The Essential Menopausal Toolbox – with Dr. Mary Claire Haver

Mindy Pelz  

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 NIF if Dr. Haver his 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. Marie Claire Haver is a board certified OBGYN. She has helped 1000s of women going through perimenopause and menopause. That’s actually her specialty. And her goal is 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 best selling 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’s so lines up with everything that I stand for, and are teaching you as well as 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 Moscone. When I brought her on on this podcast she talked about she had had some findings on the female brain. Those findings were released last week, Dr. Hamer 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 postmenopausal years? We talk about that. Then we talk about how do you decide if HRT is 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. Hamer 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. Haver. Your work has inspired me, I have been watching you do your Facebook’s lives and all your videos. And as 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.

Dr. Haver  

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.

Mindy Pelz  

Yeah, let’s do it. So I’m gonna start this off with, when I, over the last couple of days, I’ve been diving into your book. And I gotta 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, that this book was needed 2030 years ago, and I’m so happy you wrote it now and 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

Dr. Haver  

I look at the options that our mothers and grandmothers had, and when they got to our age, and their 50s, it was like, this is as good as it’s gonna get. And they just calmly accepted what the world offered to them, by and large, which ended up with them having 20% of their lifespan and 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 needing long term care facilities for extended periods of times more than their male counterparts. Are our generation the elder millennials, and the Gen Xers like us? Because I’m 55? are saying absolutely not. Like, this is not okay. And how we approach study and conceptualize our menopause, which is from the last menstrual period until we die, okay. There they are, 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 men of posse. We know the messages that work 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,

Mindy Pelz  

yeah. I 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 are not we are now being like, no more? You can treat me like this. You can’t gaslight me in an office, you can give me an antidepressant for my menopausal symptoms. There’s like this real rising up. And I call it what I’ve been rephrasing it is the patriarchal hex, that women have been under this sort of hex of accepting mediocrity. And when it comes to our health care system, and by patriarchy, I always want to say it’s power over it’s not en. I’m right.

Dr. Haver  

No, have some of the loudest voices that are the status quo are female. So I want to be very clear. This has nothing to do with men. You know, right. 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.

Mindy Pelz  

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 on to 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 does that telling us about menopause and how we need to do it different?

Dr. Haver  

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 weren’t 100% Right. Hormone Replacement Therapy was developed in the 40s 50s 60s. You know, through that pathway, simply to get rid of hot flashes forever. We defined menopause symptoms by the presence or absence of vasopressin. motor symptoms 85% of us have them. For 2025 30% of us there’s 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 Oh urologist arthritis, oh my god, frozen shoulder, all of that, besides frozen shoulder hair. He got Yeah, 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 define menopause but you know, and everything else that we are going through at this age was attributed to aging, nothing to do with hormone depletion. And it’s that’s where the new research is going. So the rough the beautiful study that it just got published in Nature magazine, by our friend Dr. Lisa Moscone, 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 app looked at the activity of, 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, if estrone estradiol and testosterone, you know, it is dying for estrogen. And so the brain parts of the brain, the hypothalamus, pituitary to functioning, the cognition, the memory centers are lighting up like firecrackers in post menopause, because estrogen receptors are like Help me Help me we need estrogen. The Old Guard attributed that we know that women are having cognition changes to menopause. They only attribute that to the loss of sleep from vasomotor disturbance. Lisa, prove 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 the subject also stops functioning normally. Also, we know great research coming out of Australia. We’ve 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 post menopause, 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 crazy. Your parents are getting older, your job is more demanding you’re not, you know, it is literally the disruption of neurotransmitters in our brains 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. FSH, as we know, right, follicular stimulating hormone which is made number two Attari. That makes us ovulate basically to simplify it. FSH rises in perimenopause and then gets really high in post menopause and stays there for the rest of our life. New data is showing that those FSH alone without the estrogen depletion is toxic to the liver and the brain increases the rate of atherosclerosis, not as Alzheimer plaques. Yeah, in the brain, just the FSH elevations, and if we can get those FSH 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.

Mindy Pelz  

Yeah. So there’s such a great explanation. So does that mean that everybody should go on hormone replacement therapy?

Dr. Haver  

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. No, it’s a medication, you need to a full discussion of the risks and benefits. But what’s happening in modern medicine is that a woman walks in with hot flashes, so classically remote, vasomotor symptoms, she has a 10% chance of getting the diagnosis of menopause put on her chart. No periods of time.

Mindy Pelz  

It’s a diagnosis. Wait, I don’t do that, right. Seems like a 5%. If

Dr. Haver  

she’s in that 10% If she’s offered treatment, four to one, it’s an antidepressant versus menopause hormone therapy. You know, only six to depending on who you read six to 8% depending because we don’t track the compounding pharmacies, right? So it’s only the FDA approved stuff. But right now it’s four to 5% are getting FDA approved HRT medications of women who are eligible. Yep. 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 cardioprotective neuroprotective benefit.

Mindy Pelz  

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’t 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 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 gonna be like how I wish, right? I

Dr. Haver  

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 will be 56 and about a month. I literally am living my best life. I have me to better relationships. Yeah, better intimacy, better health. Yes, I’m wealthier. And 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.

Mindy Pelz  

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 Peri menopausal years, I kept trying to figure out what’s going on with my brain. And 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 the grant 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 bigger picture. And when I saw that my 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,

Dr. Haver  

it’s like you’re developing Alzheimer’s at a higher rate because you live longer. And that is not true. That is absolutely, yes.

Mindy Pelz  

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

Dr. Haver  

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 then meant healthy, okay? Certainly being thin or is more healthy than being morbidly obese. Do my genetics was never going to allow that to happen to me it’d 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 crush your core and scurvy and severe vitamin deficiencies and stuff but basic day to day nutrition I had to went back to school at like 48 to learn about nutritional 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 are focused on foods rich and fiber also are rich and so many other things vitamins, minerals, nutrient you know, so it’s like you’re killing multiple birds with one stone, but most women in the US are only 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 and we will you know, most of us know that now and so women should be getting minimum 25 the health benefits or 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, bright berries, like getting food rich in that rather than just like oh locale you know, like how much fun 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 gotta eat more. Are you getting enough protein? Oh my gosh, like I was not getting enough protein

Mindy Pelz  

for sure to record what are your recommendations on protein because we’ve had some really deep discussions on this in my in my membership group, and people are struggling to get one gram of protein for every pound of bodyweight.

Dr. Haver  

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 why the Women’s Health Initiative, which kind of threw out estrogen as an, 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 scores 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 fertility scores, we are not eating enough protein to counteract the sarcopenia of aging. And so upping your protein, so I’m recommending for my patients, and I do it in kilograms, you know, I have a body scanner in my office, I, 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, with healthy body weight. And they, because they are, they’re usually about 50 or 60. So I’m like, Yes, tomorrow, this is a transition. Okay, so we’re gonna, you know, don’t 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 month, you’re gonna try to increase your increase there. And you know, protein supplements can be a great like segue to get there, I always prefer you to get your protein to food. You know, supplements are great, but they don’t replace Whole Foods. Good nutrition. Yeah. And so you know, for my patients who are transitioning to get to these higher levels, sometimes a protein shake or soured 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.

Mindy Pelz  

What would you say to the vegan? Do you it’s really possible,

Dr. Haver  

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 healthier than the Western diet. We know that, of course, but you’re gonna struggle, it’s gonna 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.

Mindy Pelz  

Oh my god, that’s so that you need to you need to that’s when

Dr. Haver  

I reached my patients all day long. Yes. Let’s get rid of the acute problems. Yes. What are the hot flashes and night sweats the brain fog? Just things that brought you here. And then we’re gonna set a course for the next 30 years. Okay, and what what are your goals? What is what is your mom look like and look at their mom is kicking ass at 95 and go to the grocery store and driving herself and playing with grandkids. I’m like, Let’s do what she does. Okay, yes, 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.

Mindy Pelz  

Oh, I love that. Okay, so that number one is nutrition. when

Dr. Haver  

anything goes. Okay, so movement. All right, I worked out to be thin cardio, cardio, cardio, pick up some weights, we cannot counteract the effects of sarcopenia 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 have a walking gym. My treadmill is a working desk. And so I walk while I work on an incline with my weighted vest. So I love the weighted vest is a hack. They’re cheap, in 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 weighted vests with protein intake, 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

Mindy Pelz  

love that stronger. I just got a weighted vest. I just told my husband this morning. I’m like, I’m a record out. And he’s like, What? What? Yep, I’m gonna start racking I’m like it even has a fancy Yeah, it’s a it’s a form of

Dr. Haver  

wrecking working. 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. Different levels, how

Mindy Pelz  

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 always So fell walking to be incredible, especially when my brains on fire. So what would give us a view of what like a week would look like as far as exercise variation,

Dr. Haver  

so I recommend to my patients for as far as cardio goes, we went 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 Sprint’s here and there you don’t have to do much to get the VO to max up. So like, shoot for about 150 minutes a week of cardio. So that’s like 33, you know, five walking sessions for 30 minutes a week or 345 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. What about yoga? Well,

Mindy Pelz  

I mean, because like it’s

Dr. Haver  

good, 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, rote 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.

Mindy Pelz  

Okay, great. Okay, so second is movement. What’s after that? So

Dr. Haver  

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 it’s 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, a great change in your mindset around how you look to how you feel. And so, rights are important again, but it should not be the primary driver of the choices for your health.

Mindy Pelz  

Yeah, I continually say that I always 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 my 100 year old self proud. And if I always keep her in mind, in my day to day, I know, I’m gonna love 100 When I get there, so I like where you’re going with your thought process on that. What about fasting? We have to bring fat Yeah,

Dr. Haver  

so no, I yeah, I love fasting for the anti inflammatory benefits. Those are clear that are it’s very, you know, neuro inflammation, 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 what time Yeah, and I’m kind of, I bumped, 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 non political. 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 just being fun 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.

Mindy Pelz  

Yeah, and what Lisa and I discussed is what we’ve seen in 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 went up menopausal woman has a ketone going through her body, that the brain fog is gone, the mental clarity and focus is back, and she agreed, but I said, well, where’s the research on that? Because unfortunately, we don’t have that we

Dr. Haver  

don’t have it. Have you experienced that? For sure. I mean, my 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.

Mindy Pelz  

Yeah, yeah. So I think we can debate like fasting lanes and fast and protein, all that. And then 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 and 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 OBS 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?

Dr. Haver  

We I have, you know, there’s definitely a relation because Milena Corden. I mean, we know and melatonin, the natural melatonin and all of these, all of these little hormones talk to each other, and the hypothalamus and the pituitary. And so we just, we are not studying women, we’re more we’re not studying female animals in the labs, you know, like, because of this exact thing. All of these ribbon rhythms are disrupted as our hormone cycle change when we’re pre and Peri menopausal, 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 can do more research here. And I’m not saying that absence of evidence isn’t. I think Peter says it’s the best absence of evidence is not evidence of absence. We I just can’t go around recommending things off the bat without, you know, bodies. This is something that would be fascinating to look at. Right. You know, I definitely think there’s a correlation.

Mindy Pelz  

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 the CEO, is I made a bold statement that women need more rest, and I gotta have great data coming next. 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 you’re and your hormonal system is shutting down. So where does rest and recovery have to be highlighted in the menopausal experience?

Dr. Haver  

So we are in perimenopause, we are in a zone of chaos. Okay. The normal signals that used to cause ovulation be we become resistant to because we are losing our egg supply. We’re born with all of our eggs. Okay. They last us until we go through menopause. perimenopause 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 are surrounding our eggs create the pathway to make estradiol and testosterone, so LH and FSH each month when we’re pre menopausal, 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 to 16. And on and on and on the whole cycle repeats itself. Okay. That is how God made us that is the perfect way right? Now we hit perimenopause, we reach that critical threshold. So the hypothalamus is constantly syncing until we die, looking for estradiol 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, Make tell the ovary to make the extra dial we’re running low, LH FSH start pulses posted to link start pulsing out dairy gland talking to the ovary, the ovaries like I can’t respond. I don’t have enough egg lab. So the hypothalamus says, Hey, where’s the estrogen Come on, I you know, send the signal pituitary said I did and it’s a sin more. That’s where we see the rises of our FSH level and perimenopause way higher than we ever were in our pre menopausal 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 FSH 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 to where it used to be a little counterpart. So she’s a little slow So timing is off. So that effects 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 UB is what we call it in my world. 90% of us have horrific au be through the period men and post 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 uniform Ready, 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 it gets no,

Mindy Pelz  

no, I love this. You keep going. I’d smile. All of

Dr. Haver  

it means perimenopause zone of chaos. Zelda. Absolutely. And when I say that women are like, Oh, my God, thank you. Thank you. I’m not crazy. So, yeah, and

Mindy Pelz  

I think that, uh, 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 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, why I get that

Dr. Haver  

doubles through the menopause transition, you know, doubles? Can we go? It’s crazy. 20% of the population, you know, like, and no one everyone’s like, Okay, this is just it is what

Mindy Pelz  

it is. Right? Right. Right. It’s, 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 speak their truth in 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 that how powerful estradiol is for stimulating different neurotransmitters, I call it a girl gang. Like she’s got a girl gang of like serotonin and dopamine and acetylcholine. And so when she goes away, her girl gang can potentially go with her. And there’s like this neuro chemical 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

Dr. Haver  

Oh, I have one of them in a posse is like she’s coming. I’m doing a conference in Galveston in January, she’s coming to talk about menopause of trauma. And like you said, we lose our resilience. So I love how you put that the armor comes down. And all of a sudden, it you know, that’s why so for healing there, 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 that. 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 building the wall higher is to like open the door. manage them, you’ll get rid of them, right through therapy. And so putting up boundaries, that’s what I did. You know,

Mindy Pelz  

yeah, me too.

Dr. Haver  

It doesn’t mean I doesn’t love them. I still love them. I still, you know, there’s so much family, this is my family 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 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 it’s healthy for me, you know, and I don’t have any guilt or shame overdoing it. So I think that’s one thing. I also for the first time sought therapy, I always thought it was woowoo. You know, I started 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.

Mindy Pelz  

Yeah, you know, you and I feel like had 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 marathon 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 into therapy and tried to work on 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. Is there 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 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, so our hormones can balance.

Dr. Haver  

So the 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 societies in the residency programs in the, and not just like the treatment of hot flashes, like, it’s the gender health gap, you know, and so yeah, there are now charges leading, like, we’re not little men with breasts, you know, to Stacey Sims, as you know, we’re not real 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 in understand how we our bodies age differently than men’s, you know, 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, because that’s a big one with 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 brain fog, 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, Wolf, 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 what how to talk to your boss here, you know, here are things that we can do. I think we’re 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, I think by the time they are our age, this will be so much better, there’ll 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 leads? But so, you know, I think we’re a generation away from that. But it’s like, so we have just hacks now. ways, right, us and our generation to kind of survive and thrive through this until we get the rest of the world on board. Yeah,

Mindy Pelz  

I love the way you’re thinking about that. Because it does take time to change your 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 her use her own intuition as to is this am I being treated? Right? Yeah. Like there was so and which brings up a really interesting point when you’re in your healthcare 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 in to the health conversation?

Dr. Haver  

I think it’s critical you 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, what, how much do we have to suffer before we qualify? You know, it’s your my job as a health as a clinician is to offer options not to judge symptom, right? 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 choice as to what she wants. Yeah, she may change her mind to do yours. We 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 tonight. We lay out their options. They make a decision based on what they think is best for them based hopefully based on facts and not fear. And moving forward. If a woman doesn’t cheat, I do not lose sleep over it. That is her choice. Right?

Mindy Pelz  

Right. So, but you’re a you’re a unicorn. I don’t know if anybody has ever told you to create

Dr. Haver  

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 trading programs on board. So what I’m developing a trading course for healthcare providers, yeah. So they can know what I know. And then help patients make better decisions. Yeah,

Mindy Pelz  

amazing. Going back to the 20 year old so one of the things that I noticed in fastonic, 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, what should lifestyle look like my 20 year old suffering. 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 pillar very interesting, as far as the changes they make to the microbiome are not great, and the nutrients they they deplete out of our system are not great. And so I’ve been thinking a lot about if somebody has 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 sup for a long period.

Dr. Haver  

So, you know, we have the contraceptive benefits of of oral hormonal contraception, and that that does because it goes through the gut does appear to have the most disruption of the gut cycle, the transdermal trans vaginal transmucosal 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 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 PCOS patient, never heard nutritional advice for PCOS, it was birth control pills, then I was on birth control pills actually was really happy with them. But I got on these forums before the internet, so I’m old. And 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 and I was like, Oh, well, that make 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 early, you know, instead of going right to birth 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 clinician, you know, the full picture of how the, you know, what the effects of these things are, I don’t think we’re doing adequate counseling for like, you know, for 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, I you know, I do see the backlash because we 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 for just to suppress their cycles so that they’re not bleeding while they’re swimming, right, like 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, your performance, you know, let’s look at other options rather than use the you know what your girlfriends were telling you where the pill, maybe Mirena 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 bones strong. You know, and not affected. I think these are nuanced conversations.

Mindy Pelz  

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 am I what is my lifestyle been what toxins have I been exposed to what is depleted me because it’s a different game. Once you go into those Peri menopausal years, which is why I want to highlight this. The the other piece is toxins. I recently saw like a year ago I saw a study that in menstrual blood they’re actually Measuring phthalates, pesticides, plastics and forever chemicals. And so when we bleed every month, we’re actually ready. Yeah. And, yeah, so the men’s 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 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 as when it comes to helping the toxic load?

Dr. Haver  

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 what’s coming out there, I’ll say, in the last, like, 10 years, all I do is post menopause. But I’d love to write it right. Yeah, send it to me. That’s fascinating. Yeah, I’ll

Mindy Pelz  

send it to you. Because then it 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, chlorella, of course, the fiber, I love the fiber thing, because you know, you if you feed the Astra below. 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 you know, I love where you’re like, let’s keep you out of the nursing. Yeah, what do we do about this? I mean, what changes the visit

Dr. Haver  

me on changes? Gotcha pearls. That is the biggest pain point for patients. Again, they’re coming from the mentality of I have to be thinned out of 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 in calories out, this is impossible. I’ve changed nothing. And you go and you look at the literature, and it’s like, are you really only eating that many calories? Are you sure? Are you really working out as much as you so I’m 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 you know, the shields comes down, the estrogen levels drop, all of a sudden our systemic inflammatory markers increase, and that drives back to the intra abdominal cavity. Insulin resistance increases, with no changes in diet and exercise that drives back 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 listeners, subcutaneous fat is the fat we all know gives us breast hip 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 neuro endocrine, you know, production of inflammatory hormones. So the higher the our levels of visceral fat, the more likely we are to develop cardio metabolic disease. So they’ve measured it. In a premenopausal woman, the average percentage of total body fat that is visceral is 8%. She goes through the menopause transition that increases to 23%. Wow, what 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 nutritionally, so HRT can help attenuate this, it’s not perfect. Okay. high fiber diet 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. Sugars 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 and probiotics, much lower levels of visceral fat and all the ensuing health changes. So lower visceral fat, lower hypertension, lower cholesterol, lower insulin resistance and lower diabetes, lower stroke on and on and on. What

Mindy Pelz  

levels do you like vitamin D to be at?

Dr. Haver  

So in my clinic, and from what I’ve read, you know, in the functional medicine world, though, I’m not classically functional medicine trained 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 haven’t 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. If they’re below 20, they are extremely deficient through the menopause transition.

Mindy Pelz  

Yeah, yeah, 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. It’s that is shocked me when watching a lot of women as 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 it the glass of wine becomes the thing you’re like gripping to as you’re going through this experience, but then it it creates the lack of sleep it creates, yeah, what what would you say about alcohol in this process?

Dr. Haver  

You know, there’s nothing healthy about it. Really, there’s 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 better used to. I’m much more prone to have a 3am 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 greed and alcohol.

Mindy Pelz  

Yeah, yes, I absolutely agree with that. And, you know, Peter Attia said this on his podcast one day, and I was like, I really like this look at alcohol, which is habit hours, if you’re gonna have your glass of wine, have it hours before sleep, do it without 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 there you would need to put some boundaries around it so that you don’t end up with the 2am wakeup. Would you agree with that?

Dr. Haver  

Yeah, so I know, you know, so I talked to patients, like, you know, we joke about drinking, you know, and I love the way that 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 to cross over because of the increased stress of perimenopause. 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.

Mindy Pelz  

Oh, yeah, I have like become like crazy about sleep where I just Nope, I cancel appointments. I don’t go on social engagements. 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 one 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?

Dr. Haver  

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, and she says, you know, get early physical therapy, like get in there and get that joint moving around 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, of frozen shoulder versus women not also have decreased length of the time that there’s you know that they’re frozen and needless therapy long term. So estrogen is better at prevention and cure for so many diseases and when we lose our estrogen that armor against arthritis, arthralgia 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 big mental like breakdown when their body comp is addition changes, it is so hard for them, their nutrition, you know, like they’ve been running it, you know, and they, it’s really hard for them to accept that all these things that kept you winning marathons and triathlons are not going to tear away at your bones and muscles. And you know, and we have to look at this differently. And so yeah, and then the rate of their, you know, once their estrogen levels dropped, and all of a sudden that the armor that they had against injury or old injuries, is suddenly popping up.

Mindy Pelz  

Yeah, I would 1,000% agree with you on that, that 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 just, 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 have to just again, thank you for everything that you’re doing. I just really appreciate the spirit in which you’re doing it.

Dr. Haver  

Thank you, same to you.

Mindy Pelz  

Thank you. And then the last question this one, it’ll be really interesting for you. I always ask every year on my podcast, I have one question that I asked. 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.

Dr. Haver  

I think the days that I don’t worry about my health, or the definition of home. You know, the days that the habits I put into place, take any thought process around. I know I’ve got this. And so to me good health is not having to think about it.

Mindy Pelz  

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 and we will definitely put links to your book. But where can they dive into your stuff.

Dr. Haver  

So the book is the new menopause. And it’s available everywhere. You can buy books across social media, it’s Dr. Marie Claire, and 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 data at the pas life.com

Mindy Pelz  

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.

Dr. Haver  

Alright, thanks for having me.

Mindy Pelz  

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.

Transcribed by https://otter.ai