← Mind Pump: Raw Fitness Truth
Mind Pump: Raw Fitness Truth
2582: The Strange Signs & Symptoms of Perimenopause With Dr. Mary Claire Haver
00:57:49
Strange Signs & Symptoms of Perimenopause with Mary Claire Haver What got her into what she does now? (1:30) The dogma surrounding women’s health. (8:05) What is menopause? Perimenopause? (14:56) The average age of menopause. (21:34) ...
Loading summary
Transcript123 lines
- [00:00]
Sal Destefano
If you want to pump your body and expand your mind, there's only one place to go.
- [00:06]
Dr. Mary Claire Haver
Mind Pump.
- [00:07]
Adam Schafer
Mind Pump.
- [00:08]
Sal Destefano
With your hosts, Sal Destefano, Adam Schafer, and Justin Andrews, you just found the.
- [00:14]
Adam Schafer
Most downloaded fitness, health, and entertainment podcast. This is Mind Pump. Today's episode, we talk about perimenopause. Believe it or not, it starts a lot sooner than you think. In fact, we learned with today's guest, Dr. Mary Claire Haver. She's an OB GYN. She's the author of the New Menopause. This is a New York Times bestseller. You can also find her, by the way, on Instagram @Doctor Mary Claire. That's D R Mary. C L A I R E. We learned from her that perimenopause starts sooner than most women think. And your hormone test won't even show it. You'll just have weird symptoms like suddenly gaining body fat in your midsection. That's one of them. But there's a lot of them. Today's episode was very illuminating. This episode is brought to you by one of our sponsors, Mass Zymes. These are digestive enzymes that break down the fats, proteins, and car to give you better recovery, better absorption, better digestion. You can find them at buyoptimizers.com mindpump that's bioptimizers.com mindpump use the code mindpump10 get 10% off. We also have a sale this month, Maps Hit and the Extreme Fitness bundle, 50% off. You can find both of them at mapsfitnessproducts.com just use the code APRIL50 for the discount. All right, here comes the show. Dr. Mary Claire, thanks for coming on the show.
- [01:33]
Dr. Mary Claire Haver
Thanks for having me.
- [01:34]
Adam Schafer
Yeah. You came heavily recommended by one of our friends. She said you did such a great job on her podcast that so many people write in and say they just learned so much from you. So it's like we had to have you on our show. So thanks for coming on.
- [01:48]
Dr. Mary Claire Haver
Thanks. These are my favorites. I like talking to the other sex you know about. You don't have your own personal story to kind of work into the conversation. So it's all about education.
- [02:01]
Adam Schafer
Awesome. We could learn a lot, for sure. So what, so what got you into what you do now? Right, because you have a huge following on social media, and one of the main things you talk about, among other things, because you. You talk a lot. A lot of things. But perimenopause, menopause, what made you go in this direction?
- [02:17]
Dr. Mary Claire Haver
Yeah, no, good question. I came from a Background of being a general OB GYN physician. So I'm board certified in OB gyn. I did this traditional four years of medical school, got my md, then did my four year residency in obstetrics and gynecology. And when I think back, you know, I was the expert in women's health, right? And I aced all my exams and did well on my board. So, you know, I felt like I've got this, you know, I'm ready to go out in the world and take care of patients. And I just remember my first several years of practice having women in menopause come in and really just feeling like I was a deer caught in the headlights. You know, the outside of pregnancy, the number one thing they were complaining of was weight gain and then libido issues, neither of which I'd really been taught on how menopause works into those problems and, like, what we can really do about it. And then. So that's all fine and good. And I was giving the same advice, work out more, eat less. That was working for me, you know, at 30. And so. And then I went through my own menopause and really had a rough time, really rough time, and really got hit, you know, I really felt like a ton of bricks. I didn't feel like myself. I was also grieving the loss of a brother at the same time. So I was like, okay, I'm just depressed from that and. But you know, muscle pain, joint pain, my back was always hurting. I wasn't sleeping well. I was gaining weight in weird places. I'd always kind of had thin privilege. And suddenly I was kind of lumpy and gaining weight, my midsection mostly, which had never happened to me before. And I was really reluctant to consider hormone therapy. I did have the classic hot flashes and they were waking me up at night and I thought, I cannot live like this. So I was trying, you know, meditation, I was trying journaling, which was all good for my mental health, but I still wasn't sleeping and nothing was helping the hot flashes. I tried different supplements. I was really scared of hormone therapy because of the Women's Health Initiative study and all the fallout from how the misrepresentation was, which we now know was, you know, the risks were overblown and the benefits were totally not discussed. So I reluctantly decided to start hormone therapy and absolutely felt like I got my life back. Did my stress melt away? No. Did it go to the gym for me?
- [04:29]
Adam Schafer
No.
- [04:29]
Dr. Mary Claire Haver
Did it eat right for me? No. But it just kind of pulled things back in alignment where I felt Like I was in control of my life again, and the efforts I was doing to stay healthy were beginning to work again. So I started talking about my experience on social media. I had a small Facebook following, just kind of talking about gynecology. But as I would broach the subject of nutrition and menopause and weight gain and menopause, the world stood up and paid attention, at least my world on Facebook. So Facebook started growing pretty quickly. And I had gotten a culinary medicine certification so I could learn more about nutrition because how much they teach me in medical school, zero. And I just felt like I wasn't able to help myself or my patients. So I went and got certified in nutrition, really learned a ton, and put together a little program that I made for my patients and a few of my followers on social and my girlfriends in town and called it the Galveston diet. Just kind of as a joke because we live here on the island. I live on the island of Galveston, outside of Houston. So it really was working well. Everybody loved it. I was talking about it on social media. That was growing. So then I was starting these little Facebook groups and kind of guiding people through the process, which was anti inflammatory nutrition. I was a huge fan of fasting back then, and I've kind of backed off from that a little bit, um, because I need protein and it's hard to get it in eight hours. And it just. Things were growing. But as I was talking about nutrition and menopause, weight gain and menopause, people were asking me more and more questions about just menopause. So I would research there. You know, when a thousand people ask you on social, is my frozen shoulder related to menopause? I stopped saying, I don't know, and I start digging, right? And I was finding all of these weird symptoms that I'd never been taught to attribute to menopause that were actually related. And I started realizing, wait a minute, there's estrogen receptors throughout our body. This is not just hot flashes and night sweats and sleep disruption. You know, this is really a total body effect that women are going through. And the more I discussed those things, the bigger and bigger it grew. Covid hit. And my kids were home, who were teenagers in early college, and they were like, mom, you got to do this TikTok thing. And I said, no, no, no, that's for kids. And they started showing me other clinicians who were on TikTok educating. And so my very first tiktoks were me dancing, kind of like swaying to music, pointing to different facts. Remember that trend you know, and those really took off so suddenly. Like, within a few months, I had several hundred thousand followers on TikTok. And of course, my dopamine's exploding, and this is amazing, and I'm making more and more content around that. But, like, I was literally learning alongside my followers. Like, they'd ask, I'd research, I. Then I'd share. And then another video would go viral because, you know, another million women would be like, oh, my God, that happened to me. The itchy ears, the tent. Tentinitis, or the vertigo, the gastrointestine, the palpitations, the GI changes. You know, of course, weight gain is always the center of every woman's. You know, but has that grew? You know, people were like, I'm tired of chasing you on social. Write a book. And I wrote the New Menopause, which ended up being a number one New York Times bestseller. And, you know, our growth on social has just continued to, you know, grow. We just hit. I think I have 6 million total across, you know, between Instagram and TikTok, we're a little over 5 million. And then we've got another million between Facebook and YouTube.
- [08:06]
Adam Schafer
Do you. Do you think that one of the reasons, besides being a great communicator, do you think one of the reasons why this really struck a nerve is that women have been told. I hear this all the time. That they've been told, it's all in your head. Whenever they come to the doctor with anything other than hot flashes, like, everybody's, oh, hot flashes. Yeah, you get that. But then they're like, oh. Because this is what I was taught as a trainer, okay? So I know fat loss. I know muscle building, I know correctional exercise. And I was told that fat distribution doesn't change. You can't. It doesn't. No. People will come to me. I store body fat in my belly now. I never used to. And I'm like, nah, that doesn't work that way. Body fat distribution doesn't change. Do you think that that's just a major experience of most women when they go to the doctor, when they come to talk about these things?
- [08:52]
Dr. Mary Claire Haver
The major experience, and this is because of the systemic way that we approach menopause in medical training across the board, and this is worldwide. No, nobody's doing it well. Is that we have relegated menopause to a very small set of symptoms, and that dogma has not changed in 25 years. When you look at guidelines and updated guidelines, like from the American College of OB GYN, they haven't updated menopause in over 10 years. And as this new data and information's coming out about. Wait a minute, this distal fat is very different than subcutaneous fat. And it goes up from 8% total body fat in a premenopausal woman to 23% postmenopausal changes in diet and exercise. Right. And so the old dogma was fat is fat. You know, calories in, calories out, and calories are important. No one's negating that. But, you know, there is a pro inflammatory drive of new fat to the intra abdominal organs, which is in and itself pro inflammatory. So it's a much more nuanced conversation around body fat distribution. And visceral fat is dangerous, you know, much more dangerous. Visceral fat is more tied to the risk of chronic disease, of diabetes, hypertension, stroke, than subcutaneous fat ever has been. That's why now we're not, when we define obesity, we're not using BMI or weight anymore. We're using abdominal circumference because that is a reasonable marker for the amount of visceral fat that they have.
- [10:20]
Justin Andrews
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?
- [10:32]
Dr. Mary Claire Haver
Yeah. So when we look historically and, you know, anthropologists have looked at it and, and what we realize is forever in science, women's health was considered to be. When I say women's health, what do you guys think about. What do you automate? What's the first thing in your head?
- [10:45]
Adam Schafer
Yeah. Period. Reproductive and having a baby. That's it.
- [10:48]
Dr. Mary Claire Haver
Absolutely. Pregnancy. I mean, the vast majority of my training, so obstetrics and gynecology. Right. Obstetrics is everything to do with pregnancy. And gynecology is the uterus, fallopian tubes. Right, right. But who's tending after the gender specific. So how women uniquely have heart attacks, how they uniquely have. So forever, the science was on men, mostly guys that look like you. No problem with that. Right. I mean, that's who was doing the studies, creating the studies, who the doctors were, who the researchers were. And they're like, we're just going to get guys that look like us, and we're just going to assume that these, this will hold forth for women. Women were excluded because of worries, you know, it was reasonable worries of birth defects. So women of reproductive age were excluded from studies until 1997.
- [11:35]
Adam Schafer
Oh, I didn't know that.
- [11:36]
Justin Andrews
Wow, 97.
- [11:38]
Adam Schafer
That's huge.
- [11:39]
Dr. Mary Claire Haver
There was a drug called, which was given to women for hyperemesis. So for nausea and vomiting and pregnancy, which caused horrible birth defects like limb, you know, like paddle limbs, like just be a little kind of.
- [11:53]
Adam Schafer
Is that the one where they flip the molecule? They did a mirror image of the molecule thinking, oh, this is a safe drug, when in reality it was like, it's actually different. Is that what happened?
- [12:00]
Dr. Mary Claire Haver
I'm not sure sure how they developed it. I'm not sure about that one. But, you know, they gave it, women took it, their nausea got better, and then their babies had terrible birth defects. Right. And so because of that, they threw out the baby with the bathwater. They said, okay, we're going to exclude all women who might even, you know, women just aren't going to be excluded because we can't risk this ever happening again. And so that kind of stuck for a couple of decades until now. Women are required to be in studies that we haven't even reached 50% yet. So when we look at data on how statins work, right, Most of that was done on men. And if you deaggregate the data on statins and high cholesterol, women's high cholesterol will get better with a statin, no problem. But she. It won't decrease her risk of a heart attack. Why? Because we have heart attacks differently than guys.
- [12:49]
Adam Schafer
Explain.
- [12:49]
Dr. Mary Claire Haver
So most men will have a blockage in the very first part of the arteries that leave the aorta. So you guys would know it as a widowmaker, right? So that's the interior descending artery of coronary artery. And so that very first part, and the most thickest, widest part is where those clots tend to form in women and men, excuse me, women have diffuse microvascular disease. Their disease tends to be down into where the arteries branch out deeper into the muscle. So therefore, the way that they have a heart attack, you know, the symptoms they present with rather, are very different than a man. A man comes in, we all know it from watching all the medical shows, clutching his chest. Chest and radiating to his neck down his left arm. Women come in with chronic fatigue, abdominal pain, shortness of breath. You know, it's not clear. And so a woman has a 50% higher chance of dying from a primary heart attack than a man. She's much less likely to be properly diagnosed in the er and it takes a lot longer because we've used this typical model of a male without understanding. Now we're getting better that women actually disease differently, we die differently than men. Wow.
- [13:59]
Adam Schafer
Wow. So, and I think part of it too is a Culture that tells women, you tough it out. It's just part of life.
- [14:07]
Dr. Mary Claire Haver
You know, here's the other thing, and this is embarrassing to admit, and it took me a long time to really tease out my own bias and what I was taught. We were taught that women tend to somaticize.
- [14:20]
Adam Schafer
Yeah.
- [14:20]
Dr. Mary Claire Haver
Ecological problems. We were never taught that about men. It's all in her head. There's no. It's all in his head. So I still. Still, still to this day, have to. When a woman comes in with multiple complaints in her mid-40s, she's got her laundry list. I have to hold that back. Right. That. That training automatically leaps to the front. Well, she's probably a little bit. You know, women tend to be unhappy at this age. Women tend to. You know, but actually, it's not true. The. These hormone changes are killing. Literally killing us, and doctors aren't trained to recognize them.
- [14:55]
Adam Schafer
Well, now let's talk about perimenopause and menopause and when you tend to start seeing it happen. And what are the early signs.
- [15:05]
Dr. Mary Claire Haver
Yeah.
- [15:05]
Adam Schafer
That maybe aren't so common. Right. Like, let's start.
- [15:08]
Dr. Mary Claire Haver
Paramount question. Thank you for asking. This is my jam. Okay, so let's start with what is menopause? Turns out menopause is one day in a woman's life, one day medically defined. It is one day after her. One year to the day after her final menstrual period. Okay, well, there's a lot of problems with that. You know, what does she do in leap year? Do you have to wait 366 days? Is it, you know, like such a random, arbitrary. What if she's had a hysterectomy? What if she doesn't have regular periods? What if she has an iud? That's stopping her periods? You know, does she not get to be menopausal? So what's actually happening in menopause is ovarian failure. So men, you guys have a set of testicles, we have the corresponding set of ovaries. Right. Most adults understand that. And so you can make your genetic material fresh every day. Every day. The testes are still working. Right. Creating little gametes that get brought out into the world. Or not. I'm gonna let you guys figure that out. And then a women, we go through puberty, and then we start. We are born with all of our eggs, a set supply. So female is born with 1 to 2 million eggs, and that will last her until they run out. And menopause represents the end of the egg supply. Okay, so when we start Ovulating. So by the time we're in puberty, when we start ovulating, we are down to three or four hundred thousand eggs. There's a process called atresia, which is a kind of a selection, you know, kind of a survival of the fittest. We get the healthiest eggs that actually get to ovulate. A woman will only ovulate 3 to 400 times in her life. And so you got a 1 to 2 million eggs supply, and they're not all healthy. And then we're hopefully going to get just the juiciest, most healthy eggs out at the end. So we're losing the unhealthier eggs through this process of atresia. We start ovulating each month. We lose a thousand eggs to get one out. And so we keep just depleting, depleting or depleting our egg supply. Perimenopause is when something kind of magical happens. So every month we have a signal coming from the brain. So the hypothalamus in our brain. You guys are scientists. That hypothalamus creates hormones. Well, it's constantly sensing for estrogen in a woman's blood. And when the estrogen levels get low, it says, okay, ovaries, it's time. So it sends a signal to the pituitary, something called GnRH, and says, hey, tell the ovaries to wake up. It's time to get an egg out. We need some more estrogen. Okay. So in the process of ovulation is where we see the estrogen production rise in the female. So then the pituitary says, got it, boss. Sends out LH and fsh, which bind to the cells around the egg, the follicular and granulosa cells. I'm getting very technical. And those are the cells that produce the estrogen and then the progesterone and sub testosterone. So that goes monthly in this beautiful EKG like ebb and flow pattern. If you've ever seen the female reproductive cycle, you'll see these kind of estrogen in the middle and blah, blah, blah. And that for a healthy woman, is a very repeatable normal cycle, month after month after month. On day 10, you can predict what's going to happen day 16, unless she's pregnant or ill or has PCOS or some disease. When we hit perimenopause, we are at a critical egg threshold level where the typical signals coming from the brain don't work. The ovaries becoming resistant to those signals. So the hypothalamus is still looking for estradiol and it's not coming from the eggs, okay? So then it gets mad. It starts saying, hey, where is my estrogen? The pituitary says, dude, I sent the signal the pituitary. And it's like, send more. So the pituitary starts pounding the ovary with higher and higher levels of FSH in order to force the ovulation. So what happens in Perry, what used to look like that pretty EKG becomes a zone of chaos in order to force the ovulations become delayed, which is why cycles become irregular. We get these much higher, like, burst of estradiol than we've ever seen in our lives before outside of pregnancy. And then progesterone never kind of keeps up, you know, after ovulation. So what used to be beautiful and predictable and normal and the brain knows what's coming now is just throw spaghetti at the wall and here we go. So over time, it's a decline in estradiol, but it is literally a roller coaster on the way down. And so perimenopause is a 7, you know, 4, 7, 10, depending on who you read. Year long stretch where symptoms begin. And so menstrual, we've always in medicine defined perimenopause, if you even thought about it, by cycle irregularity. Right? Well, guess what? The cow is out the barn. By the time your cycles become irregular, perimenopause begins in the brain. So when that hypothalamus is having to work double time and the pituitary is working triple time to get those hormones out to force the ovulation, we start seeing sleep disruption, mental health changes, and brain fog, cognitive changes, usually in the verbal and learning sections of the brain. And those hit well before the cycle becomes disruptive.
- [20:06]
Justin Andrews
Does it feel like a slow, gradual climb for the woman, or is it like a ton of bricks hits her?
- [20:13]
Dr. Mary Claire Haver
It depends. Patients kind of approach differently for some. There's a great paper that just came out in the last few months called not feeling like Myself. I mean, how vague can you get? But literally, they talk tied it to perimenopause. Like, she's like, look, I built this life that I was managing. I had my stresses down. I had it, I had it. I was in control. And suddenly I've lost my resilience. I can't put my finger on it, but something is wrong. It's usually the mental health and cognition changes that are hitting her hard. Her periods aren't irregular, so no one's waving a flag externally saying, hey, something's going on with your Hormones, but she knows something is up. So for some, it's like the rug got pulled out from under them. And others, they just feel like the last few months is just getting worse. And wor.
- [20:57]
Adam Schafer
How long before is. Does this happen in the brain? Before you start to see, typically, the changes in the menstrual cycle?
- [21:03]
Dr. Mary Claire Haver
Yeah. So by the time your cycles become irregular for most women, you were about two to three years out from full men.
- [21:10]
Adam Schafer
Wow.
- [21:11]
Justin Andrews
It's a long time to be going through this without knowing for sure what's going on.
- [21:14]
Dr. Mary Claire Haver
Without knowing. Right. And so I don't tell this to scare your listeners. I don't want them to be, oh, my God, all this crazy stuff's going to happen. But imagine if you weren't gaslit. Imagine if you were like, oh, this might be my perimenopause. I got this. You know, that you, you could understand. I think just knowing and educating and understanding what's happening to your body will alleviate so much unnecessary suffering.
- [21:34]
Adam Schafer
Well, doctor, when does this. What age, like, what's the age range that this starts to happen? Where the perimenopause starts?
- [21:42]
Dr. Mary Claire Haver
Great question. All right, let's do the math. So the average age of menopause in the US for, you know, a white woman is 51. Now, genetic, ethnically, it's all over the map. African Americans tend to go through about 18 months sooner. Asian women tend to go a little bit later. Women, Southeast Asian, so, like from the Indian continent, they go through average of 46. So. And there's a window of normal. So for in the US 46 to 55 for full menopause. Right. Remember, perimenopause back that up seven to 10 years. So we're looking at mid-30s, you know, so a good chunk, you know, at least a third of a woman's life is spent with her ovaries not functioning the way that they were in peak fertility time.
- [22:27]
Adam Schafer
Now, how much, how much does birth control kind of mask some of those symptoms?
- [22:32]
Dr. Mary Claire Haver
That's a great question. So a lot, actually. So when we approach treatment of perimenopause, or women are just utilizing birth control pills, you know, oral contraception or the patch or the ring or, you know, they're basically suppressing the hypothalamus. So what you're doing when you, when you're on the pill or taking hormonal contraception, you're giving your body enough hormones to tell the hypothalamus we're cool, shut down. You don't ovulate, you don't make a Baby. Okay. Turns out we use birth control that actually works for acne, cramps. You know, we have a lot of medical indications we, that we use off label for, for hormonal contraception. So, you know, I was on continuous birth control pills because I have polycystic ovarian syndrome. So I kind of masked the whole thing. I was like, live my best life going through, you know, and then at 48, I got off the pill. My brother had died, and I was like, let me see where I'm at hormonally and figure out what's going on here. My husband's like, I'll get a vasectomy. And. And I was immediately menopausal. So I went through somewhere in the background, you know, so for a lot of women who are on the pill, you know, especially if they're doing continuous, then they may not notice a whole bunch though it's happening in the background. So, you know, on the pill, who have mental health changes and weight gain and all the things, you know, because you can't stop what's going on behind the scenes in the ovary.
- [24:00]
Adam Schafer
Yeah. Dr. So when you said mid-30s is kind of when it's starting to happen, I immediately thought about some stats that I'm familiar with with women in particular and prescription antidepressants.
- [24:17]
Dr. Mary Claire Haver
It's the saddest thing.
- [24:18]
Adam Schafer
Is that what you think's happening because you see the.
- [24:20]
Dr. Mary Claire Haver
Exactly what's happening. So here, here's, here's the data in the perimenopause transition. So, you know, in that seven to ten year period, because of the chaos, we have a 40% increased risk of mental health disorders. So usually depression and, or anxiety. And the default is an antidepressant. I love having those medications available, but they are, I think they're overused. Once you go through the menopause transition, the rate of SSRI use doubles. Doubles.
- [24:48]
Adam Schafer
Yeah.
- [24:49]
Dr. Mary Claire Haver
Okay, so we have one in, one out of ten is on it pre, menopausally, and then one out of five and then goes to one out of four over the age of 60. Wow. So I'm really. 25% of us are depressed, you know, from some hormones, you know, from some chemical imbalance. Chemical imbalance been totally improved. So what we know now is that women in perimenopause, at least not postmenopause, but a new onset of a mental health disorder in perimenopause is better off being treated by supporting or replacing her hormones than an ssri.
- [25:29]
Adam Schafer
Wow.
- [25:30]
Dr. Mary Claire Haver
Yeah.
- [25:32]
Justin Andrews
How much does genetics play a role in the symptoms that women experience versus maybe the way they ate and dieted and exercised, leading into.
- [25:42]
Dr. Mary Claire Haver
Sure, we need to do a lot of work in this area. We know that timing of menopause, there's a big genetic correlation. Now a lot of things. What we don't know a lot about is what can extend the shelf life of your ovary. Right. We're born with a certain amount of eggs. How can you keep them healthy? Certainly anything that keeps you healthy will keep your eggs healthier longer. Right. We're all going to lose them. That, that. There's no way around that yet. There's some great studies happening there on. Oh. Or over everything from transplanting healthy, you know, taking out a few, a little bit of the ovary at 25 and putting it back in at 50 to different medications and compounds that could extend the life of the ovary. Usually in the fertility world, but it actually works to, you know, keep you out of menopause. And so. But, you know, if you smoke, if you have abdominal surgery, if you, if you have a hysterectomy, you'll lose average of four years off of the life of your ovary. Oh, wow. So, you know, and I don't think a lot of patients understand that hysterectomies are needed. But, you know, and, and all the women who are having their ovaries removed for no other reason than, oh, we just don't want you to get cancer. That is a travesty. If you have any abdominal, like inflammatory disorder, the ovaries are just floating there in the soup of the abdomen. And so we will see the shelf life of the ovary and then trauma. Great study done. Sad study. Looking at women who are sexually abused, whose kids were then sexually abused, they will lose nine years off of the life of the ovary. Symptoms tend to run in families. So if your mom had hot flashes, there's a good chance that you had hot flashes, your mom had joint pain, but it's not one to one because you get half your genetics from your father.
- [27:17]
Adam Schafer
What are some of the, some of the other symptoms? You named a couple. I wasn't even familiar with joint pain.
- [27:22]
Dr. Mary Claire Haver
So we have this cliche like well known, well defined. So hot flashes or vasomotor symptoms, there's a thermoregulatory center again in the hypothalamus that becomes completely discombobulated when we go through the, when the estrogen levels begin to fluctuate and then decline. And so that thermoregulatory center will just all of a sudden the vessels Will dilate are usually centrally. It'll start kind of in the chest and then expand up the neck and head and then out to the extremities where you'll have profuse sweating, palpitations or a known symptom of a vasomotor symptom. You'll have this incredible like crushing anxiety right before the hot flash. So but then that's the cliche sleep disruption. So if the hot flashes wake you up from sleep, that's one kind of sleep disruption. But these 2:00am, 3:00am wake ups, we are struggling to maintain our blood sugars. You know, insulin resistance rises precipitously in the menopause transition with no changes in diet and exercise. Our insulin resistance goes up, visceral fat goes up and our blood pressure goes up, our LDL goes up, the apob goes up, the ldl, I mean the HDL goes down. Starting in the brain, of course, brain fog and the mental health changes. We have receptors in our lungs. Asthma tends to get worse or have new onset asthma all over our skin. So dry skin, dry eyes, dry mouth, anything in the mucosa can get drier. The, the, we have well documentation of the genital urinary system. So, you know, dryness in the intimate area, loss of mucus, loss of elasticity, that's easy to replace with local estrogen there, joint pain. The great paper that just came out called the musculoskeletal syndrome of menopause, looking at the, they went, you know, did a deep dive. Frozen shoulder dramatically related to menopause. Women on HRT tend to have less incidence of frozen shoulder. So really there's the endothelial cells that line the arteries, not just the coronary arteries, but you lose elasticity, the vessels become stiffer and you're much more likely to form plaques. Estrogen is very protective against plaque formation in the vessels.
- [29:29]
Adam Schafer
What does hormone replacement typically look like then? Is it estrogen, progesterone, testosterone? Like all three?
- [29:34]
Dr. Mary Claire Haver
Sure. So we kind of address each separately because they each have different jobs in the body. So we usually start with estradiol in my clinic. So the original estrogen preparations available to for humans were, they hadn't figured out really how to make estradiol in big batches cheaper. So they were going and collecting horse urine and finding this like group of estrogens that were like 10 different estrogen compounds. There's estrogen, estrellane, estrase, sorry, estriol, estriol, estrone, estradiol. So and then they compounded it all into a pill and called It Premarin, pregnant Mari urine from our end and gave that to people and it worked great. It binds the receptors, it, you know. So 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 in my world who are menopause educated don't use Premarin. We use just plain estradiol. We're just trying to give her back exactly what her ovaries used to make. Just like in men, you're just going to take testosterone that might be undecanoate or you know, whatever binder it has attached to it, but you're just trying to give your body back the testosterone that, that it made it higher levels for, for men, you know, so that you perform better. Progesterone is mandatory if you're giving a woman with a uterus estrogen to protect that lining of the uterus. You never want to give a woman with an active uterus estrogen alone. You can lead to hyperplasia or potentially malignancy. So you can negate that completely by giving her a progesterogen with the estrogen. In my world, we give her progesterone again, exactly what the ovaries used to make. Turns out progesterone works beautifully in the brain, upregulates gaba, which helps with sleep. So my patients with sleep disruptions, middle of the night awakenings, anxiety at night, restless legs, progesterone can be really wonderful for them. Testosterone, absolutely. I'm a huge fan. And you know, female levels peak just like men. We have a peak. You guys peak at about 19 to 20. We peak at about 30, 25 to 30 of age. And then there's a gentle decline our whole lives. It doesn't fall off a cliff like estrogen progesterone do in menopause. But women who are suffering from hypoactive sexual desire disorder do be you and have a healthy relationship and don't have pain and can orgasm and don't have any other aspects associated with sexual dysfunction do really well with testosterone. There are two other FDA approved medications that work in the brain to help with desire. And then we think testosterone, though we don't have great studies yet, but a lot of the observational evidence for women is showing same as men, mood recovery, stamina, et cetera. My patients love it.
- [32:23]
Adam Schafer
So do you, do you test someone's. So when someone comes in with symptoms of perimenopause, do they then do a blood test first before you Determine hormone therapy or is it based off symptoms? Or both?
- [32:33]
Dr. Mary Claire Haver
You want the next billion dollar company?
- [32:35]
Adam Schafer
Yeah.
- [32:36]
Dr. Mary Claire Haver
Find the test that's going to diagnose perimenopause because we don't have it.
- [32:40]
Adam Schafer
Okay, so it's all symptom.
- [32:42]
Dr. Mary Claire Haver
Remember that zone of chaos I talked about? Spaghetti. What level are you going to use? It's all over the map. And so unless you're wearing a continuous hormone monitor and able to see all these crazy changes, it's really hard to diagnose with blood. So the way we diagnose now post menopause is easy. Low estrogen, high fsh. Done. Okay. Straightforward in Perry, I will send the FSH and estradiol and a testosterone level for all patients just to kind of. I don't want to miss anything. But usually we can make the diagnosis of perimenopause by, guess what, listening to the patient and believe her. Okay, so I do do a lot of blood work. I don't want to miss anything. So a lot of the symptoms of perimenopause look like lupus or hypothyroidism or nutritional deficiency or inflammatory disorder. So I'm often doing panels and panels of blood work to rule out those other conditions. And then we treat what's left.
- [33:38]
Adam Schafer
Got it. Well, let's. Okay, let's talk about non hormonal interventions. I noticed as a trainer, I mean, I trained people for two decades and a lot of my clients were middle aged women, I'd say probably a majority, just because they tend to be the ones that hire trainers. And I noticed generally they responded far better. And this was for most people, but they really did respond better to traditional strength training. Rest in between sets, get you strong, get you off the circuits, get you off the aerobics classes. You know, high protein.
- [34:11]
Dr. Mary Claire Haver
I just think, okay, 100%. You know, that is one of the biggest changes I've made is here's how I talk to my patients about it. We lose muscle with the aging process, both of us, males and females. For females, it accelerates, beginning in perimenopause, that whole body composition change where the scale is going up, but muscle loss is really accelerating. And then we're replacing it with visceral fat. And so they're just getting unhealthier and unhealthier and unhealthier and shortening their health span. And so when women come to my clinic and we talk about, okay, let's put out the fire of your menopause, you're functional again. So that takes two or three months to get the right dose. And, you know, it's a lot of trial and error. So finally she's like, I got this. I feel great. I'm happy. I got my hormones, you know, whatever. Then I'm like, let's talk about the diseases that are plaguing your elders. And in females, we're looking at sarcopenia, osteoporosis, and dementia. And what helps all three of those things. Weight training, resistance training, and building the muscle that your body is shedding. Okay? And that message is very clear to women at this age. They're looking at their moms. See, women are. You know, when we look at. When I. You guys follow the wellness bros, I'm sure. And they're, you know, I'm like, don't think about the sauna or the cold bath yet. We got to get your hormones straight. We got to get you in the gym. You know, like, those are the. The key things that are going to keep you healthier longer, because women are living longer than men by, like, five years, probably because that estrogen that we had was higher and keeping us healthier for longer. But what's. What's taking out our health span and not happening to guys as much is the sarcopenia and frailty and dementia. And so when women are like, I don't want to live 10 years in a nursing home. I don't want to be stuck in a bed with. Not able to, you know, losing my independence. And that is what really is motivating women to get to the gym, not to get in a bikini, not to look a certain way. It is to stay out of a nursing home. My mantra is every day in the gym is one day less in a nursing home.
- [36:17]
Adam Schafer
That's great.
- [36:18]
Dr. Mary Claire Haver
And I'm 90% doing resistance training. I do. I turn my treadmill into a walking desk. So I'm getting plenty of cardio. I always have.
- [36:25]
Adam Schafer
But, yeah, that's great. Now. That's. That's what we noticed. And now with diet, at least back when I was training, it might be change. Changed quite a bit now. But when I was training clients, the message was always low fat, low fat, low fat. And knowing what I know about fat and even dietary cholesterol and how it contributes to hormones and hormone health, they all did much better when I increased their protein and increased their fat intake. Those are the two things. So what are you seeing on your side with that?
- [36:58]
Dr. Mary Claire Haver
So women are. When I wrote Galveston Diet, which was my first book, it was all about weight loss. Weight loss, weight loss. Because that was What I was worried about, what everybody was worried about. But in this journey, I've learned so much more talk about weight anymore. I talk about body composition and living longer and stronger and trying to be in a bigger body and not a tinier body. Right. And it just, I'm like, protein and plants. Those are your priorities, right? Protein and plants. And with a lot of protein comes fat. So I'm, you know, our Greek yogurt, our, you know, a lot of the protein sources have plenty of fat available. We're doing avocado and olive oil and, you know, really healthy, rich sources of fat. We are really helping patients, especially those, because I have a body scanner in my, you know, I have the medical grade in body scanner for my patients. And we are having really frank discussions. And it's so, like, freeing for these patients to finally not look at calories or look at food as the enemy or how can I eat less? They're always now, like, I need to eat more, especially on a GLP1. So, you know, if they're coming in pre diabetic and we get them started on a GLP1, which is a huge amount of our patients in menopause, they are so excited because they are just focusing on how to fill that plate and how to eat as much as they can to stay healthy. It's such a better way to live.
- [38:18]
Adam Schafer
Yeah. Are you seeing, do you think there are any changes? Because I see in the data, like, you know, where it shows that girls are starting puberty younger, probably tied to obesity. We're seeing lots of potential effects of things like xenoestrogens. Fertility seems to be getting worse or declining. Men, sperm counts and women. You're seeing this with fertility. Do you think that there's some environmental factors that may be that.
- [38:42]
Dr. Mary Claire Haver
There has to be. There has to be. I mean, we need more research. I'm, you know, I think about all the crazy stuff I did, you know, had a hot water bottle from, you know, the, from the gas station, drinking, you know, leaving in my car in Texas at 100 degrees and drinking near boiling water out of plastic. And, you know, I just thought nothing of it at the time. And how in our family we're really paying attention to what we're cooking in, how we're storing food, where the food comes from. You know, I was the convenience queen, and I just, just want to die. When I think about what I gave my kids when they were little because I was rushing from one, you know, from the hospital to go pick them up at ballet and, you know, and all the, the way we built our lives around these convenience foods and what it's really done to our health long term. And you know, slowly I'm starting to see the changes. My kids who are 21 and 24 now are much more aware, you know, than, than I ever was at that age. I mean I, it's a miracle I'm alive actually, if you would look at me in 21 stuff I did. But you know, my kids don't live like that. They're very conscientious, you know, especially. My oldest is in medical school and she has a degree in nutrition as her undergrad. So she did nutrition science for her undergraduate degree. So she's really on top of it. It's really cute and fun for me to watch how different they approach their health than I did at that age. So I think there's hope.
- [40:01]
Adam Schafer
Yeah. What about supplements? There are supplements like chaste berry and evening primrose oil and.
- [40:06]
Dr. Mary Claire Haver
Yeah.
- [40:07]
Adam Schafer
That people will take for some of this.
- [40:08]
Dr. Mary Claire Haver
The Menopause Society took a hard look at, you know, a lot of the claims being made by some of the companies and I don't think there's a great menopause cure out there. There's not a great supplement that is going to resuscitate the life of the ovary. When I say menopause cure, I mean like bring estrogen back into your body. We haven't found that yet, but we know that the human body, like so I have a supplement company and we sell things like fiber and vitamin D and turmeric. Turme. There's good studies done on menopause and arthritis and inflammation and pain, you know. And so I looked at where the nutritional gaps were in most women in menopause. My patients weren't getting enough fiber, really struggling there. I have about an 80% patient population deficient in vitamin D. Not just low, I mean like, like in the. We have a huge amount of ferritin deficient, you know, patients who are coming in with low iron stores, you know. And so when I'm talking about supplementation and menopause, I do the deep dive through nutrition. I don't, you know, certainly there's a couple of hot plots, you know, there's some phytoestrogens like soy, like black cohosh, evening primrose oils and decent anti inflammatory that can help with, you know, take the edge off some of the symptoms. But they're not fixing the root cause. You have to be careful. When you talk about supplements for menopause, I talk about Supplements in menopause.
- [41:25]
Adam Schafer
Good point. Very, very good point.
- [41:28]
Justin Andrews
Are there, are there common, common mistakes that women make trying to self medicate to help themselves?
- [41:36]
Dr. Mary Claire Haver
Alcohol. Alcohol. Yeah.
- [41:38]
Justin Andrews
Talk about how bad that potentially is.
- [41:39]
Dr. Mary Claire Haver
It is so bad for you. You know, I grew up in the era of, you know, oh, it was, there were a little bit was healthy for you. That's not true. So there is, we need more studies. But from, from the hundred thousand women I've talked to, okay. In my, in my practice, women are not tolerating alcohol the way they used to. It's not happening. And so in my life, if I choose to drink, I am choosing not to sleep. I will wake up at 3 o'clock and I don't know if it's. That's cortisol. You know, my aura ring yells at me and you know, all, all the indicators are this is not good for me. This is not leading to my best life. Now I have really restricted. Not restricted. Yeah, restrict compared to what I during COVID Oh my God. So now it's like when I'm out with my girlfriends or I'm celebrating. I'm really conscientious about if I choose to drink and how much and you know, just, I know it's not good for my body. It's. I'm not processing it the same. But I just see so many women who are devastated by these changes and feel like, you know, alcohol is a very short term fix to kind of numb a few things, but the long term consequences just don't seem to be worth it. Where women are seeing some, some relief is with thc. And so we're, you know, just from anecdotal, no one's prescribing it for that but you know, just talking to patients, talking to women, especially in states where it's readily available, they are seeing better sleep, more relaxation, you know, better mental health even with some, you know, judicious use of THC for their menopause.
- [43:09]
Adam Schafer
I like what you said about supplements with menopause, not for menopause. I, I read some really good data on creatine.
- [43:16]
Dr. Mary Claire Haver
Oh yeah, that's my favorite. That. Sorry I left that one out. I'm a huge creatine fan. I just finished mine. I. God, Abby, Abby Smith Ryan is the best on this and Stacy Sims, you know, got really, really good data. I mean Abby does the research, but on women specifically and how, you know, brain seems to be recovering better. You know, our brains just take the hit when those hormones go crazy and creatine, you know, and plus, you know, if you're, if you're doing the resistance training. Creatine is, you know, more than additive. It seems to be synergistic.
- [43:53]
Adam Schafer
One of the challenges that, you know, because people are listening. And I know because I've talked to women like this, like, you know, I'll send them an episode and they're like, that's great. But when I go to my doctor.
- [44:03]
Dr. Mary Claire Haver
Right?
- [44:03]
Adam Schafer
Yeah. Like, how do they equip those?
- [44:05]
Dr. Mary Claire Haver
I wish I could tell every woman listening, you just walk into your OB GYN and you hand them this list of symptoms. We're not training our medical professionals. This wonderful OB GYN who delivered your babies and has been your bestie and given you great care. 80% chance they've received zero training in menopause. This is a problem. Now we're fighting legislatively to force these changes. What do we do until then? If you go to my website, which is thepawslife.com, we have a list of providers and it's basically crowdsourced. Wonderful people who've had a great experience with a menopause educated clinician have done little testimonials and we've organized them by country, city and state.
- [44:44]
Adam Schafer
Oh, that's awesome. That's great.
- [44:46]
Dr. Mary Claire Haver
People find. And no one pays to be on the list. It's totally free. Right. If you go to the Menopause society, which is menopause.org they have a list of certified providers of which I am one as well. Unfortunately, there's only about 3,000 of them for all the women in America. And so we have a long way to go. There's some great, really cost effective telemedicine options that are out there. So on our, you know, we have all of this listed on our website. We have blogs on how to find a provider who might know what they're talking about and be able to help you and take your insurance or are you willing to pay out of pocket, et cetera.
- [45:19]
Adam Schafer
That's great. Now, now I, I, I know the answer to this, but I, I would love to hear from you. Like, what do you say to people that are like, well, it's a natural part of life, like you, you go through menopause, your body's supposed to go through these changes and we're forcing you now.
- [45:32]
Dr. Mary Claire Haver
So is presbyopia, so is erectile dysfunction. You know, you can raw dog menopause and you can be healthy. It's possible you don't have to take hrt, but for most women, you are not going to be optimal yeah. And so it's going to be harder. And you may, there may be things you don't realize, the way you're sleeping, your cholesterol, your general, you know, recurrent UTIs. When I tell you the women in the nursing homes with, you know, bladder infections and all of this, if could have just been cured with vaginal estrogen.
- [46:04]
Adam Schafer
What is it typical. What does it typically look like to do hormone therapy for women? Is it injections, creams?
- [46:12]
Dr. Mary Claire Haver
It depends on the provider and what they're comfortable with in our clinic. And most of them, we call them menopause, like my friends, who all over the world, most people are doing mostly transdermal estrogen. So a non oral formulation, anything we ingest orally, anything food, medication, goes to the liver for processing first. And when that bump of estrogen hits the liver in an oral formulation, we do see a slight upregulation in our clotting factors. And so for women who are prone, that can increase your risk of a blood clot. And we don't want that to happen. So for, you know, so because of that, most of us and some other, and there's some inflammatory markers we get a little bit worried about. But overall for most women, oral estrogen is safe. But you know, if I had everything equal, I usually do transdermal, I usually do a patch because I have a steady state dose going to the patient at all times. And the patches are generic and they're really, really, really like 25 bucks for the month. So most, most patients can afford that if they don't have insurance. For progesterone, we're doing oral. Usually the progesterone molecule in its natural form is humongous and doesn't pass through the skin very well. So we get really nervous with these progesterone creams that they're really ineffective and not protecting the lining of the uterus. And then for testosterone, it's kind of choose your own adventure because we don't have an FDA approved option for women. So I prescribe typically TC stem or AndroGel, the men's formulations. And we just have to cut the dose a lot. And that can get a little tricky with, you know, a pea sized amount on something A men would do four pumps, we just need like a quarter pump because women need 10 times less the dose of men. But that bottle for a woman, that Androgel bottle will last, you know, is maybe $50 and will last her about six months.
- [47:52]
Adam Schafer
Wow. What do you, what are some of the biggest fears that the women have?
- [47:56]
Dr. Mary Claire Haver
With that'll give them cancer. And all of that has been completely blown out of the water and is disproven. But we're struggling to get that message. I mean, to this day. Like, I have a petition to the FDA right now, and it's looking good that we're going to get a meeting to have the black box warning removed from vaginal estrogen and from the estrogen products. You open it up and it's like you will die of stroke, heart attack. It's. It. It freaks people out, of course. Right. Imagine you get your testosterone. It's like you could have a heart attack or liver failure or they just.
- [48:27]
Justin Andrews
They just removed that. The black box. Testosterone.
- [48:29]
Adam Schafer
Yeah, there was a little bit of that.
- [48:30]
Dr. Mary Claire Haver
So we're fighting for that. For women, it's looking good. So stay tuned. Hopefully I'll have good news soon.
- [48:36]
Justin Andrews
Anything else on the horizon that you see that you're excited about? Like, are we. Are we progressing in this area? Are we getting better? What do you.
- [48:42]
Dr. Mary Claire Haver
Yes. A lot more clinicians are getting menopause certified. A lot are getting interested in the space. A lot are just realizing where the gaps are. Like my daughter in med school, like, it's a priority for them. Even the guys in her class are. It's kind of a new way. You know, it's new and it's fun, exciting. There's a lot of research opportunities, so the kids are. Are going after it. So many menopause papers are coming out. So that's great. There's great research looking at it. Like I said, extending the life of the ovary, different medications that might work for that. And just in overall that women are at least Gen X and below are like this, I'm not gonna live like this. I want better than my mother had. I want better than my grandmother had. You know, I don't want to have this frail loss of independence and being dependent on my family for 10 years while I decline and eventually die. You. And so 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. But it's like, for the first time, I'm seeing this generation really rise up and really, really want to take control of this part of their lives. And it's pretty exciting to be a part of it.
- [49:50]
Adam Schafer
That's great. Now, when someone starts, let's say they start with you or somebody who knows what they're doing, and they do the testing to rule out any inflammatory issues or lupus or anything else. Like, okay, we're going to start you on this hormone replacement therapy. Does it start, like at a standard dose for most women? And then you kind of work around.
- [50:08]
Dr. Mary Claire Haver
And say, okay, yeah. So like in the patch, for example, for estradiol, we have five strengths, and depending on her age, her level of symptomatology, you know, so for an older patient who's not super symptomatic, I'm going lower dose. Right. For a younger patient who's very symptomatic, I'm going a little bit higher dose. But I tell the patient, this is trial and error. There's a, you know, about 20% of patients are poor absorbers through the skin. So there could be some back and forth trial and error. We may need to try a different formulation. So, you know, there's a lot. I wish I could just get a blood level and say, oh, this is what you need, and have some tests to know how well she's going to absorb the medication, but we don't have that yet. So just telling the patient to be patient and know that this will be a little bit of back and forth till we find out that the kind of program that's going to work for her, because we're working in general with three hormones at once. Right. And, you know, the estrogen, the progesterogen, and then the testosterone from those patients as well.
- [51:03]
Adam Schafer
And each one of those poses something different. So, you know, my anxiety is still kind of bad. Oh, probably progesterone or this feels a little bit.
- [51:10]
Dr. Mary Claire Haver
Right.
- [51:10]
Adam Schafer
So probably that. Okay. And are you finding that it's kind of becoming that there's like a general range that you're tending to find most women within, or is it all over the place?
- [51:19]
Dr. Mary Claire Haver
We don't have standardized. Like, what is the therapeutic range for estradiol does not exist. And so when we're checking levels, I'm just making sure they're absorbing or they're not super absorbers. Right. So, but, you know, for example, if my level's 100, which is totally fine, and your level's 100, if you're a woman, you know, you may feel like shit, and I feel amazing. And so we'd have to up yours and still stay in a safe range. So we don't really have that. You know, what's the level that we're like thyroid. Right. Or testosterone in general. I mean, some guys feel great and be completely functional at 400, and other guys need to go up to 800. Right. It's kind of we have to listen to the patient and let her be the judge.
- [51:59]
Adam Schafer
All right, so controversial. One question. Now, A woman who has previously survived breast cancer, can she do hormone replacement therapy? Because I've heard people.
- [52:11]
Dr. Mary Claire Haver
She can do vaginal estrogen. 100%.
- [52:13]
Adam Schafer
Okay.
- [52:14]
Dr. Mary Claire Haver
100%. Okay. So that's a given for almost everyone systemic. Maybe it depends on her stage, her age, her desires, her risk factors. What's happening is the conversation is only going around risk and not benefit for these patients. And breast cancer survivors are being left in the dust. These women are. It's a travesty what's happening to them, especially the ones put into surgical or iatrogenic menopause from chemotherapy or surgery, that they're like, you're lucky to be alive. Go out into the world. And now they have osteoporosis and heart disease and diabetes because no one addressed the loss of estrogen in their body, right? There are libidos in the tank. They're having horrible pain, you know, and. And they're like, okay, you're alive. Bye. Be great.
- [52:57]
Adam Schafer
What about people? You said pcos. You said yourself, what about pcos?
- [53:03]
Dr. Mary Claire Haver
There's a couple of, like, nuances. Pcos. It's. It's harder to make the diagnosis of Perry because they are so much the same, right? Have chronic and ovulation. So both very. Both very similar, but kind of treated similarly. So you really need someone who knows what they're doing. And then endometriosis, right? You can't just willingly give someone estrogen after endometriosis. You must give them progesterone. You must do it at very much higher levels than you would on another patient, because we don't want to reactivate an endometriosis implant that, you know, didn't get treated or which could lead to a malignancy in the future. So it's a. You know, you need someone who knows what they're doing.
- [53:43]
Justin Andrews
Where else are we missing really big? I mean, you talked about SSRI stuff. You talked about breast cancer. Where else are we missing big?
- [53:50]
Dr. Mary Claire Haver
I think libido, if you guys want to talk about it. I think knowing that so many women who other previously felt like they had. They were happy with their sexual life, right? And then all of a sudden, they're not happy, right? Or their partner's not happy, or they just never want to do it again. They don't care. I mean, this is. You know, we feel like. When I talk, you know, I have several patients who are divorce attorneys, and they love to tell me all the things and so they feel like menopause is. Is a factor. Now, for some women, menopause gives them this permission to circle the wagons, take care of me, cut the crap. In their life. And for them, a divorce was needed. They're finally able to leave a relationship that wasn't circumstant serving them. But, you know, I have these women coming in who are like, I love this man. I love my partner. He, you know, they're amazing. They. They, you know, take care of me and all the things. And I. We used to have this great sex life, and now I just don't want to be touched. And these are the women who are just coming in devastated by this. And, I mean, it just opens my heart to be able to help them. Right. And give them back that part of their life that just no one would talk to them about. They were ashamed or embarrassed to go to their regular GYN who they were never taught to do anything. And to know that we have medication available. This is real. It's not your fault. And you can. You don't have to live like this if you don't want to.
- [55:10]
Justin Andrews
Is it. Is it common to see both desire and orgasms change, or is it normal?
- [55:16]
Dr. Mary Claire Haver
So one of the things, if you think about, you know, the physiology of an orgasm for females, we have to get blood flow to the area for a long enough time. We need. We need to have stimulation to that area. The nerve conduction has to be working well. So like in. In diabetes, in hypertension, you know, we can have disease processes that will decrease, decrease that. When we lose estrogen to the area, delayed orgasms become a thing, which gets really frustrating. You have decreased blood flow, so you don't have as much mucus production. So for those patients, sometimes vaginal testosterone, like the DHEA suppository, which is intra rosa, it converts to estrogen and testosterone. That could be miraculous for these patients because we do have testosterone receptors in the vulva and, like, around the introitus. So, again, you need someone who knows what they're doing. It's, you know, what you don't want to tell the patient is, relax, have some wine, go on a vacation, blah, blah, blah, blah. That's. That's malpractice.
- [56:12]
Adam Schafer
All right, well, this has been great. Our audience really love this. I really appreciate you coming on the show. And you have to do it again, for sure. Yes. And, you know, I was not aware of some of those symptoms that you mentioned, so I think that's absolutely fascinating, and I'm so glad you have a list of doctors because I, you know, one of the challenges we have, sometimes we'll have someone come on the show, it's hard to refer, and then they're like, where do I go? Like, where do I go with this? So I'm so glad that you at least have a list of 3,000 doctors that people might be able to point to.
- [56:35]
Dr. Mary Claire Haver
Yeah.
- [56:36]
Adam Schafer
All right, well, thank you so much for coming on the show. Thank you. Thank you so much.
- [56:39]
Dr. Mary Claire Haver
You're awesome. All right, thank you.
- [56:41]
Adam Schafer
Bye bye.
- [56:41]
Sal Destefano
Thank you for listening to Mind Pump. If your goal is to build and shape your body, dramatically improve your health and energy and maximize your overall performance, check out our discounted RGB super bundle@mindpumpmedia.com the RGB Super Bundle includes maps, Anabolic maps, performance and maps aesthetic Nine months of phased expert exercise programming designed by Sal, Adam and Justin to systematically transform the way your body looks, feels and performs. With detailed workout blueprints and over 200 videos. The RGB Super Bundle is like having Sal, Adam and Justin as your own personal trainers, but at a fraction of the price. The RGB Super Bundle has a full 30 day money back guarantee and you can get it now. Plus other valuable free resources@mindpumpmedia.com if you enjoy this show, please share the like. Love by leaving us a five star rating and review on itunes and by introducing Mind Pump to your friends and family. We thank you for your support and until next time, this is Mind Pump.