The FDA Just Removed a 22-Year-Old Warning | ft. Dr. Mary Claire Haver

Summary

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Podcast Summary: The Neuro Experience

Episode: The FDA Just Removed a 22-Year-Old Warning | ft. Dr. Mary Claire Haver

Host: Louisa Nicola & Pursuit Network

Guest: Dr. Mary Claire Haver (Board Certified OBGYN, Menopause Society Certified Practitioner)

Date: November 18, 2025

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Overview

This episode unpacks the recent FDA decision to remove a 22-year-old black box warning from local vaginal estrogen products, exploring its impact on menopause care, the persistent knowledge gaps in medical education, and the social, psychological, and neurological aspects of hormone replacement therapy (HRT). Dr. Mary Claire Haver, a leading menopause expert, joins Louisa Nicola to discuss historical context, patient and clinician confusion, evolving research on HRT and dementia, and how culture and misinformation shape women’s health.

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Key Discussion Points & Insights

1. FDA Removes the Black Box Warning

• Significance: The FDA’s move aims to reduce fear and misinformation surrounding hormone therapy, especially estrogen, for menopausal symptoms.
  • “It is gonna take away some of the fear and the panic that has been associated with hormone replacement therapy.” – Dr. Haver [00:04]
  • The warning label scared approximately a third of women away from using the medication, despite its localized use and lack of evidence for serious risks. [02:03–03:13]
• Context: Before the 2002 Women’s Health Initiative (WHI) study, there was no black box warning for estrogen.
  • “Black box warnings are meant for dangerous products like cigarettes... This isn't cyanide, this is estrogen.” – Dr. Haver [00:45, 03:18]

2. Divided Medical Community

• There’s a generational divide among clinicians regarding menopause care and HRT:
  • Doctors trained before 2002 routinely prescribed HRT; those trained after are much more hesitant due to the WHI’s impact.
  • “That one study really defined their understanding of menopause and what we could do for a woman.” – Dr. Haver [00:15, 05:57]
• Menopause care remains a minor part of OB/GYN training and certification, leaving many practitioners ill-equipped. [05:57]

3. Underutilization of HRT

• Only about 4–8% of eligible women use FDA-approved or compounded HRT products—dramatically less than might benefit.
  • “Well less than 10% of women who are eligible.” – Dr. Haver [03:40]

4. Anecdotes and Gender Bias in Medical Training

• Women’s menopausal symptoms have often been dismissed historically as psychological or insignificant.
  • Dr. Haver recounts being taught to categorize complex female symptoms as “whining women” (WW):
    • “If you can't figure out what's going on with her, it might be in her head.” – Dr. Haver [08:17, 10:14]

5. Research Gaps & SSRIs

• No large-scale clinical studies have focused exclusively on perimenopause treatments. [01:05, 11:02]
• Instead, the default intervention has been the prescription of SSRIs and antidepressants, which spike in use during menopause.
  • “The average prescription practices are about 10% of women are on an SSRI or one of the antidepressants right across the menopause transition. That doubles to 20%... by the time you're 65, it goes up to 25%...” – Dr. Haver [13:33]

6. Symptoms and Diagnosis of Perimenopause

• First and most universal symptom: “I just don’t feel like myself.” [15:33]
• Other common symptoms: brain fog, cognitive decline, insomnia, word-finding difficulties, loss of resilience, diminished alcohol tolerance. [16:22]
• Diagnosis remains clinical, based on listening to women’s presentations rather than objective laboratory findings.

7. Critical Window/The Timing Hypothesis

• Starting HRT within ten years of menopause or before age 60 provides the clearest evidence of benefit, particularly for heart health and potentially lower all-cause mortality.
  • “Before the age of 60 or within 10 years...the benefits outweighed the risks...” – Dr. Haver [17:35]
• Most research (especially WHI) used older women and outdated formulations (Premarin), which clouds present recommendations. There’s a need for modern RCTs; however, lack of financial incentives hinders this progress. [17:04–19:47]

8. HRT and Disease Prevention

• Undisputed benefit is osteoporosis prevention: “We can prevent her about 50% chance of having an osteoporotic fracture.” – Dr. Haver [20:25]
• The link between HRT, dementia, and Alzheimer’s is still being researched; evidence is promising but inconclusive.
  • Host Louisa notes: “Are we seeing that hormone replacement therapy is actually the cause of lower dementia incidence, or is it the...vasomotor symptoms that’s helping?” [21:11]

9. Estrogen, Brain Metabolism, and Brain Fog

• Estrogen directly influences brain glucose metabolism; its absence can trigger the brain to use myelin as fuel (catabolize), leading to potential cognitive effects.
  • “The estrogen receptor can't shuttle in glucose...so the brain cell...starts to catabolize the myelin sheath in order to produce ketone bodies.” – Louisa Nicola [28:25]
• The hormonal chaos of perimenopause is a key driver of cognitive complaints, especially among high-performing women.
  • “It's Perry where we see the biggest drama.” – Dr. Haver [32:25]

10. Social Factors and Stigma

• Misinformation and stigma lead many women to reject HRT out of fear of breast cancer, though modern evidence suggests estrogen-alone HRT may actually lower risk in some cases.
  • “Women on estrogen only from the WHI had a 30% decrease relative risk of breast cancer versus placebo.” – Dr. Haver [33:30]
• Many women quit their jobs or struggle at work due to untreated cognitive symptoms of menopause; sometimes, menopause prompts empowerment and positive life changes. [35:44-39:54]

11. Modern Trends: Vaginal Estrogen, Rejuvenation, and Wellness Hype

• Local vaginal estrogen is safe and critically important to genital/urinary health, yet woefully underused due to misunderstanding.
  • “All vaginas need estrogen, all of them, and it's healthier with it.” – Dr. Haver [43:00]
• Trendy treatments (PRP, NAD, red light therapy) often have little evidence for efficacy in menopause compared to basics: sleep, diet, exercise, stress management.

12. Lifestyle vs. HRT

• HRT is not for everyone, and the decision must be made based on accurate information, not fear.
  • “Is this a decision based on facts and not fear?” – Dr. Haver [44:10]

13. Knowledge Gaps, Politics & Moving Forward

• “Women's healthcare is political because it has to be.” – Louisa Nicola [46:25]
• Future: Dr. Haver is optimistic that younger generations will be better informed and empowered to navigate menopause proactively. [49:01]
  • “The boomers are pissed. The Gen Xers are not standing for this. The millennials […] are wanting to get ahead of it.”

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Notable Quotes & Memorable Moments

• “All vaginas need estrogen.” – Dr. Haver [01:33, 43:00]
• “Black box warnings are meant for dangerous products like cigarettes. This isn't cyanide, this is estrogen.” – Dr. Haver [00:45, 03:18]
• “There’s not been a single clinical study, large scale, on the treatment of perimenopause.” – Dr. Haver [01:05]
• “If you can't figure out what's going on with her, it might be in her head.” – Dr. Haver, relaying dated medical advice [08:17]
• “It's becoming part of their vocabulary. They're learning, they're not afraid. They are wanting to get ahead of it.” – Dr. Haver, on young women and menopause [49:01]
• “Not all my patients choose hormone therapy.” – Dr. Haver [44:10]

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Timestamps for Important Segments

• [00:04] – Significance of removing the FDA black box warning
• [03:13] – Fear and discontinuation of HRT due to the warning
• [05:57] – Medical education gaps and generational practice differences
• [08:17-10:14] – Gender bias and “the whining woman” stereotype
• [11:02-13:33] – Lack of perimenopause research & rise in SSRI use
• [15:33-16:22] – “I just don’t feel like myself” and constellation of symptoms
• [17:04] – Women’s Health Initiative and the "timing" hypothesis
• [19:47] – Barriers to new RCTs, funding gaps
• [20:25] – HRT for osteoporosis prevention
• [21:11] – Uncertain link between HRT and dementia risk
• [28:25] – Estrogen, brain energy, and myelin catabolism
• [32:25] – Hormonal chaos of perimenopause
• [33:30] – HRT and breast cancer risk myths
• [35:44-39:54] – Cognitive fallout: job performance, divorce, empowerment
• [43:00] – “All vaginas need estrogen” and modern misconceptions
• [44:10] – Lifestyle interventions & patient autonomy
• [49:01] – The cultural shift and optimism for the next decade

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Tone & Flow

The conversation is candid, evidence-focused, and as practical as it is hopeful. Both host and guest use direct language, mix personal anecdotes with scientific context, and address stigma and structural issues head-on. The tone combines professional authority, empathy for patient experiences, and a sense of humor (“bitches be crazy”, “whining woman”, “fluffy vaginas,” the “We Do Not Care Club”).

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Summary Conclusion

This episode clarifies the roots and repercussions of the FDA’s black box warning on vaginal estrogen, the generational divide in menopause care, and the urgent need for better research, medical training, and patient education. Dr. Haver and Louisa Nicola call for nuanced, patient-centered discussions about HRT, broader awareness of menopause’s neurological dimensions, and a focus on both evidence-based basics and empowering women to make informed choices—setting the stage for a new era in women’s midlife health.

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Transcript

[A]

The FDA just removed the black box warning after 22 years. What does this mean?

[B]

It is going to take away some of the fear and the panic that has been associated with hormone therapy.

[A]

You'd think doctors would celebrate. Instead, they're more divided than ever.

[B]

So when you look at the clinicians that trained after 2002, they are going to be very hesitant, very fearful, because that one study really defined their understanding of menopause and what we could do for a woman.

[A]

We've got top gynecologists who are looking at the exact same studies and reaching completely opposite conclusions. Some say hormone therapy prevents dementia and every woman should be on it. Others say that's dangerously overselling benefits we can't prove and we're setting up the next medical crisis.

[B]

Black box warnings are meant for dangerous products like cigarettes. Yes, Things that could be life threatening. This isn't cyanide. This is estrogen.

[A]

Today's guest is Dr. Mary Claire Haver, Board Certified OBGYN, Menopause Society Certified Practitioner, New York Times best selling author. Over 3 million followers.

[B]

To this day, there's not been a single clinical study, large scale, on the treatment of perimenopause.

[A]

That's insane. Is this also the period where a lot of women are getting prescribed SSRIs? Yes.

[B]

I was taught that women tend to somaticize psychological issues. So if you can't figure out what's going on with her, it might be in her head.

[A]

She's at the center of this war and we're going to find out why smart doctors can't agree on what the science actually shows.

[B]

All vaginas need estrogen.

[A]

All of them is central to your argument of why women should be at least offered hormone replacement therapy.

[B]

At least have the conversation.

[A]

I'm Louisa Nicola and this is the Neuro Experience podcast. Dr. Marie Claire. I'm so happy that you're here finally.

[B]

Thanks for having me.

[A]

Let's start with the huge announcement yesterday. The FDA just removed the black box warning after 23 years.

[B]

2003. So 22 years.

[A]

22 years. What does this mean?

[B]

First of all, I think it's a wonderful thing and that it is gonna take away of the fear and the panic that has been associated with hormone replacement therapy. So in my clinical practice, I sit down with a patient, we go over her risks and benefits and we decide she needs vaginal estrogen for her genital urinary syndrome of menopause. She goes to the pharmacy, picks up this FDA approved medication. It's $15. She's so excited Opens the box, pulls out the paperwork and sees a very large black box warning that says she is at danger of stroke, hypertension, dementia, you know, a laundry list of things that had absolutely no scientific basis for a local vaginal estrogen product. She's terrified. Calls me in a panic. About a third of women who pick up these prescriptions never use them. And we think it's because of this boxed warning, which is not really based on modern scientific evidence, especially for the local vaginal products. So removing that and allowing that conversation to happen between a clinician and her patient really, I think, is going to allow women to have the confidence and lose some of the fear around these products.

[A]

Because prior to the Women's Health Initiative.

[B]

There was no warning.

[A]

There was no warning? No.

[B]

And just the normal contraindications and normal warnings, but not this, like black box warnings are meant for dangerous products like cigarettes. Yes. You know, things that could be life threatening. This isn't cyanide, this is estrogen.

[A]

Exactly.

[B]

A natural hormone that our body produces.

[A]

So currently the percentage of women taking HRT is what, 4%?

[B]

4% of FDA approved products when we add in compounded, which isn't tracked, you know, through a national database. So we, we're guessing maybe it's 7 to 8% when we add in compounded. So still well, less than 10% of women who are eligible.

[A]

That's going to make a huge difference.

[B]

We hope so.

[A]

Okay, it was just announced yesterday, so what's the time?

[B]

So hopefully we have to get the clinicians on board because remember, you know, in order for a woman to get a prescription, she needs a licensed clinician who is willing to write the prescription. Then she has to go and get it filled. So one of the big stopgaps is we have a whole generation of doctors, nurses, nurse practitioners, you know, anyone who has clinical prescribing privileges who are never really trained on how to properly prescribe or counsel patients for hormone therapy because of the fear surrounding it. I think honestly we're about to 10 to 15 years before this is a normal, natural part of practice. That is just the trickle down effect of when these changes happen and how long it takes. Now, I do think social media tends to speed things up and we're seeing that clinically where women are really turning to social media, good and bad, to educate themselves and then go into their clinicians. Clinicians are using social media as well to get some education themselves. But as far as for like the regulatory boards and the education system, I think we're a good 10 years out before this is common clinical practice.

[A]

That's insane. How many more women are going to have to be denied hormone replacement therapy in that timeframe?

[B]

This is huge, but it's still going to take time.

[A]

Okay, so we're seeing a huge divide between, you know, you're a board certified OBGYN when it comes to social media. You yourself just said we're getting a lot of our information, good and bad. And I do agree with from social media. It's free education. Right. I get tens of thousands. I know you've had 10,000 messages I believe just about frozen shoulder.

[B]

Yeah.

[A]

So women want advice, but where to go? And then there's this huge divide between obese. Even one say that hormone replacement therapy is very efficacious and we need it. It's going to be preventing cardiovascular disease, dementia, all of the symptoms associated with menopause. And there's this other obgyn, also board certified who believes that we don't have a robust AM of studies to suggest that it is efficacious.

[B]

It depends on when they trained. Clinically relevant menopause care is not a regular part of the OB GYN education curriculum. Not. And I know this because I was a former residency program director, so I knew the curriculum backwards and forwards. And it is an afterthought at best. We have a few vignettes that we might talk to the patients about, but it really depends on the program if there's even a menopause clinic. So routine, regular evidence based, like sitting in a clinic across from, you know, dozens of menopausal patients doesn't happen in most programs. I didn't even know the menopause society existed until about three to four years ago. Until I really got into the menopause space, I thought I knew everything I needed to know. Board certified. I get recertified by the American College of OBGYN every year when I go to to take my recertify for my boards every year there are several divisions. There's gynecology, there's office practice, there's surgery, there's ob, high risk ob, there's ethics, there's genetic. There's not a menopause category even still. So it's just something that hasn't been prioritized and it depends on when the doctor trained. So if you look at someone like Sharon Malone, Lauren Stryker, you know, the doctors who were out in practice before 2002, all of them were trained on how to give hormone therapy. There was no black box warning. It was a normal routine part of their practice. And something that most of them have continued to do despite the whi. They have some more nuances in their counseling. You know, we've learned a lot from the whi, and I don't want to demonize that completely, but then you get to someone in my generation where I graduated with the whi, that was the same year, and it dramatically changed how I was thought. You know, how. What I thought about menopause and how to practice medicine and then everything after that. So when you look at the clinicians that trained after 2002, they are going to be very hesitant, very fearful, because that one study really defined their understanding of menopause and what we could do for a woman. So it really just depends on when they train now. I think that the ones coming out now or are starting now are going to have a completely different experience.

[A]

Let's go actually back to residency, because I know that you said something that really changed your life. When you were sitting in front of a menopausal woman. She was describing her symptoms, and I think it was your residency director, or maybe it was.

[B]

It was a chief resident.

[A]

It was a chief resident that. That used the three W's.

[B]

I was an intern. Now, this is before whi. Okay, okay. So this is more about how women were perceived. And. And what? So I was taught that women. Women tend to somaticize psychological issues. So if you can't figure out what's going on with her, it might be in her head.

[A]

Yes.

[B]

Or as the wonderful Dr. Elizabeth Komen quotes, bitches be crazy. So in her book, it's like the best chapter. So here's the clinical example of this. I'm a new intern. I'm so excited. It's my first day in gynecology clinic. We have a hierarchy of training. So the upper levels are really wanting to get their surgery numbers. So they're running to the pile of charts.

[A]

Yeah.

[B]

And they go through and they try to find the surgery cases first. So because they need their numbers and they want to operate. So boom, all those charts disappear. Then the next level residents go in and they grab the procedures, the colposcopies, the polypectomies, the things where they have to do things with their hands because it's fun and you want to get your training. And then the interns take whatever's left. So I pick up a chart, and it's a patient in her 40s. She was Caucasian. She had had a couple kids, wasn't trying to be pregnant. I think she'd had a tubal ligation. So Pregnancy was, you know, not an issue on the table. And she had multiple vague complaints. She was tired, she was gaining weight, she was suffering a little bit with depression, her libido was waning, she had some aches and pains. So I'm flipping through the chart and she'd seen three or four doctors before she got to us. Basically she'd been shuttled through different specialties. People had checked her thyroid, they'd done some basic lab tests. So my upper level comes up and he's like, what do you have? So they're in charge of us, right? So I'm like, and you have to do your presentation. So I'm like, I have Ms. Smith. And she's a 45 year old Caucasian female who has the following complaints. Ba ba, ba ba ba ba. They check her thyroid. And I said, yes, sir, Family medicine did. And did they do this? So she had had, you know, the basic lab test. And I said, basically a normal physical exam. I'm not sure what to tell her. And he goes, huh, sounds like you got a ww. And I didn't know what that was. It's new terminology to me. What's that? And he said, don't write this in the chart, but it's what we call a whining woman.

[A]

Oh my God.

[B]

Okay. And he said, women at this age tend to come in with lots of complaints and if their labs are all normal, there's not much we can do for them. Pat her on the neck, you know, pat her on the knee, tell her to get, you know, take some vitamins, tell her to get some more rest, tell her to, you know, have a spa day or whatever and this will pass. I took that as the truth. And I have to be honest, you know, I've of that mindset at the time. I'm lucky to be here. I have total imposter syndrome.

[A]

You're in your probably 20s at the time. So you did.

[B]

I'm 30. I'm 30, you know, and I'm younger than her. Right. I haven't gone through this yet. And I'm just like, okay. Women tend to go through this. I'd already been taught women tend to somaticize psychological issues. So maybe she's a little bit depressed or something, but never, never, ever that this could be the onset of her perimenopause.

[A]

Yep.

[B]

All we learned was how to pronounce perimenopause. There was, there's, to this day, there's not been a single clinical study, large scale on the treatment of perimenopause and.

[A]

Correct me if I'm wrong. Is this also the period where a lot of women are getting prescribed SSRIs?

[B]

Yes.

[A]

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[B]

So we see pre menopausal. The average prescription practices are about 10% of women are on an SSRI or one of the antidepressants right across the menopause transition. That doubles to 20% doubles. Then by the time you're 65, it goes up to 25% with no discussion of where hormones or the changes in our hormone levels might be playing. Now that is changing. We are seeing, I'm seeing more articles day by day looking at the connections between hormone health and mental health. So I think we're getting there, but we have a long way to go.

[A]

And look, I think it's also bi directional, right? Instead of just thinking about, well, what role does estrogen play in, you know, mental health disorders, psychiatric disorders. I think it's also women are complaining, let's just say, of sleepless nights, insomnia. So they're actually being prescribed, not Ambiens. I'm seeing people getting prescribed amitriptyline, which is a tricyclic antidepressant, which in low doses can help with sleep, but it's also an antidepressant. Right.

[B]

I think it all feeds into each other. But when we strip it down and look at the root causes, there's environmental. So a lot of women are going through aging parents, raising teenagers, you know, raising kids, troubles in their marriages. You know, it's a difficult time of life for women in general. But what I see in my clinical practice is my patients are coming in and they know their stresses, like, and they've had them managed. They were like, look, I've got the angry mother in law or I've got, my dad is in, for example, assisted living, you know, like, like I had this managed. Nothing in my environment has changed. I have changed. And I am struggling to have resilience for the life I built for myself. And that's the patients where I feel like I'm helping the most.

[A]

Now do you find that there's also a misread? Because I remember in my early 20s, obviously far away from perimenopausal, there were some days where I was agitated, sleepless nights, you know, going through, you know, you go through med school, like, I mean, how do you differentiate the symptoms?

[B]

What I do in clinic is because we don't have a great blood test for perimenopause. So how, you know, how could we possibly know? There seems to be for most women a constellation. And the first symptom, there's a great, beautiful study. And they just presented this at the Menopause Society meeting. I just don't feel like myself. And you have to sit down and listen to a woman and believe her when she tells you what's happening. It's almost universal that they're like, I just don't feel like myself. And it could be mental health, it could be cognitive changes. So she's Struggling to find her words. She's not able to complete tasks like she used to. She feels like she's developing. Add some of them in the most severe cases, really feel like they're developing dementia. She's having sleeplessness all of a sudden where she used to be a great sleeper. Not, not a woman who's always struggled with insomn.

[A]

But these.

[B]

Struggling to go to sleep because of racing thoughts. That's new. Or those 2am 3am wake ups without anything really changing in her environment. You know, struggling to process alcohol the same way that she used to. You know, so many of my patients are just ditching alcohol altogether because they just aren't tolerating it. That, that celebratory glass of champagne. You're paying for it on the other end much more than you used to when you were younger.

[A]

Let's talk about that. The timing hypothesis or the critical window. This is central to your argument of why women should be at least offered hormone replacement.

[B]

At least have the conversation.

[A]

It's the critical window which is important. But I'm not sure, do we have proper RCTs on this window yet?

[B]

The biggest RCT we have for hormone therapy is the Women's Health Initiative. Okay. And it was a randomized placebo controlled trial that looked at no hormone therapy versus in two very specific formulations, Premarin if you didn't have a uterus, or Prempro if you did. And then they followed these women for decades. Okay. They were on for 5 to 7 ish years.

[A]

Wasn't it conjugated?

[B]

Conjugated equine estrogen, which is Premarin.

[A]

Yes. Okay.

[B]

A very specific form of estrogen that actually comes from pregnant mare urine, which was a very rich source, but it contains multiple different estrogen compounds, not all found in humans, but that was the number one most prescribed estrogen at the time. So it made sense to use it. You know, why didn't they use estradiol? They wanted to use something that was clinically relevant that physicians would actually prescribe. Estradiol was not used. It wasn't commonly used in pharmacological options. So they used what was available on the market. Okay. And what they found was this is where the timing hypothesis, this is something we knew for a long time that when they looked at the younger patients, so the average age in the study was 63. But there were younger patients and there were older patients. But when they stratified the risk and the benefits based on age, what they clearly found was that before, in women in the study, before the age of 60 or within 10 years of their final menstrual period of their menopause, they saw that the benefits outweighed the risks, certainly. And for the, for cardiovascular disease, they did see in that group that the all cause mortality was decreased versus the placebo group. So death from any cause. And they did see that they had a low lower chance of heart attack and if they started young enough. So what we need now is a randomized controlled study just looking at these younger patients with the modern formulations. That's what we need to be able to fire with estradiol and progesterone or just estradiol if she doesn't have a uterus or with a marine iud. We have a lot more options now, so. But what people in the know tell me is that those studies are never gonna happen. That estradiol is cheap and you know, unless the NIH funds it, which the funding is dried up quite a bit during this administration, that we're just not in the right political, you know, politics is who decides who pays for funding from government institutions. We're just not there yet right now to be able to fund such a study. But I'm not giving up. I feel like we have an opportunity to get women motivated and galvanized now that we've got this black box warning off. There's a lot more attention. Women are talking about menopause, there's a lot more interest, there's a lot more, more funding from private sources going into this kind of research. So I'm not giving up.

[A]

No. And look, you can confer some form of data from observational data, right?

[B]

So that's how I counsel my patients, from observational data. This is what we see. Can I promise this for you? Absolutely not. But I know it's not going to be harmful if you're in this window. And it might be protective at best. Now what we do know, it protects for, that it's FDA approved for, Even though the U.S. preventative Services Task force is not caught up. Is prevention of osteoporosis clearly correct? Yes, we can prevent osteoporosis. That is clear. There's no arguing that data. If we start a patient, we can Prevent her about 50% chance of having an osteoporotic fracture with age as long as she stays on it.

[A]

Well, we've got the KEEP study, we've got the WIMS study. Like we've got three beautiful studies that actually correlate to lower osteoporotic events. And taking a woman who's actually been diagnosed with osteoporosis to normal bone mineral density in the matter of like, 12 weeks.

[B]

So when I'm counseling my patients and they're talking about potential prevention, I'm really focusing on the bone health benefits and what that could do for her and what the actual data is showing. If we don't do anything, lifestyle is very important here. So if you just stay on the course, what the actual risks are down the road, which are huge, one in two women can expect to have some type of osteoporotic fracture in her lifetime.

[A]

That just accelerates with age, mortality. Yes. So I'm a. I'm currently doing a systematic review.

[B]

Okay.

[A]

So I'm. So I'm an Alzheimer's disease researcher, and I'm now tasked with trying to understand the difference between is and this is related to brain health and dementia and Alzheimer's disease. Are we seeing, across the board, when we look at all the studies, mainly human randomized controlled trials, are we seeing that hormone replacement therapy is actually the cause of lower dementia incidence, or is it the fact that it's fixing the vasomotor symptoms associated with perimenopause? And what we don't have is we don't have the data. So I'm. Right now, I don't know. I'm very much on the bench. I'm very much, you know, pro hrt. I see it, especially given my area of expertise. But I'm right now, I'm Switzerland and trying to understand, is it the vasomotor symptoms that's helping an individual or is it the hormone replacement therapy? And even if it is, I still stand with hormone replacement therapy being a really great adjunct to lifestyle interventions. But look, if you're fixing the vasomotor symptoms, insomnia, that's going to help brain health, mental health, you know, depression is huge, as you mentioned. Hot flashes. Yes. Brain fog, another thing. So.

[B]

So have you looked into the care. The. Welcome.

[A]

Yes. At Dr. Lisa Moscone's work.

[B]

Moscone's work. So, you know, talking to her, when she started getting into the. There was no model to even study estrogen's effects in the brain. She had no tracer to track estrogen in the brain. She had to make one. And that took years. And so we just. There's so much opportunity here for us to learn. And there is interest now. And now private donations are coming and pouring in to study this. So I'm so curious to see what you find.

[A]

Oh, I can't wait. I'm so Curious as well now, particularly because I'm now really veering into female health and trying to really understand why 70% of all Alzheimer's disease cases are women. And we have a strong prediction that it's because a lot of the risk factors associated seem to peak during midlife. If you care about brain health, then you can't just think about what you eat. You have to think about what you breathe. Most cleaning products release volatile compounds that act as neurotoxins. This is why I switch to Branch Basics. Because I wanted a cleaner environment for both my home and my brain. Their concentrate replaces every cleaner in your house. No synthetic fragrance, no endocrine disruptors, just clean plant based ingredients. Now I use this for everything. The countertops, the laundry, even the floors, especially my kitchen. And it's crazy how much lighter my home feels without that chemical fog in the air. You guys need to go and try this. Branch Basics.com, use code NEURO to get 15% off their premium starter kit. Guys, I'm so bullish on this area of my life and trying to remove all of the toxins in my environment and this is a really great way to start. Branch Basics.com use code NEURO. I've talked about recovery, travel and movement, but here's something that most people literally forget about. Your feet. And I'm talking about what shoes are you wearing and what socks are you wearing? Because guys, I've been wearing hollow socks and honestly, they've changed how my legs feel after long flights or heavy training days. They're like compression socks, if you will. They're really, really long, but they are made from baby alpaca fiber, so they're lightweight, super soft, and way more breathable than anything synthetic. The compression is graduated, which means it supports circulation without that painful squeeze. I can wear them for hours and my legs feel fresher, lighter and more recovered sometimes. I know this is crazy, but I lay down on the floor at home and I put my legs up on a wall for like 10 minutes. I've got to tell you, it is so good for circulation. So if you're on your feet all day or you're training super hard or you're traveling often, you'll notice a difference in these For a limited time, Holosox is running a buy three, get three free sale. Head to HollowSocks.com to check it out. That's HollowSocks.com for up to 50% off.

[B]

What you guys say is, and I'm not an Alzheimer's specialist, is Alzheimer's is A disease with symptoms in. At the end of life that starts in midlife.

[A]

Oh, yeah. And the data is just, you know, and. And we do take Lisa's work into consideration with the glucose. You know, the drop in glucose metabolism in the brain. Bring energy metabolism.

[B]

Shall we talk about the brain eating itself?

[A]

Well, I don't want to say that just yet, but there's been some notable doctors, you know, who put us out, who actually also said that the brain consumes itself. And I think, you know, you've got over 3 million followers. How hard is it to get on and really push out this.

[B]

You know, soundbites are sound bites. And I've seen several esteemed colleagues have quotes taken out of context or just a little snippet. And the Internet goes wild. Look at the. The biggest one for me was when Rachel Rubin talked about the labia. Yes. Majora kind of atrophy. Atrophy. And so I wrote a substack about it. And then when I went to ask the public. So that's a website where you can see what's trending on the Internet. So I get curious sometimes. And so I type in menopause. And the number one after weight gain was the labial atrophy question. And I'm like, wow, all the things that women are concerned about. This was the hottest trending thing, was the appearance of the labia. And of course, there's functional things as well. So I wrote a substack, and it went viral, where I was just explaining the science behind it and what you can do. So a little vaginal estrogen goes a long way to maintaining the architecture of the area. It was just crazy what the Internet is gonna jump on. So I always take a deep breath and calm down. And so when I saw that clip go viral on the brain eating itself, I thought, you know, I watched the testimony where they talked. So. So let's talk about the science for your listeners of the demyelinization. So, yeah, you're the brain researcher.

[A]

Yeah, yeah, I can definitely talk about that. So the brain has around 87 billion neurons, and every neuron has around 15,000 connections. At birth, it's 3,000. As we do new things, it forms new connections, and it's a beautiful thing. And along the axon, we have. It's like the leg, I would say, of the neuron, we have this thing called the myelin sheath. Okay. And it's made of fatty oligodendrocytes. It's a type of brain cell. And this is what helps us with conduction speed.

[B]

You Know, it's the insulator.

[A]

It's in the insulator.

[B]

It's like the plastic around the cords. Yeah. Of your charger.

[A]

What I've done a lot of are electromyographies where we're picking up on ms, for example, and what we'd see is slow conduction velocity. That would mean that the myelin sheath is a breaking a part of that or it's thinning. But it turns out that the primary fuel source for the brain is glucose. We know that. Right. And as Lisa Moscone's research has shown, what we go through during perimenopause and postmenopausal women, we see a reduction in brain glucose metabolism. That means that the brain cell itself cannot uptake glucose the same way it would in your 20s.

[B]

And is that directly related to the estrogen receptor?

[A]

Well, yes and no. Okay. There is, you know, we believe that yes, it is, because there is. The estrogen receptor can't shuttle in. It's not no longer functional because there's no estrogen. So it can't shuttle in glucose as. As well as what it used to efficiently. So then the brain cell is like, okay, I need energy because it's a hungry organ. It needs energy to survive. It's the most vascular rich organ in the entire body. It says, well, where am I going to get my energy from? Where am I going to get my fuel from? So because it's so smart, it starts to catabolize the myelin sheath in order to produce ketone bodies to use as fuel.

[B]

This is the same thing that happens outside of the brain when we run out of glucose, which we all do. Like when we sleep, the body will switch to burning fat for fuel. That's a natural process, you know, when we're not giving it continuous glucose. So it just makes sense.

[A]

It does make sense. And that's what, you know, Dr. Roberto Brinton said at the. She didn't use the word eat itself. No, she used the word catabolize. But there's other prominent neurologists have said. Said that the brain consumes itself, but it's temporary. It's temporary. And so, you know, back to like this n of 1, right. So I spend. I split my time as a researcher then in neurosurgery. And we see, you know, there are no randomized control trials on some of the things that we're doing in the surgery. You know, I'm in a specific area, which is neuroplastic neurosurgery. Right. So we're doing reconstruction of skulls. And we're literally forming a whole new board certification. Well, not me, but my director is. And, you know, he's like, okay, we need to publish this. We need to publish it. So it's like, well, I don't have the data yet. So this just shows you that observationally, this is great because we're seeing it on our post. Surgical patients. And I just wish the whole world knew what academic research really involved. Yeah, brain fog is. I think it's also misunderstood. But why is it so big during perimenopause?

[B]

What we know in perimenopause is rather than what I was taught, and what I thought I understood was that estrogen had went through this slow, gentle decline until menopause, when it bottomed out, and then you were zero. What I didn't learn until about three years ago. And I have to give credit where it's due. Nanette Santoro did this work in 1996. She had women collect urine samples, God bless them, for six months, every single day. And she tracked metabolites of estrogen and progesterone. She did premenopausal patients, perimenopausal patients, and postmenopausal patients, and measured that across the board. And what she found and published, that never got widely circulated, was that in perimenopause, you know, in premenopause, we have this very predictable ebb and flow month after month after month. If you're having normal, regular cycles, it almost looks like an EKG. On day 14, your estrogen does this. On day 21, your progesterone does this, and it makes this very reproducible, predictable curve. In perimenopause, we go into chaos because ovulation begins in the brain, not in the ovaries. The ovaries just do what they're told. So when we reach a critical egg threshold level, the signals coming from the brain that used to stimulate an ovulation each month don't work. So the brain doesn't get the feedback of the estrogen level rising like it used to. It can't. It needs more. So the hypothalamus is like, hey, where's my estrogen? Talks to the pituitary, says, hey, pituitary goes, boss, I sent down the signals. I sent down my FSH and my lh and they said, send more. So we see these much higher levels of fsh, that kind force these ovulations. The timing becomes off. We see surges of estradiol higher, like, higher than we've ever had in Our entire life. Then we see crashes, we see delays in progesterone, never can quite keep up. And this chaotic pattern can go seven to 10 years before the final menstrual period, before you run out of eggs. And so that is where we realize there's chaos in our hormones, and that chaos feeds back directly to the brain. Not only is the brain not getting that regular ebb and flow, and for some women, we have cyclical, understandable fluct in our mood and in our brain function. And we're seeing it athletically as well.

[A]

Yes.

[B]

And so tying to our cycle, imagine in perimenopause, my toughest patients were my perimenopausal athletes who were competing in triathlons at a higher levels, who were like, I can't function like I used to anymore, or my lawyers, my, you know, people who are using so much cognitive function, you know, at work, who are completely struggling. So that's kind of where I started seeing the patterns was in perimenopause, things really calm down. And we rewire the brain after menopause. But it's Perry where we see the biggest drama.

[A]

Yeah, I have a friend. She is 42, about to be 43, and she messaged me. She's like, I'm late. I haven't had my period for two weeks. Not pregnant. And she's also experiencing like. She's like, I'm waking up at night and I'm boiling hot. I'm like, hi. I said, do you listen? You're one of my best friends. Do you listen to my podcast? And I said, I think maybe you're in perimenopause. Maybe you need to go and speak to somebody about it. Yeah. But let me tell you, her mother, irrespective of the BRCA gene, did have breast cancer. She's fine now, so she's petrified. And that's the first thing she said to me. She goes. She goes, I'm not doing that. I'll get breast cancer.

[B]

What we know is that women on estrogen only from the WHI had a 30% decrease relative risk of breast cancer versus placebo. It was only the women who were taking the combination. And it wasn't even statistically significant increase. It never reached 1 in 10,000.

[A]

Wasn't it out of.

[B]

Of versus baseline?

[A]

Yes.

[B]

So every woman has a risk of breast cancer. We have breast. Men have a risk of breast cancer. But then when you. So we. We take out the baseline, it was only one extra case per thousand per year. And again, everything. We take every aspirin Every Tylenol has its own particular risks and benefits, and so that's how I counsel my patients. This isn't HRT for everyone. This is nuance. This is precision. This is talking to her about her goals, her needs, and what we think it might be able to help her with.

[A]

Back to the brain fog. You know, it's this. This feeling in the front of your head where you feel all cloudy. I know you mentioned, like, the hypothalamus and the regular periods, but do you think it's also due to the fact that they're not getting into deep sleep? Not activating the glymphatic system?

[B]

And the glymphatic system, yeah. So lots of great sleep research coming out across the transition. I wear one of these trackers. Lots of women are wearing trackers. And anecdotally that data is being collected. And so when the neuro researchers are looking at it and looking at. And they're also putting in their menstrual history, there's a lot of patterns coming up where we're see loss of deep sleep. We're not clearing out those proteins through the glymphatic system. You know, we need a lot more research here. But the observational data is showing a correlation. I mean, I really focus on sleep with my patients.

[A]

Oh, wow.

[B]

So I'm like, sleep is number one, you know, for heart health, for brain health, for mental health. If you're not sleeping. We've got to start here and focus.

[A]

I don't know if you've seen this, but you might like this for your patients. There's new human data out that shows that you can activate the glymphatic system as well. Well, through just here. If you were to massage your face. Yeah, I can send you the data.

[B]

Oh, my God. I want to see it.

[A]

I'm gonna do a reel on it. We've had Dr. Kellyanne Neotis on the podcast and she's also mentioned this as well. And so she's getting her patients to actually do this form of lymphatic drainage on her face. On their faces. To.

[B]

Amazing. I'd love to see it.

[A]

Which can actually eliminate amyloid beta. Wow. Yeah. Do you have patients coming in with cognitive deficits?

[B]

I mean, I'm not measuring them, so we're not doing the, like, cognitive testing. They're coming in complaining of brain fog, difficulty functioning at work. The data out of the. I think it was the uk. One in five to one in ten women are quitting their jobs in menopause because they don't feel like they can complete their jobs. Not now. Some women quit their job because they hate their job. And it's menopause. Does this wonderful thing where we can finally circle the wagons.

[A]

Yes.

[B]

And put ourselves first.

[A]

Like the We Do Not Care Club.

[B]

The We Do Not Care Club. Like, look, this job is not serving me.

[A]

Me.

[B]

I'm better off not having this particular position. But these are my patients coming in who love their jobs, who are thriving in their jobs, who were ready to lean into this, you know, their wisdom and their leadership, and they are struggling because of cognitive deficits at work. So these are the patients where I'm. I'm really trying to help, you know, help them figure that out.

[A]

Part of my routine of eliminating toxins for better brain health and overall longevity is about removing the toxic burden that I place on my body. And one of the smartest things I've done is switched all my makeup and all my skincare products. You know how I always say that your brain and your body are connected? Well, your skin is a part of that story. When your skin barrier is strong and inflammation is low, it shows. That's exactly why I changed all of my products to Jones Road Beauty. Their daily moisturizer and face wash are simple, clean, and support skin health without the harsh chemicals or fillers. That's right. Right. No fillers. It's skin care that actually respects your biology. I use them after training or when I'm traveling. I actually use them 24 7. I don't use any other product. If you want to look at this, even if you want to look at the ingredients list, you can go to Jonesroadbeauty.com use code NEURO. You will get money off and you'll get this free gloss with your first purchase. Just go on their website, have a look at the ingredients, have a look at what they offer. Try it out. Try the face wash out because you won't be sorry. I've become more bullish on testosterone. We've got our own approved testosterone for women in Australia. Here it's not. But off label, you can prescribe it.

[B]

We have great data for sexual function.

[A]

For sexual function, yes. But the data on women feeling like themselves again, like, motivated to go back to work, invigorated is fantastic.

[B]

I'm seeing that clinically, but I'm not making claims to my patients that this is gonna turn your life around. You know, I might share a patient anecdote or something and I'll be like, let me know if you're noticing other aspects of your life that are improving. But I really focus on, for them, if they have sexual dysfunction, where it might be helpful for them.

[A]

I think I heard you mentioned or someone mentioned that the divorce rate seems to skyrocket in menopause.

[B]

So the gray divorce is. And it's funny, those are another viral video on social media whenever I talk about divorce. So this all started. I have a patient who was a divorce attorney, and she comes. She came to see me, and we're just chatting in clinic. And she said, you know, she was from the south and had this cute little accent. You know, I think part of my patients are divorcing because of menopause. And I said, really? Why? And she said, the untreated general urinary syndrome of menopause, and that they're feeling kind of forced to perform and they're having pain and no one's addressing it. And when they go through the divorce proceedings, it comes out that they were. They felt abused, you know, physically, and that, you know, that was a huge contributing factor to their. To their marriage ending. And they want their pound of flesh back.

[A]

Oh, gosh.

[B]

In the divorce. And so I was like, wow, reeling from this, you know, And I talked about it on social media, and there was really two camps. It was women saying, yes, yes, yes. Like, menopause changed me, and therefore my husband couldn't relate to me anymore, and he loved, left me. The other half of women felt very strongly that it gave them permission to leave a marriage that wasn't serving them. So it was very, very stark, the divide of, like, no, he was an asshole, and menopause gave me the power to leave, you know, and the other half were like, it. It destroyed my marriage.

[A]

What is the urinary genital.

[B]

Great question. Thank you for asking. Genital urinary syndrome of menopause. You'll hear here it's also been called senile vagina. Okay, horrible term. It's been called vaginal atrophy. So basically, our tissues in the urethra, the tube that drains the bladder. The bladder, the tube of the vagina and the labia, the whole general urinary system, from the pubic bone, basically, all the way back to the anus, exquisitely sensitive to estrogen levels. So when those estrogen levels decline, we see the tissue of the labia majora, labia minora, bladder, urethra, vagina, thinning, losing elasticity, losing its ability to produce mucus, therefore, lubrication, also losing the microbiome. The microbiome changes, therefore making us more. All of that Makes us more prone to urinary tract infections. Okay, so women come in with a very, like, beat up, bruised, you know, general urinary system. They can't tolerate intercourse. It's absolutely horrible. You know, their doctor says use some, you know, lubricants can be helpful here, but they're not fixing the root cause. And everyone's terrified of estrogen and don't understand the nuances between vaginal and even doctors between vaginal, estrogen and systemic. And these women aren't getting properly treated for something that almost all women are going to have some degree of. And it is contributing to the lack of intimacy, which starts eroding away in a marriage.

[A]

Have you heard of PRP and vaginal rejuvenation? So Kim Kardashian's on this new TV show with. Oh, gosh, Naomi Watts.

[B]

Naomi Watts.

[A]

Because we just met Naomi at her event that she had here. And God love her, this is all's fair.

[B]

Yeah, I haven't seen it yet. I just watched the clips.

[A]

So there is this scene in the second episode, right, where, you know, Kim is saying she's doing things for herself. She's got a divorce. And she's like, I went and had PRP rejuvenation. She got PRP into her vagina. She's like, now it's big, it's fluffy. It's back to what it was when I was 20. And then Naomi Watts is bringing up NAD as the Holy grail for inflammation during menopause. And I'm like, firstly nad. No, they also said nad. And I just feel like there's just so much marketing around menopause right now. Spotlighted and now on the big screen on Hulu.

[B]

Wow.

[A]

Yeah. And I thought prp.

[B]

I don't know who they did the. Did the research.

[A]

I don't know who did the research because they actually didn't even. They said nad.

[B]

When we talk about longevity for women and when we talk about what happens to the body in menopause, when we look at all of these, you know, gadgets, you know, the red light therapy, the cold plunges, the sauna, if you are not eating, a plant focused, protein rich diet, if you are not sleeping at least, you know, eight to nine hours at night, if you are not managing your stress, none of that is gonna be helpful. Like, we have to get back to the basics here. That stuff is like the sprinkles on the top of the cake. And the data is, you know, not great for women. And we're basically packaging all this done on mostly Young male athletes and. And saying, here, here you go, menopausal woman.

[A]

Yes.

[B]

Now for the rejuvenation of the vagina. There's, you know, this is misogyny. This is patriarchy. This is, you know, but also female empowerment. You know what? If you want your vagina to be fluffy and all those things, you know, you have the right to be able to do that, but the evidence is not great. The best thing you can do for your. All vaginas need estrogen, all of them, and it's healthier with it. So if you're not doing estrogen first in the vagina, doesn't matter. The PRP and all the things and the lasers, you know, none of that is necessary. Estrogen. Vaginal estrogen is safe, efficacious, and it's gonna work almost 100% of the time.

[A]

Oh, my gosh, I love that. No nad is going to make your vagina bigger than. More so than estrogen. More fluffy. More fluffy. Okay. You wouldn't describe it as the miracle, right? Because during my, you know, my early 30s, when I was doing all this research, I was like, okay, the holy grail here is actually weightlifting.

[B]

Well, what are we looking at? What are your goals? You know, when we talk about weightlifting, if you're talking about osteoporosis prevention, frailty prevention, diabetes prevention, strength training, and maintaining your muscle mass is probably one of the best things you can do.

[A]

What do you say to a woman who says to you, I want to do this all without hormone replacement therapy? Great.

[B]

Okay, first of all, I ask why, like, is this a decision based on facts and not fear? And if we have that discussion and she's still like, I'm not interested. That's her right. I'm totally down. Not all my patients choose hormone therapy.

[A]

What if she says, because this is what I received, like, there was a reel of mine, as we mentioned, went viral. There's around 8,000 comments. And I was like, reading through them and they're like, yeah, but hormone replacement therapy, you know, our grandmothers lived to 90 and they didn't take HRT and they were fine.

[B]

Maybe your grandmother lived to 90. But when we look, you know, we haven't lived as a population. When we look at populations, science, it's only in the last 50 to 75 years that women have really significantly outlived menopause as a population. So we have artificially extended our lives with good nutrition, with vaccines, with plumbing, with, you know, the things that killed people. They weren't dying of heart attacks. They were Dying of saber toothed tigers eating them. They were dying of, you know, not having access to antibiotics. They were dying of infections. So now we, we've kind of fixed a lot of that and we have people living 30 years without the benefits of their estrogen. So this is really kind of a new time where we're seeing 51% of the population living without the benefit of their hormones now replacing those hormones. How much of that is that going to extend their health span and their lifespan? We're not sure because we experimented with it for about 20 years and then we took it away. So we don't know how much of that is going to really improve. We know it's going to decrease our risk of osteoporosis and fracture and that is a huge.

[A]

Extend life.

[B]

Yeah. And you know, most of my patients don't wanna live to 120. They don't care if they die at 100. They're not in this to be shirtless on the COVID of Vogue, you know, like some of the science bros. They're not interested in that. No, they just don't wanna be a burden on their families as they age. They wanna live as independently as long as possible. And that looks very different than what most of the men I see on the Internet talking about this and so talking about, you know, longevity. They want to be able to love their loved ones, take care of themselves and live a pretty pain free life.

[A]

And remember their daughter's names and some of the experiences that they had throughout their life.

[B]

So how much HRT can be helpful for that, we don't know yet.

[A]

Yeah, I think one of the beautiful things that I've learned from you is that women's healthcare is political because it has to be, because we have to make, we have to set policies. But as Dr. Vonder Wright says, a woman in care is apolitical and she should have the choice to be on hormone replacement therapy if she feels it's best suited for her or not. Exactly.

[B]

Yeah. So what I tell these patients who are like, you know what, it's not for me, I don't want to do it. Not everyone tolerates it, you know, is okay, we really have to double down on all the lifestyle factors and then we treat each symptom accordingly. But we have non hormonal options for hot flashes. So like you said, you know, how much of dementia is the neurokinin receptor versus the loss of estrogen? Right. The hot flashes contributing to loss. So is vioza. Are those type of drugs the neurokine and agonist going to be a player in decreasing the rates of dementia. These drugs just came out, we don't know yet.

[A]

I think the only thing that's Misunderstood still is 45 year old woman comes to you cycles still every 28 to 30 days. She's having all the vasomotor symptoms.

[B]

But your tshirt estrogen, TSH is fine, Fine.

[A]

Estrogen, progesterone, one to one ratio, everything's fine. Blood work wise, even if you do a timestamp and do her blood work every single day for five days, blood work seems fine.

[B]

We do a trial and see if she gets better.

[A]

And there's nothing wrong with her.

[B]

It's low dose. Yeah. It won't suppress her ovulation if we do a low dose estradiol patch or something.

[A]

Why would it suppress her ovulation?

[B]

It's not high enough dose to suppress the ovulation. So she's still gonna have her normal, you know, cycling in the background. But what we do is take out some of the chaos. We're gonna stabilize things a little bit so the brain is not looking for that estrogen.

[A]

Can a woman still fall pregnant on hormone replacement therapy?

[B]

Yes, absolutely. So if contraception is an. I always address that first. What are you using for contraception? We have to get this addressed. So a birth control pill might be an option for a perimenopausal patient because she also needs contraception if she's having cycle irregularity where her cycles are super heavy. You know, a birth control pill might be an option for her as well.

[A]

Yeah. I'm seeing so many women actually message me saying I'm perimenopausal. I had stroke, struggled to fall pregnant because now that I fixed my hormones and I'm in, I'm 43 because I felt pregnant. I'm like, good for you. That's amazing. We're going to finish off now. I mean, I wish I could. I don't even know where we went with the podcast. I've got all these notes here if you guys are following on YouTube. I don't know what, I didn't even look at them. But I love what you're doing. Where do you see this whole sphere menopause going in the next 10 years?

[B]

I think that women are aware of it. They're talking about perimenopause. The boomers are pissed. The Gen Xers are not standing for this. The millennials and all the kids coming up behind us, it's becoming part of their vocabulary. They're learning they're not afraid. They are wanting to get ahead of it. I have more and more patients coming in at younger ages just wanting to get educated and get ahead of this so that they can transition as well as possible. What they don't want is to be blindsided like our generation, our mother's generations were.

[A]

Oh, I love that. Well, Dr. Mary Claire, thank you so much for coming on the podcast.

[B]

So happy to be here.