← My So-Called Midlife with Reshma Saujani
My So-Called Midlife with Reshma Saujani
Why You Can’t Sleep, Focus, or Fit in Your Jeans—and What to Do About It with Dr. Mary Claire Haver
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- [00:01]
Reshma Sajani
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- [01:44]
Dylan Mulvaney
Hi, is this an okay time? It's your girl Dylan Mulvaney and I am inviting you to my weekly cocktail party and my brand new podcast, the Dylan Hour brought to you by Lemonade Media. Life is stressful and there is so much darkness in the world. I think we could all use a little bit of trans joy. So join me every week as I interview some of my favorite A list, celebrity friends and gurus and of course the dolls while we sip and spill the scalding hot tea. So put your worries aside and join me at the Dylan Hour. You can listen on Apple, YouTube or wherever you get your podcasts. Love ya.
- [02:20]
Reshma Sajani
Lemonade. Welcome to my so Called Midlife a podcast where we figure out how to stop just getting through it and start actually living it. I'm Reshma Sajani I don't know about you, but this perimenopause thing, it has been a bitch. It has totally uprooted my life. And I get it. Why women quit their jobs, leave their marriages, run away. Because life just feels like an absolute mess. Nothing, nothing feels good anymore. Nothing is working anymore. For example, getting a good night's sleep, it's like an impossible thing. I, like, dream about how it used to feel to put your head on a pillow and actually sleep through the night for seven hours, because that doesn't happen for me anymore. And whew, the anxiety. I mean, I'll be sitting in some random hotel room because I'm flown in to give a speech the next day and all I wanna do is go to sleep, but I can't because I am so anxious and my heart is just like thumping, thumping, thumping. And I think I'm about to have a panic attack. Instead of sleeping, I just lay there and do breathing exercises or all the bizarre things that are happening to my body, like the sudden onset of allergies and anaphylaxis and histamine intolerance. And here's the thing, all these things are happening and I feel like I got no one to talk to about it. I mean, the people I love, like my husband, they know that it's impacting my life, but he doesn't know how to help me. And when I go to doctors to talk about my allergies or talk about the fact that I've had a period for three weeks, their best advice is like, sorry, take an antidepressant or just wait it out until this phase is done. So the point is, is that, like, I've had menopause in my mind for a long time now, pretty much since 45, when shit hit the fan for me. So I was like beyond excited to have this conversation with Dr. Mary Claire Haver because she is literally the Beyonce of menopause. She is OG on menopause, she's prolific, she is smart, she is compassionate. She's a board certified OB GYN specialist, a Menopause Society certified practitioner, a certified culinary medicine specialist. Wow. And just a passionate entrepreneur and bestselling author whose life focus is women's health. And for the first time, she just made me feel seen. It was like having a conversation with a friend who was just way smarter than me about menopause who just kind of broke it down like I was a three year old. She gave me some real good tips. She made me understand just why things are happening in my body. And she's had some real lasting effects on me. Like, I take fiber now. Like, it's my job. So, all you midlifers, I know you're struggling with so much of the same things. I know the list of things I just talked about, the anxiety, the depression, the not being able to sleep, the pooch around your belly that just came out of nowhere and doesn't want to go anywhere. Like, I know that, like, you got all the same problems and you are also just looking to be seen. So this episode is my gift to you, and I truly hope you get as much out of it as I did. Because for me, meeting Dr. Mary Claire Haver, it was a game changer for me and it's had some real lasting impact on my life. And I can't wait for you to listen. Hey, Dr. Haver, we're so excited to have you on the show.
- [06:19]
Dr. Mary Claire Haver
Thanks for having me. Super excited to be here.
- [06:22]
Reshma Sajani
So, Dr. Haver, on this show, we love to talk about midlife mindset. So that means, like, you feeling good, thumbs up, as my son would say, or thumbs down. What is your midlife mindset?
- [06:34]
Dr. Mary Claire Haver
Oh, my God. Thumbs all the way up. I am 56 years old and I am living my best life. I have better sex, better relationships, better boundaries. I'm putting myself first. I'm doing what I want to do. I've learned to put boundaries around people that I love that were taking away my energy. You know, that was the gift of menopause for me, was I had to prioritize towards my own needs for the first time or I wasn't gonna make it right. And so, I mean, HRT has fixed the hot flashes and the brain fog and, you know, but Lord, I am not giving those boundaries back.
- [07:14]
Reshma Sajani
All my listeners are all midlifers, and they're all like, okay, how do I get there? I wanna know how I get there. Like, did you go from like, okay, at 40, this fucking sucks. And then something happened and you made it like, what? Tell me what unlocked this.
- [07:29]
Dr. Mary Claire Haver
Okay, so I was high functioning, type A. I had it. You know, my husband's working overseas. I got teenage daughters. I had it. I was absolutely rocking the game. This was the life I built. And then all of a sudden, I couldn't put my finger on it. But I started to lose resilience. Things were bothering me more. I started to not sleep as well. I started to, you know, depend on alcohol more to take the edge off, but I couldn't really, you know, put my finger on it. Then I had a couple of big Life events. And I completely lost it. Where I would have bounced back probably at 35, my brother died suddenly. And that was like a kind of a big wake up call. And at the same time, I had gotten off of birth control pills. I was about 48, and I didn't realize it, but I was fully menopausal. Like, I kind of masked most of perimenopause ish stuff, you know, it was starting to creep up. But, you know, being on pills, you know, was. I was treating it at least three weeks out of the month. And then when I got off, you know, I'm grieving my brother, I'm doubling down at work, I'm gaining weight. That was the other thing. I was, I was always had thin privilege. Always, always, always, you know, and all of a sudden, what in the hell is happening to my abdomen and my midsection?
- [08:46]
Reshma Sajani
You're like, what is that pouch on my stomach?
- [08:48]
Dr. Mary Claire Haver
Right, right. And I'm like. All my patients had shook theirs at me during their well woman exams. And I'd be like, oh, work out more, eat less. Come on, girl, you got this, you know. And then all of a sudden, it was me. And I'm doubling down at the gym. I'm, you know, starving myself. I'm going in these crazy fad diet. I. What did I do? Some lemon juice and cayenne thing.
- [09:09]
Reshma Sajani
I was, oh, I've done that. I've done that. I think it was like the Beyonce diet. And I was like, I could, I could do that. Yeah.
- [09:15]
Dr. Mary Claire Haver
So where kind of I started, like, medically was I was terrified of hormone therapy because I thought I'd get breast cancer. Right. And I have a terrible family history of cancer. Lost two brothers to cancer. And I'm a walking miracle that I'm even here. So I'm like, how can I fix this belly fat? My husband's like, you're obsessed. I had teenage girls. He's like, they're watching you. I'm negative self talk.
- [09:38]
Reshma Sajani
I'm fat.
- [09:39]
Dr. Mary Claire Haver
You know, and he's like, honey, you know, And I was like, okay, I'm type A. I'm gonna fix this.
- [09:45]
Reshma Sajani
And do you know at this point that it's menopause or are you just like, I'm getting. Cause you know, people always say, like, the older you get, your metabolism just slows down. And. And oftentimes you don't even connect that to menopause. So what, what, what are you thinking at that time?
- [09:58]
Dr. Mary Claire Haver
I'm thinking I'm not working hard enough. I'm not trying hard Enough, obviously, because all these things that I've told patients for 20 years have to work, otherwise I'm a liar, okay? And I've told them the wrong thing until it just would not work for me. You know, the starvation, the multiple workouts, I'd lose a little bit. It come right back. Like all the little tricks that I could get the 10 pounds off real fast, gone.
- [10:20]
Reshma Sajani
You could tell a patient, be like, well, they just don't have the discipline. I'm telling them to do it. They're just, they're eating the Oreos and they're really not going to the gym. But for you, you know, you're doing.
- [10:28]
Dr. Mary Claire Haver
It's disgust, the stuff that came out of my mouth. But I realized there's much more going on with menopause. This body composition change. I'm like, what is body composition? I remember Googling that. Like I did not even know what body composition was. I lived and died by the scale. I told my patients to live and die by the scale. I had no idea the significance of muscle mass and what that meant and how that would help you age.
- [10:49]
Reshma Sajani
And Dr. Haver, I think one of the things, so you talk about how like, like you crushed medical school, right? Like you were like you crushed it, top of your game. But when you went through school, they had no education around women's health and menopause.
- [11:04]
Dr. Mary Claire Haver
Well, in menopause, so I think in medical school. So I went to a, you know, Louisiana State University, great school, super proud of my education. But when I look back, I think we had maybe in four years, one lecture. There were no menopause clinics in our ob GYN rotations. There was no clinics focused on the health of women after reproduction. And then I did a Residency and OB GYN, another fantastic program. Over 50% of my training, probably 55, 60% was obstetrics. Getting pregnant, staying pregnant, problems with pregnancy after birth, you know, all of that important stuff. Like, I am not knocking what I learned. Then there's gynecology, which menopause would fall under. But we're spending half the time in the OR important stuff, learning the surgical procedures, all the different things, because we're doing, you know, uterus, ovaries, vagina, vulva. And in my second year, I had a six week block of rei, which usually is fertility, right? But that's where menopause falls, that falls under. So in that six weeks, one hour a week, I had a lecture from a menopausal woman, from one of our professors about menopause. That was it.
- [12:11]
Reshma Sajani
One of the things you said is you learned only about hot flashes in school.
- [12:16]
Dr. Mary Claire Haver
So for decades, the most recognizable symptom of menopause was the vasomotor symptom, usually in the form of a hot flash, hot flush if you're in Europe, and the ensuing sleep disruption from that and the sweating. Other symptoms like the mental health changes, the weight, the body composition, you know, the visceral fat gain, the musculoskeletal changes, the increase in autoimmune disease, the insulin resistance, cholesterol changes. Everyone just attributed that to aging, and no one was looking at it. So when we look at the studies around the treatment of menopause, it's all for hot flashes, because you can't blame a hot flash on anything else.
- [12:59]
Reshma Sajani
That's right.
- [13:00]
Dr. Mary Claire Haver
But now the research is going this way. So we know now from the Australia data, and Martha Hickey was on it, and so they see a 50% increase across the menopause transition of mental health disorders.
- [13:15]
Reshma Sajani
Wow.
- [13:15]
Dr. Mary Claire Haver
50%. Okay. It's not like we all collectively decide in perimenopause, let's become depressed or anxious or, you know.
- [13:23]
Reshma Sajani
Yeah.
- [13:24]
Dr. Mary Claire Haver
And so what's happening is now the researchers are recognizing that zone of chaos in perimenopause. So I thought during perimenopause, that transition where you're reaching that critical egg threshold level, that estrogen levels would just gently decline. Right. Until they bottomed out. No.
- [13:41]
Reshma Sajani
What's happening?
- [13:42]
Dr. Mary Claire Haver
It's a roller coaster. This crazy.
- [13:44]
Reshma Sajani
It's going up and down, up and.
- [13:45]
Dr. Mary Claire Haver
Down, up and down, up and down, higher than you've ever had in your life and plummeting to, like, these very rapid rise and falls. And progesterone is not keeping up. Right. It's. It's starting to kind of putter out as well.
- [13:57]
Reshma Sajani
You know, we. We talk about menopause in the show, but we don't. We haven't really talked about perimenopause. What is perimenopause? When does it start? Great, let's start there.
- [14:06]
Dr. Mary Claire Haver
So to define perimenopause, let's define menopause. Okay? So menopause, medically, and it's a horrible definition, is one year after the final menstrual period. That is medically how we define it. Natural menstrual period. Well, what if it's leap year? Do you have to wait 366 days? What if you've had a hysterectomy or an ablation or you have a moraine IUD and your periods are suppressed, or you have polycystic ovarian syndrome. Do you not get to be menopausal? What it represents is the end of ovarian function and the end of the ovaries ability to produce estradiol and progesterone. That is really what it is. Defining it by an arbitrary symptom is a mistake. But here we are.
- [14:44]
Reshma Sajani
So all your eggs are done, gone.
- [14:46]
Dr. Mary Claire Haver
Yeah. So let's go to normal. Normal cycles, right? Normal reproductive years. We're not a steady state. And what I talk about when I see people talk about hormone balance, I want to jump off a roof, okay? Because they obviously don't understand endocrinology. We are never balanced in a healthy female who is ovulating regularly.
- [15:04]
Reshma Sajani
And what are the hormones that every female has? I mean, we have hundreds, but the big. What are the big four, the.
- [15:09]
Dr. Mary Claire Haver
So when we talk about sex hormones coming the ovary and everything involved, we have testosterone that we make it in other places. About half of our testosterone comes from the ovary. Fairly steady state. Okay? Estradiol, progesterone, and from the brain. Remember, ovulation starts in the brain. LH and FSH from the pituitary gland that speak directly to the ovary. Without LH and fsh, we do not ovulate. Okay? So in a healthy, normal menstrual cycle, in A woman At 25, our hypothalamus in the brain is constantly sensing for estradiol levels. When they naturally get low in your cycle, it sends a signal to the pituitary through something called GnRH, gonadotropin releasing hormone. Hey, bro, we're running low on estrogen. Wake up the ovary, tell it to start doing its job. Sends out LH and fsh. To do that, binds to these follicular cells around the eggs. Those cells start converting testosterone to estradiol. Blah, blah, blah, blah, blah. Boom. We ovulate, you get a spike of estrogen, and the progesterone forms. Everything sloughs off, and we start all over again. Okay, perimenopausal. What happens? We reach a critical egg threshold where the signals coming from the brain, the ovaries, become resistant to those signals.
- [16:21]
Reshma Sajani
You know what. What threshold is that?
- [16:23]
Dr. Mary Claire Haver
So we don't know. It depends from woman to woman, there's some level of egg supply where the same levels of LH and fsh, which always work to secure an ovulation, no longer work. So the brain goes, whoa, what's going on? Where's my estrogen?
- [16:37]
Reshma Sajani
Right?
- [16:38]
Dr. Mary Claire Haver
And there. And pituitary is like, boss, I sent the signal he's like, send it again. Send more. So we get these bigger, harder pulses to force these ovulations to happen. So they're delayed. Sometimes we get two eggs. That's why we see a higher incidence of twins as we actually get older. You know, it's a. We see these women will go in and get their hormones checked. They'll see levels of estradiol 3, 4 or 500. Because we get these loop ovulations. Very, very chaotic on the way down. So it's not like a.
- [17:07]
Reshma Sajani
And typically that's happening at 35, 36.
- [17:11]
Dr. Mary Claire Haver
Yeah. So talk about timing. Again, very. The genetic variation is huge. The ethnic variation is huge. Okay, so for someone who's from the Indian continent. Right, right.
- [17:24]
Reshma Sajani
South Asian woman like me, what happens?
- [17:26]
Dr. Mary Claire Haver
South Asian 46 is the average age of menopause, not 51 like the average white woman like me. Okay, so we gotta back it up five years.
- [17:33]
Reshma Sajani
That sounds about right for me.
- [17:35]
Dr. Mary Claire Haver
Okay, so in the US we quote 51 because studies were done on me, people who look like me. So seven to ten years is. Tends to be that transition. So do the math. So we're looking at 45, you know, average age of 51. We're looking at 41.
- [17:50]
Reshma Sajani
Average age 51, that you begin perimenopause or menopause.
- [17:53]
Dr. Mary Claire Haver
Menopause. So seven to ten years behind that. Okay, so now we're talking, you know, 41 to 43. That the perimenopause would begin for me. For South Asian women, it's much younger, late 30s. And trust me, these. This disruption from the brain to ovary begins well before your cycles become irregular.
- [18:29]
Reshma Sajani
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- [24:00]
Dr. Mary Claire Haver
Why? Yeah, okay. So when our estrogen levels begin to decline and become erratic, we see a shift happening of we see inflammation go up. So it's the chicken and the egg. So estrogen is an incredible anti inflammatory hormone that is incredibly protective of our liver, of our endothelium, of our levels of visceral fat. When we lose that protection. Okay, we are. Insulin resistance rises with no changes in diet and exercise. When the insulin resistance rises, inflammatory markers start to go up. So when we have higher levels of inflammation, we shunt more fat to the intra abdominal cavity, doing nothing else.
- [24:40]
Reshma Sajani
Got it.
- [24:41]
Dr. Mary Claire Haver
So what we see is if you had a twin sister. Okay. And I took the ovaries out of her. All right, A premenopausal woman, age matched, has a most of her. We look at her total body fat. About 8% is visceral, and that's a roughly healthy level. Okay. That goes up to 23% through menopause.
- [25:00]
Reshma Sajani
Got it.
- [25:00]
Dr. Mary Claire Haver
Just take out her ovaries, and you shunt that much more to the abdomen.
- [25:03]
Reshma Sajani
Okay. So that's why I'm getting weight sleep like I used to sleep, like a baby. Now it's like I need a fan, I need a white light, I need two cbd, I need three magnesium, and I'm still waking up three to four times. Why can't I sleep?
- [25:22]
Dr. Mary Claire Haver
Let's talk about it. I used to just lay my head on the pillow, and now it's like an hour of sage and smoke and mirrors and medication and all the things. I get it. Okay, so why is this happening? Two reasons, probably more. But we have a thermoregulatory center in our brain. It's in the hypothalamus. Same organ. Right. And it controls our temperature. So it goes absolutely hog wild when our estrogen levels start declining and going cattywampus. So it's more to do with estrogen decline than the chaos. The chaos is more the mental health changes and the. So restoring those estrogen levels tends to stabilize the vasomotor control center in the brain. Okay, so we're waking up with hot flashes. The hot flashes will wake us up. Some people's vasomotor symptoms are actually palpitations rather than the thermoregulatory center. So we have kind of this. A broader range. So that's waking us up. Progesterone. So when we lose the ability to make progesterone or progesterone at levels our body is used to, we see less. Gaba, which is a hormone very important for sleep and relaxation, produced in the brain, which directly affects our sleep. Most of my pat. You know, we can stop the hot flashes and get them to go to bed, but adding in progesterone, you know, estrogen is great for hot flashes. Progesterone Is better for that good quality sleep. Wonderful studies right now being done with aura looking at sleep disruptions. We're pointing to our rings. Sleep disruptions through the menopause transition. And you may. They're, you know, women are wearing them and they're reporting their menstrual history.
- [26:58]
Reshma Sajani
Oh, and I have latency every day. Latency, latency, latency. You have too many wake ups, you're too unrestful. Because my aura is telling me, because I, I don't, I have intermittent sleep is essentially what happens.
- [27:09]
Dr. Mary Claire Haver
So progesterone, especially early perimenopause, you know, when they're not really needing estrogen quite yet again, it's, it's a very nuanced conversation.
- [27:16]
Reshma Sajani
Okay.
- [27:16]
Dr. Mary Claire Haver
Progesterone is magical for sleep. L theanine is really helpful. And magnesium, L theonate, wonderful study. Just came out this week on lherate.
- [27:25]
Reshma Sajani
That's what the magnesium has really helped. Okay, third question. Why do I have to go to the bathroom all the time? I am constantly, constantly pink. Like constantly. Pain.
- [27:34]
Dr. Mary Claire Haver
Okay, so gsm, Genital urinary syndrome of menopause. Gsm estrogen receptors are all over our body. Okay? It's not just hot flashes. It is everything. So in the, specifically the bladder, the bladder, neck, the urethra, the vagina, tons of estrogen receptors, all of that tissue together, vagina, vulva, bladder, bladder, neck, the whole apparatus hugely sensitive to estrogen levels. When they decline, we lose elasticity, we lose mucus production, we lose the ability of our, our body to fight inflammation and bacteria. So recurrent UTIs, incontinence, irritation, what we thought was interstitial cystitis, especially in that age group, is probably untreated genital urinary syndrome and menopause. I'm going to blow some of your listeners minds. Vaginal estrogen is the key right now. I would put you on vaginal estrogen if you were my patient to see how it worked.
- [28:29]
Reshma Sajani
Just see how it works. See if I pee less. Okay. Why do I feel depressed and anxious? Because.
- [28:36]
Dr. Mary Claire Haver
Right.
- [28:36]
Reshma Sajani
Like the littlest things set me off.
- [28:40]
Dr. Mary Claire Haver
So. And that's new. Is this new for you? Right.
- [28:43]
Reshma Sajani
Yeah, I'm a pretty, I'm a pretty like standard, you know, like I don't get too excited, I don't get too sad. I'm just kind of steady.
- [28:50]
Dr. Mary Claire Haver
Betty, the perimenopause transition is an incredible window of vulnerability for a female's mental health. Why? Because our neurotransmitters, especially dopamine, serotonin, norepinephrine are directly related to levels of those hormones in our brain. And when those hormones go crazy or, you know, start declining or stop becoming predictable, the brain hates it. And so brain fog, mental health changes. And the studies are coming out left and right. Right now, lots of people are looking at the mental health changes and that, guess what? Estrogen replacement or estrogen therapy is more effective in perimenopause than SSRIs, than the standard antidepressant medications. It's absolutely phenomenal.
- [29:38]
Reshma Sajani
So I have noticed, Dr. Haver, that a lot of these symptoms get real intense midway through my cycle. Why is that?
- [29:46]
Dr. Mary Claire Haver
So, like, we talked about the chaos zone. We see kind of a bump because we don't have that predictability. What the kind of thought process is is that we're seeing worse pmdd, premenstrual Dysphoric disorder, or that, you know, we've known about this forever. This happens in little bits when I talk about the chaos and what happens in the brain. For some women, they're super susceptible and have really bad PMS or PMDD all their whole reproductive life. But we see this sudden surge of it in perimenopause, you know, and so women who had it, I'm like, get ready. We need to be on the lookout and get really aggressive about treatment. But it's very common that I will see patients who never had issues before suddenly having debilit, mess, you know, rage, anger, anxiety, depression, cannot function for 2, 3, 4 days, and then it kind of calms down, and it's, you know, very much tied to their cycles.
- [30:43]
Reshma Sajani
So I want to talk about my situation.
- [30:45]
Dr. Mary Claire Haver
Okay. Now I can't practice medicine in the state of New York. I could just give general advice.
- [30:51]
Reshma Sajani
I'm going to tell you what my doctor said. I just. I mean, I thought it was really interesting. It was. Enlighten me. I actually want to share this with the viewers. So I didn't realize how much menopause was connected to the same fertility challenges that I was having. So I had recurrent miscarriages, you know, more than I can count. And when I, you know, and oftentimes similarly, I would go into the doctor like, oh, you're just. You're 38, you're 39. Your eggs are old. And my sister's an OBGYN, and she started looking at my records, and she's like, no, this isn't right. And she said, you know, I'm seeing some autoimmune issues. I want you to get it checked out. And what I discovered then was that I had aps right And a heightened immune system, a ton of killer T cells. And every time I got pregnant, around 10, 11 weeks, my body would attack the fetus, right? And so once I figured it out, I had a concoction of like heparin and blood thinners and a bunch of stuff, right? I was able to kind of carry my first son. So I go through this, right? And I'm thinking as I'm in menopausal, none of this is relevant to when I start having my menopause. And I'm like, do I take hrt? What do I do? Da da, da, da, da. And finally, the third doctor says, wait, wait a minute here. And oftentimes the symptoms I was having not just are the ones I described, but I had intense itching. I would randomly break out in an allergic reaction out of like nowhere in hives because the histamines. And so this incredible doctor kind of put it all together for me of like, no, this is related to this.
- [32:29]
Dr. Mary Claire Haver
I mean, we've known this correlation forever that there's certain autoimmune disease clusters that spike in perimenopause. Again, estrogen is our friend, and estrogen is an anti inflammatory. And when we, we have lower inflammation levels, we have lower autoimmune disease. And so when we take away that protection, we see, you know, in females, a surge of these very female specific types of autoimmune disease, like hypothyroidism.
- [32:55]
Reshma Sajani
Wow.
- [32:56]
Dr. Mary Claire Haver
So, yeah.
- [32:57]
Reshma Sajani
So I want to ask you something. I've actually, I've asked several people who've come here and talked about menopause about this, and maybe I'm like, okay, I haven't exactly gotten it. How do I know, right, that this is like menopause or perimenopause or how do I know it's not something else?
- [33:13]
Dr. Mary Claire Haver
Sure, Great question.
- [33:14]
Reshma Sajani
Because I now tend to fall in this, right, this thing of, ah, it's my menopause, that's why I snapped at you today. Or that's why my hair is itching, or that's why I can't sleep. Or it could be a whole host of other things.
- [33:28]
Dr. Mary Claire Haver
So when I have a patient come to clinic, postmenopause is easy to diagnose. I don't have periods anymore. You know, we have a great blood test for post menopause. We do not have a good blood test for perimenopause. So I can diagnose perimenopause by talking to the patient and believing her. I do a ton of blood work though, okay, so she comes in she's got her list of symptoms. First of all, I believe her. I believe her. I don't automatically dismiss it to you're stressed, you need more water, you need more sleep, you need more. Look, I was taught, it was taught to us that women tend to somaticize their symptoms. That we take something biological and we give it a psychological cause. Not for men, only for women. It's all in her head.
- [34:12]
Reshma Sajani
What was the term they used to call them? Ww?
- [34:15]
Dr. Mary Claire Haver
Yeah, the whiny woman. I've talked, you know, I go, I've spoke at American College of Ob gyn and there I heard whiny Gyne's. I've heard Madame Dolores in New York, I've heard total tbd, total body Dolore in Miami where they, you know, where there's a lot of Spanish or if she was white, www. Whiny white woman. And so my upper level's telling me this. So. And now I look back, I mean it took like 10 years for me to go, wait a minute, I'm a wimey woman. I'm her, you know, but I'm not. This is real. This is real. So the first thing I do is acknowledge what she, what is happening is real. Second thing I do is I get a lot of blood work to see. So it could be, is it autoimmune disease? Is, is this overlapping? Is this also a nutritional deficiency? What is her. You know, I check inflammation markers. I mean we are going all in with our patients to see, you know, I don't want to miss. I picked up lupus, I picked up lots of things. And, and you know, is she anemic? Is she, you know, is this part of it? Then we talk about therapy, you know, we talk about everything from pharmacology to supplements to. And then we just give her a try. I'm like, let's try hormone therapy for three months and see what gets better.
- [35:26]
Reshma Sajani
Right?
- [35:26]
Dr. Mary Claire Haver
And you cannot believe the quality of life we can give back a woman by giving her back her hormones.
- [35:45]
Reshma Sajani
Fasting isn't just about shedding weight. It's about recalibrating your system and setting your health journey up for success. This is why I love Prolon. Prolon's fasting mimicking diet allows me to eat during my fast so my body stays nourished while also getting all the benefits of a traditional prolonged water fast and more. And now with Prolon's new next gen program, I can enjoy the same science backed benefits they are known for in an even more convenient program. Prolon is a plant based nutrition program featuring soups, snacks and beverages designed to nourish the body while keeping it in a fasting state, triggering cellular rejuvenation and renewal. NextGen builds on the original Prolon with 100% organic soups and teas, a richer taste and ready to eat meals. Everybody knows fasting can have health benefits, but they also know fasting can be challenging. Not with Prolon. Developed over decades at USC's Longevity Institute and backed by top U.S. medical centers, Prolon has been shown to support biological age reduction, metabolic health, skin appearance, fat loss and energy. With Prolon NextGen you get everything you need prepackaged and ready to go. Each order of Prolon's five day program comes with five boxes labeled by day so you know what to eat each day. I did the five day program and I can feel the difference already. It really helped me get on my A game when it comes to my health. Now I can't wait to experience Prolon's next gen and continue to see my progress grow with its convenient program that fits my busy lifestyle as a midlifer. To help you jumpstart a plan that delivers real results, Prolon is offering my so called Midlife with Reshma Sejani listeners an exclusive chance to be among the first to try NextGen with 15% off site wide plus a 40 bonus gift. When you subscribe to their five day program. Just visit prolonlife.com midlifecrisis that's P-R-O-L-O-N-L-I-F-E.com midlifecrisis to claim your 15% discount and your bonus gift. Prolonlife.com midlifecrisis I want to tell you about a podcast you should check out. It's called Climbing the Walls. This six part series investigates why women with ADHD have gone undiagnosed for so long and how that changed dramatically during the pandemic when the diagnosis of ADHD in women skyrocketed. The show asks why women? Why now? How has this underdiagnosis impacted women's mental health? This is such an important podcast for women to listen to. So many midlifers are experiencing late in life diagnoses of ADHD and trying to understand what this means and how it impacts our everyday lives. I checked out the first episode and it's such a beautiful, thoughtful conversation on understanding your diagnosis and how it has ripple effects on your mental health. Also, it tackles the ever growing question of how so many women go through their lives without knowing they have adhd. It's a must listen for everyone out there who had their late in life diagnosis or who think that they may be experiencing ADHD symptoms. To listen to Climbing the Walls, Search for Climbing the Walls in your podcast app. That's Climbing the Walls. Hey midlifers, I want to tell you about a podcast you should check out. It's called ADHD Aha. Hosted by Laura Key. It's candid stories from people who share the moment it clicked that they or someone they know has adhd. You'll hear real stories about what ADHD symptoms can look like and how a diagnosis can change someone's life. They even talk about how ADHD can be a factor behind impulse spending, troublemaking decisions and social anxiety. I've been wanting to learn and explore more about how ADHD impacts women's lives during midlife. So many women are experiencing late in life ADHD diagnosis because it was overlooked while they were younger. So I was really excited to discover adhd. Aha. I checked out one of their episodes about burnout and thought it was so eye opening. They had an amazing in depth discussion on how ADHD can lead to burnout when we aren't taking care of ourselves and what signs we should be looking for when facing potential burnout. Seriously, this is a must listen episode for anyone with or without ADHD to listen to adhd. Aha. Search for ADHD Aha in your podcast app. That's ADHD Aha. With Aha spelled A H A. I want to talk about the intersection of nutrition and menopause.
- [40:25]
Dr. Mary Claire Haver
Yeah.
- [40:26]
Reshma Sajani
What should we be eating and focusing on during this time period?
- [40:31]
Dr. Mary Claire Haver
Good question. You know more than ever with age and with menopause because they kind of compound on each other. We can get away with a lot when we're younger. Okay. Look at the diets of our college kids. So menopause takes away the ability to get a freebie, you know, for most of us. And you should be focusing on protein. And I'm talking about. So when I, when my patients come into clinic, we focus on the immediate things that are keeping her from functioning on a day to day basis. Is it hot flashes? It night sweats? Is it brain fog? Is it depression? Is it, you know, whatever. We fix that. Okay then I feel great. I'm back to me now. We talk about her parents, her aunts, the elders in her family and their what diseases have plagued them with older age? What are we trying to avoid? Because I don't know about you, but I'm in the sandwich generation and I am Dealing with, with three sets of parents in laws who are not doing well in old age. And it's a lot. And so, and so my husband and I are constantly like, what can we do to try to avoid most of that? I don't want to negate what they did or they're lovely people and we love them so much, but it is a lot of suffering.
- [41:42]
Reshma Sajani
Oh, my father ate a ton of Indian food, drank a whiskey every night and he's got diabetes and a heart attack at 56. I, I'm with you, right? And all I'm doing is, how do I not? Because I too live a highly stressed life. How do I not end up there, right?
- [41:58]
Dr. Mary Claire Haver
So there's a lot of genetic variation. Look at your family history. You know, I'll have people come in with perfect labs. They have no visceral fat, but they're having, you know, life crushing depression. We focus on that. You know, I'm like, keep eating what you're eating. You're, you know, how do we prevent a metabolic free fall if, if that is going to be your path? How do we prevent sarcopenia, osteoporosis or dementia? What do we know? And usually it's the same stuff. Adequate protein, about 1.6 grams for every kilogram of lean body mass for a woman. I don't look at men's studies, I just look at us. Okay, so most women are getting maybe half that on a day to day basis, right? Because they were always taught to be thin and calorically restrict. And protein kind of goes out the window. Plants and protein. So we focus on plants and protein. There is a theoretical place where a woman would never need a supplement because she could get everything from her diet. It's possible, but it's very, very hard. Okay? In, in clinical practice, it is really, really hard. So supplements are there to fill in the gaps. Plants and protein and then avoiding the processed foods, not to say never. You know, we all go to parties, things happen. But watching your added Sugars, less than 25 grams a day, at least 25 if not 35 grams of fiber per day. Those are the two core things all my patients, you know, we talk about. We know that works for everyone.
- [43:14]
Reshma Sajani
Yeah, I just started taking a fiber supplement. Why is fiber important during menopause? And I started taking it because I just got my cholesterols and my LDLs and my HDLs were like off the charts. Right. Which is because of the estrogen drop.
- [43:29]
Dr. Mary Claire Haver
So fiber does several things. It slows down the absorption of sugars. So when you eat a meal that has carbs and fiber together, right? And a lot of carbs have fiber, natural fruits and veggies have fiber. It slows down the absorption of the sugar so you don't get the insulin spikes, IGF receptors, the insulin growth factor receptors. You know, all of that on the liver will, you know, those insulin spikes are going to help to drive cholesterol levels. It really is less about your, you know, saturated fats. We look at a 2 to 1 unsaturated to saturated fat ratio, and that seems to really help move the needle. But fiber slows absorption of blood glucose, feeds the gut microbiome. It is the prebiotic. So keeps your gut microbiome well fed and happy. We're also adding in probiotic supplements a lot of times, like I was going.
- [44:21]
Reshma Sajani
To ask you, do you need a probiotic and a fiber supplement or just one or the other?
- [44:25]
Dr. Mary Claire Haver
You should do both. So if you're eating something rich in probiotics, if you're doing plain Greek yogurt every day, you know, a 3/4 of a cup, that should be enough probiotic. But it's usually just lactobacillus. So I tell my patients, when you're going to Whole Foods or wherever to pick out your supplement, you want something that has lots and lots of strains. So like billions. And you want as many strains as possible, right? You want to fill the pond with as much variety as possible because our gut microbiome changes to that of a man. Great studies done through Zoe looking at the gut microbiome health. Like they got stool samples all the way through perimenopause and menopause and looked at how the gut changed through the menopause transition.
- [45:04]
Reshma Sajani
So you've recommended a nutrition program called the Galveston Diet, right?
- [45:07]
Dr. Mary Claire Haver
I wrote that book. Yeah.
- [45:08]
Reshma Sajani
Yeah, that's right. You wrote that book. Tell me about it. And could you. Okay. Cause one of the things, like I listen to these conversations and I'm like, okay, you know what I mean? Protein and like no saturated fats. But sometimes I'm like, tell me what I should eat for breakfast, tell me what I should eat for lunch and tell me what I should eat for dinner. And I'm just gonna do that every day. So can you do that for me?
- [45:28]
Dr. Mary Claire Haver
So kind of when I first got into studying nutrition, so I actually got certified in culinary medicine in 2019 for, from the American College of Culinary medicine. So like 18 month program, took all the labs, had to go to San Antonio, New Orleans, work in kitchens. It was awesome. So I Learned a lot because we again, in medical school, zero on nutrition, you know, like the actual functional nutrition. So I took what I learned there and I was looking at studies on inflammation. I wanted to lower inflammation in menopausal women, knowing that there was a big connection with visceral fat and weight gain. And so there were, there's good studies done on fasting with inflammation. Now I've kind of backed off on like being very rigid about fasting now because it's hard to get your protein in, in a tiny window. Right, right.
- [46:15]
Reshma Sajani
So you don't recommend intermittent fasting in the same way, Maeve?
- [46:18]
Dr. Mary Claire Haver
I still do it kind, you know, I talk about it, I talk about the risks, the benefits, but I tell patients not to sacrifice nutrition to be able to fit in an eating window, you know, and that if you're trying to build muscle, you shouldn't fast. So Galveston diet had anti inflammatory portion, a fasting portion, and then what we call a fuel refocus portion, where we were looking at macros. What I've done differently now. So that was 2015 when it was weight loss. Weight loss, weight loss. Right. So I got into the weight loss space. Well, then as I kept learning and reading and researching, I'm like, this is less about weight loss and more about body composition. Yeah, this diet, you'll lose weight, but wait a minute, are we going to gain muscle and lose fat? Like, are we just losing a whole lot of muscle? You know, so if I ever wrote a book again on nutrition, it would be more protein centric, less rigid about fasting and more about body composition. More like celebrating your curves, your shape and muscle. I'm now trying to have a bigger body. You know, I'm constantly fighting to have more muscles. So that's a much more fun place to be than constantly thinking about, I can't eat this or I can't eat that.
- [47:24]
Reshma Sajani
Yeah, I love you say that like we need to move away from thinness being a sign of health. Right. Can you elaborate why being thin is not the same as being healthy, Strong and healthy.
- [47:36]
Dr. Mary Claire Haver
Yeah. So, you know, forever I was taught calories in, calories out, thin is healthy. You know, you could just look at a patient and tell her what your cardio metabolic status is. And then you start seeing these younger patients who are thin, falling out and having horrible cholesterol and horrible, you know, and so BMI is now, you know, the World Health Organization and American College of Cardiology, all the big societies are stepping in and saying, we are rethinking BMI as a Measure of the risk of chronic disease. The waist hip ratio or an abdominal circumference is more important than the BMI because you're discounting muscle when you talk about bmi and that is a more clinically relevant indicator of the risk of chronic disease. Plus you say they're obese if they have a waist to ratio for a woman Greater than 1 plus 1 risk factor like hypertension, insulin resistance, etc. So that now qualifies for obesity.
- [48:32]
Reshma Sajani
How does GLP1s fit into this?
- [48:35]
Dr. Mary Claire Haver
So I use them in my clinic and I can tell you, for my patients who've lifelong struggled with, you know, being over fat and under my, you know, it is a miracle. For the first time, the food noise, inflammation goes down. They've never seen them more motivated. They're absolutely sticking to the, you know, plans that we put with them. They're able to do it. Like the mindset part is really there for them. And really we're seeing good results for menopausal weight gain as well. So women who really had normal weights and didn't have to worry about their weight until menopause, you know, we start with hrt. Typically if they're menopausal and you know, get their symptoms under control, we give them a nutrition plan. Then we see them back in three months if they're still struggling. And so Rocio Salis Whelan, my good friend, she's in New York, she's an endocrinologist and has, does incredible work. Taught me so much about GLP1s. She said, you know, there's all this talk about, you know, vanity, weight loss. She said, if a woman is maintaining her weight, but it is taking 90% of her day to do it, and it is, you know, the thought process, the, the, you know, it is making her unhealthy in every other part of her life. Why would you not try it?
- [49:45]
Reshma Sajani
Right?
- [49:46]
Dr. Mary Claire Haver
To see if you could take that angst away from her and allow that beautiful brain of hers to go think about other things like making the world better or building her position at work, you know, whatever, anything. But am I eating? Am I not eating how much I'm going to work out? So she says it's worth it.
- [50:02]
Reshma Sajani
Yeah, tell that voice to be quiet so you can focus on other things. So you've been doing this work for a while and you are like one of the, I mean, you're just, you're a sage. Like, you are like, you break it down in a way that like no one else does. I guess I want to ask you, like, what's the thing that surprised you? And what do you think? Think the thing is that we still have to, we still have to work on everything.
- [50:27]
Dr. Mary Claire Haver
I mean, what surprised me how much I didn't know? How much every day I'm surprised, how much I, if I open my mind and listen, if I, if I treat, to heal, if healing a person is my goal, rather than taking a random set of, of guidelines of fixing a sick person. But if I'm here to promote health, it absolutely has blown my mind. And here's one of the most disappointing things. The people, the institutions, the organizations who have been in control of women's health after reproduction are not happy about this movement. They are horribly, horribly disappointed. They have built careers and lives off of a very narrow definition of menopausal symptoms, you know, and how we're supposed to treat them. You know, there is society saying we should be doing cognitive behavioral therapy as first line treatment of menopause. Wow. It's outrageous. It's outrageous not to say I love cbt. I've had CBT for traumatic, you know, things that have happened in my life. But to think that I would use that to manage a hot flash. I just out think a hot flash. I'm like, why are you assigning a psychological, you know, treatment for a biological condition? I, you know, so that has been really disappointing. Here I am thinking, oh good, all these societies are going to be so excited and, you know, really see that women are galvanizing or interested in their healthcare and really want to ask him more questions and asking more questions and the pushback. Now, let me, let me be clear about this. Remember, I was that doctor. I was a great obgyn. I delivered babies. I did wonderful pap smears. I was a good surgeon. I was, you know, high risk ob. I did it all. I was terrible, terrible, terrible menopause provider. I will tell you this straight out. And I dismissed and I, you know, I didn't know what I didn't know and it wasn't my fault because no one taught me, it was not part of my required training. And no one since my graduation put articles in front of me on a regular basis as part of my CME to say, this is important and this is how you should be taking care of these women once they're done having babies. Okay? Once their ovaries shut down. So we have some OB GYNs who aren't happy with this menopause movement either because it's making their job harder because they weren't Taught. And they're having 15 minutes, you know, I have an hour with my patient and that is a privilege. Yeah, that's a privilege. I could never have run this kind of practice. I have now in the old traditional, you know, it's fee for service insurance. The current guidelines do not promote the health of a woman after reproduction ends. I know that's controversial, but I'm saying it loud and proud.
- [53:07]
Reshma Sajani
And you're, you're building a movement. Listen, you're building a movement that's gonna change the structure. So anyway, I wanna get to the, I wanna, you know, close out here and just because I think you have so much like again, sage advice to give. Like for women entering perimenopause, what's the first step they should take?
- [53:25]
Dr. Mary Claire Haver
Educate yourself. Educate yourself and realize that the, this, this change is coming. And probably the things that you've been doing for your diet, your nutrition, your sleep, for most of you, not all are going, you're going to struggle to maintain homeostasis. It's going to get harder. Either your mental health, your musculoskeletal health, your gut health, your, you know, and could be all of them. But there's usually kind of one thing. And there's a really interesting study called not feeling like Myself nfln. And that's usually the first sign of perimenopause. Like the symptoms, like everyone says, hot flashes. Well, that's the most recognizable symptom. The first, the most common symptom is fatigue.
- [54:06]
Reshma Sajani
So wait, where's the study? Where can they read it?
- [54:09]
Dr. Mary Claire Haver
So if you google not feeling like myself scholarly, it'll come up.
- [54:13]
Reshma Sajani
Okay, we'll put in the show notes. Okay, so read that article.
- [54:16]
Dr. Mary Claire Haver
Yeah. And you'll be like, what? What? You know, and so these online menopause companies, Midi Alloy and Ever now, my three favorite, they do not pay me, you know, but I've vetted them. You know, a lot of people are struggling to find an in person menopause provider like Educate Yourself, get the new Menopause. That was my book. You know, there's other great books out there.
- [54:37]
Reshma Sajani
So read the New menopause, read the scholarly art and maybe sign up for a session with one of these companies, right? That can give you like, give you a counselor. I did that, right. And said, I'm going through this, what do I do? And it was enormously helpful.
- [54:50]
Dr. Mary Claire Haver
And because you really can't rely on your poor, busy, lovely ob GYN to be able to keep up with this. It's moving too fast. And they are still doing great care in what they were taught to do. And it's a really special OB GYN who has been able to step outside of their training to be able to do really good menopause care.
- [55:08]
Reshma Sajani
No, it's true. I, I experienced that too also. It's like you lose that. Like the last time I went to my OBGYN was like when I was struggling with fertility issues. And then you kind of, you know, you don't have that same relationship. Okay, well, this was so amazing. Thank you, Dr. Haver. When's your new book coming out?
- [55:23]
Dr. Mary Claire Haver
Not till 2026. The new perimenopause. Yeah.
- [55:26]
Reshma Sajani
All right. We'll be looking out for it.
- [55:29]
Dr. Mary Claire Haver
Okay.
- [55:29]
Reshma Sajani
Thank you so much. Dr. Mary Clairhaver is the author of two best selling books, the Galveston Diet and the New Menopause. I truly cannot thank her enough for taking the time with me with all of you midlifers, because I know you learned as much as I did. So here's one last thing. Thank you so much for listening to my so Called Midlife. If you haven't yet, now's a great time to subscribe to Lemonada Premium. You'll get bonus content like me and Tamranal talking about raising sons and being aware of the way that society just treats them differently than girls. Just hit the subscribe button on Apple Podcasts. Or for all the other podcast apps, head to lemonadapremium.com to subscribe. That's lemonadapremium.com thanks y'all. We'll be back next week. I'm your host, Reshma Sajani. Our associate producer is Isara Acevez and our senior producer is Chrissy Pease. This series is sound designed by Ivan Kurayev. Ivan also composed our theme music and performed it with Ryan Jewell and Karen Waltock. Our VP of new content is Rachel Neal. Special thanks to our development team, Oja Lopez, Jamila Zara Williams and Alex McGowan. Executive producers include me, Reshma Sajani, Stephanie Whittles Wax and Jessica Cordova Kramer. Series consulting and production support from Katie Cordova. Help others find our show by leaving a rating and writing a review. And let us know how you're doing in Midlife. You can submit your story to be included in the show@speakpipe.com midlife follow my so Called Midlife wherever you get your podcasts or listen ad free on Amazon Music with your prime membership. Thanks so much for listening. See you next week.
- [57:27]
Dr. Mary Claire Haver
Bye.
- [57:37]
Sarah Silverman
Want more from your favorite Lemonada Media podcasts? While supporting the shows that help make life suck less. Subscribe to Lemonada Premium today. As a subscriber, you'll unlock exclusive bonus content like never before heard interviews, behind the scenes moments, bonus episodes, and so much more. It's easy to sign up no matter what podcast app you use on Apple. You can just click the Lemonada logo in the Apple podcast app and hit subscribe. For all other podcast apps, head to Lemonada supportingcast FM to subscribe. That's Lemonada supportingcast fm.
- [58:14]
Dr. Mary Claire Haver
Why hello there.
- [58:15]
Unnamed Speaker
This is your pal Sarah Silverman. You know, the standup comic that's not afraid of a diarrhea joke. Oh my go so brave. I hope you're enjoying this podcast that you're listening to. I am just dropping in here to let you know about another podcast I think you'd like, and it's called the Sarah Silverman Podcast. Each week, listeners from all over the world call in and they ask me for advice or they talk about something going on in their life.
- [58:38]
Dr. Mary Claire Haver
Anything.
- [58:39]
Unnamed Speaker
Their silliest, grossest, deepest, darkest situations. And then I respond whether I'm qualified to or not. Go ahead. Search for the Sarah Silverman Podcast wherever you get your podcasts.
- [58:49]
Dr. Mary Claire Haver
Bye.