What No One Ever Told Us About Menopause

Summary

The Goop Podcast: What No One Ever Told Us About Menopause

Release Date: March 4, 2025
Host: Gwyneth Paltrow
Guest: Dr. Mary Claire Haver, Board-Certified OB-GYN and Certified Menopause Practitioner

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Introduction to Menopause Conversations

[01:58] Gwyneth Paltrow opens the episode by highlighting the pervasive misinformation surrounding menopause. She introduces Dr. Mary Claire Haver, an authority in menopause care, known for her book The New Menopause. Gwyneth emphasizes the importance of re-shaping the narrative around menopause to empower women with accurate information and proactive health strategies.

Misconceptions and Educational Gaps in Menopause

[03:16] Dr. Mary Claire Haver discusses the significant gaps in medical education regarding menopause. She reveals that during her four-year medical curriculum, menopause was covered in merely six hours, barely scratching the surface. Dr. Haver underscores the systemic issue where even specialized OB-GYN practitioners lack comprehensive training on menopause, leading to inadequate patient care.

"We are not prioritizing the health of women after reproduction ends." — Dr. Mary Claire Haver [06:48]

Evolutionary Perspectives and Cultural Shifts

Gwyneth inquires about the evolutionary design of menopause, referencing the grandmother hypothesis—the idea that post-reproductive women contribute to the survival of their species by passing on knowledge. Dr. Haver explains that historically, low life expectancy limited the post-menopausal period, but modern advancements have extended this phase, necessitating better support and understanding.

"Our function shuts off completely...in certain cultures, women became sources of wisdom." — Dr. Mary Claire Haver [08:24]

Hormone Therapy: Myths vs. Facts

A major portion of the discussion centers on hormone replacement therapy (HRT). Dr. Haver debunks longstanding fears stemming from the Women's Health Initiative study, clarifying that bioidentical hormones are not inherently dangerous and that the study's risks were overestimated. She criticizes medical institutions for not updating their guidelines to reflect newer research that highlights the benefits of HRT for most women.

"It's all anyone talked about before the Internet...The benefits are going to far outweigh the risks." — Dr. Mary Claire Haver [10:14]

Managing Symptoms and Short-term Relief

Dr. Haver outlines her comprehensive toolkit for managing menopause, which includes:

• Nutrition
• Movement and Exercise
• Stress Reduction
• Sleep Optimization
• Supplementation
• Pharmacology

She emphasizes a functional approach, addressing immediate symptoms while laying the foundation for long-term health and well-being.

"It's about not just fixing the immediate symptomatic things...but to set her up for success." — Dr. Mary Claire Haver [14:21]

Emotional and Mental Health Challenges

The conversation delves into the mental health impacts of menopause, where hormone fluctuations affect neurotransmitters like GABA, serotonin, dopamine, and norepinephrine. These changes can lead to increased depression and anxiety during the menopausal transition.

"We see a 40% increase in mental health, usually depression and/or anxiety." — Dr. Mary Claire Haver [20:56]

Gwyneth shares her personal struggles with anxiety and sleep disruptions, highlighting the interconnectedness of hormonal changes and emotional well-being.

The Role of Telemedicine and Digital Platforms

Dr. Haver praises the emergence of telemedicine platforms dedicated to menopause care, such as Alloy and MIDI. These platforms are rapidly training clinicians to meet the growing demand for specialized menopause treatment, filling the void left by traditional medical training.

"They're collecting data like crazy...They want to help fill the gap." — Dr. Mary Claire Haver [24:56]

Physical Health: Bone Density and Muscle Mass

A significant focus is placed on maintaining bone density and muscle mass to prevent long-term health issues like osteoporosis and increased fall risk. Dr. Haver advocates for:

• Weighted Vests: To enhance bone density and balance.
• Strength Training: Essential for muscle preservation and overall health.

"Muscle determines our basal metabolic protein. You're not eating enough, and you're not eating enough protein." — Dr. Mary Claire Haver [64:30]

Lifestyle Interventions: Nutrition, Exercise, and Sleep

Dr. Haver emphasizes the importance of a high-fiber diet (35 grams or more per day) to reduce visceral fat accumulation and improve insulin resistance. She also discusses the critical role of quality sleep, advising against long-term reliance on sleep medications and advocating for natural sleep hygiene practices.

"Fiber keeping that gut microbiome happy...Movement, stress reduction, adequate sleep." — Dr. Mary Claire Haver [62:16]

Sexual Health and Relationships

Sexual health often suffers during menopause due to hormonal changes. Dr. Haver discusses solutions like topical estrogen and DHEA suppositories to enhance vaginal health and libido. She also shares her personal experience of improved sexual health through testosterone supplementation, highlighting its benefits for muscle mass and bone density.

"I have better sex, better relationships, better boundaries...I'm a better mother, a better partner." — Dr. Mary Claire Haver [15:30]

Addressing Trauma and Empowerment

Dr. Haver speaks about the trauma many women experience due to dismissive medical practices and societal stigmas around menopause. She advocates for longer, more empathetic consultations to address not just physical symptoms but also the emotional and psychological impacts.

"She goes to the doctor eight times before anybody realizes her constellation of symptoms could be menopause." — Dr. Mary Claire Haver [34:14]

Future Directions and Research

The episode concludes with Dr. Haver discussing her forthcoming book, The New Perimenopause, which aims to compile and analyze recent research to provide actionable insights for women navigating menopause. She highlights the need for ongoing research and the benefits of private sector funding in accelerating menopause-related studies.

"We're just left to navigate this...We are like totally putting this behind a wall that they're not going to get access to." — Dr. Mary Claire Haver [47:09]

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Notable Quotes

• Gwyneth Paltrow: "I found that nobody changes until they change their energy." [01:50]
• Dr. Mary Claire Haver: "This isn't just a few hot flashes overnight. This is changing the trajectory of our health in so many ways." [06:48]
• Dr. Mary Claire Haver: "Anything that lowers inflammation in the brain or in the body...is going to decrease your risk." [10:24]
• Dr. Mary Claire Haver: "Women are owed centuries of research here." [22:17]
• Dr. Mary Claire Haver: "You're losing 7 to 10% per decade until about 70, and then it goes up to 25% of your muscle mass per year." [64:23]

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Conclusion

Gwyneth Paltrow wraps up the episode by encouraging listeners to take charge of their health, ask informed questions, and approach menopause with confidence and curiosity. She reiterates the importance of reshaping the narrative around menopause to better support women through this significant life transition.

"The more we talk about menopause, the more we can reshape the narrative around women's health." — Gwyneth Paltrow

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This episode of The Goop Podcast serves as a comprehensive guide to understanding menopause, debunking myths, and providing actionable strategies for women to navigate this phase with empowerment and informed choices.

Transcript

[Gwyneth Paltrow]

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[Dr. Mary Claire Haver]

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[Gwyneth Paltrow]

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[Dr. Mary Claire Haver]

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[Gwyneth Paltrow]

With available Google built in.

[Dr. Mary Claire Haver]

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[Gwyneth Paltrow]

And Olufsen premium sound system.

[Dr. Mary Claire Haver]

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[Gwyneth Paltrow]

When you are pioneering anything or introducing new ideas to the culture, you get criticized. You do.

[Dr. Mary Claire Haver]

Yeah.

[Gwyneth Paltrow]

Did you hear about that? I didn't find the one. I found someone I respected and we.

[Dr. Mary Claire Haver]

Made it the one. In the sort of longing kind of view of love.

[Gwyneth Paltrow]

People understand each other as if by magic.

[Dr. Mary Claire Haver]

Nothing in itself is addictive on the one hand. On the other hand, everything could be addictive if there's an emptiness in that person that needs to be filled.

[Gwyneth Paltrow]

I now know that nobody changes until they change their energy.

[Dr. Mary Claire Haver]

And when you change your energy, you change your life. Gwyneth.

[Gwyneth Paltrow]

I'm Gwyneth Paltrow. This is the GOOP Podcast, bringing together thought leaders, culture changers, creatives, founders and CEOs, scientists, doctors, healers and seekers. Here to start conversations. Because simply asking questions and listening has the power to change the way we see the world. Here we go. Welcome Back to the Goop podcast. Today, I'm sitting down with Dr. Mary Claire Haver, a board certified OB GYN and certified menopause practitioner who has been at the forefront of reshaping the conversation around menopause. You may know her as the author of the new Menopause or from her incredible work helping women better understand this transition and take proactive control of their health during this time. There's still so much misinformation when it comes to menopause, from hormone therapy myths to. To the misconception that it's all in our head. It's not. Dr. Haver has been instrumental in changing this narrative, giving women the tools they need to navigate this phase with confidence. Today, we'll explore the misconceptions around menopause, how to take control of your health during this phase, and the key factors that can make a difference in how you feel. Dr. Haver, thank you so much for being here.

[Dr. Mary Claire Haver]

Thanks for having me.

[Gwyneth Paltrow]

I wanted you to come on this podcast since I saw you last summer speak at a conference. And, you know, I think. I think I've driven a lot of what I do at goop kind of. It's always pretty timely, right? It's always like, oh, I'm at this phase of my life and I'm encountering this problem or obstacle or something. I don't understand, you know, whether it's, you know, to do with anything. And admittedly, I have been spending, I think, an inordinately large amount of time on this particular subject. I think just because there's so much on postpartum, there's so much on marriage, there's so much on all of these other things. There's so much that we go through, you know, what inflammation or autoimmune. But for some reason, even me, with all of the access that I have, I found that it's a very difficult subject to crack and understand that. I think it's amazing that at this point now we're all talking about it and there's so many women and public facing women who are happy to be the face of menopause and kind of help, you know, change the way that we perceive it. Because there was just no mention of it when my mother was going, I mean, barely, you know, or as I started to go into perimenopause, I just felt so isolated and alone. So, you know, I hope the listeners forgive me for talking about perimenopause and menopause again. But I think it's really important and you have such a, like, candid, fresh way of approaching the subject. So I'm really happy to have you on the podcast.

[Dr. Mary Claire Haver]

Well, I'm so glad to be here. I just. I was joking earlier. I feel like it's become my whole personality. But, God, for such good reason. When I look back at my medical education and my training, you know, super proud of where I went to school and everything that I learned. And it wasn't until I was traversing my own perimenopause and menopause that I realized I don't know enough. There's a huge gap here. So I think in medical school we had an hour of menopause, like one lecture, just kind of very basic, touching the surface on, you know, in a four year curriculum. And then I chose OBGYN for my specialty, which was amazing. You know, like you said so much about childbirth and postpartum and getting pregnant and staying pregnant and everything to do with your female organs, the ovaries, the uterus, the vagina, the vulva, all the things, you know, I learned so much. And I think when I look back as how much of like practical clinical menopause education did I have, I think it was six hours total in a four year curriculum. And that's just scratching the surface. This is the last third of our lives. This is, this isn't an over a few hot flashes overnight. This is changing the trajectory of our health in so many ways. And I think the biggest, biggest thing that I realized that I did was never taught where there are estrogen receptors in every organ system of our body and they're all affected and each of us has a very individual expression of our menopause. So if me, who's supposed to be the expert, right, the women are coming to me for their female health care have only barely scratched the surface. You know, imagine someone who goes to their family practitioner or an endocrinologist or their internal medicine doctor to get help and they weren't trained. So it's, you know, it's a systemic problem and that we're not prioritizing the health of women after reproduction ends.

[Gwyneth Paltrow]

So take me back a little. I was wondering, you know, thinking about when, when did this, you know, I feel like so much change in the industrial, like when we became industrialized nations or like in the Victorian times, like when, when did we, I mean, because certainly there must have been, I imagine, not that I've done any research on it, but in indigenous cultures I'm sure that they didn't just expect women to go out and die once they stopped menstruating.

[Dr. Mary Claire Haver]

It's really interesting the anthropologists who have looked at this. So the average life expectancy historically has been somewhere in the late 40s to 50s and that was mostly due to diseases that we now have conquered with know, vaccines, antibiotics or accidents, you know, things that we really, in the way we set up our lives, we don't have to deal with. So we have this lots of women now living well past their ability to bear children. But we do know from looking at other species that have menopause, there's not very many, but there's certain whales and, like, a couple of giraffes maybe. But in these cultures that are more matriarchal or in these species, it's called the grandmother hypothesis. And not as a caretaker or a babysitter, but as someone who passes on wisdom. And so the anthropologists are saying, we think that in human culture, if a woman was lucky enough to be one of the survivors to outlive her menopause, she became the one who passed on the knowledge that would improve the survival of the species.

[Gwyneth Paltrow]

So are we built evolutionarily to kind of die after menopause? Because some days it feels like.

[Dr. Mary Claire Haver]

It feels like it. So most women didn't live very much longer, you know, after their menopause. It's really something that is so unique to us because men don't have the same thing. They have a sort of andropause where testosterone levels just gently decline over time. For men from, like, they peak at 18. Shocker. And then just kind of gently decline. But they can bear children. You know, they can propagate children until death if, you know, it gets a little harder, but they're able to do it. Whereas our function shuts off completely, you know, depending on ethnicity, at the average age of, you know, 46 to 51, depending on where in the world you are. And, you know, what would be the benefit of that one? Survival, Possibly because if a woman just kept having children, who would take care of the children? Right, right. You kind of have your set group of kids and then you raise them to a certain age to that they're. They go off into the world. And then, you know, in certain cultures, we realize that the women who survived then became, you know, sources of wisdom, shaman. You know, they had very large roles in their communities outside of just childcare.

[Gwyneth Paltrow]

So the design of it actually makes sense. But now I think we're. We're stuck a little bit, or we have been historically. And I know that that study that they did on hormones in the 90s, which is really like, I honestly, when I look back and I think, you know, how my mother went through menopause without hormone replacement and that there's still a lot of fear, you know, a lot of fear. It's interesting. Like, I think now it's kind of working. And the idea that replacing your hormones with bioidentical hormones is.

[Dr. Mary Claire Haver]

Is not, you know, like, inherently dangerous.

[Gwyneth Paltrow]

Exactly. But. But still there you know, there are women who are very skeptical or being told by their doctors, you don't need this. And it's dangerous. It just happened to me with a friend the other day.

[Dr. Mary Claire Haver]

We have an entire generation of clinicians who has, since the Women's Health Initiative stopped the study and the interpretation was really blown out of proportion. The risks were grossly overestimated. The benefits were just completely silenced. And that, that megaphone that shared that information kind of went viral before the Internet. You know, it was the number one news story of 2000, medical news story of 2002. It's all anyone talked about. It was in the COVID of every major newspaper, Time magazine, you know, the New York Times, that estrogen was dangerous and caused breast cancer. And letting that genie out of the bottle, you know, it's been really difficult to get that information spread that this study's been looked at again. All the information has been reworked. It actually, for the vast majority of patients, it's really safe and the benefits are going to far outweigh the risks for her, you know, it's not. Nothing is risk free, right? No medication is risk free. But we have 22 years of clinicians and counting, you know, 23 now who are being taught that somehow, you know, if you look at the nih, you know, what is on the website that, you know, even American College of Abgen today, they haven't updated the hormone therapy guidelines since 2014. And they still say lowest amount for the shortest time possible and only if she has severe symptoms, which isn't true, right?

[Gwyneth Paltrow]

Because I was reading about, say, dementia, for example, or like, I have two copies of the Alzheimer's, you know, I have the Apoe 4, I have 3 and 4. So, you know, I have to, like, be really careful not to have inflammation in my brain. But for example, like, from what I understand for me, I really need to stay on estrogen for 10 years at least, right? Or for life.

[Dr. Mary Claire Haver]

So a study out of Scandinavia that specifically looked at carriers for the, for the Alzheimer high risk genes, and the patients who had the gene and were given estrogen therapy had better cognition and higher brain volumes than the patients that weren't so specific to your high high risk, we know that it is protective, right? And we think that, and we need more studies to back this up, that it is starting young would be protective for most women, at least in the first five years of menopause, right? Because like you said, anything that lowers inflammation in the brain or in the body, which then goes to the brain is going to decrease your Risk, Right? Acura's all new avx. A compact SUV that isn't just built for one thing.

[Gwyneth Paltrow]

It's precision crafted for everything. To escape the grind.

[Dr. Mary Claire Haver]

With available all wheel drive to go with your flow.

[Gwyneth Paltrow]

With available Google built in.

[Dr. Mary Claire Haver]

Hey, Google, turn it up. Okay. Turning up the volume. And crafted to be heard with an available bang.

[Gwyneth Paltrow]

And Olufsen premium sound system.

[Dr. Mary Claire Haver]

The all new Acura adx. Crafted to match your energy. Acura precision crafted performance take your vibes on Google is a trademark of Google llc.

[Gwyneth Paltrow]

I want to talk about the toolkit that's in the book because you kind of delineate six different strategies for how to approach menopause. Can you talk a little bit about who they are?

[Dr. Mary Claire Haver]

Yeah, thanks. Thanks for asking. So say you're a patient in my clinic and you come to me and you're like, okay. And usually they come in what I call the fires of menopause, like debilitating brain fog or horrific hot flashes or like, you know, debilitating sleep disruption, musculoskeletal pain. They have lost control of their lives and they are very, very worried that they're not able to function. They're thinking about quitting their job, getting a divorce, whatever, you know, libido is in the tank. And then so they come to me for like, immediate relief. Right. So we do a bunch of blood work, we rule out autoimmune disease and all the other things. Hypothyroidism. I do a ton of blood work, look at nutritional deficiencies.

[Gwyneth Paltrow]

So you kind of take a funct approach as well.

[Dr. Mary Claire Haver]

Right? So I do.

[Gwyneth Paltrow]

Right.

[Dr. Mary Claire Haver]

And then we figure out where she is in her menopause journey and we discuss. So when I look at the toolkit, I'm not just, you know, slapping a hormone pouch on her and sending her on her way. Right. I think that would be a disservice. She's spending an hour with me and we're trying to, like, set her up for success. Not just to like fix the immediate symptomatic things that she's having, but to set her up for a life where she's going to thrive for the next 30 years. Because my theory is. And of course it's very selfish, but I'm 56. I am literally living my best life I ever, ever, ever had. I have better sex, I have better relationships, I have better boundaries, I have better nutrition, I understand my needs more. I've completely flipped from trying to be a thin person to trying to be a bigger person. And, you know, so. Because why? Okay, I'VE I've put out the fires of my menopause. I can sleep now if as long as I don't drink alcohol, all of that is better. But now my focus is staying out of a nursing home.

[Gwyneth Paltrow]

Right.

[Dr. Mary Claire Haver]

You know, and not burdening my children longer than health span. Yeah is health span. And I think when I hear a lot of the BRO wellness guys who I follow and I love, they're so focused on live longer, live longer, live longer. They don't carry the burden that we do as females where our health spans are so much shorter than men. We live 25% of our lives in poor health than our male counterparts. And this is not just to do with hormones. Hormones kind of hastens that process. So the toolkit is about nutrition number one, movement. So extra some would exercise, stress reduction, sleep optimization, supplementation and pharmacology. And all of that works synergistically together to get her to a place where she's, you know, sleeping at night, managing her, her life, you know, the life she built that she could no longer manage. We get that back and now we're going to set a course for her to have the best health right. For the next 30, 40 years.

[Gwyneth Paltrow]

And are there things you do in the short term to manage symptoms while you're sort of doing the detective work around nutritional deficiencies?

[Dr. Mary Claire Haver]

And so usually most of the fires will be put out by stabilizing or replacing our hormones. Stabilizing in perimenopause or replacing in postmenopause.

[Gwyneth Paltrow]

Right. So that's. So you'll do that first and then you'll sort of go on the journey of what. Because are there underlying things that are causing worse symptoms?

[Dr. Mary Claire Haver]

So certainly the way you show up health wise in menopause will, will kind of, you tend to. So women who have more unhealthy habits, alcohol, processed foods, don't exercise on a regular basis, you know, will have worse symptoms. So the healthier you are when menopause knocks on your door, the kind of, the better your course is going to be. Now that being said, I have had some of the healthiest athletes in the world come to me who are absolutely devastated. So it's not, I don't want anyone out there who's like, well, what else can I do? I eat perfect. I whatever I'm like, when those hormones start fluctuating in Perry and then slide out in post, even the healthiest person could be absolutely debilitated. So I don't want anyone to feel bad. But you know, by and large, the healthier you Are the better habits you have in place, then you're going to have less symptoms.

[Gwyneth Paltrow]

Yeah, I noticed that too. Like, I mean, I'm really in the thick of it right now, so my. I'm all over the place. But I noticed my symptoms are like pretty well under control. Unless, you know, in January when the fires were happening, happening in la. I've like, used alcohol for its purpose, like medicating. I was like medicated, you know, and I normally. Now it's this point I don't drink a lot at all. Maybe I'll have one drink a week, but those two weeks I think I drank every night and my symptoms were completely out of control. It was the first time I really noticed, like causation in that way.

[Dr. Mary Claire Haver]

Yeah. So lots of my patients say the same thing. They've really just spontaneously realized that they've cut back on alcohol or just quit altogether because it just hasn't been worth it. They don't bounce back the same way. It stays in their system a lot longer. They're seeing so much sleep disruption and their hot flashes are horrible.

[Gwyneth Paltrow]

Subject. I know it's crazy on the subject of sleep because this is something I think that really plagues women who are in perimenopause and menopause. I feel like in this, I went through kind of. I've always been a real sleeper and I went through like a particularly bad time with it and I. I feel like hopefully I'm coming out the other side. But there were nights where my anxiety.

[Dr. Mary Claire Haver]

Yes.

[Gwyneth Paltrow]

I just thought it meant, oh, you're not going to be able to sleep because, you know, your hormone, you know, you don't have enough progesterone over. But like, it wasn't that I would just wake up or other. Like, I would get crushed with anxiety, which I've never had in my life. And I would lie in bed, like, thinking about every mistake I've ever made, every person's feelings I ever hurt, like every bat, you know, And I would be up like for six hours.

[Dr. Mary Claire Haver]

It was crazy, just spinning. So one of the things we see across the menopause transition especially. So if you think about what's happening in the brain, the neurotransmitters, especially gaba, serotonin, dopamine and norepinephrine are heavily influenced by estrogen, progesterone and testosterone and the balance between the three. And when your brain, once you start go through puberty, gets very used to this cyclical pattern. For those of us who are healthy and have regular cycles and we all have like our good days and bad days of cycle, days of our period. But you know, you learn how to sleep, you learn how to maneuver through that. In perimenopause, we call it the zone of hormonal chaos because the feedback signals from the brain, what used to look like an EKG each month, you know, this like bloop, bloop, bloop. Now you have much higher levels of estradiol than you've ever had and not at all temporal. Like you can't say on day 14, I'm going to do this and day 21, I'm going to do that. It's all over the place. It is completely unpredictable. And our brains hate chaos. So we see across, you know, when I say across transition, I mean going from regular cycles to no period, that's a 7 to 10 year transition for most women. And we see a 40% increase in mental health, usually depression and or anxiety.

[Gwyneth Paltrow]

Now is that chemical or is it because like, I guess my question is, are the hormone fluctuations like biologically tied to serotonin going down or is it just like you're miserable, you're just miserable from your symptoms and your kids leaving.

[Dr. Mary Claire Haver]

The house and through empty nesting at the same time.

[Gwyneth Paltrow]

Right.

[Dr. Mary Claire Haver]

And so what we see is that when the fluctuations start happening, you know, the hormones happen first, the hormones fluctuate, then we see the neurotransmitters start to fluctuate. And that's when the mental health, the anxiety, the, you know, now if you also have hot flashes, as 85% of us did, and you wake up, you know, those wake us up in the middle of the night, but they don't cause anxiety so much. The hot flash is the thermoregulatory center in the hypothalamus in our brain, and it goes cattywampus. And so we're just like waking up sweating to death. And you know, I had it last night. Then the anxiety starts right where the brain like gets away from you. There's something magical about gaba, which is elevated when we take the progesterone. That seems to help calm things down.

[Gwyneth Paltrow]

Do you supplement GABA as well?

[Dr. Mary Claire Haver]

You can, it's just not regulated. So we don't have a lot of great. You know, again, everything I say is prefaced by. Women are owed centuries of research here.

[Gwyneth Paltrow]

Totally.

[Dr. Mary Claire Haver]

And so when you go to PubMed, which is the NIH, like clearinghouse database for peer reviewed journal articles, and I just type in the word pregnant pregnancy, we have a little over 1.1 million articles. Amazing. We need that. Right. We need healthy pregnancies and all that. We've all depended on that data to deliver our children. And then we type in the word menopause and that drops to about 98,000 right now. So about 10 to 1. If I type in the word perimenopause right now, it is 6,800. So you think about grants, funding, brain power, research focus. Perimenopause has been completely left out, and we're just left to navigate this. And our. Our healthcare providers don't know what's going on. You don't even know the right questions to ask. So that.

[Gwyneth Paltrow]

And it's really protracted.

[Dr. Mary Claire Haver]

Oh, yeah. It's years. For some women, it's years. Yeah.

[Gwyneth Paltrow]

I feel like I've been in it for years.

[Dr. Mary Claire Haver]

The best study I read in all this research I'm doing for the next book, which is the new perimenopause, but it's going to a whole year before it comes out, was something called not feeling like myself. And they actually quantified what that meant and what's causing it. And it's perimenopause. And it's usually the first symptom. They can't put their finger on it. But something is different. There's no new stresses. Same husband, same kids, same all the things, you know, because the women are first ones to come to me and say, well, my mom died or I lost my job or whatever, and they're like, let me get through this, and then we'll figure out the rest. I'm like, okay. But they're like, nothing has changed. But I. They lose their resilience to the life they built for themselves. And that's not fair.

[Gwyneth Paltrow]

No.

[Dr. Mary Claire Haver]

So. And like, the rug gets pulled out when you look at, like, Alloy and MIDI and these great telemedicine healthcare providers who saw, oh, my God, we don't have enough doctors who know enough about menopause or clinicians. Let's build a telemedicine platform, which I think is genius. And they collect data like crazy. And so I think it's ever NOW collected over 100,000 questionnaires from women online. They go and they fill out. The number one complaint was fatigue. Number two was sleep disruption. Number three was weight gain. You know, hot flashes were number five or six.

[Gwyneth Paltrow]

Right.

[Dr. Mary Claire Haver]

You know, and when you look at the ones that are the most disruptive, like musculoskeletal pain. Absolutely. Slaying women who were like, athletes and training, like, doing all the things and all of a sudden, like, everything hurts.

[Gwyneth Paltrow]

Yeah. Funny. I, like. I made a note to ask you about the digital platforms because, you know.

[Dr. Mary Claire Haver]

They'Re coming out in droves.

[Gwyneth Paltrow]

They're coming out in droves.

[Dr. Mary Claire Haver]

And I think. I think they are a. We can't. It's hard to go back and train someone who's out of a training program. And they have to, really. If you want to do menopause care today, you really have to go outside of the box if you're training and seek outside training, which is what I did, and. But fortunately, these telemedicine platforms are hiring and training so that they can develop providers quickly. My daughter's in medical school, my oldest, and so she's always telling me everything. Every time they talk about menopause or mention something. She's doing a menopause research project, you know, right now, so.

[Gwyneth Paltrow]

So it's more than six hours now.

[Dr. Mary Claire Haver]

It's a little more than six hours. We're getting better. And it's cute. Acute, you know, she's got a large friend group. Thank God she's, like, found her people. And they all love menopause. Like, they wear the menopause T shirts and they, you know, when. When they. I, like, take them out for drinks or something because they live in. They're all in the same town where I live now. And the guys are just as into it as the girls kiss for their moms and their sisters and their aunts. You know, they're seeing this gap and they want to help to step in to fill it.

[Gwyneth Paltrow]

And presumably, and I think we've seen a lot of it there, there's also, like, white space there in terms of practice and business. And, you know, it's like we're. We're more than half of the population.

[Dr. Mary Claire Haver]

So my clinic is now strictly menopause.

[Gwyneth Paltrow]

Wow.

[Dr. Mary Claire Haver]

Which for me, I miss surgery and babies, but then I don't. You know, the middle of the night stuff is hard. And it was my 50th birthday present to myself to step away from kind of that traditional grind and do something that I really believed in. But it was a huge leap of faith. I didn't know if anyone would come see me. I took my girlfriends out to dinner and was like, all right, I think I want to open a menopause clinic. They're like, is that a thing? And I said, I don't know. I'm just going to try it and see what happens. And I'd always been employed. I worked for a hospital system. I worked for universities. And you just show up with your stethoscope and they're like, here's your room, go to work. Here's your computer. And so I had to like, get the Idiot's guide to opening a Medical Practice, but it's been incredibly successful and now I have a staff of, you know, seven clinician, six clinicians.

[Gwyneth Paltrow]

And are you training them?

[Dr. Mary Claire Haver]

Yeah.

[Gwyneth Paltrow]

So you develop like a rubric for how to.

[Dr. Mary Claire Haver]

For our clinicians? Yeah.

[Gwyneth Paltrow]

That's amazing. I have very dry lips, so I've always been something of a lip balm and lip mask connoisseur, if I do say so myself. So I wanted to make the best ever lip mask, like, better than anything on the market, better than anything I ever tried, because it's what I needed. That's why I'm excited to share our newest GOOP product with you. The Nourishing repair lip Mask. Formulated with high performance clean ingredients, this mask delivers clinical grade results, increasing hydration by over 160% with just one swipe. The result, smoother, softer and more protected lips that look as good as they feel immediately and over time. At goop, we believe in beauty as wellness. That's why our products are carefully crafted to be clean, holistic, and results driven. To try our nourishing lip repair mask or any of our Goop Beauty products, use code goop [e-mail] for 15% off your first Goop Beauty purchase. I'm really excited for you to try our products and I hope you love them as much as I do. Just going back to touch on sleep for a second is all sleep sort of not created equal. Like if you take. Take melatonin or if you take. Great question.

[Dr. Mary Claire Haver]

I'm learning alongside you here. And so I'm really leaning on like Andrea Matsumura who's like sleep goddess, M.D. she and I have known each other for years and so she like got a fellowship in sleep medicine. And it's so much more than just reading sleep apnea studies. You know, she's really focusing on teaching women how to sleep. And so when you take sedatives, they're fine for the short term. You've traveled in a different time zone. You know, you need a couple of days just to help readjust your schedule. But long term, they're not good, you know, to, to depend on a medication to make yourself fall asleep because you're not getting the same quality sleep when you take a sedative. Melatonin looks like long term use of melatonin is associated with increased dementia. And so we wonder, is it the melatonin which Is something that's naturally produced in the body, or is it that. That sleep disruption leads to more dementia?

[Gwyneth Paltrow]

I've read that quite a lot, actually, that sleep is the number one most important thing.

[Dr. Mary Claire Haver]

Yeah. To restore your brain, to let your muscles grow, to protect your body.

[Gwyneth Paltrow]

It's interesting. I've noticed. I. When I. If I fly overnight, it's the only time I take something to sleep. That's. I try to only do it then. And it's always the worst. Like, my sleep scores on my order ring are always the worst. If I take anything to sleep, I think it's really fascinating. It thinks I'm dead. It's like 56.

[Dr. Mary Claire Haver]

I wear one as well. And same. We have a place in Colorado. And so when I go from sea level up to, you know, 10,000ft and Telluride, it thinks I'm dead for two days until I acclimate. So. But yeah, I love, you know, this tool because it has taught me so much about sleep hygiene and quality sleep and things that I do that affect my sleep.

[Gwyneth Paltrow]

Yeah, I notice personally, like, if I. I'm so impacted if I don't. If I don't sleep now, I mean, whereas, you know, when you're younger, you can kind of bounce back really quickly from it.

[Dr. Mary Claire Haver]

But one of my most viral memes, you know, funny videos I try to do was sleeping in a hotel in your 20s versus in your 50s. I used to just, like, fall in the bed with my clothes on from whatever adventure we'd been on, versus, like, having my special sleep pajamas and, like, putting out all my, you know, my L Theanine and my progesterone and my, you know, extra estradiol in case I get up. And my, you know, like, all the things and the shaman and the sage thing, the spray I put on my pillow, my mouth guard.

[Gwyneth Paltrow]

I've seen that. That's so funny. I'm. I'm exactly this. But it's okay. So in other words, like L Theanine or.

[Dr. Mary Claire Haver]

Yeah, the. The studies on L theanine don't show any harm. The studies on magnesium so far, you know, and we have multiple types of magnesium do not show any harm.

[Gwyneth Paltrow]

That's great. That's good to know. So in terms of nutrition, so it's, I think it's for a lot of people, very difficult to go, you know, to see a nutritionist or to understand where they're deficient. And I'm. I'm very heartened, too, because there are a lot of, like, consumer kits that people are getting now, too. But I. There's probably some pitfalls there too, for people at home, you know, who are. Get. Ordering their own labs, the blood work.

[Dr. Mary Claire Haver]

Gosh, you can go to Quest now and order your own blood work.

[Gwyneth Paltrow]

How do you feel about that? Because.

[Dr. Mary Claire Haver]

So I. I think about that a lot because I'm. That's one of, like, the business things in my mind that I consider. Would I. Because I'm doing the function Health one as an experiment right now. And I went all in. I did the gallery. It's the Mark Hyman one. And I was like, let me do this as a consumer and see how this is. And would this be something I could develop? Of course, his is very high tech, but, you know, could I offer this to patients? Not really my patients, but, like, women who follow me who want to know, you know, in a very specific way. And those are the questions I ask myself, like, what if they're abnormal? Who is their doctor? Right, right. And so where do you go? It's one thing to have the lab test drawn and the Mark Hyman program, if he's not paying me to say that's actually gives you a beautiful output. Like, explains in such great detail why this test was done, what it means. And, you know, I've had no surprises on my blood work, thank God. But I, like, I did the gallery cancer test, and, you know, I'm waiting on those results. So I lost. I've lost two brothers to cancer. So I'm very interested, you know, in what that would mean. I think there's value. But I also worry, what if she has abnormals? Where does she go? I think giving her data without giving her solutions, you know, or at least not being there to guide her through this abnormal finding. I'm worried, how do you navigate that? What does that look like?

[Gwyneth Paltrow]

Especially because, you know, from what I understand, certain results can mean, you know, it can look like, oh, you know, your. Your vitamin B is low, but it might be that, you know, you have methylation issues or, like, things that need to be addressed before. Before, just like taking a supplement for it. Right. Like, it's more complex than just there's an abnormal result.

[Dr. Mary Claire Haver]

Right. And, you know, for example, my testosterone level looked a certain way, but then my binding globulin was another way. And, like, that's a very nuanced conversation. So I think that there is benefit, and especially if everything's normal and you just pat yourself on the back and feel great. But where I'm worried is, like, you know, and what would probably hold me from offering Something like this without the doctor patient relationship is, what if she has something abnormal and it leads to her making a decision that's not in her best interest? Or there's no one to guide her through what to do.

[Gwyneth Paltrow]

If there was an AI model that was able to.

[Dr. Mary Claire Haver]

Maybe. But again, that's above my pay grade. I'm still seeing patients face to face. I spend an hour with my girls who come in. Do you really? Yeah.

[Gwyneth Paltrow]

That's so nice. Yeah.

[Dr. Mary Claire Haver]

You have to unpack a lot of menopause trauma. So I spend that time with the patient.

[Gwyneth Paltrow]

Tell me more about that. What is the trauma? When. When somebody comes, you know, there's.

[Dr. Mary Claire Haver]

There's a woman. I just read a statistic, and I'm not shocked. But it is shocking as a doctor to see. It is. She goes to the doctor eight times before anybody realizes her constellation of symptoms could be menopause. That's eight doctor visits, eight co pays, eight times off of work, eight times. Having to get a babysitter where you are dismissed, blown off, or given some misdiagnosis, and that's a problem. And so my clinic is outside of insurance model because now I can take an hour. And so women are really motivated when they come to me. And because they're paying out of pocket to see me. And so I want to give them that time to really kind of go through all of her issues, because we're not just addressing her menopause symptoms. We are addressing her quality of life and trying to create a path forward so that she can feel like I do.

[Gwyneth Paltrow]

You know, I'm so inspired by how you feel. Let's talk about your. The line where you said you're having the best sex of your life.

[Dr. Mary Claire Haver]

I am. Okay, so there's a couple of things. Kids are out of the house. That's a huge one. So, like, just being naked is easier, you know, I love my husband. He. We've been together forever, so 30s plus 32. I lose track. We got together in 93, so whatever. The math works out. And he retired from his Chevron job. He was an oil executive in oil and gas, and I barely saw him. He was commuting all the time. He was traveling all over the world and whatever. You know, we great father, good, you know, good best friend, all that. But, you know, we were losing that connection. You know, just our lives were so busy and my, like, menopause world was taking off and it was so foreign to him. And so he stepped in. He has an mba, and as things were kind of getting crazy with Our supplement line, which was. Was growing exponentially. I was struggling with contracts and having to deal with suppliers and, you know, and we grew it from the ground up. I have no vc, no funding, Mary Claire, you know, so he starts jumping in and he goes and meets with suppliers and he kind of gets involved in the business and he realizes, wow. And then he. His retirement, like, he was able to retire. He had that magic number with the corporation where he could get full benefits at retirement. And I said, listen, I will have to pay someone your Chevron salary to do all the things you're doing now, or you can just come work for me and not get paid.

[Gwyneth Paltrow]

I'll pay you in blowjobs.

[Dr. Mary Claire Haver]

He retired, so. So that put us in the house all the time together. And it's so awesome watching him kind of fly in this area and watching him do. And I have such an appreciation for him differently than just being really the world's greatest father, which he is, but, you know, and provider and all those things. But, like, we're partners in this, and it's just really grown. So on top of that, I started testosterone for muscle mass. So I'm lean like you are, and when I go and we have a scanner in my office, that's another thing where I can measure visceral fat, muscle mass, and all that, so I can counsel my patients about protein and nutrition and all those things. So I was like, my muscle mass is low. It's always been low. I've always been a skinny girl. Okay, I want more muscle mass so I don't break my hip like my mom just did, you know, at 80. So I want to decrease that risk. There's no guarantees. And I was like, let me try testosterone. This would be off label for me, but I know that women with higher percentiles of testosterone have better muscle mass and bone strength and bone density. And so I said, let me just do it for that. I never complained of my libido. Like, no one complained. We were fine. We were fine. Definitely there's an uptick in the area that's so great. And it's not chandelier esque. It's not, you know, but it's more than vacation sex. And so it is. Like, I'm a little more interested and maybe even initiate once in a blue moon, which had not happened in a very long time. So, you know, that's my n of 1. That's just one person's experience. But my patients overall are pretty happy with it now. You know, it's proven for hypoactive sexual desire disorder. But who gets to define that? You know, if it's. If it's concerning to you, if it's, you know, hypo. HSDD is. If it causes her distress. Okay. It doesn't. Was not causing me distress, but I think if it got taken away, I would miss it.

[Gwyneth Paltrow]

Well, it's an interesting thing to think about because I think, you know, our sexuality is such an important part of who we are. And to worry that you're maybe, you know, losing that aspect of yourself or that it's harder to connect to that part of yourself, it feels quite demoralizing. You know, it feels like it's in concert with all these other life changes and you're at. So it doesn't. Sort of. Why I asked you before, is it, like, circumstantial that we start to feel more depressed or is it chemical?

[Dr. Mary Claire Haver]

Because I think it's all of it.

[Gwyneth Paltrow]

Right.

[Dr. Mary Claire Haver]

You know. Yeah, it's a little bit of everything. Because we're complicated beings.

[Gwyneth Paltrow]

Yes. Very. Ask our people around us.

[Dr. Mary Claire Haver]

Yeah.

[Gwyneth Paltrow]

I have a question from a friend of mine who is having, like, very low feeling. Low sexual feeling.

[Dr. Mary Claire Haver]

Like sensation.

[Gwyneth Paltrow]

Yes. Like.

[Dr. Mary Claire Haver]

Okay.

[Gwyneth Paltrow]

Yeah. During. And you know, she's going through perimenopause. A little bit younger than I am, but never had that issue before, like.

[Dr. Mary Claire Haver]

Delayed orgasm kind of thing.

[Gwyneth Paltrow]

Just like, not. She says it's like kind of a numb. Like she doesn't feel that much.

[Dr. Mary Claire Haver]

So couple of things. As you know, the genital urinary area is highly. Changes greatly one of the parts of our bodies that change the most and the fastest.

[Gwyneth Paltrow]

How so?

[Dr. Mary Claire Haver]

When the estrogen progesterone, testosterone. Well, testosterone declines our whole lives from 25, 30 down. So there's not like a cliff like happens with estrogen and progesterone. So testosterone kind of in the background is declining. Okay. And then estrogen, progesterone, like, fluctuate wildly like a roller coaster on their way down and out completely. Blood flow is everything. You know, that's why Viagra works in a man. He doesn't have a desire issue. He has an arousal issue. And so women can have decreased arousal.

[Gwyneth Paltrow]

That.

[Dr. Mary Claire Haver]

Which is what sounds like. Like the brain is there, but it's Nothing's getting to where it's supposed to be. And they're not feeling.

[Gwyneth Paltrow]

So that's a blood flow issue.

[Dr. Mary Claire Haver]

It can be blood flow. It can be nerve conduction disorder. So we have to, you know, we look for diabetes and. And different, you know, ways. But things that we know might help are things that would increase blood flow to the area. So topical estrogen. There's a medication called intrarosa, which is a very specific. It's DHEA suppositories that you put in the vagina. And so they're like our breast cancer patients who are terrified of estrogen. The vaginal estrogen is safe for everyone, including a breast cancer patient. It just, you know, with all the hoopla and they're so scared. DHEA works beautifully for them that DHEA gets converted to estrogen and testosterone in the vagina. So for patients in that situation, I'm able to get her estrogen and testosterone to the vaginal vault. It kind of makes its way out and gets onto the vulva. And we're seeing improvements in, you know, that would be something I would try and some systemic testosterone as well.

[Gwyneth Paltrow]

Interesting. So just another question on the sexual friend and then we can move off of it. But what is happening for you specifically that's making, I think I've, I.

[Dr. Mary Claire Haver]

Part of my like menopause makeover is I'm taking care of me first for the first time in a very long time. And putting myself first has made me a better mother, a better partner, a better business person, a better, you know, putting my own, giving myself permission because if I didn't do that, I would not be here.

[Gwyneth Paltrow]

And how are you putting yourself first?

[Dr. Mary Claire Haver]

You know, well, it all coincided with empty nesting. So, you know, I'm not missing the gym. I'm saying what I'm thinking instead of, oh, I don't want to upset anyone or, you know, I'm putting up important boundaries even with some family members. I love you, but I'm here and this is a line I will never cross again or I'll try not to. And really focusing on how do I want to live the next 30 years, what kind of relationship do I want to have with my husband and children, you know, and not taking that for granted. So really giving myself permission to do that work and get the therapy and write in the journals and do those things.

[Gwyneth Paltrow]

And then there's like, would you describe it as like more of an overall integration with yourself?

[Dr. Mary Claire Haver]

And I think so. You know, I always thought therapy was woo woo. And for the week, I kind of grew up in that generation and we were rewarded for working hard and falling in bed exhausted and all of our workouts were just to sweat a lot and. And now it's, it's so different that I have to take care of me and be my caretaker. And that's just going to make me fill up my cup more so that I can give.

[Gwyneth Paltrow]

Yeah.

[Dr. Mary Claire Haver]

Where it's important.

[Gwyneth Paltrow]

What about like, if we have elevated, you know, toxic loads that we're carrying? Obviously we live in a super toxic environment. There's plastic and you know, things, all the things even in our leggings and there's, you know, glyphosate all over and forever chemicals in our cells and everything. So do our toxic burdens impact menopause?

[Dr. Mary Claire Haver]

That's a great question. And no one's looked at it really. Yeah. So, you know, how would a tox free life, whatever that looks like, impact the juncture of the menopause experience? The menopause symptomatology is this, you know, all of these exposures that we now have, the endocrine disruptors, which are absolutely real. You know, where is that all playing into this? And you know, a lot of people who don't, like me will say, oh, women went through menopause, you know, for centuries and they never complained. Well, women were socialized not to complain. And if they did complain, they got thrown into mental institutions or left on the side of the road. So there's that, you know, women couldn't leave a marriage that they weren't happy with because there was no economic way for them to survive or their children. So we've, we've changed a lot of that, but we don't know, we don't know until we start studying these things.

[Gwyneth Paltrow]

Yeah, I do wonder that, you know.

[Dr. Mary Claire Haver]

I think it would be better, you know, as any better health choice will make most things better in your body.

[Gwyneth Paltrow]

Yeah. Because if we know that there are certain compounds we store that have, you know, cause inflammation. I'm sure there's, I mean, I'm not sure because I'm not a doctor, but.

[Dr. Mary Claire Haver]

I would imagine we are not taught a lot about that in medical school. You know, there's, there's toxicology as far as like poisons, but things that are, have been worked into our everyday environment and you know, consider to be safe. Ish. That's really not part of the standard medical curriculum right now.

[Gwyneth Paltrow]

Do you think that that's important going forward?

[Dr. Mary Claire Haver]

I do, but I also think I do, but I think now that we have ways to rapidly get education out to the public through social media, through medical information. Was GATE kept for a long time into medical journals that a lot of people had no exposure to. Like even today, some of the best articles out there that I've learned so much from are behind paywalls and that the average person just can't get their hands on and probably would struggle to understand a lot of the scientific data. So that's what I like to do on social is break that stuff down for them. But I'm like, there's a lot of really smart people out there who could probably understand this to some level. And we are like totally putting this behind a wall that they're not going to get access to. And you know, all these guidelines and decisions and things that have been made were in these very ivory towers. And now that we've democratized having access to information, when love or hate the new administration like things are changing very, very rapidly on how we're funding research. So like Lisa Moscone, one of my favorite neuro researchers in the world, she wrote the Menopause Brain Plug to Lisa. Just. She's with Will Cornell and she has stepped away from traditional funding through nih, which is it takes years to get. You're constantly under the gun to publish, publish, publish. Now she's working for a private, she's funded by a private institution. She's only focused on outcomes. She does not have to generate a single paper though I know her, she will and because she wants to share her findings. But she's on a fast track to discover the, you know, what exactly do we know about menopause and hormone therapy and maybe a serm, which is a specific estrogen receptor modulator and decreasing the risk of Alzheimer's. Like her, she has a three year job to only solve that. Wow, it's really amazing. And stepping away from traditional funding is allowing her to do that with a lot of ease.

[Gwyneth Paltrow]

But presumably, you know, if it's happening, if it's being funded in the private sector, it's because there's a financial upside.

[Dr. Mary Claire Haver]

Maybe, but someone has to pay.

[Gwyneth Paltrow]

Yeah, absolutely.

[Dr. Mary Claire Haver]

And who's going to do it? She can't work for free. So she's just excited, excited to not have some of things that become burdensome in the old system.

[Gwyneth Paltrow]

I think it's great to be able.

[Dr. Mary Claire Haver]

To move a lot faster.

[Gwyneth Paltrow]

Yeah, I think you, you make a really interesting point too around the democratization and access to information. And I think we've been patronized for such a long time.

[Dr. Mary Claire Haver]

I agree.

[Gwyneth Paltrow]

And you know, now we are able to have visibility into some of this data and I think that also inherently.

[Dr. Mary Claire Haver]

Moves things in a fast and I think for things like forever chemicals and, and toxins, you know, you have to realize that your healthcare provider most likely received little to no training on this. And so you're going to have to step outside of the box. And what I meant, you know, is and educate yourself and make those choices because you're the one buying these things. And so like in our home, you know, we're getting rid of the plastic and we're only using glass for food storage. You know, we're trying to, you know, make those changes in a responsible way, you know, for our own household.

[Gwyneth Paltrow]

Yeah. Especially for somebody like me that genetically I don't detox well and I need to be slightly more careful without being, you know, overly paranoid. It is a mate. It, you know, it's a balance. Yeah. And for so long, you know, I would drink water out of a plastic bottle. Same, you know, 100 degrees in the car for three hours while I, you know, like left in an appointment or whatever and definitely imbibing lots of microplastics along the way. So what about, you know, I also have some friends who don't want to take hormones.

[Dr. Mary Claire Haver]

Some can't.

[Gwyneth Paltrow]

Some can't because they've had breast cancer.

[Dr. Mary Claire Haver]

Right.

[Gwyneth Paltrow]

But some are like very into the wellness world and they just don't want to mess with it.

[Dr. Mary Claire Haver]

What I tell the. And I have patients same, you know, I am not here to convince anyone to take hormone therapy. I just want those decisions to be made on facts and not fear. So I might be just give. Walking them through the studies what was walked back, what we absolutely know. But if you want to, and I joke, raw dog menopause and just go hormone free, fine. You can be healthy without, without hormone replacement it is possible, but it's just a lot harder for, you know, depending on where your box is being checked, you know, you may never sleep the same. Okay, then we have to figure out alternatives. And so you being on a nightly sedative is not going to be healthy. You know, and so we, we look at where they're struggling, where they're suffering and we try to find alternatives, you know, through lifestyle, through stress reduction, through pharmacology, through supplements, whatever it's going to take to have them function as healthy as possible. So it's absolutely possible.

[Gwyneth Paltrow]

Right. So one of my very close friends who had breast cancer, she's on tamoxifen.

[Dr. Mary Claire Haver]

Tamoxifen.

[Gwyneth Paltrow]

She's been told that she can't take any hormones and she's really suffering through crazy hot flashes.

[Dr. Mary Claire Haver]

I really. These poor patients, our breasties, we call them in our world, are really getting left in the dust because these medications which are needed to reduce their recurrence risk. Absolutely needed. But no one's managing the fallout from that. No One's talking to them. Tamoxifen, you know, has a better safety profile as far as what's happening to your brain, what's happening to your heart, what's happening to, you know, your bones than the aromatase inhibitors. But again, you know, it's a balance between risk of recurrence versus quality of life. And then what's your path to cardiovascular disease? So, you know, if I have a patient who's. And I have several who are breast cancer survivors, and they're coming in for, you know, hot flashes. We now have vioza, you know, we have. Have clonidine patches which work pretty well. Some of the SSRIs actually can work. And to blunt the hot flash, Neurontin, which is a really medication that's been around forever. Neurontin is used in restless legs and can help with hot flash. So we do have options. And she deserves that conversation. Just sadly, we have to kind of piecemeal her treatment. Depending on. You can go symptom by symptom when hormone therapy would kind of, you know, she has an absolute contraindication. She doesn't have to suffer.

[Gwyneth Paltrow]

Right. You know, what about like, black cohosh and, you know, red clover? Is there any variety?

[Dr. Mary Claire Haver]

Maybe. Right. So red clover, black cohosh. I mean, any supplement like that, that weekly. But the way they work is they weekly bind their phytoestrogens and soy. Okay, they're phytoestrogens, meaning they look a lot like estrogen under the microscope. Very, very similar. So they'll weakly bind to some of the receptors, which will lessen the symptoms.

[Gwyneth Paltrow]

Oh, interesting.

[Dr. Mary Claire Haver]

The other thing with those patients is get an early bone density. You know, don't leave your bones to chance. And there's great research on. Of course, you always see me on social with a weighted vest on. So the weighted vest, vibratory plates, box jumps, you know, all these things that we can do with nutrition supplementation to. To help with bone strength.

[Gwyneth Paltrow]

This is what I. There are two areas. This is great. We're getting into these areas. Touch on, because. So you wear your weight vest. What is the calculus around how much weight for how much you weigh?

[Dr. Mary Claire Haver]

The whole weight of us thing came about because I was like, having patients who were osteopenic, right. Which I am, breast cancer patients, and absolutely. No, no, no, no, no. For hormone therapy, I'm like, what can we do? So I'm like, literally going down PubMed, pulling everything on what. What has worked. And I ran across two or three articles and they, you know, smaller studies, but they're done in nursing homes, so they call them in facilities, and they were doing weight training, weighted vests, vibratory plates, like, all these different things. And the collagen that, you know, that. Full disclosure, I do sell this particular collagen because I was so excited when I read the study, called my husband. I'm like, get this on our. You know, so for the weighted vest, the benefits began at 10% of body weight. But when you think about who is in a nursing home, there's not a lot of obese people there. So, you know, it's putting that extra. And because it's a vest, it's putting it right on the axial spine in the hips, which are the two biggest areas we target, because the spinal compression fractures cause so much disability and, you know, and pain for women, and then the hip fractures kill them. And so, you know, we want to, you know, particularly, do the hand weights work? I'm like, you know, we have no studies showing that these will improve your bone density. They probably do a little bit. But, you know, we really want to focus on the.

[Gwyneth Paltrow]

And the distribution of weight in these.

[Dr. Mary Claire Haver]

Vests front and back. So people like, oh, I have a backpack. I'll put some weights in, or, I got to go rucking all the boys. Sure, rucking would be fine. And I've actually met the man who owns Goruck, and he's lovely, but I just. I go to the menopause studies, and that's what I look at. And so they wore vests, and the weight was equally distributed roughly front to back. And these sweet little old ladies, they put them in the gym and they had better balance and they had improved bone density.

[Gwyneth Paltrow]

What. Just out of curiosity, what brand of. Like, where do you find these?

[Dr. Mary Claire Haver]

So I heard Aldi sell some. I found mine on Amazon. And I'm actually in development, talking to a company about. Because the one I wear.

[Gwyneth Paltrow]

Yeah, you should make them.

[Dr. Mary Claire Haver]

It's fine. But it doesn't accommodate breasts. It was made for men. And so people are complaining of being smushed in the chest area. So we're working on a design that will, like, more fit the female form perfect so that, you know, women with larger breasts will feel comfortable.

[Gwyneth Paltrow]

And how often do you wear it?

[Dr. Mary Claire Haver]

So those studies were done three times a week. So I tell my patients, listen, throw it on when you're going. Walk the dog when you go on your walks. Just. This is just one extra thing. We have a very long seawall in Galveston, and that's like the walking path for the whole town. And so now it's we'll be walking down, you know, my girlfriends and I with our vest on and we'll see somebody else. We're like, hey, you know, it's like a thing now. And I see them in Telluride too, you know, if, you know, you know, starting a trend. But also when you're doing yoga or even balance training, you know, you want to have it tight because when you go upside down and do your inversions, you don't want it sliding all over the place. But the women saw better balance. So I'm like, stand on one foot, like, do some good mornings so that you can really improve balance with that weighted vest on so that you decrease your risk of fall.

[Gwyneth Paltrow]

Okay. And then do you also supplement with heavy weight training?

[Dr. Mary Claire Haver]

I have now? So I didn't lift weights. I kind of like went all cardio, running marathons with my friends, you know, and then started doing Beachbody. You know, picked up a few weights, lightweights, doing Beachbody, and was going to Zumba with my girlfriends, you know, really socializing and having fun. But once I got serious about hanging on to my bone density and building muscle, I need to work heavy. And so I was doing some of the more aggressive programs on Beachbody again and I was getting hurt, I was pulling things, my back would go out and I'm like, I'm not doing this right. So then I invested in a trainer, a woman I met in New York who has, she works in the Hamptons and has a place in New York and she makes a program for me and we'll kind of video each other and she's watching my form and, you know, to make sure I'm doing it right. So I've been working with her about a year and it's really been amazing.

[Gwyneth Paltrow]

Have you done presumably on your scanner before and after?

[Dr. Mary Claire Haver]

Yes, yeah. So I've gained, gained about 4 pounds of muscle, which on my frame is like amazing. That's great. So, yeah, but it takes, it's a lot. It's like a full time job, you know, with the eating enough protein and I know the protein and that's a whole different mindset. I'm now eating to be stronger and not be thinner.

[Gwyneth Paltrow]

Yeah, yeah, that's what I'm trying to do too, is really make that switch. And you know, I think in our generation we really were totally raised and.

[Dr. Mary Claire Haver]

You know, as a doctor, I was like, oh, I'm good, I'm. I'm thin, I'm healthy. And I was chipping away at my bones and muscles all those years Right, right, right.

[Gwyneth Paltrow]

Yeah, yeah. I mean, I'm making a real concerted effort to do it. And, you know, I follow you and all the. All the doctors and have my doctors. I'm really. I'm really trying, but sometimes I'm like, gagging down, you know, I can't. I'm like. It's tough.

[Dr. Mary Claire Haver]

It's.

[Gwyneth Paltrow]

It's hard. It really, it. And I know that, you know, it's necessary, but. So on the subject of, you know, there are. And this is well documented, but the shapes of our bodies start to change in menopause. Right? We're starting to sort of thicken out in the middle. What the fuck?

[Dr. Mary Claire Haver]

Yes, Mary Claire. So welcome to the body composition changes associated with menopause. So when I first looked into this, this. It just pisses me off. Excuse my language. You can bleep that out. But, like, all the studies were like, women just get lazier as they get older. They just tend to gain weight. There's nothing you can do. But so when you look at. So then I found this. I just reposted it the other day. I read a study that was written in 2019, but I didn't read it until like a year and a half ago. And it was looking at body composition changes. Now that we have tools like the in body scanner, the DEXA scans that can measure muscle mass. Mass and measure visceral fat. And they looked at weight. So weight across the menopause transition, they looked at 1200 patients, is a steady state gain. Okay. Across, however, muscle mass, rapid descent, decline in perimenopause, and then it stabilizes in the first few years after menopause with a decline as we age. So we have this, like, falling off the cliff. The opposite for body fat. They didn't look at visceral. They just look that total body fat, and they see rapid expansion of fat accumulation, which I don't have to tell you, every woman who this happens to, which is 98% of us, knows it, all of a sudden you're putting on fat in new places, right?

[Gwyneth Paltrow]

What's with the new places part?

[Dr. Mary Claire Haver]

Like, you know, it's so funny, Gwyneth Paltrow is asking me this, like, if I. Everyone looks at you and like, she's perfect, but you're human, you know, Definitely far from it.

[Gwyneth Paltrow]

And very human. But what if I used to gain weight? It used to be sort of an equal distribution, and now it's like, yeah.

[Dr. Mary Claire Haver]

From breast to hip bone. And. Okay, so what's happening there is, as our estrogen levels decline the liver takes a huge hit and we see cholesterol.

[Gwyneth Paltrow]

In what way going up.

[Dr. Mary Claire Haver]

So, so FSH goes up, estradiol goes up. They both have direct effects to the liver. So in the liver we see the LDL cholesterol going up. So I'm sure your listeners are like, oh my God, I did nothing different. And all of a sudden my cholesterol numbers shot up. And then, same here as well. And then your HDL kind of stabilizes and drops off a little bit. So your overall cholesterol goes up, LDL goes up, and the bad LDL marker, LDL apolipoprotein B goes up as well. So with not a single change in your diet and exercise, you're singing my song, girl. Okay. The other thing is that your insulin resistance goes up. So my, you know, we have the HOMA IR score, which anyone can do. It's a, it's a ratio of fasting insulin to fasting glucose. And if it's below 2 and you can go on an online calculator, you know, someone can pull up their labs on quest or whatever and you can do this because it's not going to give you that result. If it's less than 2, you're probably doing fine with insulin resistance. But we become insulin resistant and then we become pre diabetic. And then we become diabetic. So the diabetes measurement is typically done with the A1C. Yeah, hemoglobin A1C. So we see that trending up across the menopause transition as well. So when that insulin resistance marker goes up, we also see your high sensitivity reactive protein begins to increase. Your homocysteine goes up and your sub rate goes up. And so we see these inflammatory markers going up, up. Estrogen is so freaking protective of our bodies and when we lose it and when it starts going caddy wampus and we lose it like everything goes crazy. When those inflammatory markers go up, you start driving fat to the visceral cavity to the intra abdominal organ. So all of a sudden you get a belly where you never had one before.

[Gwyneth Paltrow]

That's what it is. It's downstream impact of inflammation.

[Dr. Mary Claire Haver]

Yeah. Directly related to estrogen loss. What do we know attenuates that? Okay, so this is like my, my, the belly fat challenge I've done and all the things. So I looked, I looked in all the studies. What do we know that menopausal visceral fat gain, which is belly fat in your, in your world, what works HRT will attenuate it. Okay. Nothing's better than your 25 year old ovaries. And sadly, you know, none of us took them out and preserved them and put them back in at 50. So okay, maybe for our kids, you know, that'll be a thing or some artificial ovary. But you know, for now we just of hrt, it's not perfect. You know, we, it's a lot of trial and error. Not the same formulation, does the same thing. You know, oral is very different than transdermal and you know, each has its benefits and risks. But any form of menopause hormone therapy containing estrogen will attenu attenuate the visceral fat gain. High fiber diets, which is why I talk about fiber all the time. So for cardiovascular we're looking at 35 grams or more per day. Most women get 10, 10 and so women who get 25 or more have much less visceral fat accumulation. Also their insulin resistance goes down. You know, so fiber keeping that gut microbiome happy. Decent studies looking at probiotic supplementation either eating something rich in probiotics every day. But if you can't do that, say your most us it's dairy, you know, they're getting it from yogurt. But if you can't do that because of an intolerance supplement might be the right thing for you to decrease that risk movement. You know, zone two cardio seems to be really beneficial for visceral fat accumulation. So I go through and then stress reduction, adequate sleep, all the things. All the things.

[Gwyneth Paltrow]

Is it possible to sort of get your old shape back or should we just like relax and not care and accept our new.

[Dr. Mary Claire Haver]

When I do the body body scans on patients, you know, we look at total body fat and then we look at visceral fat. And I'm just focusing on the visceral fat number. I don't care what the scale says. Those are curves, the subcutaneous fat. I don't care.

[Gwyneth Paltrow]

Right.

[Dr. Mary Claire Haver]

I don't care. But getting them to undo that lifetime of shame.

[Gwyneth Paltrow]

Yeah.

[Dr. Mary Claire Haver]

And lifetime of drive to get to the least amount of subcutaneous fat ever. Except now my kids generation is more about they like their curves. So I'm super happy we can celebrate that with them. But not me. I mean that was not at all how I grew up.

[Gwyneth Paltrow]

Me too. Yeah. I really do like that. The, I mean look, we're still objectifying ourselves and other women so that's not great. But I, I do like that it's trending in a more self accepting way.

[Dr. Mary Claire Haver]

Right. And it's healthy.

[Gwyneth Paltrow]

Yeah.

[Dr. Mary Claire Haver]

So I don't I. I try. And I can't tell you the tears of some women, like, especially my athletes, who've been told they were obese. You know, the Ilona Meyer type people who is just a freaking machine of health and has more slabs of muscle on her and absolutely, she's going to live forever, you know, and so versus some little frail, you know, was dieted her whole life and is now in a nursing home incontinent with broken hip and, you know, dementia.

[Gwyneth Paltrow]

Is there a correlation between muscle mass and longevity?

[Dr. Mary Claire Haver]

Yes, a hundred percent, especially for women. Muscle. So when we look at geroprotection, that's a word. Okay. Geroprotection means protecting yourself in your geriatric years, which is 65 or older. And that is just around the corner for me. The ovary, which goes away, is protective. The most protective are the muscle and the ovary. And so we can artificial back our ovary with hormone therapy, but you have to fight. So if you do nothing and don't lift weights and don't stimulate that muscle, you will lose 7 to 10% per decade until about 70, and then it goes up to 25% of your muscle mass per year.

[Gwyneth Paltrow]

And why is it that people who are on GLP1s, which seem kind of miraculous for certain people. Yeah.

[Dr. Mary Claire Haver]

So there is concern there, and I think it's legitimate.

[Gwyneth Paltrow]

But is it?

[Dr. Mary Claire Haver]

I think it's poor counseling and it's not the medication.

[Gwyneth Paltrow]

Okay. So it. It itself does not.

[Dr. Mary Claire Haver]

If any of us took enough GLP1, we wouldn't need at all. Okay. And when we starve, you know, when you severely calorically restrict, about 50% of the weight you lose is muscle, and 50% is fat. Muscle determines our basal metabolic protein. You're not eating enough, and you're not eating enough protein, so. Right. Your total caloric restriction is down. So you're going to chew up any and everything to, you know, and your muscle is like. Muscle and bone are constantly remodeling. And a lot of women don't realize that the bones you have today are not the bones you had 10 years ago, because we're constantly chewing up bone and laying down new bone. Same with muscle and with aging. So there's an aging factor which we can't undo. And then there's a menopause factor. Those accelerate across the menopause transition.

[Gwyneth Paltrow]

Okay. So it's not that it inherently makes us lose muscle at a more rapid rate. It's just that overall, we're eating less protein, less calories.

[Dr. Mary Claire Haver]

Right. There's. We don't see yet. I mean again, more studies, but I, there's no, as far as I can, I've seen in the data, no direct effect to the muscles. It's more of you are not giving your muscles enough to maintain and you're losing and you're so happy with the scale, which is completely understandable. So when our patients come in and we determine they're a good candidate for GLP1, you know, pre diabetic or whatever their issue is, we had another hour of counseling about how important. And we have the body scanner doing their body scans to track their muscle mass throughout the process, adjusting the dose so that they can, you know, because we do live in an obesogenic society. And I would love to go back to 50 years ago when so few people had prediabetes and were obese. You know, even the way we define it now, which is not with the bmi. But we can't ignore the fact in this country we have a chronic health problem. You know, and now the, the debate is how do we solve it? Right. You know, and so I'm just one doctor, I have one clinic with, you know, a bunch of practitioners and we are all united in this. It's a tool, it can be a really helpful tool. But in the wrong hands or without the proper counseling, we may do more harm than good.

[Gwyneth Paltrow]

Because of other side effects.

[Dr. Mary Claire Haver]

Well, side effects are one, if she can't tolerate it, she can't tolerate it. Now like tirzepatide is way better on the GI system than semaglutide, at least with our patients. So we're actually starting with tirzepatide.

[Gwyneth Paltrow]

Okay.

[Dr. Mary Claire Haver]

Because we just don't have to deal with as much nausea and diarrhea.

[Gwyneth Paltrow]

And does it have the same anti inflammatory effect?

[Dr. Mary Claire Haver]

Yes, so far.

[Gwyneth Paltrow]

What is it about these drugs that lower inflammation?

[Dr. Mary Claire Haver]

So they're looking into that. First people said, well they're just the diet. You know, I've never seen my patients so motivated to really eat clean and stick to, you know, by removing the food noise. And that constant, you know, I've never had it, but I've had enough patients talk to me about it to understand. And the food noise, you know, what we're seeing across the spectrum is not only is it food noise, it's gambling noise, it's alcohol noise, it's.

[Gwyneth Paltrow]

I mean, isn't that fascinating?

[Dr. Mary Claire Haver]

All those drives. So there are receptors in the brain that are, when you take that stress away, I think it's anti inflammatory because it removes, it lowers your cortisol levels because you're constantly battling that internal demon of I need to shop, I need to drink, I need to gamble, I need to eat. You know, wow.

[Gwyneth Paltrow]

Is it because it's addressing some sort of, like, pleasure feedback loop?

[Dr. Mary Claire Haver]

So one of the side effects that we saw when we started using semaglutide in the clinic was anhedonia, right? Which is loss of pleasure. And they weren't depressed, but they just kind of couldn't. Their get up and go was gone. They didn't want to go out to e. They didn't want to go to a movie. They want to have sex. You know, I have that, so I'm fat.

[Gwyneth Paltrow]

That.

[Dr. Mary Claire Haver]

But it seems that we're having a much better time with ter's appetite for that. Fascinating article in the New York Times just came out that talked about how marriages are changing when one partner gets on. And I was like, okay, because, you know, I'm on one half of that side because I treat only women. And I'm like, I think she has some, some important points here. The way you feel about your body changes because the way you look and the way the world's reacting to you changes. The things you socialized around, eating and drinking and whatever, change. And if both partners aren't doing it together, you know, her, in the story they gave the example, the partner was normal weight. He didn't. It wouldn't benefit him at all. But like, the whole way that they connected and socialized really changed and it was really affecting their marriage. So that is now something I incorporate into our counseling. As, you know, think about these things as you move forward. How do you socialize with your husband? You're going to maybe have to find some new creative ways to connect.

[Gwyneth Paltrow]

So interesting. I mean, I can't remember a class of drugs that's had this kind of medical, social, sociological, emotional.

[Dr. Mary Claire Haver]

So many.

[Gwyneth Paltrow]

It's wild. Yeah, it's wild. I would love to talk. Just one last question about your forthcoming book about perimenopause. First of all, thank you for taking the time to research and do some investigation here because as we were talking about earlier, it's a black hole. It's a black hole.

[Dr. Mary Claire Haver]

There's not one single large scale research study on the treatment of perimenopause. It is literally the menopause think tank. What are you doing? What are you doing? What's working? How are you helping? I mean, okay, I have a patient and we, we have these little office hours. Not office hours, but like, we're just throwing out complicated patients or how would you manage this? It's really a beautiful thing, but we are crowdsourcing with our little group of perimenopause care and figuring it out.

[Gwyneth Paltrow]

So what data set are you using to write the book?

[Dr. Mary Claire Haver]

Good. Good question. So there's really good data on now and this is all really recent data coming out looking at cardiovascular risk factors across the menopause transition. So Circulation magazine, which is American College of Cardiology's like journal, has published a few like you know, you have to dig coming out of Australia, incredible research on mental health changes and what seems to be working. And it turns out that giving a woman stabilizing her estrogen with hormone therapy is more effective and probably more appropriate than giving her an antidepressant.

[Gwyneth Paltrow]

Right.

[Dr. Mary Claire Haver]

In perimenopause.

[Gwyneth Paltrow]

Amazing.

[Dr. Mary Claire Haver]

Well, I can't wait to for a new onset. Right.

[Gwyneth Paltrow]

Right. So I'm so I can't wait to read it. Yeah.

[Dr. Mary Claire Haver]

Hopefully I will be out of perimenopause mean 2026. I think we just set the date April 2026. That'll be release.

[Gwyneth Paltrow]

You'll have to come back on.

[Dr. Mary Claire Haver]

I would love to.

[Gwyneth Paltrow]

Thank you so much for being here with me.

[Dr. Mary Claire Haver]

Thank you for having me.

[Gwyneth Paltrow]

You're so amazing. A thank you so much for tuning in to today's episode of the GOOP podcast. I hope this conversation empowers you to take charge of your health, ask the right questions and approach this phase with confidence and curiosity. Because the more we talk about menopause, the more we can reshape the narrative around women's health and the better prepared we're all to navigate it. Thanks for listening and see you next time. This has been a presentation of Cadence 13 Studios. I hope you'll listen, follow, rate and review all of our episodes, which are available for free on Apple Podcasts, Spotify, Odyssey or wherever you get your podcasts.