The School of Greatness - #1 Menopause Doctor: 5 Daily Habits to Sleep Better, Feel Healthier, and Beat Menopausal Belly Fat

Episode Date: July 15, 2024

Have you saved your seats at Summit of Greatness 2024 yet?! Get them before they sell out at lewishowes.com/ticketsToday, we welcome Dr. Mary Claire Haver, who delves into the critical and often overlooked topic of menopause. Dr. Haver discusses the alarming lack of education and training around menopause, highlighting that most OBGYN training programs include only a few hours on the subject. She shares her personal journey of going through menopause and realizing how much more comprehensive the education and treatment should be. Dr. Haver outlines the multifaceted impact of menopause on women's health, including physical, emotional, and mental health aspects. She emphasizes the importance of nutrition, sleep, stress reduction, movement, and appropriate medical interventions to navigate this phase of life healthily and proactively.Buy her new book for yourself and a friend! The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and FactsIn this episode you will learnThe multifactorial effects of menopause on women's overall health and well-being.Practical strategies to manage menopause, including nutrition, sleep, stress reduction, and exercise.The importance of hormone replacement therapy (HRT) and its benefits beyond just treating hot flashes.The role of partners in supporting women through menopause and how education can foster better understanding and compassion.The reasons behind the inadequate education and training on menopause in medical schools.For more information go to www.lewishowes.com/1641For more Greatness text PODCAST to [phone]More SOG episodes on women’s health:Dr. Mindy Pelz – https://link.chtbl.com/1543-podGlucose Goddess – https://link.chtbl.com/1575-podRhonda Byrne – https://link.chtbl.com/1525-pod

Hey everyone, this is Lewis Howes and I am so excited to invite you to the Summit of Greatness 2024 happening at the iconic Shrine Auditorium in Los Angeles, California. This is more than just an event. It's a powerful experience designed to ignite your passion, boost your growth, and connect you with a community of other inspiring achievers. Join us Friday, September 13th and Saturday, September 14th for two days packed with inspiration and transformation from some of the most incredible speakers on the planet. Don't miss out on this chance to elevate your life, unlock your potential, and be part of something truly special.

Make sure to get your tickets right now and step into greatness with us at the Summit of Greatness 2024. Head over to lewishouse.com slash tickets and get your tickets today, and I will see you there. This is going to happen to 100% of us who live long enough. This is not optional, and it is going to rock her world. So I think education is everything. As an OBGYN, when you started entering menopause, did you think that you were prepared and educated?

Not at all. I got one hour of menopause in medical school. For real. Every clinician who touches a woman should have required menopause training. Word certified OBGYN. Menopause expert. Her name is Dr. Mary Claire Haver. Dr. Haver's new book is called The New Menopause. The wonderful Dr. Mary Claire Haver.

It seems like the medical world has failed women. I would have to agree with you. In my training, there was this underscore of women tend to somaticize their symptoms, meaning it's all in her head, basically. Called WW, right? The WW, the whiny woman. The WW was a term used by my upper level residents. 85% of women will go and talk to their doctor and mention the cliche symptoms of menopause, right? Only 10% right now is the offered treatment, and it's usually an antidepressant. No one's coming to save them. Wow. Strong over skinny, nutrition over calories, and educate yourself about what's coming because it's coming.

What would be the three to five things that you would say, if you can only do these three or five things? Right, and I can't write you a prescription. Yeah, I can't write you a prescription, but these three to five things will drastically help improve in any way possible during menopause. So I would tell her. Welcome back, everyone, to the School of Greatness. Very excited about our guest. We have the inspiring Dr. Mary Claire Haven in the house. So good to see you.

Thank you for being here. It's great to be here. Now, I'm very fascinated about the topic that you're an expert on. Thank you for being here. It's great to be here. Now, I'm very fascinated about the topic that you're an expert on. And I saw that you posted a video a few years ago of OBGYN training program being about eight hours of training around menopause education. That's right.

I don't know if that's still the case today, but that's what I think it was back in the day. I'm curious, how is this possible that there's only eight hours of, I guess, educational training for menopause when I've also heard you say about a third of all women are in some stage of menopause right now? How is that possible? Yeah. And it seems so confusing for so many women and probably even more confusing for the men in their lives who are trying to figure out how to support the women who are going through these complicated challenges. Right.

So I think it's multifactorial as to how we got here. And I left, I was a program director in 2018. I left that job. So I was teaching at an academic institution. I had seen patients, teaching med students, residents, but I was in charge of the curriculum for the residents as dictated by the American Board of OB-GYN. OK, so I know exactly up until that point what was required. And menopause was required, but we didn't have menopause clinics.

We didn't have more than just a few required lectures. It was really just menopause is the end of the period. You might get osteoporosis. It's just the most cliche kind of basic, basic learning. No nuances about treatment and training. And so how do we get to where this is a natural process, but it affects 100% of women who live long enough, completely going into ovarian failure, loss of all of sex hormone production from the ovaries, pretty much. And then she's expected to live the last third of her life without the benefit of her sex hormones and no discussion around how that affects her heart or her brain or her bones or her general greys system or her mental health, you know, and how, like, we can shepherd her through

this last third of her life to live as healthfully as possible by limiting these effects of the hormones. And so, I mean, I went through the training program. I was all on board until 2018 until I realized I went through menopause. And was like, wait a minute. This is much bigger than we're teaching, than I was taught, than what I actually believed. As an OBGYN, when you started entering menopause, did you think that you were prepared and educated? No, not at all. Even though you were treating women and helping women in menopause for years, you didn't feel prepared.

So I gaslit myself for probably six months. So a lot of things were happening to me at once as most women my age at that time. What was happening? So I was 48. I had been on birth control pills for treatment of polycystic ovarian syndrome, which worked great for me. It's not for everyone, but I was fine on them and had been on them for years and years. Decided to come off and to see where I was at hormonally. At 48? 48. And so average age of menopause is 51. So I figured it was coming. Okay.

Let me see where I'm at. And I get off and I'm like, my brother gets really sick. So I'm from a huge family. I have six brothers and one sister. My oldest brother died when I was nine. My next brother, Bob, the second in line, had HIV and hepatitis hepatitis and so he I got a call from the hospital I was in the OR and I get a call like an emergency call and they kind of put the phone up to my ear I was finishing a case that my brother had had a stroke and was in the hospital and he'd

been kind of in and out of the hospital for a while so he was in the end stages and so I I just like went home he got discharged from the hospital to hospice. And my sister and I did his end of life care. And like everybody coming to that, it really was a beautiful way to die, you know. But I had just stopped my birth control pills and I just kind of forgot. Now remember, I had been on them for treatment of a condition where I didn't have periods. Okay. So me not having a period was not a red flag.

So here I am months into this. I think I'm grieving, which I was, but every single thing that I'm going through, I'm attributing to my grief. Definitely there was something there, but then as the grief fog starts to lift and I'm trying to get back into my habits, I gained weight and I wasn't sleeping. You know, I realized, wait, when was my last period? This is a hot flash. You know, like I, I'm in menopause. Like I literally could not figure it out for months in myself. And so I always thought I would treat hormone therapy like an epidural and in labor, like, we'll see how I do. You know, if I'm a good girl and I'm strong, I won't need it. Right. You know,

if I could take the pain. And of course, I got an epidural at three centimeters, which is very early in the process because I was in so much pain. And so I felt like hormone therapy was an act of not being strong enough and throwing in the towel. I had no idea the protective benefits of HRT for my heart, for my brain. You know, all I knew was it was the last ditch treatment for debilitating hot flashes. And that pretty much there wasn't much else it could do for me. And so I go on HRT because I

can't sleep. And I know if I don't sleep, I'm setting myself up for failure and everything. Plus I was working shift work at the hospital, very busy life, trying to raise teenagers, all the things. And immediately I feel better. And all of a sudden other things are getting- After therapy, after hormone therapy. After starting hormone therapy. Okay. I start sleeping, the hot flashes go away, but also like the weird joint pain I was having gets better. Some of the brain fog lifts. I'm like, whoa, this is a bigger deal. The same time I was struggling to lose some of the weight I gained through the grieving process and what now I know is menopause. And I couldn't get it off.

And I'd been thin. I'd had thin privilege most of my life. I could diet for a week and get back into whatever genes. And it was easy for me. It was like melting off. And it was not coming off. And it was about 20 pounds. It was all in my midsection.

And I was like banging my head against the wall like getting up at 5 a.m to go work out i was doing two a days i was calorically restricting to dangerous levels i was doing all the negative negative things and my husband like pointed out your girls are watching your what your girls are watching like you're modeling after what you're exhibiting behavior i was like literally an almond mom. Wow. You know, like I was just – and judging them for their food choices. And it was all really about me. And so my husband was like – he was going on a trip. And it was like a two-week trip.

And he said, I said, when you get back, I'll lose this 10 pounds or whatever. And he goes, I don't care what you look like. Like, I love you. You're beautiful. But you're not happy. Like, you're getting up at night to pee and you're weighing yourself. You're constantly talking about your weight. You're, you know, this isn't working. And what do you tell the kids when you can't exhibit, you know, you can't expect change if

you keep utilizing the same behaviors. And he's like, figure it out. You're smart. You're a doctor. And so I took that as like a challenge. And so I went to the PhDs at the university I was employed at. And, you know, I was everybody's doctor at that point. I was like, what's going on in menopause? I can't lose weight. My patients aren't losing weight. What is this around my middle? And they're like, well, that's visceral fat.

I'm like, what's that? Because you'd always been skinny. I didn't even know. Right. You know, like I didn't even know the difference between subcutaneous and visceral fat. Like we learned nothing about nutrition in medical school. I mean, the minimum. And so they send me a few articles. I just started going down rabbit holes about inflammation and

visceral fat and nutrition. And so that's where, you know, the whole, the, my first toe in the water with menopause was let's get this weight off. And it was the pain point for so many of my patients. What is the number one pain point for women in menopause? Is it getting rid of excess weight? Is it dealing with hot flashes? Is it dealing with... So when we look at... So for forever, menopause was only quantified by absence of periods and hot flashes. Those were the top two. But when you actually... And what is a hot flash? Good question. Just so I can be educated. So yeah, a hot flash is a thermoregulatory dysfunction. So there's a little temperature gauge in our hypothalamus, in our brain, and it has a really a set point. And when our estrogen levels decline, we end up with

dysregulated serotonin, which then resets the temperature gauge. So what we used to just kind of go with the flow, all of a sudden we'll have this profuse sweating. Profuse, like most women, it'll start somewhere in their chest area and you'll feel this heat building and then it'll just rise up. I can probably make it happen. Go up into your neck and then your head starts sweating. It's going down your arms. I mean, some women will drench their entire clothes, but it usually starts central and it goes peripheral. It lasts seconds to minutes, but it is completely disruptive. Does it, is it happen multiple times a day? It depends on the patient. So it could be disruptive. Does it happen multiple times a day? It depends on the patient. So it could be, some patients will have multiple times a day,

like to the point where she, you know, so that's severe. Some will have it once a week. It really does vary from woman to woman, and it's not really tied to exact estrogen levels. So it's more to do with neurotransmitters and how those are affecting her. But 85% of women will have those, but probably 90 to 95 will have body composition changes. Almost 100% will have fatigue, like differences in, and almost every single woman that I talked to was like, something wasn't right. I couldn't put my finger on it, but I felt different. And either it was through sleep or what her body was doing, but like she wasn't changing anything in her nutrition, in her exercise, in her stress levels. Everything was stable, but her body was changing.

And the thing is, we have estrogen receptors in every organ system of our body, and it will affect each of us differently. And so doctors love the duck, you know, walks like a duck, talks like a duck, walks like a duck. It's a duck, right? So we have these checklists of things. Okay. This is the flu. This is, you know, broken leg. This is whatever, but menopause. Yeah. The symptoms of menopause. Right. Are variable. So 85% of us hot flashes. Sure. A hundred percent of women will lose their fertility and their periods will stop. sure. 100% of women will lose their fertility and their periods will stop. Normal regulatory periods will stop. But probably 90%, you know, fatigue, probably 80% sleep disruption. 50% of

women at any time will have sexual dysfunction. So changes in libido, pain, you know, we see almost 100% body composition change. So not just weight gain, but where we gain weight changes. So we stop depositing fat so much in the subcutaneous area. We can still do that, but we start shifting a lot of fat to the intra-abdominal cavity or that visceral cavity. So you're talking about from the legs and the butt to the stomach? Yeah. Okay.

Yeah. So when most women typically, estrogen drives a more pear shape, which is natural and healthy versus all of a sudden you're having new fat in the abdominal cavity. You're like half pear. Yeah. Half pear. Suddenly you look pregnant. Interesting.

Yeah. Or their pants are getting tight and they can't figure out why. What do you think is the biggest, what do you think is the, I mean, it seems like there's a lot of challenges or changes that women go through during this period of time. And how long does menopause tend to last for? Yeah. Great question. So menopause is actually one day. So let me walk you through all these definitions. It's so confusing. So menopause is medically defined, which I think is a terrible thing, one year after your last menstrual period. That is menopause. And it's one day. Everything after that is post-menopause and everything before that. So you go normal reproductive cycles, that very predictable EKG-like ebb and flow of your

hormones that happen each month in a healthy patient, very predictable, right? So we know she's going to peak on day 14 with estrogen and then that's going to drop and it's going to rise a little bit more, but then we'll have a surge of progesterone and the whole thing starts over every month. And that's very, very predictable. Perimenopause is when that predictability starts declining until your period stops. So it could be once every two weeks. It could be- It could be 10 times a day. It's very, very variable. So here's why. Here's why. And what I think your listeners and followers should understand. Difference between us. I was born female,

you're born male, right? You make your genetic material in the testes every day. And you can do that probably till you die. It might be a little harder as you get older, but you can do it, right? Females are born with all of their eggs and it has to last them until they go away. So we actually reach our maximum egg count five months in utero when our moms are still pregnant with us. And then they decline. So we lose quality and quantity over time. How many eggs do most women start with? At birth, one to two million.

Two million eggs? Holy cow. And then by the time we're 30, we are down to 10% of our egg supply, roughly about 120,000. And then by the time we're 40, we're down to about 3%. And menopause is when you have no more eggs. You're done. Today, all your eggs are gone. It's, yeah. And there's nothing, no sex hormones are being produced by the ovaries anymore. Usually, what's the average age of that? Yeah. So menopause, 51 average. However, normal is still 45 to 55.

PERI, and I'll walk you through that. PERI begins seven to 10 years before that. So the hypothalamus pituitary, right? Two glands in the brain. You probably know them well. The hypothalamus is constantly sampling our blood for estradiol. It is what drives that monthly period. Okay. So the brain is like, we're good.

Estrogen levels are good. Oh, they're getting low. They're getting low. Sends something called GnRH, gonadotropin releasing hormone to the hormone, to the pituitary. Pituitary is like, all right, boss, I got it. Starts pumping out LH and FSH, which are stimulating the ovaries to ovulate and make those hormones, right? And so what happens when we start losing quality? We reach some critical threshold in the number and quality of our eggs. Then the brain's, then the ovaries like can't do it with the same LH and FSH. It's not, it's comes resistant to those signals. So the brain's like, where's the hormones? I sent you the signal and the material is like, I try. And

he's like, try harder. So you get these bigger surges of those stimulating hormones, almost like what we give in a, in a fertility shot. Right. And then the ovaries like, okay, fine, spits out an egg. So we get these wild fluctuations, super high surges of estrogen, way higher than you ever had in your normal reproductive stage. Then these crashing lows.

So what used to be this EKG predictable thing becomes a zone of chaos. Literally everything looks like this. It's trending down, but it is a rollercoaster on the way down. And then you end up in menopause and it's like flat line. That doesn't sound enjoyable. Well, it's less tumultuous if you understand what's happening.

So educating yourself is half the battle. If you're educated and knowing when you hit these ages, there's going to be a lot of changes. Well, you don't have to be afraid. Right. Don't be afraid. It's going to be a lot of changes. I mean. But you don't have to be afraid. Right. Don't be afraid. It's going to happen and we can coach you through it. And there's so many things, nutrition, exercise, stress, you know, all the pillars of health are helpful.

But just understanding what's happening. And so you don't gaslight yourself and being able to stand up for yourself at your doctor's office. Because here's the problem. Like the first question you asked was like, how did we get here? Where a woman can't reliably walk into a doctor and get information and she has no idea what's happening to her body? How society views aging, how society views women in aging, how the medical profession deals with women. In my training, there was this

underscore of women tend to somaticize their symptoms, meaning giving a psychological reason instead of biology, just blaming it's all in her head, basically. And that's been going on for thousands of years. It's called WW, right? The WW, the whiny woman. So the WW was a term used by my upper level residents for a woman who was coming to our clinic who had a laundry list of vague symptoms some headaches some fatigue depression libido joint pain whatever everything's an issue it sounds like it's like a little bit of issues this is texas so i have this long tall texan you know in his white lab coat with his cowboy boots, meaning well, it was taught to him saying, well, there's not much we can do for her.

You know, like it's just this women go through this at this age and, and, and I just bought it. I bought into it. There was no education on like, can you prevent some of these symptoms? Can you optimize certain things? Can you? And my last year of training was when the Women's Health Initiative came out and HRT was taken off the table. So there was no education around perimenopause and how we can intervene and decrease symptomatology and improve. Then the other thing, so we have the chronic things, the hot flashes, the night. So it's the things that bring people to the office. the night. So it's the things that bring people to the office. But what I think the bigger impact is that if you look at men and their risk of heart disease, so there's things that lead to heart disease, hypertension, high blood sugar, diabetes, stroke risk, et cetera. It's pretty

linear with age for the most part, as much as that could be biologically plausible. Women are pretty much lower than men until menopause. Then they shoot up and then they go past them. So menopause is a huge risk factor for chronic disease. The loss of estrogen affects the liver, cholesterol goes up. It affects the intima of the artery. It's very, very protective of the lining of the artery. So much less atherosclerosis. You take age-matched women. Remember, it's normal 45 to 55. So if you go through menopause on the younger end, you are higher risk because your body's away from estrogen longer and all the protection that it offers. Don't women in general live longer than men? They do, but 25% of that life

is in poorer health. So their lifespan is longer, but their healthspan is horrible. Women are three times more likely to end up in a nursing home or three times more likely to end up with dementia and frailty. Whereas men, that doesn't happen. They kind of live, have a short decline and die. Right? So they're way more functional in general. Of course, not every man, not every woman. But what we're seeing the trends are women are living three to four years longer, but they're in nursing homes and they can't take care of themselves. Do women suffer dementia more than men? Yes. Really?

Yeah. Two to three times more. Why is that? So there's a great book on this subject. Lisa Moscone wrote The Menopause Brain and The Double X Brain, and she explores a lot of this. And we know that estrogen is really protective in the neurological system. And when those levels decline, we start seeing acceleration of disease. But what about for men if we have less estrogen, right? Yeah. So you actually kind of, your estrogen stabilizes. It's lower than women's, but once we go through menopause, you have more than me.

Come on. You have more than me. Wow. Yeah. So you still have a little bit of baseline protection. That kind of stays most of your life. Now, with all these different, I guess, I don't know if you call them symptoms or challenges that women face during these years of menopause. I guess it's one day, but the years of experiencing menopause. Right, the post-menopause years, yeah. What would you say is the biggest loss for women?

Is it the gain of fat, the unwanted fat? Is it that they don't have the sex drive that they once do or it shifts and it changes? I think it depends on- If they feel like, oh, now I'm actually getting older. Am I as valuable as a woman in society? I think all of it. Really? I think it's all of it.

It's all hitting at once. They are feeling so- Okay, so like at work, when you look at the economic impact of menopause, this is an age, so I'm 55, you know, I am at the top of my career and it's only going up. And had I been suffering from brain fog to the point, one in five women will quit their jobs because of cognition changes in menopause. This is at an age when we should be leaning into our careers. The kids are grown for most of it.

You know, we're just at that age where- You've got the most wisdom, the most experience, the most knowledge. And now they've lost so much confidence because they can't find their words or they can't calculate anymore. And they can't, you know, they're used to these high level cognitive function and they've lost executive functioning. So we see ADD, you know, mental health changes, the dopamine changes, the serotonin,

the norepinephrine, all of this is linked to our hormones. And when they, you know, when these changes happen, especially in Perry, where it's so chaotic, the brain loves to know what's coming, right? So the brain really thrives for most of us in that estrogen is going to surge, progesterone is going to surge, it's used to it. And then when we get to Perry and we see this chaos, surge, progesterone is going to surge, it's used to it. And then when we get to peri and we see this chaos, mental health, I think it's 40% increased risk of depression in perimenopause. Greatest risk of a female commit suicide is between 45 to 55. I mean, just look at the numbers. We look at serotonin, SSRI use, so antidepressant use doubles between premenopause and post-menopause and then goes up after age 65. And these are things that don't have to happen, that we can actually intervene early and provide

education, counseling, therapy, and decrease these risks as we age. Walk me through, because you've worked with a lot of... How many women have you worked with, like one-to-one, privately? And since my menopause clinic opened? Yeah. Oh God, over a thousand. Yeah. So walk me through if you can

and put me and anyone, man or woman in the seat of what is a woman feeling emotionally, spiritually and psychologically when they realize they no longer have any eggs left and they can no longer, even if they didn't want to have kids anymore left and they can no longer, even if they didn't want to have kids anymore, but they can no longer have the ability to have children themselves,

what emotionally goes on with women who experienced that moment? There's no more. I think it's a fleeting moment. I went through it myself and I've talked to all these patients. You go through a little bit of mourning and then you're like, I don't have to worry about it anymore. We're done. I mean, I had my children. I purposefully did not have more. I wanted to focus on the two that I had and was happy with that. We did try one more time. It never worked out. But at a certain point I was like, we're done. Yes. But you had a rhythm of a cycle, We're done. Yes.

But you had a rhythm of a cycle. Yeah. You know, a physical cycle. But you go through this chaos, you know. So it's not like the door shuts one day. You go through months, years of what the hell is happening to me. So also, you know, they're losing confidence because of, you know, cognition changes. They're losing libido.

Their, you know, marriage is affected. Their relationships. They're losing their resilience to anxiety and stress. And so, so many things are happening to this woman. By the time they get to my office, they've seen five or six, they've gone to one guy for palpitations, another woman for, you know, they've been dismissed, gaslit, told this is normal. This is part of your life, weight gain, eat less. You're just lazy. You're fat, you know? And then they get to me and I'm like, I got move you know and they're so great like the tears pour i have kleenex i'm just one that they're validated and then and then we start talking okay what what are our tools that we're going to use to pull you out of this someone so imagine i'm you know you can imagine i'm a 49

year old woman or 50 year old woman that's gone through five seven different doctors finally gets your book and realizes oh i need to need to come see you. And I come in for two hours, I'm sobbing, I'm crying. And I'm telling you every symptom I've had. And I say, I don't know what to do. What's the next thing you say to me? And what will you do to support me or any woman watching who's uncertain on how they can feel safe and protected about what to do next? One, I listen to her and I believe her. And that is half of the therapy right there. So because of the way society perceives women, the way medicine perceives women, the way we're training our clinicians by and large, at least in my generation,

of this, it's all under head and women are just, you know, emotional to like have someone believe you and just say, and we say, yeah, yep, that, yes, yes, yes. Here's a study that proved, you know, here's that. Now let's talk about what we're going to do about it. And I mean, I could basically tell them to go home and do handstands and eat toast or something and they would feel, you know, and so, but we start with therapeutic options. We go through hormone, non-hormonal pharmacology, nutrition changes. I do so much blood work. I'm looking for autoimmune disease. I'm looking for hypothyroidism, nutrition deficiencies. I'm just trying to get a broader picture of her whole

health. And so once we kind of get the acute things taken care of, get the hot flashes under control, get her, you know, brain working working again get the muscle pain back in order then we start plotting out the next 30 years so they're focused on i'm like tell me about your mom tell me about your grandmother how did they age did they fall and break a hip were they incapacitated how long were they in the bed at the end of their life you know did they have to do you have to hire someone to come in the house? Were they in a nursing home? What do you want? And they don't want that. So we start mapping out nutrition, exercise, looking at risk for osteoporosis, looking at risk for heart disease. What can we do on what I call the toolkit to put some new things into place that are going to limit that time where you can't take care of yourself.

If you weren't able to do blood work for someone, someone's watching and they're not able to come to your clinic, what would be the three to five things that you would say if you can only do these three or five things during your menopause process? Right. And I can't write you a prescription. Yeah. I can't write you a prescription, but these three to five things will drastically help improve in any way possible. What would those three to five things be during menopause? So I would tell her she needs to watch her fiber intake. So she needs to be getting minimum 25 grams of fiber per day.

More fiber. More fiber. Most Americans are getting, women are getting 10 to 12. And so maybe half of what they need. That fiber is going to feed our gut microbiome, keep it healthy. It is going to decrease the rate of which the blood glucose goes up. It'll decrease the absorption of sugars into the bloodstream. It will also decrease, keep us fuller longer.

So it decreases some of those hunger cues that are going on, which go absolutely cattywampus in menopause. It will, the foods that are rich in fiber are also rich in minerals, vitamins, cofactors, all the things that keep us healthy. So nutrition should come first. Okay. That's number one. Second is limit added sugars. So added sugars are sugars added in cooking and processing, not fruits and vegetables. So much of the glucose, you know, the, the, um, my patients, A1C start creeping up, you know, in menopause, their cholesterol starts creeping up.

Fiber will go a long way with cholesterol, but the added sugars are huge. So limiting those to 25 grams or less per day, most people are getting about a hundred. They're giving that in like one drink. Right. So, and like starting to pay attention to that and be like, Oh my God, you know, like I got 80 today and I didn't even think about it. So working on that, prioritizing sleep, it's hard enough. So things like what many of my, and I'm so excited to see research come out on this, but alcohol consumption is so sleep disruptive for anyone, but it is literally debilitating in menopause. Our ability to tolerate alcohol in the ways that we used to, if you're a drinker, change. And no one can tell me why yet.

I know there's data coming. And our sleep is so much harder as we get older because the hot flashes, the night sweats, the hormone changes. And then when you add in alcohol, like I know if I choose to drink more than a glass of wine, you know, then I'm choosing not to sleep. It is, it is just not going to work for me. Yeah. There's a study, I think Dr. Daniel Amen has a study of, I think, over a hundred thousand brain scans. I don't know if you've seen this study. Maybe it's more than a hundred thousand, but something like hundreds of thousands of brain scans.

He wants to scan mine. Exactly. I did a scan. And I asked him about alcohol and many other things, like any types of drugs, cigarettes, alcohol. And I go, is there any benefit to drinking alcohol in the brain, the body, or anything? And he goes, I can't see any benefit. Right.

And it only depresses you and suppresses your ability to think, to recover, and to feel healthy. It makes you sick. And I get there's a culture around drinking. I've never been drunk. I've never had a glass of wine. I've never had a can of alcohol. I feel like it's sips in my life, but I've never had a full can. And I think life can be challenging enough without alcohol. It's like, why add a depressant? If, especially during a challenging season of life where you're already facing symptoms that are challenging, why put more pain on yourself? And we see through the transition, because there's the lack of understanding, education, and women are desperate. They're turning to alcohol.

I'm sure. Because you want to have some relief right and i get it right sugar alcohol drugs cigarettes whatever it might be but that's only going to hurt you even more isn't it yeah but the short term it's hard to so hard let that go it somehow when i phase it i phrase it in terms of sleep it makes more sense and they're like oh well oh, well, I really, I know I need to sleep. I'm like, okay. When, when women aren't getting sleep during this phase of menopause. Everything goes bad. Everything goes bad. Yeah. I mean, it just, I, I describe it as a traffic circle. So we have like our healthiest traffic circle where good nutrition, good sleep, stress reduction, you know, all these things feed in. So we're just much more resilient. We can handle the viruses and the bad days and the parents dying, you know, all the things that

life throws at us. And then we have the circle starts slowing down and then start spinning the other way. And that's, you know, the loss of sleep and it all kind of, and then the increase in visceral fat and then the weight gain, and you feel bad about that. Then your mental health takes a hit and now you can't think it works. You know, and it's just you end up in this. The shame and whatever. Yeah. And so you're embarrassed.

You're ashamed. Your relationships are falling apart. You're just, ugh. And so we talk about trying to slow that negative circle down and start, you know, getting it to stop and then spinning it the other way. Okay. So that's the third thing. Prioritizing sleep. What would be one or two others?

So movement, exercise. So most in my generation, we moved to be thin. Thin was a measure of health. And that is probably one of the biggest fallacies. Just moving your body to be thin, just eating to be thin was how we were raised. And I have had to do some massive self-reflection and some therapy to let that go. Really? And that number on the scale for so many of us was how we judged ourselves, how we set up, you know, get on the scale in the morning. It's a good day. Wow. Based on that number. That number represents water, visceral fat, muscle mass.

You know, I could have gained 10 pounds of muscle, but I would have felt so horrible about myself. I did not understand that that muscle is what is going to keep me healthy as I age. If you could give one piece of advice to any woman in their 20s and 30s about their body. Strong over skinny. Strong over skinny. Nutrition over calories. And educate yourself about what's coming because it's coming. What is the biggest risk women have in their 20s

and 30s about trying to stay thin and skinny versus strong and healthy? So it's hard for them to see it because they're 20, right? And they feel good and they look great. They feel like they look great because the clothes are, you know, and, but what they're not seeing is we peak our muscle mass and our bone density at about age 30. Wow. And it's that musculoskeletal unit is tied together. And so you have to, the, the, wherever that line is for you, we start losing muscle and

bone mass after age 30 and menopause accelerates that when we lose estrogen and testosterone, like Matt, we start losing it really fast. How much harder is it for you to gain muscle now? Oh my God. It is so hard. I mean, it's literally every day. I'm like looking at my plate and I'm like protein, plants, fiber, you know, I'm, I'm not even caring about calories and I'm totally changed the way I move my body. Really? Weightlifting. I mean, I used to like work out like, you know, in Zumba last year, a couple of years ago with the eight pound weights. I never got any heavier. I wasn't trying to be stronger.

I just, you know, and now I'm like trying to bench press my weight, you know, and do all these things because I sit there in the gym and it's all about me staying out of the nursing home when I get older. And that muscle mass determines your basal metabolic rate, determines your resilience to insulin resistance. It's everything. Yeah. Dr. Gabrielle Lyon has been a big proponent of promoting muscle. She's where I learned all this stuff. Yeah. And just really like-

She changed my life. The number one factor of aging, I think, is a lack of muscle or of death. I can't remember what it is, but one of the main reasons- Greatest predictors of early death. It's like a lack of muscle. And mostly because you fall and you can't get up or you can't function after you break something and the muscle will prevent that from happening and keep you stronger and healthier. So what I tell my patients is osteoporosis is real and 50% of women will have an osteoporotic fracture before they die. Okay. If you fall and break your hip, your chance of death in one year is 30% with surgery.

Why is that? If it's decline. You can't get out of bed. It's like the beginning of the end. And then if you're not healthy enough to have the surgery, 79% will die in one year. Wow. Because you're bedridden. And that year is horrible.

Marked with decline. Now, some people, it's not everyone some people can recover from a hip fracture but man if you're over 60 65 and you have a hip fracture it is really a bell ringer for a very bad outcome for you but this is preventable and it start it can start in your 30s like that's what i'm telling the younger patients like get to the gym start lifting weights focus on your you know vitamin d make sure you're getting good dietary calcium, like do everything you can to get strong muscle and bones, eat enough protein. Thank you, Dr. Lyon. And focus on that is going to keep you healthy and strong and also probably help you lose the fat. But you know what? Curves are beautiful and we all have different shapes and sizes and

subcutaneous fat does not necessarily mean that you're not healthy. It's the visceral fat. Right. Exactly. Okay. So movement and then one more, what would be the- So stress reduction. And why menopausal patients are finding that easier now. Really? Because they are realizing that no one's coming to save them and it's time to start prioritizing themselves. And that can look different for different people. But in menopause, women are really like, okay, this is it. If I don't do this, like they are really putting up boundaries.

It's fun to watch. Really? They're like, it's my time. I'm done. Oh, wow. Feed yourself. Make your own food. Take care of that.

I got to take care of me. Wow. So it's really, really awesome for me to see them. They're like, mom's changing. Yeah, yeah. This and like, you can make your own dinner. Yeah, yeah i'm meditating leave me alone so but what that stress reduction looks like can be boundaries can be meditation can be journaling can be a phone call can be hanging out with a girlfriend can be you know whatever but like find that okay those are great i think you gave me five different tools that women can do during this menopause phase to

make it more enjoyable, make it less stressful. Yeah. I have a question about menopause and divorce. Yeah. It seems like divorce happens a lot around that scene of life. Yes, absolutely. And maybe it's not all because of menopause, but it's because of whatever, unsaid things for 20 years.

People have been married, our kids are gone, whatever it might be. I have a couple of patients who are divorce attorneys and they have lots of opinions. I'm popping the popcorn and listening to them. So they said, you know, so there's, there's women who were never in a great relationship, but stuck it out because kids and finances. You shouldn't have been together. And whatever. And now you're like, and now they're like, I'm out. Okay. So take those

out. People who felt like they had a good partner and now what happened? And so most of those divorce, the first set is mostly initiated by women, men, the happiest men in the world are men who are married and the most unhappy women in the world are women who are married. Wait, say that again. The happiest, the happiest men in the world are married men and unhappiest women in the world are married women. Why is that? I, you know, well, I think it again the happiest the happiest men in the world are married men and unhappiest women in the world are married women why is that i you know well i think it's the the jobs we give ourselves and the job society expects on us and all the mental load and the work and the you know and there's lots of tiktoks about that right now and i find it all fascinating and that was kind of what happened in early in my own marriage and we've worked it out and it's fine. There's definitely, we have,

we have division of labor things, but it's a lot more equitable now. But I think the second set, so women, we have increasing depression. That's a risk factor for divorce. We have increasing cognitive changes. She's not happy in her job, job changes. And there's a lot of sexual dysfunction, which can destroy a relationship. That's what I wanted to ask you about, the sexual dysfunction or just the changes in sex desires or drive. Yeah. Let's go through that. So when we look at female sexual dysfunction, first of all, it has to be a problem for her. So some women... Do women want sex more during menopause or they want less? Some more, some less.

Is it in general? It's like it declines. General, it declines. The drive declines. So, and that's probably hormonal. So we have five buckets. Typically, we have an orgasmic disorder, an arousal disorder, pain. That's huge in menopause.

We have a relationship disorder, which we kick those guys out. And, you know, we already talked about that. And then we have desire disorder. So orgasmic means that you're struggling to have an orgasm. So about 10% of women are anorgasmic from birth. They'll never have an orgasm in their whole life. And no one talks about it or thinks it's a big deal. And, you know, that's part of society's thing.

We're just receptive and, you know. But then there's secondary anorgasmia where you used to have orgasms and now you can't or they're taking a lot longer or they're less. The peaks are lower. Right. And so that happens a lot in menopause. Our blood flow to the area changes, the health of the tissue changes, and that's all kind of related. And so there are medications to help with that. You have to be able to talk to a doctor who's receptive and knows how to treat it. So then but the biggest thing we see is hypoactive sexual desire disorder, where it is causing distress to a woman, loves her partner, feels totally supported, wants to want to do it, but just can't get that first one.

Like doesn't feel it. Yeah. And it, she'll do it as a chore and to make him happy. That doesn't sound good. But there's not, she's just not, and it's killing her. And so- That could destroy a marriage. That could, that could.

And so that's, you know, so we have, we know testosterone helps with this in menopause. For women. For women. Okay. So our testosterone levels drop 50% or more through the menopause transition. We have a different pathway to make testosterone, but we do see an andropause in women. So not as much as estradiol drops. When the estrogen drops, all the health of

the tissue in the vagina. So we end up with this GSM, general urinary syndrome of menopause. So it becomes thin. You lose elasticity. You can't make mucus. It's dry. It's painful. You can tear the skin with intercourse. I mean, I have some women who are like, I am just gripping the side of the bed. I'm so painful, but she feels like she'll lose her marriage if she doesn't put up with it. And I'm like, this, this is totally fixable. This is such an easy thing to fix. Vaginal estrogen, which is a cream prescription. So easy. Uh, or if creams and pills and rings, there's different ways to get it up there, but that will fix that. And so, and if it doesn't hurt, your desire might come back. Right. You might enjoy it more. Right. And so,

so that is a, the female sexual function piece is complicated, but it is doable. You just have to find the right, and we're not teaching our trainees on how to talk about it to become, most OBGYNs aren't comfortable speaking about it. So we're failing women there as well. Wow. Yeah. So, so have you seen women say, I need to get a divorce? It's just not working because their sex drive is low or something is a challenge for them? Typically, there's a lot of guilt and shame there because they do love their partner. Then the relationship thing comes into play. I had a woman who was telling me, I love him and he's so creative and wonderful and he's

trying so hard. It's just not happening. And like, for her, me, for her. Now, does she have desire for other men? No, no. Now it's funny because some will be like, I just figured out I needed a new husband, you know? So, you know, the same female sexual response is complicated. And first thing I ask about is a relationship issue. Sure. And if they're like, I can't stand him. Oh yeah. I'm like, well, there's a problem, you know, anything I can medicate. And we do have two FDA approved medications, but they're typically not covered by insurance for HSTD in the peri and premenopausal women as well. Got it. Wow. How do women know they're still valuable and worthy when they've gone through menopause or maybe they have a low sex drive or they're not connected to their partners anymore?

Or with all these changes happening, how can you speak into women and let them know that they're actually more valuable after menopause versus when they're in their 20s and 30s? I try to elevate the stories of success and women who felt that way and then have kind of come through it, you know, either with whatever therapies we put together for them, hormone therapy plus nutrition and all the changes. And, you know, we talk about it in the book of that they got their lives back. I can't tell you how many times the women have thanked me for hearing them, believing them, offering them options, and then them coming back and saying,

I'm me again. I'm me again. I mean, my life isn't perfect. I still have stress, but I'm back to my fighting where I can roll with this. And, you know, relationships get better. Everything gets better. Really? When you feel like you're a human being again and you're not constantly in self-doubt. Wow. But, I mean, as women start to age, is that a big fear for women? That they're getting older or they're less valuable? Or, like, now that I can't, you know, my eggs are gone and my less valuable as a woman,

like how can a woman still be more valuable? I think for a woman who has had her family and made the conscious decision, we're done. I have my children I want and I'm good. And then it's, you know, the loss of women feel invisible at a certain age or at a, you know, at a certain level of aging where they talk about, you know, people used to open car doors for me or say hello when I walked by, you know, in New York talking about walking by the doorman, you know, and they used to get a hello or, you know, no one wants a cat call, but, you know, just pleasantries. Smile a gentle eye. And all of a sudden it's like they're invisible.

Really? They've reached this level of invisibility and it's somewhere in the 50s, 60s, 70s, you know, where they just don't feel like the world sees them or hears them or values what they have to offer. Why is that? Why do they feel that? I just think it's the way we just value youth so much and women especially. I mean, there's so many examples of like magazine covers. And, you know, if you and I shot a magazine cover, they'd leave you just, well, you know, they'd leave you just like you are. I would be photoshopped to the 25 year old, you know, to oblivion. They might leave in one wrinkle because I am 55, but you know, it's like,

and all the pressure to look a certain way or to be a certain weight or to, you know, you know, it's always like, you look good for your age or, you know, instead of just like, I am a rocking 55 year old, you know, and that's okay. And I don't expect to look like 25-year-old me. I don't want that girl back, you know. I might take her eyebrows, but, you know, there's a few things I miss. But, you know, I wouldn't trade my life, my experience, my relationships, you know, where I am right now, how good I feel every day when I wake up to look a certain way. you know, where I am right now, how good I feel every day when I wake up to look a certain way.

But it seems like there's so much pressure and so much focus on women staying skinny over strong, staying young over aging in a healthy way. Yeah. I mean, we are fighting and I've found the menopause, which is Gabrielle Lyon. And we have cardiologists. The menopause. The menopause is a group of clinicians who we all have the same mission is to elevate the aging woman into where she needs to be. And we all kind of found each other online or met at conferences and, and, you know, just found we were speaking the same language and we now promote each other's books and speak at each other's conferences and anything we can do, because overall we may have different ways to message, but our mission is the same and it is leave no woman behind. We are all, and we're all this age, you know, or older,

maybe a little bit younger, but like this is inevitable and we can make this better for everyone. I mean, there's the, so the new menopause, right, is the name of my book. Well, there is an old menopause. And this was the older generation of clinicians who felt that a woman needed to accept her place in the world and that menopause was a natural thing. It is natural. But that, you know, she just needs to be grateful for being alive. Your time is coming down. And this is just aging and decline and you're just going to have to get over it. Instead of helping her navigate this, we are aging. No one expects to live forever, but there's something better out there for us and we deserve it. And

we're going to fight for it. Wow. And we're going to show other people how to do it. It seems like the medical world has failed women. I would have to agree with you. The medical system, I don't think the individual doctor goes out in the world and thinks I would have to agree with you. The medical system, I don't think the individual doctor goes out in the world and thinks, I'm going to fail a woman. I think the way we've built the system was for the basic white guy, at least in the US. And so all of the studies, women were not even required legally to be in studies until 1993 from the NIH. Okay. So we have an entire generation. Now that happened because thalidomide was being used in pregnant women for nausea and it ended up causing birth defects. And that freaked everyone out, understandably,

but they removed all women from studies after that, just in case they might get pregnant. Then when you talk to researchers, it's much more expensive and harder to study women because of their cycles or because of peri or postmenopause. And men are just predictable. So they just study mostly men and just take those things and infer them to women when we don't really understand the gender differences and the sex differences and how cardiovascular medications affect. So greatest example, statins, right?

We use statins left and right to treat high cholesterol. Most women will have significant elevations of cholesterol through menopause. So here she goes through the change. Boom, her cholesterol goes up, goes to her PCP. You need a statin. Statins have never been shown in women to decrease the risk of a heart attack or decrease death from cardiovascular disease. So why do we do it?

Because it worked in men. And we just do it. Wow. So there is no evidence to support that. It will lower cholesterol. It will not decrease the risk of a heart attack. Oh, interesting. Because we develop disease differently and for different reasons. And this was published by the American Heart Association in Circulation Magazine.

I didn't make this up. And so yet there's no studies right now. So now it's like us fighting, getting the NIH grants, getting Congress on board. What the menopause is doing is advocacy, is fighting on a legislative level to force these things to happen, force these American College of OB-GYN, American Board of OB-GYN. And why should all of women's health fall in the lap of the poor, busy OB-GYN who American Board of OB-GYN. And why should all of women's health fall in the lap of the poor, busy OB-GYN who's trying to deliver babies and prevent cervical cancer, right? I did that job. It's a hard job. This should be required in medical school. I got one hour of menopause

in medical school. Every clinician who touches a woman should have required menopause training, not just hot flashes, night sweats, and what HRT may or may not do for you, but how our sex differs in disease and how we need to treat women differently. I mean, if you read Eleanor Clegg Horne's The Unwell Woman and you look at The Invisible Woman just came out, Invisible Women, just looking at how in science women are just kind of ignored because we're harder. Harder to study. Yeah. And so we're not little men.

We're more than just a man running, a short man running around with a breast and a uterus, you know, breast and uterus. So we're actually, the way we present with disease, the way we're treated with disease is vastly different. Yeah. So what started out with like hot flashes and weight gain is actually a much bigger, bigger picture. So to start it out with like hot flashes and weight gain is actually a much bigger, bigger picture.

And what are the biggest, I guess, risk factors for disease with menopause? Are there higher risk factors for diseases like breast cancer or other types of- So menopause, you see the cardiovascular disease risk starts rapidly accelerating. Yeah. So that's because our insulin resistance goes up and our cholesterol goes up. So the risk factors for heart disease go up once you go through menopause. So you take two 50 year old woman, one is premenopausal, one is post, and she has like a 50% increased risk of cardiovascular disease once she's postmenopausal. Yeah. So estrogen is incredibly protective for the lining of those vessels in the heart where those plaques start building up.

Oh, okay. Wow. So in being on HRT early, if you start early enough, and menopause is actually will decrease your risk of cardiovascular disease 50% per year if you start early enough. Hormone therapy. What is the hormone? What's the art? Replacement.

Hormone replacement therapy. What if women don't like the idea of taking drugs or therapies? So it's going to be harder, but it's not impossible. So you're going to have to double down on the other pillars of health. So your diet, your exercise, your stress reduction, really staying on top of the risk factors. So you can still prevent the increases of disease by doing the other things correctly. Right. But not holding the discussion around HRT, which most women aren't getting. So 85% of women will go and talk to their doctor

and mention the cliche symptoms of menopause, right? Only 10% right now is in 2023 be offered treatment. And it's usually an antidepressant. Oh, not HRT. Not HRT. Only 4% to 6% of women are on HRT, right? Interesting. Who are menopausal.

What happens when you give a woman experiencing menopause an antidepressant? So, well, if she's really depressed, sometimes her depression gets better. But again, everything has side effects, including HRT. So I don't want to make like, you know. But her libido goes down. She can gain weight. It depends on the specific SSRI or SNRI. So there are side effects that can be pretty debilitating. But a woman is like four times more likely to be given an SSRI right now for the treatment of her menopause than hormone therapy, which is the gold standard. Certain SSRIs have been shown to somewhat decrease hot flashes, but they're not great. And they can help with depression symptoms, which can be severe, you know, in menopause.

Right, right. But there's side effects. But yeah, but then there's side effects. So, you know, every discussion around medication with a patient is risk-benefit ratio and discussing possible side effects. It's also like if HRT, if it sounds like it could be right for you, it doesn't mean you should stop eating fiber and sleeping well. No, no, no, no, no.

It doesn't mean it's like, okay, I can do this. It's not magic. Right. No. And now you're negating a trip to Wendy's though. Right, right. And those Frosties are good though. So yeah. So it's like, it's not perfect. It's a tool in your toolbox. So when I approach menopause care with my patients, it's a toolbox and we have tools in here and they're all important. I think I saw one of your videos on Instagram that was like, this is my daily menopause routine, but it was like 17 different things. It was like a cream and pills and this and that. I was like, that can seem daunting. It can, it can. So I'm on, I'll tell your followers, I'm on systemic estrogen replacement

and I do that with a patch. So that goes to my brain, my bones, you know, everywhere, but I still have extra estrogen locally. So I have top and bottom. So I have facial estrogen to help with thinning skin. So we lose 30% of our collagen, which women know, every menopausal woman knows she has lost some collagen in her skin, especially her face. So I do a little topical estrogen here. And then I also use some in the general urinary area as well. Okay. And then I have pro some in the general urinary area as well. Okay. And then I have progesterone. So, and that really helps with sleep. So it's magic. I'm telling you, like if nothing else, especially in perimenopause, progesterone could save

a woman's life. So if she's not sleeping. So love my progesterone at night. And then I do testosterone as well. Wow. But I mean, a hundred years ago, women didn't have these options. They also died. They just died. Yeah. They I mean, 100 years ago, women didn't have these options. They also died. They just died.

Yeah, they died in their 50s, 60s. So 150 years ago, the average life expectancy, they died before menopause was like a thing. Really? Yeah. And so there was the occasional, but someone my age 200 years ago was very rare to be alive. And so sure, they had the occasional one,

but the average life expectancy, we are now because of life expectancy, you know, we are now because of modern medicine, modern plumbing, modern technology, are living 30 years outside of our menopause, way longer than most humans lived as females. How can men who lack potentially the emotional agility to navigate anyone else's emotions beyond theirs. Yeah. Let alone, you know, once a few days out of a month, like they're maybe used to with the partner they're with, to now what could be any day of the week for years. Years.

Of emotional uncertainty. How can a man, you know, how can a woman send this to a man in their life and say, I'm not crazy. I'm just going through this season of life. I'm trying to do everything I can to navigate and manage it and balance everything. But what would you say to men who maybe don't have the tools don't have the experience don't have the emotional capacity within themselves to look at emotions be there for the women that they love yeah without you know making them wrong shaming them telling them like figure your life out i can't help you like what can a man do with their capabilities without telling them to go learn a million things i I don't know. Like they still have their lives, their responsibilities, their stresses as well.

What can men do to help women in menopause? So the best office visits I have are when their partners come and they're there to help understand. And I do a lot. That's a long visit because I'm educating two people at once. Right. And so those are the couples where I know they're going to make it, you know, like he's really here for the right reason. He's bought in. He's, he's, he wants this to work and he wants to understand. And so this is going to happen to a hundred percent of us who live

long enough. This is not optional and it is going to rock her world. So be aware. I mean, I think education is everything. And so if not my book, there's other books out there like pick up a book and educate yourself, you know, read the book together, get it on audio, whatever, you know, so that you have some grip and understanding, which will help you have more compassion. And help you lean into this time for her so that and help her navigate and help her get her to the doctor, you know, facilitate these things so that she can get on the path to going back to who she used to be. Yeah. Well, it's probably a journey for men, too. Yeah. In this phase. challenge that men go through in terms of watching the woman they're with, hopefully they love, for years, see the woman transform into something different? What is the biggest

challenge that men go through after, I guess, postmenopause? I think most of us go through, we're not the same people we were 20 years ago. No one is, right? And so most relationships that stay together, you kind of ebb and flow and grow and change together. You're on this kind of tangential thing together. And what breaks up most marriages is, I think, in the early days is you grow apart. And then all of a sudden, she's doing this, and you're still on your little path. this and you're still on your little path. And just understanding that it's like, how did you deal with teenagers, you know, and all of the hormone changes in puberty that you had to like, go through with your kids. You love them. You're not getting rid of them. You're committed. You know, this will end. There are probably things you can do to facilitate, but that's going to look different for every couple. Yeah. Yeah. Wow. Have you seen, have you seen, it's happening. It's either way, whether you like it or not, it's happening. It's happening. So be along for the ride. Yeah. And you know, some women kind of,

I mean, that quietly tell me, and they're kind of embarrassed, like, like my period stopped and I'm okay. Now maybe they've had joint pain or some headaches, but like they kind of skated through the worst of it. Is that more of a mindset, like approaching it with a positive mindset or an attitude of like, hey. So when you look at, there's some data on cognitive behavioral therapy, but man, that's hard to do and hard to access, at least in the US. But there were some studies in Great Britain looking at cognitive behavioral therapy and menopause. And those women did better and really felt like they had less symptomatology and were doing better. But I don't want to say that CBT is a replacement for hormone therapy or whatever.

I think it's a tool in a toolkit, especially if you're having the mental issues that can be very, very powerful and help address some other issues. So women who have good nutrition or healthier when they start the perimenopause journey do better. Now, I don't want to shame any woman who's living in hell who had perfect nutrition and was working out, you know, doing all the things. But overall, they do better. But overall, they tend, the earlier, the healthier you are when you show up is how you'll kind of go through it. What is the age again for premenopause to menopause? Sure. So average 51 for menopause, period, stops.

45 to 55, still normal. 7 to 10 years. So let's back it up. So around 35, I really think patients should be screened for perimenopause and getting the education system going in their 30s. Like, this is coming. These are the things to look for. Don't be scared.

Da, da, da, da, da. You know? What is the, I guess, what is the oldest woman who had menopause? Do we know? Like how, is there a way to prolong menopause? This is a great question. To push it in the future to your 60s? So that is where the most exciting research is.

So there's the occasional woman who will kind of go into her 60s, you know? Really? It's pretty rare.% of women will be no no not without help because they're that quality is poor so that they might get pregnant but it doesn't so they must having the period still in this yeah but still having a period it's pretty rare but it'll happen so but 95% of women will be through by the age of 55 so then we have our stragglers. So we don't know what can push out the life of the ovary other than good health and nutrition. We know things that will cut years off the life of the ovary. So chemotherapy, anything that'll like disrupt the ovary, you know, chemotherapy,

radiation in the abdomen. Yes. Surgery. So hysterectomy, which a lot of women have, you lose four and you leave your ovaries behind, you're going to lose four years off the life of the ovary. Okay. In the book, we talked about a study that was done specifically looking at women who had childhood sexual abuse, whose children were then sexually abused. And for whatever reason, they looked at their age of menopause and it was nine years. Nine. Wow. Earlier than the average. Nine years earlier. Yeah. So we know that stress, that that kind of stress will take off the shelf life if you're, you know, because you're inflamed and autoimmune, you know. We know that smokers do go through earlier. African

American women tend to go through about a year, year and a half earlier. You know, genetics plays a huge part. Asian women tend to go through a little bit later than Caucasian. Then we have, if you have a bilateral tubal ligation, so tubes tied from, you know, you lose a year and a half. Yeah. So anything that disrupts blood flow or the health of the abdominal cavity, ovaries, endometriosis, you go through sooner because of all the inflammation in the abdomen. So there's lots of things that can lower the age of menopause, how many kids you have. So if you are ovulating all the time, you lose more eggs each month. So women who've never had children and weren't on contraception go through a little bit sooner. Women who are on birth control for a long time get a few more months in.

It's really interesting, but the best research, I love, love, love coming out right now. There's a couple of companies that are looking at AMH, which is a kind of bizarre hormone in our ovaries that can extend the life of the ovary. Really? So they're really looking at technology and pharmacology that will make menopause optional. Come on. Yeah. You think it's possible? Not for...

Mine are dead. They're gone. But you'd have to start young. But it would basically decrease the signals that are causing the atrophy and the atresia of the ovarian follicles. What would life look like for a woman that never had menopause and lived until they died? Well, like a man. You just age and die.

I think we'd live longer. Really? I think we'd live longer. Really? I think we'd have a longer health span. Interesting. So, but what these people are saying is that, what these researchers are saying, that it won't extend your ability to bear children much longer, but it will give you enough estrogen for protection. Interesting.

To maintain that protection. You're still going to age and die of something. Right, right. But we're not going to see that acceleration. So women will just live a lot right now, which is longer than men. And they won't go through those emotional changes. Right. And so taking that, you know, what it would do for women's mental health and their resilience and their ability to function and work, you know, through that, I think. Is this available now for women? No, no, no.

It's all experimental right now. But there's OVIVA is one of the company, Daisy Robinson. And then there's one, I can't think of the name of the company right now, but there's two I know because I've been on panels with them and I just sit there. Oh my God, that's amazing. So like for my daughters who are 23 and 20. It might be possible. That might be possible.

I mean, my 23 year old, who's going to be a doctor, she's a first-year, well, now second-year med student. She's like, mom, menopause really should be an option. Like, I should not go through all these things. You know, like, I might get on hormone therapy and PERI and just skate on through. What is the most interesting thing you've learned in the last year while working on your book and working with women who have gone through all these different complicated, you know, emotions. That I totally misjudged the women of our age. I totally bought into the line that this is the end and that, you know, I just wasn't going to be as much of a person. Menopause scared the hell out of me. And I felt when I finally realized it was

menopausal, I felt old. I felt like it was the end. I felt, you know, and how wrong that was and how I am killing it right now. Let's go. You know, I am like, let's go. And I'm bringing my daughters and I'm bringing other physicians and I'm, you know, I'm just, this, no, I'm saying no, I'm not accepting what the status quo, the old menopause, because this should be the best time of our lives. Wow. All right. I'm not accepting what the status quo, the old menopause, because this should be the best time of our lives. Wow. All right. I like that.

Yeah. That's exciting. Yeah. Wow. What are you most excited about in your life? I just love my kids and my family. You know, that I don't worry about, like, paper college and, you, I'm not worried. And now I can help out my nieces and nephews, like that level of stability that I didn't grow up with. You know, I, my parents

went bankrupt when I was a kid and just kind of living through that, which made me who I am, but I don't want to repeat that, um, for my kids. It's like, how do you create just enough hardship for your kids to be resilient, not give them ever just enough to be successful, but not enough to do nothing. So I'm always walking that line with them. But, um, and just really like celebrating my siblings. And I have lost three brothers to two to cancer, you know, one to the HIV and hepatitis and just life is short and you got to smell the roses and do the things and climb the mountains

and, and do the travel. And if I don't take care of myself, I'm not going to be able to fulfill all those goals. And there's so much cancer in my family. Like two brothers, five aunts on one side, you know, like multiple, multiple, multiple cousins. Like I've got a gene. There's something not okay. And like it is my job to take care of myself. Wow.

I've got a gene. There's something not okay. And like, it is my job to take care of myself. Wow. And if I don't like eat the foods and do the work and live the life and do the stress reduction and, you know, then I'm not going to get that, that option that I really, really want. I mean, what, I mean, I've heard you talk about the loss of your three brothers who you've lost, right? What is that? How do you navigate being a mom when you lost three siblings in your current family, but then you have kids? Yeah. How do you just navigate life with the loss, but also the love? Yeah. So you lose them one at a time. So it's not like you wake up and they're gone. So I was a little girl's nine when Jeff died and it really kind of redefined our family. Mom was pregnant with number seven.

I have, there's eight of us. And then she had another baby two years later and then she had hysterectomy and there was no more kids. So, you know, watching them watch me grieve was really hard. And cause I was so close to my brother, Bob, when he died in 2015 and he was like, you know, he had the same partner for 35 years that he and Randy came for like every Mother's Day and Easter and, you know, we decorate and he's just so talented. And so he'd do all these wonderful special things with my daughters and,

you know, dress them up and make them fancy things. And, and so that was a tough loss. And then when Jude died, you know, Jude got sick right after Bob died, he got, was diagnosed with cancer and, you know, it was COVID and we were sneaking over the state line to go see him and try to take care of him. And, you know, his travel was embargoed for good reasons, but, you know, and just trying to like spend time with him and take care. And then in the end I was able to do his end of life care too. So, um, for the last week or so, and it just really, you know, they were older with Jude and watching them like celebrate the wins is really cool. And we have like a little

thing in the kitchen where all the boys um we have the little church cards you know from their with their pictures and then my dad died like nine months after but he was old and it was not you know still and he had a broken heart so um so broken heart from well he buried three of his kids you know you think he died of a broken heart i you know he just kind of like once jude died I just saw him just kind of go quickly. And that was a blessing that he didn't have this long drawn out, you know, horrible thing. But, you know, now here's my mom. She's been alone without my dad since 2021.

She's buried three kids. She now has dementia. And she just, it's really hard. It's hard for her. Yeah. And so me just openly talking to my kids about my feelings about that and like what I'm doing in my life to try to prevent, not that you can't guarantee everything, but like, I'm just trying to limit their time of dealing with me like that.

Right, right, right, right, right. Yeah. Do you have any advice for people who are grieving a loss of life on how to also take care of themselves so they don't decline. So I didn't, I did it wrong the first time with Bob, you know, and I, I didn't give into the grief. I fought it. I would only cry on my drive home from work. I didn't get therapy or counseling, you know, I did everything wrong. And so- Try to push through it. Right. I'll be fine. And then, um And then with Jude, I said the things to him. Like Bob, I didn't say... I didn't have the closure.

And so with Jude, I said the things. I said all the I love you's and I said the goodbyes and I said everything wonderful. And then I really leaned into it and I let myself be sad and I let the kids see it. And I, but I didn't, I didn't want to be overly dramatic about it, but you know, it was such a different experience. I ate well. I knew it was coming. You know, I worked out, I made myself do the thing. So I was so much healthier through the process mentally and physically. I still grieved, but I just came out of it so much better. Yeah. So don't lose yourself in the grieving process. No, you got to grieve. You got to let yourself go there, but you know, the days you can't get

out of bed, that's okay. But the days you can, you need to go and eat the right things and go to the gym, you know, and keep those pillars of health going because you're just going to get through this so much easier. Wow. I'm curious in a moment for you to share the biggest thing that's opened up for you or the most important thing from this conversation that you want people to take away from. For me, it was how men can be educated and informed more. And so that when the time comes, even if they don't know how to navigate it, at least they can say, I'm here for you. I'm here for you. I'm going to learn the best I can, and I'm going to do my best to be here for you. And I think if a woman sees their partner,

their male partner, even to do that, it should help them feel a little more safe. They may not understand everything, and they're never going to because they're not going to experience it. But now you can put words to it, right? And there's a thing happening, and it's, okay, we're going to get through this together. So women watching, send this to your men so they can understand the gist saying, I understand you're going through something and I'm going to do my best. It's a good start. The next thing is the five keys to kind of taking care of your health pre-menopause and

during it so that you can optimize the experience and you don't have to suffer as much and hopefully not suffer at all through these different kind of five keys that you laid out. And then I would also say like just the, I think sex is really important in keeping a relationship healthy. So doing the things sexually, specifically with like the creams and other things, that could be an easy relief for making it still work for you. It's not painful. So those would be kind of three things that stuck away from me.

But what would you say is the number one takeaway for you that you share that you want everyone to be reminded of? Just that this is an inevitable process, but suffering through it is not. And it can be, and it hopefully for you, it's an entryway or your partner or your mother, whoever's listening, you know, whoever that you love in your life is going through this, that she is going to be okay. She might need some extra love and support and things are changing for her and it's not her fault. And, you know, be there for her and, you know, get her an appointment, help her find a menopause informed provider and, you know, help her get on the path to being okay.

That's great. That's beautiful. Your book is out right now. It's a New York Times bestseller, The New Menopause. And it really helps cut through all the confusion and give people more clarity about what they're dealing with, what they're going through, what they're going to go through and how to prevent any unnecessary pain and stress and overwhelm from the process. So I'm excited about that. People can get the book everywhere. The new menopause, we'll have it linked up as well. Dr. Mary Claire, you are on social media. You've got like 4 million

plus followers everywhere. Where can people follow you or connect with you online? like 4 million plus followers everywhere. Where can people follow you or connect with you online? So all social media, it's Dr. Mary Claire. You can find me. And then on our website is The Paws Life. So we have blogs. We have guides to download to talk to your doctor,

how to talk to your doctor, what lab tests to ask for. I try to have as many tools as possible on our website. The Paws Life, Dr. Mary Claire on social media. You got a lot of great content on there so people can just start watching some of that as well. This is a question I ask everyone towards the end. It's called the three truths. So imagine a hypothetical scenario. You get to live as long as you want, but it's your last day.

Okay. You get to create and do everything you want in life from this moment until that last day. But for whatever reason on the last day, you have to take all of your work with you. So this conversation is gone. The books you write, anything you create from this moment on is gone. Okay. But you get to leave behind three lessons to the world. And this is all we would have to be remembered of you, be reminded of you

is these three lessons, or I like to call three truths. What would those truths be for you? It's never too late. Die with the family you create. And love is always the way. and love is always the way. I want to acknowledge you, Dr. Mary Claire, for being a powerful voice for women who struggle, suffer, and feel maybe like life is starting to be over at a season of their life.

And for you to jump in, to dive in, to give clarity around this, to research this and be a personal example on how life can just begin during menopause or after menopause and not start to end. It looks like you're thriving. You're doing your best work right now. You're happiest. You're healthiest.

You're educating yourself about your nutrition, your body more than ever now. Yeah. So to me, it looks like life is just beginning. Yeah. Rather than starting to end. I just told one of my friends and she's in her thirties. I was like, my life began at 50. She's like, I'm so proud of you.

And I was like, my life began at 50. That's cool. Not that I didn't love my life before. Sure, sure. Started at 50. That's exciting. Well, I acknowledge you for being this model in the world. So thank you for helping so many people.

My final question, Dr. Marie Claire, what's your definition of greatness? Oh, man. That you leave more in the world than you, you leave more behind than you took. I hope today's episode inspired you on your journey towards greatness. you leave more behind that you took. our Greatness Plus channel on Apple Podcast. If you enjoyed this, please share it with a friend over on social media or text a friend. Leave us a review over on Apple Podcast and let me know what you learned over on our social media channels at Lewis Howes. I really love hearing the feedback from you and it helps us continue to make the show better.

And if you want more inspiration from our world-class guests and content to learn how to improve the quality of your life, then make sure to sign up for the Greatness Newsletter and get it delivered right to your inbox over at greatness.com slash newsletter. And if no one has told you today, I wanna remind you that you are loved, you are worthy, and you matter. And now it's time to go out there and do something great.