your goals? What does your mom look like?

And look, if their mom is kicking ass at 95 and growing the grocery store and driving herself and playing with grandkids, I'm like, let's do what she does. Okay. Yes. But if your mom like mine is frail and demented at 80, I'm like, we're not going to do what she did. Let's look at what we can change, you know, because that's your genetics. Yeah.

I love that. Okay. So that number one is nutrition. Anything else you say on that? Movement. Okay. So movement. All right.

I worked out to be thin. Cardio, cardio, pick up some weights. We cannot counteract the effects of circropenia of aging without resistance training, most of us. And so I now, the majority of what I do is not focused on cardio. I do some cardio, of course. You know, I set up my, I have a walking gym, my treadmill is a working desk. And so I walk while I work on an incline with my weight of vest. So I love the weight of vest as a hack.

They're cheap. They're multiple sizes. You want to start with about 10%, but great studies done in the elderly of us, you know, which is nine years away for me, by the way. And looking at prevention, like improvement in their balance, in their strength and in their bone density scores, great data on weight of best with protein and take sometimes vibratory training. There's lots of little hacks and things that we can do. But like really focusing on strong over skinny. Yeah. Oh, I love that. Strong over skinny.

I just got a weighted best. I just told my husband this morning, I'm like, I'm a wrecker now. And he's like, what? Like, yeah, I'm going to start wrecking. I'm like it even has a fancy fun name. It's a form of wrecking. I like that it distributes the weight evenly over the shoulders rather than just all on your back. And so my husband is all into it now. So we have like six of them. So in different levels. How much, so I can tell you in putting my own exercise variation together that I've definitely found weightlifting to be great, but I've also found walking to be incredible, especially

when my brain's on fire. So what would give us a view of what like a week would look like as far as exercise variation? So I recommend to my patients, as far as cardio goes, we want about 150 minutes a week. That seems to be kind of the tipping point. And most of that in zone two, a little bit, you know, do a few sprints here and there. You don't have to do much to get the VO2 max up. So, like, shoot for about 150 minutes a week of cardio. So that's like, you know, five walking sessions for 30 minutes a week or three, 45 minutes,

if you have to crunch it down. And then two to three days of progressive load resistance training, a push day, a pull day, you know, just making sure you're hitting everything. Don't forget about stretching. and don't forget about balance. You know, those are the things that are going to decrease our risk of an osteoporotic fracture. And what about yoga? Where, I mean, because like a Syracodicry is a good friend.

Yoga, depending on the type, stretching, balance. And if you're doing a lot of vinyasa and, you know, you're getting a lot of, you know, you see yoga arms all the time. You know, these women are ripped. And so, again, yoga can be fantastic for relaxation, for stress reduction. It's just we must also push our muscles. So you have to do the more aggressive forms of yoga to get that to happen. Okay.

Great. Okay. So second is movement. What's after that? So nutrition, you know, strong over skinny, nutrition over calories. Educate yourself. Educate yourself. You know, learn.

Our books, you know, there's so much great information out there, websites, whatever, you know. And realize you don't have to accept the status quo. But if you probably don't change the habits you've got right now at 30, for most of us, this is not going to go as well as it could for you through this aging process. You know, that includes menopause. Yes. And, you know, changing your mindset around how you look to how you feel. And so, what's important again, but it should not be the primary driver of the choices for your health.

Yeah, I continually say that I all, I feel like I'm partnering with my 100-year-old self. Like literally every day, I'm like, what do I need to do today to make me? my 100-year-old self-proud. And if I always keep her in mind in my day-to-day, I know I'm going to love 100 when I get there. So I'd like where you're going with your thought process on that. What about fasting? We have to bring fasting up. So no, I, I, I, I love fasting for the anti-inflammatory benefits. Those are clear. It's very, you know, neuroinflammation. We have great data. Systemic inflammation, we have great data. Where my patients are struggling as we're aging is, protein. And so my myself, I used to break my fast at noon typically. And I'm kind of, I bumped my window

back about two hours so I can have enough time to get the protein in. And I'm not walking around all day with a chicken breast, you know, in my hand. And so, no, I'm going to chicken breast. And so, you know, I feel like I'm still getting the benefits, the anti-inflammatory benefits. You know, the data for weight loss is not great. You know, and again, I'm not focusing on. on just being thin as a measure of health, and I'm discussing that with my patients. Right. But I do think there's a place for it,

and there's, you know, some great data on anti-inflammatory benefits. Yeah, and what Lisa and I discussed is what we've seen, and she's seen this, I've seen this, where something about the ketone. In fact, I keep diving into, like, does the ketone actually activate one of the estrogen receptor sites? Because something happens when somebody has,

when a menopausal woman has a ketone going through her body, that the brain fog's gone, the mental clarity and focus is back. And she agreed, but I said, well, where's the research on that? She goes, unfortunately, we don't have it. We don't have it. But have you experienced that for sure. I mean, in my personal life, you know, I fast in the morning is, you know, after my, after my sleep. And so I just keep going. And I am absolutely my most productive in the morning. Again, it's quieter. I'm an empty nester now. You know, there's, lots of things feeding into it. But like, I am doing my best work, my best writing, my best reading, researching in those fasting hours for sure, hands down. And many of my patients say the same thing.

Yeah, yeah. So I think we can debate like fasting lanes and fast and protein, all that. And then I, I really lately have been like, we can't stop talking about the ketone for menopausal women, just a small amount because it does seem to supercharge the brain in a really unique way. So Another concept that I've been thinking a lot about is the different rhythms that women put themselves in. So one of those rhythms being the circadian rhythm. So I'll give you an example. I have a good friend who's in her early 40s. She just spent six months traveling from many crazy different time zones, and her whole cycle is completely off.

So she meanders into her OB's office yesterday, and there's a conversation about do we have to adapt your HRT? And one of the things I kept saying to her is you just took yourself out of your own circadian rhythm, bring a routine back. to your circadian rhythm and then see what's necessary in the changes of your of your HRT. So where does circadian rhythm fit into a woman's hormonal rhythm? We, I have, you know, there's definitely a relation because Melanacorden, you know. I mean, we know and melatonin, the natural melatonin, and all of these, all of these little hormones talk to each other in the hypothalamus and the pituitary. And so we just, we're not studying women. We're not studying female animals in the labs, you know, like,

because of this exact thing, all of these rhythms are disrupted as our hormone cycle change when we're pre and perimenopausal and it makes us harder to study. So they're like, she's just a small dude with breasts. Let's just study them in and like, you know, so we need more research here. And I'm not saying that absence of evidence isn't, and I think Peter says this the best absence of evidence is not evidence of absence. I just can't go around recommending things off the bat without, you know, God, this is something that would be fascinating to look at. Right. You know, I definitely think there's a correlation. Yeah. So, and then that also leads me to the nervous system rhythm. And this was something that actually came up the first time I went on,

on Diary of the CEO, is I made a bold statement that women need more rest. And I got a There's great data coming out now, right? Yeah. I got a lot of mixed, like, back at me. A lot of feminist women were, like, appalled that I said women needed more rest. But what I know about the nervous system is you're stuck in fight or flight and your hormonal system is shutting down. So where does rest and recovery have to be highlighted in the menopausal experience?

So we are in peri menopause. we are in a zone of chaos. Okay, the normal signals that used to cause ovulation, we become resistant to because we are losing our eggs supply. We're born with all of our eggs, okay? May last us until we go through menopause. Parymenopause begins when we reach some critical threshold in the quality and quantity of our egg supply. So in general, by the time we're 40, we're down, by the time we're 30, we're down to about 10% of our egg supply, by the time we're 40, we're down to about 3%. just to give you perspective. And at birth, we have one to two millionaires. So, so here we go. So the normal signals that the follicular cells that surround our eggs create the pathway to

make estradiol and testosterone. And so LH and FSAH each month, when we're premenopausal, we get this EKG-like, very predictable rise and fall of our hormone levels if you're healthy, if you're in the same time zone. If you're, you know, like if all the planets line up, you know on day 14, this is going to happen, day 15, D-16, and on and on, the whole cycle, piece itself. Okay? That is how God made us. That is the perfect way, right? Yeah. Now we hit perimenopause. We reached that critical threshold. So the hypothalamus is constantly sensing until we die, looking for estrodial in the blood. When it doesn't see it or when the levels drop, it sends the signal to the pituitary through GNRH to say, tell the ovary to make the estrogenial.

We're running low. LH and FSAH start pulsating, start pulsing. Out of the pituitary gland talking to the ovary. The ovary's like, I can't respond. I don't have enough egg for that. So the hypothalamus says, hey, where's the estrogen? Come on. I, you know, send the signal. The pituitary said I did, and it says send more.

That's where we see the rises of our FSH level in perimenopause, way higher than we ever were in our premenopausal years. Finally, we get that pulse. We get that boost. The egg is like, fine. We get the egg come out, but it's a much higher estradiol level, because we needed much higher FSAH to make that happen. So we get bigger surges in our estrogen, though the timing is off.

It's delayed. And then we have a much bigger crash. And progesterone, yeah, you're quite used to where it used to be in her own men apart. So she's a little slow. So timing is off. So that affects our periods in multiple different ways. Too heavy, too light, too much, too little. You know, everything's off on the table.

It's abnormal uterine bleeding. A, U.B is what we call it in my world. 90% of us have horrific. A-U-B through the period of monopause transition. That's affecting our sleep. That's affecting our cognitive abilities. That's affecting our mental health. Like everything becomes chaotic. So like you said, the nervous system is like, what the heck is going on? Our nervous system thrives on uniformity, you know, knowing what's coming, knowing it's predictable, you know, not only in our day-to-day activities, but how our body's reacting to the normal stresses of life. And I know I'm going

off on tangents here, but I get so excited. No, no. I love this. You keep going. All of it means perimenopause, zonopaths. Zonapath. Absolutely zen of chaos. And when I say that, women are like, oh my God, thank you. Thank you. I'm not crazy.

Yes. Yeah. And I think that, you know, I've been saying that. I hear you saying that. We have so many people, like, if there's one thing that women need to hear is you're not crazy. When I look at the statistics on suicide, the most common time for a woman to commit. suicide is between 45 and 55. And I'm like, yep, I get that.

Our SSRI use doubles through the menopause transition, you know, doubles. It's crazy. 20% of the population, you know, like, and no one, everyone's like, okay, this is just, it is what it is. Right, right. Right. It's insane, which is why I hope the women listening to this, the women that follow you and me, like feel like they can rise up now and.

and speak their truth during these years instead of being gas lit and told that you should take an antidepressant. The other interesting piece that I've been really thinking about is I saw a study that showed how powerful estradiol is for stimulating different neurotransmitters. I call it her girl gang. She's got a girl gang of like serotonin and dopamine and acetycholine. And so when she goes away, her girl gang can potentially go with her. And there's like this neurochemical. armor that comes down. And what I experienced was it was like all my traumas, all the unresolved stuff in my life that I hadn't dealt with was like right there for me to deal with. So what do we know about emotional healing during this time and what we need to do to deal with traumas?

So, oh, I have one of the menopausees is like, she's coming, I'm doing conference in Galveston in January. She's coming to talk about menopauseant trauma. And like you said, we lose our resilient. So I love how you put that. The armor comes down and all of a sudden, it, you know, that's why I, so for healing, what I've seen success in my patients, so we know that restoring the estrogen levels through menopause hormone therapy is better than SSRI at decreasing the, but I think there's power in revealing those traumas so that we have the space to like rectify them because they're always kind of behind a wall. The best thing to do besides the building, the wall higher is to like open the door, manage them, you know, get rid of them, right,

through therapy. And so putting out boundaries, that's what I did, you know. Yeah, me too. It doesn't mean I doesn't love the person. I still love them. I still, you know, there's so my family. This is my family I'm talking about. And I hear you. But I have put up walls and I have no guilt or shame about doing it now. I used to feel so guilty when I had to prioritize my own mental health over theirs. And now I'm like, no, you know, I have my own children to take care of. I have my own, like, family that I've built, my own life. And this is my priority. And I, you know, you are part of my life. And but I have boundaries that I'm not going to allow you to cross. And that is healthy for me, you know, and I don't have any guilt or shame

over doing it. So I think that's one thing. I also for the first time sought therapy. I always thought it was woo-woo. You know, I started in, and that therapist taught me to incorporate journaling and gratitude and, you know, taking out time and it's made me a better mother, a better partner, a better, you know, and so that was really, really powerful. But it did take that armor coming down for me to realize I was in crisis mode and I could not continue or I was going to destroy my family that I built, you know, and so I had to get help. Yeah. You know, you and I feel like have similar paths through menopause and how we approached it because, you know, I went into my 40s, like an extreme runner, like I was, you know, marathon runner. And I was, and I was like paleo at the time.

Like, I did everything extreme until I realized it didn't work. And I had to have more variation. And then in my early 50s, those traumas that I hadn't dealt with, I felt like they were there for me to deal with. I, too, went into therapy and tried to work. And then, in my early 50s, those traumas that I felt. on dealing with those. And in the boundary making, in the production pace that so many women, high-achieving women are at, one of the key things that I've recently discovered is that many women just aren't feeling safe. They're not feeling safe within their doctor's office. They're not feeling safe within their marriages. They're not feeling safe within corporations. and when a woman's body doesn't feel safe, her hormones, I don't care how much cream you rub on

yourself are never going to be in balance. So can you talk a little bit about do we have strategies for helping ourselves feel safe? What can we do as women coming together to create cultural safety? Where should we speak up so that we continue to create an environment of safety for women and so our hormones can balance. So when we look at the doctor's office, this is a systemic issue and how we're training our clinicians. And, you know, what, you know, besides me educating,

you know, the masses via social media and my patients in my clinic, I'm also part of advocacy groups that are fighting for legislative change, you know, fighting for menopause to be required study, you know, in the medical society, in the residency programs and the, and not just like the treatment of hot flashes, like,

it's the gender health gap, you know? And so there are now charges leading, like, we're not little men with breasts, you know, to, that's Stacey Sims is, you know, we're not little men. And, you know, like, we need to study how these drugs affect women. One of the, so that, you know, and then train our clinicians so that a woman has a safe space to, you know, females have a space to discuss this. and that the clinicians are trained and understand how our bodies age differently than men's, you know, and how unique we are and how our needs need to be met individually. In the workplace, you know, there's a lot. We're still working on that piece.

Right. That's a big one. One in five women of our age are quitting their jobs, not because of life stress, because they don't feel like they can do their jobs anymore because of the brainfall. You know, and they're not feeling that they have a space to discuss, what's going on or any accommodations that can be made. And so that is a piece we're working on as well. Jennifer Weiss Wolves is writing, she wrote the legislation to get women's health, like more funding for women's health in general. And so she's working on tools where like we can present

on social media. Here's how to write your congressman. Here's how to talk to your boss. Here, you know, here are things that we can do. I think we are honestly a generation away. I think our daughters, I don't know if you have children, but you know, I have two daughters, 20 and 23. I think by the time they are our age, this will be so much better. There will be no more taboo or, you know, it'll just be, how do we most effectively allow women to thrive during this time instead of her putting on armor and battle to go and get what she needs. But so, you know, I think we're a generation away from that. But it's like, so we have just hacks now on ways for us and our generation to kind of survive and thrive through this until we get the rest of the world on board. Yeah, I love the way you're thinking about that because it does take time to change a culture, although menopause, like I feel like we've gone from a cultural hush about menopause to a little bit of cultural chaos where I said to a friend the other day, I was like, you know, do you feel like we have a lot of menopause books out? And she's like, it's so overwhelming. And I feel like the more we can unify voices, the more we can give the power back to the women that are going through the process and let us.

her use her own intuition as to, is this, am I being treated right? Yeah. Like, like, so, and which brings up a really interesting point when you're in your health care office or you're on your health care journey, where does that women's intuition kick in? Let's use you as an example. Somebody walks into your office. You give a protocol. Maybe a woman, and I'm not, no, no criticism of what you might say, but maybe a woman's like, that doesn't feel right for me. where does a woman's intuition need to come into the health conversation? I think it's critical. You just need to arm a woman with information and education,

and she will make good choices for herself, the end. And so, you know, I just had a woman write in and say, my doctor told me I wasn't having enough hot flashes to warrant treatment. And I was like, how much do we have to suffer before we qualify? You know, my job as a health as a clinician is to offer options, not to judge symptoms. You know, it's like really hard decision. I'm just laying out her options to include nutrition, stress reduction, sleep optimization, pharmacology, supplements, whatever.

And then she gets to make her own choices to what she wants. Yeah. She may change her mind in two years. You know, but this is, it's not a one-size-fits-all. It's really up to her. we don't, I don't think we do this to men. We lay out their options. They make a decision based on what they think is best for them, hopefully based on facts and not fear, and moving forward. If a woman doesn't cheat your cheat, I do not lose sleep over it. That is her choice.

Right. Right. But you're a, you're a unicorn today. I don't know if anybody has ever told you that. I'm trying to create more unicorns. So I'm developing a training program for clinicians to fill in that gap that they didn't. get, you know, until we can get all the training programs on board. So what I'm developing a training course for healthcare providers. Yeah. So they can know what I know and then help patients make better decision. Yeah. Amazing. Going back to the 20 year old. So one of the things that I noticed in Fast Like a Girl, I got a lot of mama bears coming to me and saying, how should my 20 year old eat? How, you know, what what should lifestyle look like my 20 year old suffering? And, And one of the things I can say for my 24-year-old daughter and I, we've had multiple

conversations over the years about birth control. And when you look at just the pill, the studies on the pill are very interesting as far as the changes they make to the microbiome are not great. And the nutrients they deplete out of our system are not great. And so I've been thinking a lot about if somebody's been on birth control for two decades and they come screaming into perimenopause, they're already in a bit of a depleted state. What do we need to know about the 20-year-old and the chronic use of birth control? And what would the woman going into perimenopause need to know if she had been on birth control

for a long period? So, you know, we have the contraceptive benefits of oral hormonal contraception. And that does, because it goes through the gut, does appear to have the most disruption of the gut cycle, the transdermal, transvaginal, transmeucosal options tend to be a little bit better because they just go right into the bloodstream for that. So, but I mean, good nutrition is good nutrition, you know, and it's especially important if you're going to utilize contraception. Now, we, you know, it has the same effect if you're utilizing it for, for, you know, medical management of a gynecologic issue. And so, you know, for myself, I was a PCO. patient. Never heard of nutritional advice for PCOS. It was birth control pills. The end. I was on birth

control pills. Actually, I was really happy with them. But I got on these forums before the internet, so I'm old. So I got diagnosed in medical school. And then I found these chat rooms back before social media, you know, the early chat rooms talking about using nutrition to treat PCOS. And I was absolutely fascinated. You know, and then, Metformin came out as a treatment option for it. And I was like, oh, well, that makes sense because it's, you know, insulin, insulin resistance, you know. And I was like, God, if we just started with nutrition for this advice, you know, instead of going right to break control pills, we could probably treat most PCOS, you know, and use other forms of contraception. So I just think we're not giving patients the full picture because we're not teaching the clinicians, you know, the full. And picture of how the, you know, what the effects of these things are. I don't think we're doing adequate counseling for, you know, for how I love contraception women who don't need to be pregnant. You know, we need to have lots of ways for them not to be pregnant who aren't ready for it or

this is not a good idea for them. And so, you know, I do see the backlash because we're not doing adequate counseling of the demonization of birth control pills, you know, good and bad. I have long-term athletes who are coming in to suppress their cycles so that they're not bleeding while they're swimming, right? Like the big swimmers. And because it's really disruptive for them, but also we lose a lot of testosterone when we suppress ovulation. And I'm like, that might impact your, your performance. You know, let's look at other options rather than, you know, what your, your girlfriends were telling you were the pill. Maybe a Morena IUD might be a better option for you. If you're looking for cycle control and contraception, you know, your cycles,

will probably go away and then you'll still be ovulating in the background so you still have your normal hormone cycles and you get that good testosterone to keep your muscles and darn strong you know and not affect your athletic performance I think these are nuanced conversations well yeah and I think this is why we have to like you go into your 40s you need to look back and go what what have I what is my lifestyle been what toxins have I been exposed to what has depleted me because it's a different game once you go into those perimenopausal years which is is why I want to highlight this. The other piece is toxins.

I recently saw, a year ago, I saw a study that in menstrual blood, they're actually measuring phallates, pesticides, plastics, and forever chemicals. And so when we bleed every month, we're actually detoxing. And, yeah, so the men, but we have a lot of younger generation that they're not bleeding anymore. And then what do we do with the postmenopausal woman that doesn't have that? that detox anymore and we live in this toxic culture that we're in. Do you have any hacks or strategies you recommend for menstrual women when it comes to helping the toxic load?

I have to go back and look at that research. I haven't really, you know, that is one area that I have very little training on. Again, because it's probably newer research, looking at menstrual blood and what's coming out of there. And in the last like 10 years, all I do is postmenopause, but I'd love to read it. Yeah, send it to me. That's fascinating. Yeah, I'll send it to you because then it leaves this question if you're not bleeding every month and you're not detoxing every month. So what strategies, you know, I've been recommending simple things like, you know, Corella, of course, the fiber, I love the fiber thing because, you know, if you feed the estrobolome, now, you know, make sure you're having bowel movements

every day. Like, there's a lot sweat every day. There's a lot of great ways we can detox. but I think we should be aware that we don't have the menstrual detox. And so I'll send you the article because I think it's really interesting. My other question is the visceral fat change. So I always laugh because I'm sure you get this. Like the videos that do the best on my YouTube are menopausal belly fat. And I love where you're like, let's keep you out of the nursing home. Yeah, what do we do about the visceral changes?

To be honest, Dr. Pettles, That is the biggest pain point for patients. Again, they're coming from the mentality of, I have to be thin, da, da, da, da, that. And then all of a sudden, through their menopause transition, with no changes in their diet and exercise, they suddenly develop a belly. And that gets people's attention because it's about 90% of us. And I was one of them. And I'm like, this is impossible. Like everything they taught me in medical school was calories and calories out.

This is impossible. I've changed nothing. And you go and you look at the litter. term, it's like, are you really only eating that many calories? Are you sure? Are you really working out as much as you're like, I'm telling you, this is happening to me. So when you break down what is happening. So estrogen is a really powerful anti-inflammatory hormone. And when the shield comes down, the estrogen levels drop, all of a sudden our systemic inflammatory markers increase. And that drives fat to the intra-abdominal cavity. Insulin resistance increases with no changes in diet and exercise,

that drives fat to the intra-abdominal cavity. Once that fat hits the intra-abdominal cavity, it is much more pro-inflammatory than our subcutaneous fat. So for your listener, subcutaneous fat is the fat we all know. Gives us breast, hips, cellulite. We don't like it. It's cosmetically distressing, but it's a very different actor than our visceral fat is much higher in the neuroindocrine, you know, production of inflammatory hormones. And so the higher that are levels of visceral fat, the more likely we are to develop cardiometabolic disease. So they've measured it in a premenopauseal woman, the average percentage of total body

fat that is visceral is 8%. She goes through the menopause transition that increases to 23%. Wow. Wow. It triples through the menopause transition. I don't have to tell a woman this. She knows it's happening. Yes. So what do we know? Nutri—so HRT can help attenuate this. It's not perfect. Okay.

High fiber diets, 25 grams or more, less likely you will see a decrease in visceral fat. Limiting added sugars, not sugars found in cooking, not sugars found in natural foods. Suggers put in there from cooking and processing, women who limit those added sugars to 25 grams or less per day, much lower levels of visceral fat. normal vitamin D levels, much lower levels of visceral fat. Probiotic, diets rich in probiotics, much lower levels of visceral fat and all the ensuing health changes. So lower visceral fat, lower hypertension, lower cholesterol, lower insulin resistance, lower diabetes, lower stroke on and on and on.

What levels do you like vitamin D to be at? So in my clinic and from what I've read, you know, in the functional medicine world, though I'm not classically functional medicine training. So I don't want anyone to, I don't want to pretend that I am 60 or above. is what I'm shooting for, you know. So, but most of my patients who are not supplementing, it's really hard to get it through our diets. We decrease absorption, you know, all the things we're protecting our skin, rightfully, you know, from excessive sun exposure for skin cancer.

And so that is leading to lower levels of vitamin D. Most of my patients aren't below 60. They're below 20. They are extremely deficient through the menopause transition. Yeah. Yeah. And I would agree higher is better. And getting it up isn't as easy as just dropping some supplements.

You have to really do it continuously. That is shocked me when watching a lot of women's vitamin D levels, how some can get it up quickly and some can't. So it's a really interesting conversation. Of course we have to talk about alcohol because alcohol is a really interesting one because the glass of wine becomes the thing you're like gripping to as you're going through this experience, but then it creates the lack of sleep. It creates, yeah.

What would you say about alcohol in this process? Gosh. You know, there's nothing healthy about it, really. There's really very few benefits for that 20-minute high. You're sacrificing your sleep. You're sacrificing calories. You're sacrificing your mental health. You know, and I know for me and most of my patients.

And I do drink. If I choose to drink, I'm choosing not to sleep. You know, I've gotten the hot flashes taken care of, you know, with my hormone therapy. But I still don't have the same level of sleep that I used to. I'm much more prone to have a 3 a.m. awakening. And alcohol is almost 100% of the time going to do that to me. And so I've had to make a choice between sleep and alcohol.

Yeah. Yes. I absolutely agree with that. And, you know, Peter Atia said this on his podcast one day, and I was like, I really like this look at alcohol, which is have it hours. If you're going to have your glass of wine, have it hours before sleep. Do it with food. Do it in an environment.

Yeah. Do it in an environment where you are in a social setting, where it might be relaxing you a little bit so you can have that human connection moment, that there may be a place for it, but you would need to put some boundaries around it so that you don't end up. with the 2 a.m. wake up. Would you agree with that? Yeah. So I know, you know, so I talk to patients like, you know, they joke about day drinking, you know, and I love the way that Peter framed that. And like, it can be let some of those walls down so you can have that connection or, you know, decrease the social anxiety. But just be

really mindful and keep those boundaries up so that so many of us are crossing over and we're more likely lead a crossover because of the increased stress of paramedopause. And then if you're not sleeping, everything, you know, it's like we got to get sleep as a priority. And if this is affecting your sleep, you know, we really have to look at this carefully. Oh, yeah. I have like become like crazy about sleep where I just, nope, I cancel appointments. I don't go on social engagements because I'm like, I need sleep or I can get a little crazy. The last thing I want to ask, and this came up, I actually heard you say this.

on Mel Robbins podcast and I thought, wow, I wish I had known this when I was in active clinical practice, which is this concept of the frozen shoulder happening to so many menopausal women. And I will tell you what I saw in practice is the extreme worker outers. When they hit their late 40s, the injuries were not repairing the way they used to repair. So is there anything other than awareness that that might be a hormonal shift, not a structural change. Is there anything we can do for those athletic women that don't want to experience chronic injuries? So when you start feeling symptomatic, at least Vonda Wright is kind of my go-to person. She's an orthopedic surgeon and specializes in menopause. And she says, you know, get early

physical therapy. Get in there and get that joint moving as early as possible. Do not wait. We know from the Duke study and now newer studies coming out, women on hormone therapy have decreased incidence of frozen shoulder versus women not, also have decreased length of the time that they're, you know, that they're frozen and need less therapy long term. So estrogen is better at prevention than cure for so many diseases. And when we lose our, estrogen, that armor against arthritis, arthritis, and adhesive capsulitis comes down. And so many women are like, thank you, because I felt like I had broken something or done something wrong. And I'm with you. The toughest menopause customers I have are the athletes. You know,

they have the biggest mental like breakdown when their body composition changes. It is so hard for them. They're nutrition, you know, like they've been running at the, you know, and they, It's really hard for them to accept that all these things that kept you winning maraths and triathlons are not going to tear away at your bones and muscles. And we have to look at this differently. And so, yeah, and then the rate of their, you know, once their estrogen levels drop, then all of a sudden the armor that they had against injury or old injuries is suddenly popping up.

Yeah. I would a thousand percent agree with you on that hyper. achiever, woman. Like, if you're listening to this, you know, you can hear it in both of us. Like,

we've been there on many levels, and that rest and honoring the body becomes really important, not the push through grit that we learned in our 20s and 30s. It's a whole different skill set. It's crazy. So this has been amazing.

And I just, again, I really love the spirit in which you're bringing this forward. and I love that women are waking up when they hear you, when they hear me. Like I just, my quest is for women to feel heard and seen and feel like they have a voice in this culture that we haven't had a voice. So I just, I have to just, again, thank you for everything that you're doing. I just really appreciate the spirit in which you're doing it.

Thank you. Same to you. Thank you. And then the last question, this one will be really interesting for you. I always ask every year on my podcast. I have one question that I ask. And this year I'm asking, what is your definition of health? I think too many women will say they want to be healthy, but they don't know what the definition of health is.

I think the days that I don't worry about my health are the definition of health. You know, the days that the habits I put into play, take any thought process around. I know I've got this. And so to me, good health is not having to think about it. Yes. It's like a flow, like a flow you get into. I love that. So how do people, how do people find you and your work? And we will definitely put links to your book. But where can they dive into your stuff? So the book is the new menopause. And it's available everywhere. You can buy books across social media it's dr mary clare and um just about every platform and then we have a website with lots of great tools freebies information how to talk to your doctor how to find a doctor

dot-da-da at the pause life dot com yeah beautiful well thank you you know from the bottom of my heart i just really appreciate what you're doing for women and you know it's just an honor to have this conversation with you so appreciate you all right thanks for having me thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it, so please leave us a review, share it with your friends, and let me know what your biggest takeaway is.