Mind Pump: Raw Fitness Truth
Episode 2582: The Strange Signs & Symptoms of Perimenopause With Dr. Mary Claire Haver
Release Date: April 24, 2025

Introduction

In Episode 2582 of Mind Pump: Raw Fitness Truth, hosts Sal Di Stefano, Adam Schafer, and Justin Andrews delve deep into the topic of perimenopause with their expert guest, Dr. Mary Claire Haver, an OB-GYN and author of the New York Times bestseller, The New Menopause. This episode sheds light on the often-overlooked aspects of perimenopause, challenging existing myths and providing science-backed insights to help women navigate this critical phase of their lives.

Dr. Mary Claire Haver's Journey into Menopause Education

Dr. Haver shares her transition from a traditional OB-GYN practitioner to a leading voice in menopause education. Initially feeling unprepared to address the complex symptoms of menopause beyond pregnancy and basic gynecological issues, her personal experience with menopause catalyzed her mission to educate and support other women.

Dr. Mary Claire Haver [02:17]:
"I was giving the same advice, work out more, eat less. That was working for me at 30. And then I went through my own menopause and really had a rough time."

Her struggle with untreated symptoms during her own perimenopause led her to obtain certifications in culinary medicine and nutrition, culminating in the creation of the Galveston Diet and significant growth in her social media presence.

Understanding Perimenopause: Definition and Mechanism

Dr. Haver provides a comprehensive explanation of menopause and perimenopause, emphasizing that menopause is medically defined as one day after the final menstrual period. Perimenopause, however, begins years before this final transition, marked by ovarian failure and hormonal fluctuations.

Dr. Mary Claire Haver [15:07]:
"Perimenopause is a 7, you know, 4, 7, 10, depending on who you read. Year long stretch where symptoms begin."

She explains the hormonal interplay involving the hypothalamus, pituitary gland, and ovaries, highlighting how the ovaries become resistant to hormonal signals, leading to irregular cycles and a cascade of symptoms.

Symptoms of Perimenopause: Beyond Hot Flashes

While hot flashes and night sweats are commonly associated with menopause, Dr. Haver expands on a myriad of less-recognized symptoms affecting various body systems:

• Cardiovascular Changes: Increased visceral fat leading to higher risks of diabetes, hypertension, and stroke.

  Dr. Mary Claire Haver [10:20]:
  "Visceral fat is more tied to the risk of chronic disease, of diabetes, hypertension, stroke, than subcutaneous fat ever has been."

• Mental Health and Cognitive Effects: Elevated risks of depression, anxiety, and cognitive fog long before menstrual irregularities become apparent.

  Dr. Mary Claire Haver [20:05]:
  "We have a 40% increased risk of mental health disorders during the perimenopause transition."

• Musculoskeletal Issues: Joint pain and conditions like frozen shoulder linked to hormonal changes.

  Dr. Mary Claire Haver [29:28]:
  "Frozen shoulder dramatically related to menopause. Women on HRT tend to have less incidence of frozen shoulder."

• Dermatological and Respiratory Changes: Dry skin, eyes, mouth, and worsening asthma symptoms.

• Metabolic Shifts: Increased insulin resistance and changes in lipid profiles.

Challenges in Medical Training and Diagnosis of Perimenopause

Dr. Haver criticizes the current medical approach to menopause, highlighting a significant gap in training and awareness:

Dr. Mary Claire Haver [08:51]:
"We've relegated menopause to a very small set of symptoms, and that dogma has not changed in 25 years."

She points out that menopause guidelines, such as those from the American College of OB-GYN, are outdated and fail to address the full spectrum of menopausal symptoms. This oversight leads to misdiagnosis and under-treatment, with many women being dismissed or labeled as experiencing "somatic problems."

Justin Andrews [10:20]:
"Why, why did we suck so bad at this? I mean, it's serious. It's like every, every woman goes through it. So how could we miss so big on something so common?"

Hormone Replacement Therapy: Types and Considerations

A significant portion of the discussion revolves around hormone replacement therapy (HRT) as a solution to perimenopausal symptoms. Dr. Haver outlines the different hormones involved and their therapeutic uses:

• Estrogen (Estradiol): Replaces the estrogen that declines during menopause. Modern practices favor transdermal estradiol over older formulations like Premarin for better safety and efficacy.

  Dr. Mary Claire Haver [29:34]:
  "Most of the data on the safety, efficacy and including the WHI study were done with this particular form of estrogen. Now, in modern prescribing practices, most of us use just plain estradiol."

• Progesterone: Essential for women with a uterus to prevent hyperplasia and potential malignancy from unopposed estrogen.

  Dr. Mary Claire Haver [29:34]:
  "Progesterone works beautifully in the brain, upregulates GABA, which helps with sleep."

• Testosterone: Addresses hypoactive sexual desire disorder and other symptoms related to libido and energy.

  Dr. Mary Claire Haver [32:22]:
  "Testosterone receptors in the vulva and, like, around the introitus. So, again, you need someone who knows what they're doing."

Dr. Haver emphasizes individualized treatment plans, which often involve trial and error to determine the optimal hormone dosages and combinations for each woman.

Non-Hormonal Interventions: Diet, Exercise, Supplements

Beyond HRT, Dr. Haver advocates for holistic approaches to managing perimenopausal symptoms:

• Strength Training: Essential for combating sarcopenia, osteoporosis, and maintaining overall muscle mass.

  Dr. Mary Claire Haver [34:11]:
  "Weight training, resistance training, and building the muscle that your body is shedding."

• Nutrition: Emphasizes high protein and healthy fats over the traditional low-fat diets, focusing on body composition rather than mere weight loss.

  Dr. Mary Claire Haver [36:57]:
  "Protein and plants. Those are your priorities, right? And with a lot of protein comes fat."

• Supplements: While not substitutes for HRT, supplements like fiber, vitamin D, and creatine can support overall health.

  Dr. Mary Claire Haver [40:08]:
  "We do the deep dive through nutrition. There's some phytoestrogens like soy, like black cohosh, evening primrose oils and decent anti-inflammatory that can help... But they're not fixing the root cause."

Environmental Factors Impacting Menopause

Dr. Haver touches upon the role of environmental factors in hormonal health, though she calls for more research in this area. She acknowledges lifestyle choices and exposures that potentially exacerbate menopausal symptoms.

Dr. Mary Claire Haver [38:18]:
"We need more research. I'm seeing the changes. My kids... they are much more aware... It's really creeping into our health long term."

Overlooked Aspects: Mental Health, Libido, and More

The conversation highlights how perimenopause affects intimate aspects of women's lives, including libido and sexual function. Dr. Haver discusses the physiological and psychological impacts on desire and orgasms.

Dr. Mary Claire Haver [55:09]:
"We have testosterone receptors in the vulva and, like, around the introitus... You can help them. It's real. It's not your fault. And you don't have to live like this if you don't want to."

Future of Menopause Treatment and Awareness

Optimism prevails as Dr. Haver discusses emerging trends and future prospects in menopause treatment. Increased certification among clinicians, ongoing research, and a growing awareness among younger generations signal a positive shift in managing menopause.

Dr. Mary Claire Haver [48:41]:
"Women are getting excited about this last third of their lives and all the opportunities available to them and knowing they have to change their habits and stick to them in order to live that way."

Conclusion and Resources

Dr. Haver underscores the importance of education and proper medical support for women undergoing perimenopause. She directs listeners to resources like her website, thepawslife.com, and menopause.org for finding certified providers.

Dr. Mary Claire Haver [44:03]:
"We have a list of providers and it's basically crowdsourced. Wonderful people who've had a great experience with a menopause educated clinician."

The episode concludes with hosts expressing gratitude towards Dr. Haver for her invaluable insights and encouraging listeners to seek knowledgeable healthcare providers to navigate perimenopause effectively.

Key Takeaways:

• Perimenopause Begins Early: Often in the mid-30s, years before menstrual irregularities become noticeable.

• Wide Range of Symptoms: Beyond hot flashes, including mental health changes, joint pain, and metabolic shifts.

• Insufficient Medical Training: Many healthcare providers lack comprehensive knowledge of menopause, leading to misdiagnosis and inadequate treatment.

• Hormone Replacement Therapy: A viable option with various formulations, requiring personalized treatment plans.

• Holistic Approaches Needed: Incorporating diet, exercise, and supplements alongside medical treatments.

• Growing Awareness: Increased research, clinician education, and patient advocacy are improving the management of perimenopause.

Resources:

• Dr. Mary Claire Haver's Instagram: @Doctor Mary Claire
• Website for Certified Providers: thepawslife.com
• Menopause Society: menopause.org

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