Dr. Mary Claire Haver on The New Perimenopause

Summary

---

Podcast Summary: This Is So Awkward

Episode: Dr. Mary Claire Haver on The New Perimenopause

Date: June 23, 2026
Hosts: Dr. Cara Natterson & Vanessa Kroll Bennett
Guest: Dr. Mary Claire Haver

Main Theme

This episode dives into the realities, biology, and myths surrounding perimenopause, guided by Dr. Mary Claire Haver, author of The New Perimenopause. The hosts—whose mission is to bring clarity, reassurance, and humor to puberty—bring the same approach to the topic of perimenopause, exploring its timing, symptoms, brain effects, and the importance of education and self-advocacy for women and caregivers.

---

Key Discussion Points & Insights

1. Perimenopause: Timeline and Universality

• Definition and Timing:
  Perimenopause is a 7-10 year transition state leading up to menopause (which occurs, on average, at age 51 in the US, normal range 46-55). Perimenopause can start as early as the mid-30s but is definitely present by the mid-40s.

  • Dr. Haver: "Perimenopause is not optional. It happens to 100% of us who live long enough. This is a scheduled expiration date for every single one of us the day we're born." (01:40)

• Not a Single Moment:
  Perimenopause is a process, not a moment—mirroring how puberty unfolds in stages rather than overnight.

2. Brain Changes: The Bookends of Puberty & Perimenopause

• Brain Rewiring:
  Both puberty and perimenopause are periods of neurological reorganization:

  • Dr. Haver: "Just like puberty rewires the human brain, the menopause transition—perimenopause—rewires the female brain to be better functional in the last 30 years of her life." (04:21)

• Symptoms & Mental Health:
  Cognitive and mood disturbances during perimenopause are real and driven by biological processes—fluctuating hormone signaling causes the brain to react, often resulting in brain fog, executive function losses, and spikes in mental health disorders.

  • Statistics: "We have a 40% increase in mental health disorders across the menopause transition... SSRI prescriptions double." (12:24)

• Hormonal Feedback Loop:
  As ovarian response falters, the brain increases LH and FSH output, leading to irregular and sometimes explosive hormone levels.

• Placebo Effect and Validation:
  Simply being heard and having symptoms normalized is powerful, as many women feel seen for the first time in medical encounters.

  • On validation: “For patients, just knowing that they’re not crazy, that there’s a cause... very realistic expectations of what hormone replacement can and can’t do… they’re just getting so many parts of their lives back.” (52:03)

3. Tracking & Future Tech

• Hormone-Tracking Wearables:
  There is research and development underway for wearables that could track hormonal patterns (with more success currently for sleep and temperature than for hormones like estrogen/progesterone).

  • Dr. Haver: "How do you measure something that goes into chaos for seven years? … Not there yet with the data." (18:27)

• Screen Time and Modern Stressors:
  Unprecedented levels of screen exposure affect both youth and adults' brain health—an evolving area where more data is sorely needed.

4. Estrogen’s Whole-Body Impact

• Master Regulator:
  Estrogen acts on virtually every organ system—not just reproduction. Its withdrawal in perimenopause impacts the heart, kidneys, bones, muscle, skin, and more.

  • "It is a master regulator for almost every organ system in our body.” (24:19)

• Delayed Motherhood & Overlapping Life Stages:
  Increasing numbers of women have children later, plunging some directly from postpartum into perimenopause, amplifying both strains.

5. Musculoskeletal Health and Bone Loss

• Rapid Bone Loss:
  The most rapid loss of bone density occurs in perimenopause—not simply late post-menopause.

  • “The fastest acceleration of bone loss is in perimenopause … we can lose 20% of our bone density in the four years around menopause.” (28:29)

• Importance of Early Bone Banking:
  Building bone mass by age 25 (“bone bank”) pays dividends, highlighting the importance of high-impact exercise and weight training in youth and beyond.

• Prevention and Intervention:

  • Lifting weights, jump training, adequate calcium, and (if appropriate) hormone therapy are all tools.
  • Weighted Vests:
    Dr. Haver advocates for weighted walking and vests as one component of building or preserving bone, though it shouldn’t replace other forms of resistance or impact activity. (33:40)

• Access to Bone Density Testing:
  Insurance often only pays for DEXA scans after age 65—a “horrible mistake,” says Dr. Haver. All women should know their bone density status younger.

6. Testosterone & Sexual Health

• Women’s Testosterone:
  Women lose about 50% of peak testosterone by menopause, with variability in levels and effects.

  • “Testosterone has a lot to do with muscle.” (41:36)

• Clinical Use & Regulation:
  No FDA-approved formulation for women yet—current practice borrows tiny fractions of the male gels or compounds, with mixed reliability and calls for regulatory improvement.

  • “We don’t have an FDA approved formulation for women. ... So what we do in the meantime is we either compound it or we borrow the men’s version.” (44:05)

• Testosterone's Effect on Desire:
  Works centrally (in the brain) for libido, primarily for those distressed by low desire—normalizing variability in women’s interests in sex.

• Destigmatizing Therapies:
  Placebo and expectation effects are notable, but therapies like vaginal estrogen and testosterone can have real, measurable health impacts (e.g., UTI reduction, improved sexual function).

7. Advocacy, Research Gaps & Empowerment

• Systemic Neglect:
  Menopause research receives less than 1% of major healthcare funding—most goes to new drugs, not holistic understanding or preventive care.

  • Data Needed:
    "Menopause gets less than 1% of the funding.” (20:48)

• Power in Education:
  Healthcare must prioritize teaching and validating women’s experiences rather than dismissing or pathologizing them.

  • Dr. Haver: “When you educate a woman, nothing bad happens. When you explain to her why this is happening, nothing bad happens.” (28:10)

• Cultural Bookends:
  The episode draws parallels between puberty and perimenopause as inflection points demanding more openness, practical guidance, and community for positive change.

---

Memorable Quotes & Moments

• "Perimenopause is not optional. It happens to 100% of us who live long enough." — Dr. Mary Claire Haver (01:40)
• "Just like puberty rewires the human brain, the menopause transition—perimenopause—rewires the female brain to be better functional in the last 30 years of her life." — Dr. Mary Claire Haver (04:21)
• "We have a 40% increase in mental health disorders across the menopause transition. I think we doubled the use of SSRIs." — Dr. Mary Claire Haver (12:24)
• “The fastest acceleration of bone loss is in perimenopause. ... We can lose 20% of our bone density in the four years around menopause.” — Dr. Mary Claire Haver (28:29)
• "Every vagina needs estrogen. The end. And if you can't make your own, we gotta put some there." — Dr. Mary Claire Haver (49:20)
• "When you educate a woman, nothing bad happens." — Dr. Mary Claire Haver (28:10)
• "For patients, just knowing that they're not crazy, that there's a cause of this, that they didn't do anything wrong… they're just getting so many parts of their life back.” — Dr. Mary Claire Haver (52:03)

---

Timestamps for Highlight Segments

• Perimenopause Onset & Universality — 00:30, 01:40
• Brain Changes, Mood, and Hormonal Signaling — 04:21, 08:15, 12:24
• Mental Health Statistics and SSRIs — 12:24–12:59
• Wearables and Hormone Tracking — 18:20–20:08
• Screen Time & Tech Stress — 20:17–22:33
• Estrogen’s Role in Organ Systems — 24:19–25:24
• Bone Loss, Bone Banking, Weighted Vests — 28:29–33:40
• Testosterone, Libido, and Women's Health — 41:36–49:20
• Therapeutic Practicalities & Placebo — 52:03–55:28
• Validation & The Power of Conversation — 52:03–54:05

---

Tone & Takeaways

• The conversation is candid, science-driven, humorous, and deeply empathetic.
• Dr. Haver passionately blends hard data, clinical anecdotes, and advocacy—calling for societal normalization and medical empowerment of perimenopausal women.
• Listeners are left with a sense of validation, practical tips (bone health, weighing exercise options, knowledge about hormone support), and a call to equip oneself with knowledge and advocate for better care.

Final Word:
This episode is a clarion call to place perimenopause in the same category as puberty—a shared, universal experience worthy of open discussion, education, and respect.

---

Transcript

[Commercial Narrator]

Study and play come together on a Windows 11 PC. And for a limited time, college students get the best of both worlds. Get the unreal college deal everything you need to study and play with select Windows 11 PCs. Eligible students get a year of Microsoft 365 Premium and a year of Xbox Game Pass ultimate with a custom color Xbox wireless controller. Learn [e-mail] studentoffer while supplies last ends June 30 terms at aka mscollegepc.

[Dr. Mary Claire Haver]

Perimenopause, which basically when the brain starts glitching because the ovaries can't respond in the usual fashion because enough eggs have been lost, is a 7 to 10 year transition. And so definitely by 46 you are somewhere in the process this is happening. Like perimenopause is not optional.

[Cara]

Hi Mary Claire, welcome. Welcome back to the podcast. We are so happy to have you here.

[Dr. Mary Claire Haver]

Thanks for having me.

[Cara]

So you are out with a new book which is called the New Perimenopause, a follow up to your big blockbuster, the New Menopause. And it feels like the right place to start this conversation given where our audience is all converge is what's the youngest starting point that we're looking at when we talk about perimenopause? I mean, is it or is this people in their 30s? Is it people in their 20s?

[Dr. Mary Claire Haver]

That's a great question. Yeah, let's break down the statistics around it. So when we talk about menopause, so when you're, you know, you have no more periods, the ovaries have shut down. Right. That in average in the US is 51, however normal. So under the normal curve is 46 to 55. Okay. Perimenopause, which basically when the brain starts glitching because the ovaries can't respond in the usual fashion because enough eggs have been lost, is a seven to ten year transition. So let's just do math. Let's take the most extreme case, 10 years and the most extreme case of perimenopause. You know, so 46, as your menopause now we're still this is normal. This is outside of premature ovarian insufficiency, surgical menopause. This is just a woman going through her life. It isn't so 35, 36, you know, that's on the young end, but it's possible. And so definitely by 46 you are somewhere in the process, like this is happening. Like remember, menopause is not optional. Perimenopause is not optional. It happens to 100% of us who live long Enough. This is a scheduled expiration date for every single one of us the day we're born.

[Cara]

So basically, we tell our audience endlessly that the brain doesn't fully mature until they're nearly 30, sometimes older. And basically the path that we are laying out for them right now is just about when your brain is done baking and you can make really great decisions. You are entering into this, maybe entering

[Vanessa]

into this stage of life, then the other crap starts. It's just like. It just like goes from. It just goes from one to the other. I'm Mary Claire. I'm working really hard not to swear on the podcast anymore. Good luck. I know it's very hard. So I'm coming up with synonyms for the words that I really, really want to use when referring to, to all of this. One of the things I love about how you frame perimenopause in the book is twofold. One, that it's a. It's a transition, right? It's a process. It's not a moment. So I want to talk about that. And two, in relationship to that, and you just touched on it, that it starts in the brain. And you know, for. For those of us who live who swim in the puberty waters and talk about how that starts in the brain, it's like this beautiful bookend thinking about perimenopause. So can you talk about a. How it's a. It's a journey. I'm trying to be positive and optimistic.

[Dr. Mary Claire Haver]

No. So just like puberty rewires the human brain, the menopause transition, perimenopause rewires the female brain to be better functional in the last 30 years of her life. And for some women, a lucky few ones, they don't even notice it. They're just like, da, da, da, da da, my period stop one day and yay. But for most of us, you know, it can be really life altering. And what the problem is, we can talk our children through puberty, right? We can provide resources. We can do all these things. We had nothing, nothing for perimenopause. So let me explain, kind of, let me do some basic endocrinology and dig into science a little bit. So in our normal reproductive lives outside of menopause, menopause is not entered the child. So human females are born with all of our eggs and there's only like five species of animals that go through menopause. So we're kind of unique. It's kind of cool.

[Vanessa]

I actually did not. I didn't know that. Who are the other what are the other species?

[Dr. Mary Claire Haver]

A few species of whales, which are very matriarchal, and some giraffes, some very specific giraffe does it. So we're born with a said egg supply. Men, you know, we have ovaries and testes, you know, the same organ. Basically. If you take an embryo out at, you know, 10 weeks, it looks the same. And. But men. So that factory can reset itself and makes fresh material, genetic material, every single day until they die. Okay, fine. Yay for them. Back to us. We go through meiosis 1 and get frozen, like, while we're in utero. And those eggs get frozen in the first differentiation of when the egg cells are formed. And they sit there until ovulation, just like that, frozen in time. Then through this process called atresia, which we actually don't understand very well because no one studied it, we start losing egg supply from the minute the eggs are formed. So at birth. So, like, when the eggs all kind of differentiate from this primordial soup that makes people. We got about 4 to 5 million. By the time we're born, we're down to 1 to 2 million. Okay, then by the time we're 30, we're down to 10% ish of our original egg supply. And by the time we are 40, we're down to 3% of that original egg supply. So that's quantity and the quality of that egg, the genetic quality of that egg. We're taking hits from the environment, from nutrition, from X rays, from all of the things that can disrupt any part of our body. Right. This genetic material is just getting banged on. You know, men can recover from that so much faster because for most of them, they just keep making fresh stuff, you know?

[Cara]

Right. And their machinery has broken down a little. So, like.

[Dr. Mary Claire Haver]

Yeah, yeah, yeah, yeah, yeah. I don't want to. I don't want to make the male experience smaller than. Than it is. And they go through their own stuff. But I'm an obgyn. I don't even think about them. So, you know, that's not my. That's not my jam. I'm like, what about us?

[Vanessa]

And so leave the testicles to somebody else.

[Cara]

I. I just want to make it clear that they have their own. They have their own waxed aging process.

[Vanessa]

Car is obsessed with the concept of male menopause. We're not going to allow her to go there because it's. Yeah, wait, but you're talking about. So we're talking about what's happening in the ovaries, but in the right. As that process happens.

[Dr. Mary Claire Haver]

What's happening in 25? You are partying all night. You're getting up at 8 in the morning with a. With a stamp on your hand.

[Vanessa]

You're going to work, no problem.

[Dr. Mary Claire Haver]

You're ovulating every month on a dime. Now, I'm not not talking about women with PCOS or endocrinologic dysfunction. I'm talking about the 90% of us who ovulate on a regular basis. The ovaries don't ovulate without being told to.

[Vanessa]

Okay?

[Dr. Mary Claire Haver]

This is so important to understand. They don't ovulate on their own. They must be told by hormones from the brain. Okay? So we have a hypothalamus and pituitary gland, and this is very tied to puberty. So the hypothalamus make something called GnRH, which talks to the pituitary. We make our LH and FSH, which start becoming pulsatile and tell the follicular and the granulosa cells around the little egg, the genetic material. Okay, we're gonna ovulate now. Okay? So we ovulate, we get this burst of estrogen mid cycle as females. Then we get our progesterone hump towards the end. And then the brain, okay, so the hypothalamus and the pituitary is like, I love estrogen. I love estrogen. Estrogen is won. Estrogen levels naturally drop to their baselines in a cycle. The brain is like, whoa, whoa, whoa, whoa, whoa, whoa. I want that estrogen level back up. That's when it starts sending the hormones again. So LH and FSH fluctuate normally. So does estrogen and progesterone. So if we plot our cycles, month after month after month, if we look at those four hormones, lh, fsh, estradiol, and progesterone, we see an EKG ISH pattern. Very repeatable, very predictable for a healthy person, you know. You know, on day 22, she's going to do this. On day 19, she's going to do that on day, you know, and then she's going to ovulate and the whole thing's going to restart. Okay? All of this is dependent. The signals coming from the brain, the ovaries doing their job. What happens? As we lose our egg supply, the ovaries become resistant to that signal. Okay? You don't have enough eggs to respond. Healthy eggs respond in the right fashion. Okay? So signals come down. First month of perimenopause, the ovaries are like, trying not. It's not happening. Not Happening at the right time. It's not happening. Well, the brain is like, you know,

[Vanessa]

like, thank you for meeting me in my estrogen.

[Dr. Mary Claire Haver]

Where are my, you know, where's my feedback loop? It's not getting it. So it's like, well, we must not have sent enough stimulating hormones down. So it starts pounding the ovary with higher and higher levels of fsh, which. One of the ways we diagnose menopause is super high levels of FSH, right above 50 to. To force those last few eggs to respond. So what happens is what used to look like an EKG becomes estrogen. We have delayed cycles, and then when we do ovulate, sometimes two eggs kick in because the FSH levels were so high. So we get these explosive levels of estradiol, only high, as we've seen in pregnancy. Progesterone can never quite keep up like it used to because the follicles aren't as healthy. And so now it becomes. I take four strands of spaghetti, throw it at the wall, and here are your cycles for the next seven to 10 years. Okay. The brain, our brain, both mental health and cognitive health is heavily tied to this process. What happens in the end? Dopamine, oxytocin, serotonin, norepinephrine. Same thing that's happening in puberty. Like, the brain is used to knowing what's coming. Right. And all of these neurotransmitters are tied to the same hormone levels. Also, brain glucose utilization is heavily tied to estradiol levels. Right.

[Vanessa]

So we're going to get into this because Cara and I have been thinking a lot about this, again in the context of puberty, but in this context, I want to explore this because it's so fascinating, and I think people really don't know it. And I want to make sure that I can't stop thinking about. Someone was telling me a story recently where they had to do their prep for their colonoscopy, and they were taking the stuff that they needed to take, but it, like, wasn't kicking in. And so they started to take, like, more and more of the stuff in the effort to get it to kick in. And I. When you're talking about LH and fsh, all I could think about was, like, someone prepping for a colonoscopy and the brain being like, here, no, no, no, no. Take more, take more, take more. And it's. We don't think about it. We think about it in the physical sense, but in the brain sense. What does that mean, do to us? Like, what. How does that impact us.

[Dr. Mary Claire Haver]

So we're working out on a biochemical, mechanical basis, like, exactly what's happening. And lots of, like, the neurologists are looking at it like the state is exploding. But when we look at the data, as far as we have a 40% increase in mental health disorders across the menopause transition, I think we doubled the use of SSRIs. Like, we have a big increase in SSRI prescriptions across the menopause transition. 10% of women are on SSRIs pre menopause, and it goes up to 20% and then hits 25 at age 65.

[Cara]

So, wow.

[Dr. Mary Claire Haver]

Like, hello, wow. Brain fog. Hard to quantify. Why? Because the studies we use for cognitive decline are for dementia. Right, Right. So it's like, does she have dementia or not? Brain fog is, I can't find my keys. Dementia is I don't know what these keys are for. Okay, so when you're measuring the most extreme end, so say, you know, my patients stay at home moms with 10,000 responsibilities. Right. Doctors, lawyers, you know, whatever their job, like, they were functioning at this level. Now their executive function has taken a hit. They don't have dementia, but they can't do their jobs, they can't do the activities of their lives that they've set up to do. They are struggling, they're quitting, they're changing. They're not embracing this time of life. We're supposed to fly. And so that's hard to quantify because we don't have the test for it yet. Like, how do we diagnose brain fog? Well, she said so. So seeing if someone gets better, you know, in science, we have to measure everything. And I get that. But, like, what I'm seeing in my clinic is, and we know from a mental health perspective, women who have new onset of mental health disorders at the, you know, perimenopause. She was fine before, or she was fine on meds, and now she's not. Right. With no changes in her environment. Right. No. No new stressors or anything. They do better giving them HRT instead of a new, new start. Ssri or doubling, you know, adding a second med. You could. Like, if she's been on Prozac, you can add hrt. So, like, like, that data is now coming to the forefront. And I talked a little bit about

[Vanessa]

it in the book.

[Cara]

We'll be right back. But first, a word from our sponsors. Raising tweens and teens can feel totally overwhelming. So can finding a therapist to support you, not to mention one who actually takes your insurance. That's where most online therapy platforms really fall short.

[Vanessa]

I've had times when I needed to find mental health providers but found it impossible to find a therapist online who took my insurance.

[Cara]

Rula does things differently. They offer therapy from licensed professionals for an average copay of just $15 per session. Go to rula.com Tisa to get started today. That's R U L A.com T I S A for quality therapy that's covered by insurance.

[Vanessa]

RULA is engaged with 120 insurance providers and a diverse nationwide network of over 23,000 licensed therapists and psychiatrists so you can find the right therapist for you based on your needs and state requirements. Thousands of parents are already using Rula to get affordable, high quality therapy that's actually covered by insurance and helping them and their families. And so can you visit rula.comtisa to get started? That's R u l a.comt I S A Tweens and teens have a lot to worry about with periods, leaks and sleepovers and during sports, even managing periods at point summer camp. But KT period undies are a total game changer.

[Cara]

I mean Vanessa, they do not scream period underwear. And with fun colors and styles, teens want to wear them. It's a total win. I mean seriously, you put them on and some styles have the same absorbency as super tampons. They even make great period swimwear so that girls can swim on their period. Whether it's a pool day at summer camp or just hanging out with friends, there is no sitting out or stressing, just confidence in and out of the water.

[Vanessa]

So if you have a teen girl, I would hands down recommend kt. It's not just underwear, it's giving our girls the confidence they deserve. Go to nix teen.com that's K N IX teen.com and use code awkward for 15% off. That's K N I X teen.com code

[Cara]

awkward Vanessa Summer always makes me rethink my wardrobe. It's when I go from freezing to boiling. And that's why I keep coming back to Quince.

[Vanessa]

Totally. Quince has beautiful everyday pieces like 100% linen pants, dresses and tops with styles starting at $32. Kara the pink linen shirt I'm wearing in our new headshots is my fave from Quince. And I know you have not put down your new quince purse since you got it. And it's not just clothing. Quint has become a destination for elevated essentials across home, kitchen, bedding and beyond, making it easy to bring A luxury feel into everyday life.

[Cara]

So elevate your summer wardrobe. Go to quint.com awkward for free shipping on your order and 365 day returns. Now available in Canada too. That's Q-U-I-N-C e.com awkward for free shipping and 365 day returns. Quince.com awkward I have two separate questions. You can pick one or the other or you can find a way to weave them together. One question is where is the place for a wearable? I want a wearable that measures my estrogen and progesterone, but I want to know my hormone levels and see how they fluctuate. I'm wondering if the future holds that and then I'm going to hold my second.

[Dr. Mary Claire Haver]

There are companies looking at this. They contacted me, me because everybody wants to talk to Mary Claire.

[Vanessa]

Because you're the queen of following.

[Dr. Mary Claire Haver]

You know, listen, how do you measure something that normally fluctuates on a day to day basis? How do you measure something that goes into chaos for seven years, you know,

[Cara]

for at least four years, right?

[Dr. Mary Claire Haver]

What are you measuring? What are you looking at? So I've talked to some of the wearables, not looking at hormone levels but looking at sleep pattern disruption. So sleep is the next thing that goes, right? Mental health, you know, the three big brain changes. Sleep, sleep disruptions, mental health, brain fog. So I think and with temperature, by looking at ovulatory patterns, using temperature, just like we do in fertility. The other side of fertility is menopause. You know, like we don't the same thing. So I'm in talks with Aura to see if we can use their data like, like you know, the, the not using, you know, personal information. But can we track these patterns, right, and be able to help patients self diagnose their periods?

[Cara]

Well, I'm raising my hand here for, you know, I mean everyone I know is wearing a glucose measuring device for very good reason, right? They're looking at their metabolic health and they're looking at all the things and they're trying to prevent type 2 diabetes. And I just am raising my hand here, Mary Claire, don't forget it. I will put on the wearable to measure my estrogen.

[Dr. Mary Claire Haver]

It turns out right now we haven't mastered serum. So those wearables go into, they don't go into the bloodstream, they go into the dermis. And so we don't have enough validated studies to pull, you know, these fluctuating hormone levels out. We'd probably be okay with testosterone because it's more steady state. So we're not there yet. I would not.

[Cara]

Great.

[Dr. Mary Claire Haver]

God bless him. They're trying, but. And I think we could go a long way there, but we're not there yet with the date, with the, the data. But they are looking.

[Cara]

And here's the other piece of data that I'm starving for. I want to understand, maybe your wearables actually track this. I want to understand how all the things that come at tweens and teens also come at adults. People are on screens all the time, online all the time. Right now, they're on AI all the time. I know. You know, we're both physicians. We know these things impact the way our brains function, feel, and the way our brains work. And where does that fit into all of this?

[Dr. Mary Claire Haver]

Menopause gets less than 1% of the bunking of funding. And so, you know, that's kind of low on the totem pole. It's like when we look at what big, big, big money is funding. It's new drugs, right? New drugs for osteoporosis, new drugs for hot flashes outside of hrt. So, you know, I would love to see that data. Right. I had to put a block on my phone. I have a. I have a brick, which I highly recommend. And I bricked myself out of social media because it was a job for a long time, like me building a following and educating or whatever, but I was going down rabbit holes and staying up too late, scrolling and doing sc, you know, and like reading negative comments and only seeing that and not the positive to, like, my menopausy friends. We all had a pact and we bricked our phones. So I have a work block on social, like in the morning, an hour at lunch, and then a couple hours in the evening. That's the only time I'm on social. So I can, like, do other things, check my email if I need to, whatever. But, you know, and I'm encouraging my patients. You know, you don't have to buy the brick to do it, but, like, I think we need to be limiting this. But.

[Cara]

Right. You know, and I think it'll be super interesting to see how that data evolves over time because, you know, I wish we could measure it all, but it feels inevitable that I'm worried about

[Dr. Mary Claire Haver]

the tweens right now. You know, watching my nieces, my best friend's kids who had later kids in life, you know, I'm. I'm 57, so. And my kids are 22 and 25, so I didn't raise them in the social Media era. They were, they were, you know, there were some, they were playing games and stuff, but now, wow, wow. Like this didn't even exist 10 years ago. And so, and it's like such a big part of their lives.

[Vanessa]

But I think in response, we need the same sort of nuance, inquiry and conversation that you've really put forward in terms of menopause. Like I think the initial reaction is fear and anger and sort of like black and white answers when it comes to tech. And that's like, you know, what happened with all the menopause research at a period of time. And like what you and your colleagues have done is said, no, no, no. This is like a nuance complex, ongoing conversation, exploration, resetting. And I think, I hope that's where we are as a culture with respect to kids and tech. I mean AI makes it incredibly complicated, but I think there's a place to say, okay, this is worrying, but we're not going to get paralyzed by our fear. The same way.

[Dr. Mary Claire Haver]

Yeah.

[Vanessa]

That you said to folks, hey, let's not get paralyzed by someone's irresponsible use of data. Let's get curious. Let's like really dig in here. So as we think about like all the sort of, it's really multidisciplinary, right. The, this treatment of menopause, the understanding of menopause is so much more varied than we ever truly understood until recent years. And God willing, more research will help us understand even better. But one of the things you talk about, I want to move to the bot from the brain and the sort of emotional experience to the body to the below the neck. I want to learn more about from you. You talk about estrogen as working on entire organ systems in the body and that was so fascinating to me. What does that mean? How does it work? Why do we need to understand this

[Dr. Mary Claire Haver]

as we're learning is so much more than reproduction. Right. Super important in reproduction. Couldn't reproduce without it. But it is a master regulator for almost every organ system in our body. I mean really, you know, it has effects on every organ system. Our hearts. I just published something on kidney stones on, you know, not public. I just read an article someone else wrote and shared it with the world and of course the world goes crazy, but musculoskeletal heart, bones, skin, we're going into this. So we were going into this so blindly and myself, even as an OB GYN did not understand the far reaching consequences of this. And you know, combine that with some of your moms who are having baby, you Know, we've now reached the point where women, more women over 40 are having babies than under 20. So yay for no more teen pregnancies. You know, that's. That's coming a long way. But these women are going from postpartum into perimenopause.

[Cara]

Yes.

[Dr. Mary Claire Haver]

So. So some of the women my age with teenagers who are listening to you guys are like, they never get a break.

[Vanessa]

Right? You need to know something. Your episode on our podcast is our most popular episode of our 380 episodes. Your episode. So it is like the intersection of this moment in time. Not moment, moments. Years in time for as decade as parents and as, as women as human beings is so, so powerful. And so, yes, like, the ages have shifted. We understand. Can we use. Let's start with the skeletal system and talk about the role of estrogen there. And then we're going to explore some other, other systems in the body.

[Dr. Mary Claire Haver]

So we have to look at aging and menopause, and they're kind of tangled up together. So we look at musculoskeletal system. The bone and muscle are attached, right? And they have to work together. The reason muscle is there is to move the bones. Okay. Turns out muscle has way more bone have. Both of them have way more effects all over our body than we ever realized. Every time we contract a muscle and bone, you know, when bone is put to use, we release myokines and these chemical messengers that go to the brain to decrease the risk of dementia, that we, you know, lower inflammation that do all this stuff. And so one of the, like, downstream effects that we see is the musculoskeletal syndrome of menopause, like muscle pain. What we used to think was fibromyalgia is quite often musculoskeletal syndrome of menopause. We just need to stabilize that estrogen for her, and a lot of those aches and pains will get better. We look at, like, tendon pain. Like, I used to have back pain and perimenopause, and I couldn't understand. I'm just sitting in my chair. You know, I just posted something about, I'm now at the age where I just sleep and wake up with pain. Like, just from sleeping. Like, what? All I did was sleep. And. And so aging plays a part in this. But, like, for women, we lose so much resilience to those conditions. And, like, one of the biggest things is, is frozen shoulder. And so it used to be called women's shoulder, 50 year old shoulder. You know, why, why is that? Like, it took the orthopedic world a lot, basically, until enough female orthopedic surgeons went to menopause and they're like, something ain't right. And to say, hey, maybe there's a connection here. So, so hats off to Jocelyn Wittstein and Vonda Wright, two orthopedic surgeons who've published on this. And like, women are just like, when you educate a woman, nothing bad happens, right? When you explain to her why this is happening, nothing bad happens.

[Cara]

That's right.

[Dr. Mary Claire Haver]

I mean, forever the medical establishment thought will cause her anxiety. She'll be, I'm like, no, we need to teach women why this is happening, what's going on and what they can do about it.

[Vanessa]

Mary Claire, you write in the book about the percentage of bone loss that a woman experiences in the sort of perimenopause.

[Dr. Mary Claire Haver]

So this is something I was taught in residency. One of the few things about menopause, you know, was that we have acceleration of bone loss and menopause, I thought it was like postmenopausal and that was like a long term problem, an old lady's disease. The fastest acceleration of bone loss is in perimenopause. So for women who have babies later in life, so we reach our max bone density, like our bank of bone, right, in our 20s. Okay, so for like women who grew up doing like high impact activities, you know, gymnasts have like super high bone density. You know, runners tend to have lower bone density. There's lots of reasons for that. Long distance runners, really, not sprinters. So there's a lot of things in our lives, you know, poor nutrition, you know, girls who aren't getting enough calcium, you know, girls who are have low estrogen levels for different reasons. You know, chronically suppressed hypothalamic stuff. You guys know about all this and depo provera, you're suppressing estrogen and so, you know, they'll bounce back, but they'll never reach that, that bone back. Okay, so, so, you know, 25 and then aging takes over, right? So we move bone with age from disuse. Then we hit menopause and we have this rapid perimenopause, rapid acceleration of bone loss. It's crazy. We can lose 20% of our bone density in the, you know, in the four years around the menopause transition. So. But insurance typically doesn't pay if your doctors remembers to order it for a bone density till 65. Everyone who takes their broken bones in women thinks that is a horrible mistake. Everyone is involved in osteoporosis, thinks this is you know, endocrinologist thinks this is ridiculous. And so we are, and I say it loud and proud on social media, get a bone density. Both of you should know your bone density right now. Oh, yeah, you know, where was that bone bank? Where are you right now? You have time. Well, anyone can grow bone. Even at 90, it's harder. But like the younger you are, when you realize what your bone bank is at where you are, you have more time to make up for this.

[Cara]

And that goes in lockstep with. We should also be doing things to promote bone building, starting at incredible.

[Dr. Mary Claire Haver]

What does that look like? You know, what advice do we give my mother, right, who has Alzheimer's and horrible fragility fractures? My mother was told to be thin her whole life. The only medical advice she got, take this for your triglycerides and diet. And so my mother was on a diet her whole life. She fought to be. And she's this 5 foot 8 ex college basketball player, you know, who was just trying to be smaller her whole life. She never lifted a weight. So how do we grow bone? Well, you lift weights, you put estrogen back in your body. You know, there's multiple ways to do it. You don't have to have estrogen, but man, estrogen goes a long way to protecting our bone loss. So it's FDA approved for the prevention of osteoporosis. There are bone building medications out there and they're hard to take. You know, there are. Some of them require an infusion where you have to go to infusion center. They work, right? They work, but we don't have to get there.

[Cara]

Right. And one of the simplest interventions that people can do is also literally to take jump breaks during the day. And it sounds so silly, but it is so actionable. Like you can do squats, you can do jumping jacks, you can do any. Like just get a little impact.

[Dr. Mary Claire Haver]

10 minutes a day.

[Cara]

Yes. Yeah.

[Dr. Mary Claire Haver]

10 minutes a day of jumping. You know, it's amazing. So, and if you have like Dr. Wittstein talks about, and if you have herniated disc or reasons why, you know, impact might be an issue. There are low impact things you can do that work.

[Cara]

Yes. Yeah.

[Vanessa]

When in the book where you describe bone loss. So in the last year, I've had both my hips replaced, severe osteoarthritis at 49. And it came on quickly. Like, I always had hip stuff. I played many, many sports. I carried four children to term. I have genetic stuff. Right. But like, my parents didn't have both their hips replaced in their late 40s. And I'm reading about the bone loss, and I'm reading about the onset of arthritis.

[Dr. Mary Claire Haver]

And it was like, Arthritis, Yeah.

[Vanessa]

And you were. It was like. Because everyone was like, what's happening to you? Why is it so. And I remember thinking, like, am I in perimenopause? Like, what's happening? Why did it happen so quickly? And as I'm reading in the new book, I was like, oh, my God. I. I was not making this up. Cara conferred on me.

[Cara]

I mean, her face like this every day. She was in so much pain.

[Vanessa]

And now I'm like, amazing. But now I'm thinking about, okay, well, what else do I need to do? How else do it now that I'm healthy again, how do I prevent it? How do I take care of myself in it? So it. I'm not like, other joints don't start to.

[Dr. Mary Claire Haver]

Shoulders.

[Vanessa]

Yes.

[Dr. Mary Claire Haver]

Like, that's the next thing.

[Vanessa]

So it was really. It was really, really eye opening. I really encourage people to. To look at it. I'm dying to ask you the question about weighted vests. Can we please talk about weighted vests? Because when I picture you, I. Even if you're in the dramas, I picture you with a weighted vest on. Like, your cup of coffee and your nightgown and your weighted vest.

[Dr. Mary Claire Haver]

I just have the right level is sitting on the boxes for the weight of vest that I have.

[Cara]

Okay, that's funny.

[Dr. Mary Claire Haver]

So weighted vest. I, you know, was like, okay, I had low bone density and was like, so many of my patients are having low bone density. They're like, what the hell? What can we do? So what do I do? I go to pubmed and I start looking and I'm like, I run across studies done in premenopausal, postmenopausal women with osteoporosis, osteopenia, looking at the use of weighted vests. Now, usually they were. And these are some small studies, you know, they were doing exercise as well. But I thought, okay, it's not going to hurt me. I walk a lot. Yeah. I've turned my treadmill into a walking desk. You know, whatever I can do to weight. The body responds to any resistance. And so I was like, hey, consider this as part of your toolkit. This should not be the only intervention you use. You still need to lift weights. You probably should do jump training. You know, all those things count. But, you know, that was my excitement. Like, this is a. I found one on Amazon, you know, for very reasonable price. I'm like, I'm gonna throw everything at this, right? That's just me. And I start wearing it on video and people were like, where'd you get that? So I'm sending out the link, whatever. And then I'm like, you know what? I don't like the way it sits right here. There's no pockets. I'm like, let me see if I can make one of these. So I made my own witted vest and it's a great seller for us, you know, and it's got cooling fabric and whatever. I'm not here to sell weighted vests. But, you know, then like the haters come and they're like, what are you talking about a weighted vest? I'm like, every bro wearing their weighted, they call them different, right? But for a woman it's a weighted vest. And for a man, what are they? You know, all those guys do and CrossFit and those, you know, the military has been using them for decades, right, to train their special forces to simulate having the, you know, big backpacks that they wear and they run around in and they're like, they don't really help with bone density. I'm like, okay, they don't. We don't have the head to head study saying just wearing a weighted vest, right? And so is going to be all that helpful. But women love them. It gets them outside. They walk with their girlfriends with them. You know, it, it is extra resistance and if it gets you outside and moving and enjoying life. And so I put mine on, on the treadmill when I'm doing work. It troubles on an incline for me. It mimics my backpack when I'm hiking. So as I'm training, I'm in Colorado right now. And so in Colorado I have a few walks that don't have a lot of elevation change. So I'll throw it on for that. I have multiple weights that I kind of play around with. The other thing I love it for is in the gym and I have X amount of like hand weights to do stuff. And if I want to add a little extra weight for squats and I, I can't get for like I have a 30 pound. My husband has, I don't use them that much. But 30 pound and 40 pound, there's no 35 pound. And for me with this tiny frame, I can't jump from 30 to 40, but I could put on a weighted vest and kind of fudge the numbers a little bit, right? You know, so like there's multiple uses for it.

[Cara]

We'll be right back. But first a word from our sponsors.

[Commercial Narrator]

Zootopia 2 has come home to Disney.

[Vanessa]

Let's go get ready for a new case.

[Dr. Mary Claire Haver]

We're gonna crack this case and prove we're the greatest partners of all time. New friends. You are Gary Desnake. And your last name? Desnake.

[Commercial Narrator]

Dream team. Hidden new habitats.

[Dr. Mary Claire Haver]

Zootopia has a secret reptile population.

[Commercial Narrator]

You can watch the record breaking phenomenon at home. You're clearly working it. Zootopia 2 now available on Disney.

[Dr. Mary Claire Haver]

Rated PG.

[Commercial Narrator]

You thought this was your run club era. Turns out it was more of a thinking about Run Club era. The good news, Someone's marathon training is about to start. Sell your workout gear on Depop. Just snap a few photos and we'll take care of the rest. They get their race day fit and you get a payout for trying. Someone on Depop wants what you've got. Start selling now. Depop. Where taste recognizes taste.

[Dr. Mary Claire Haver]

Tomorrow morning is knocking. Stock your fridge now. How about a creamy mocha frappuccino drink? Or a sweet vanilla smooth caramel maybe? Or white chocolate mocha? Whichever you choose, delicious coffee awaits. Find Starbucks Frappuccino drinks wherever you buy your groceries.

[Cara]

Yeah, I'm in the gym every Friday morning at 6am I call Vanessa on my way to my weight training workout. And I've started quizzing the woman who is teaching me about weighted vests and proper posture with weighted vests. Because that becomes really important as well. And this leads to my question about all of us have kids, right? In the same age range, right? And they do as we do and not necessarily as we say. And my weighted vest is sitting by the dog leashes. And at what point? Right, because that's my. Because brain fog. So let's talk about the science behind it. Like we're talking a little bit about therapeutics and a lot about prevention. And so to the prevention side, how early is too early? At what point are some of these interventions not preventive but creating their own issue? Like is there a point at which people should not be people, young people. Right. Should not be wearing weighted vests? Or is it great for all skeletons?

[Dr. Mary Claire Haver]

I don't think we have enough data.

[Vanessa]

Right.

[Dr. Mary Claire Haver]

And so the studies I looked at were done in older women. Like most of them were older than 60. And so I'm like, if it's working for her mama at 65, I'm 57. You know, I'm right there. Most of the data done in the younger population were more like the military grade that the men wear, you know, and women wear them as well.

[Cara]

But.

[Dr. Mary Claire Haver]

And they're Measuring totally different things. They're not looking at bone density or, you know, but like any form of exercise, it can be abuse. Right.

[Vanessa]

Or.

[Dr. Mary Claire Haver]

And what I wouldn't tell a younger person is don't do this in lieu of something else. Right. If you're going on a walk, you can wait and walk. If you're already doing this, you can add this to it to give yourself a little more resistance. But don't think this is gonna replace jump training, weight training, jump rope. You know, things that are gonna help you build that bank of bone right now, what you're your peak, you know, bone building level and on top of calcium intake, you know, all the things, right?

[Cara]

Yeah. And that's the key message. Like, it's like putting money into a savings account now. It's gonna compound so much more. 25 before you hit the plateau and then the drop in your bone density. You can pre bank so much bone density. And I think our younger kids really deserve that messaging. And the American Academy of Pediatrics has spent a lot of time trying to talk about resistance training for that reason. They are very big on trying to message the importance of. Because people are asking about weightlifting, especially in boys, and what's too much and all things. And there's no dilemma around resistance training and building bones from there.

[Dr. Mary Claire Haver]

My old, the 25 year old is in med school and she's a four. Like, I don't think she goes to a gym and lifts weights. I mean, she'd like to, but right now her whole world is, you know, step two. And I'm not gonna like make her feel bad about that, but I will get on her in residency when she starts residency. But, you know, so Maddie doesn't have that kind of pressure. And when I look at how she thinks about her body, talks about her body and how she exercises, it's so different. I didn't, I went to aerobics and it was. That's it, you know, and it was to be thin. But she is, like she said, I'm trying to grow my leg muscles. Right?

[Cara]

Yeah.

[Dr. Mary Claire Haver]

She wants to be strong.

[Vanessa]

So let's talk about.

[Dr. Mary Claire Haver]

I love that.

[Vanessa]

Let's talk about muscle loss and what it means for us in a, in a bigger way, in a metabolic way, in terms of just like health and safety.

[Dr. Mary Claire Haver]

Muscle loss looks like it has more to do with aging than like the drop in estrogen, progesterone. Testosterone has a lot to do with muscle. And we have a. Just like men have an age related decline of testosterone. We don't fall off a Cliff, in menopause. But we do decline over time. Right? So by the time you go through menopause, your testosterone levels are about half what they were at your peak at 25. Okay, just to give you some ideas, we know that in endogenous testosterone levels, so, you know, I see 70 year old women, I take a cohort of 70 year old women, they're all going to have different testosterone levels based on genetics and whatever else. The ones who are in the highest quartile have the lowest fragility scores and the most muscle mass. That's part of it. But does taking exogenous testosterone, like, give you a boost? We haven't figured that out yet. And I just interviewed Mopara from Baylor and he's, you know, he was part of the people, whatever. And he said, we don't have the data yet to say take testosterone, your muscle get big. But he's like, it makes sense, right? If you're lifting, if you're eating the protein right now, what the loss of estrogen does, you lose the satellite cell stimulus. That's Fonda Wright's work in her basic science lab. And so growing muscle in a woman after menopause seems to be a little harder. If you don't have your hormone levels restored.

[Cara]

Can we dial back to testosterone for a second?

[Dr. Mary Claire Haver]

Sure.

[Cara]

Help us understand how women are going to get testosterone formulated for them and FDA approved and. Right, because. And maybe just for the uninitiated, there aren't many listeners like that, but a quick summary of the mess of testosterone prescriptions for women.

[Dr. Mary Claire Haver]

So the best data we have on testosterone is in the sexual function world. We have female sexual dysfunction, which can have a lot of reasons. It's not all just lower testosterone levels, but specifically for hsdd, hypoactive sexual desire disorder, and a layman's term, low libido. Right. And it has to cause distress. That's key. We have to normalize women who just aren't interested and that can be okay. It has to bother you.

[Vanessa]

Right? Meaning in order to seek treatment for it, it's okay if you don't want to have sex and that's fine. It's you. If you want to have sex and you don't want to have sex, if that makes sense.

[Dr. Mary Claire Haver]

There's a mismatch in a couple.

[Vanessa]

If there's a mismatch, then 50% of

[Dr. Mary Claire Haver]

women will see this, this response. We don't have an FDA approved formulation for women. We're probably a year or two away from that. There is some interest in the FDA to look at this again, there's a couple of companies trying to get something on the market. But, you know, these things take time. So what we do in the meantime is we either compound it or we borrow the men's version. So in our clinic, like Dr. Cara, they do a lot of injectables. Our clinic, I just, I was never trained in that. So I'm borrowing the gels from the men's version and that's how we prescribe it to patients. It's not easy. Right, because we have to titrate it to 10% of the male dose.

[Cara]

Yes.

[Dr. Mary Claire Haver]

It's great that their bottle lasts us months. So the price comes way down. And the compounding, you know, it really depends on the compounding lab.

[Cara]

Right.

[Dr. Mary Claire Haver]

So.

[Cara]

Right.

[Dr. Mary Claire Haver]

So sometimes. And then there's abuse in the compounding world. Like some of the pellet companies are very abusive. So, you know, for us in the menopause, who are doing this on a regular basis, when you look at the guidelines, they're very clear from Ishwish, which is the International Society for the Women's Sexual Health and Wellness, they are very clear on, you know, limiting compounding. In lieu of these FDA approved options that are for men, we're just using them off label for women.

[Vanessa]

Yeah.

[Cara]

And I just want to echo what you're saying, because one squirt out of a bottle that is FDA approved for a guy and then taking it and estimating your own 110 at home is not scientific. And that is an onus on women. And the compounding piece, there are some fabulous compounding pharmacies and there are some compounding pharmacies that are simply either not double checking what they're making, or their suppliers are not necessarily the most valid suppliers. And it's no fault of theirs, but they just don't know what they're passing along. And so in the name of women, I mean, you have done. What's very interesting about your work is you're not just an educator, you've actually gone and helped change laws and rules. You're an advocate in every way. And so this is the fight that I would imagine comes. Not the fight, the collaboration that comes next, which is how can we help women get a medication that is dosed properly for them?

[Dr. Mary Claire Haver]

And the best news is that we have it in Australia, we have it in. And that greases the wheels a little bit for the US to make it.

[Cara]

That's right.

[Vanessa]

Mary Claire, can you just explain how it works? Like why does testosterone help? Just for people who haven't Read your. All your books.

[Dr. Mary Claire Haver]

Libido is a mood. Libido is in the brain. It's not in the vagina, the uterus, whatever. But it works on multiple levels. So it changes those neuroreceptors. Right. Into a pattern that is more receptive. And when we look at desire, there's spontaneous desire and then there's reactive desire. Most women naturally don't have a lot of spontaneous desire, and that goes down with age. Meaning you wake up and you're like, yeah, you know, we have, like, a man with a. He wakes up with a boner. And so literally. But, you know, and that's healthy, right? You want them to have boners because it means they don't have heart disease. And so. But for women, we. Most of us need some kind of stimulus. And that could be somebody doing the dishes or putting the kids to bed. You know, it could be a spicy novel, it could be whatever, right? But like, something that has to take our brain out of itself to, like, get in the mood. And so testosterone, like, helps with that shift of getting you, like, oh, this is a good idea. Instead of. It's another job I have to do.

[Cara]

Mary Claire. I'm married to a cardiologist, so I just have to add that you can have a boner and heart disease at the same time.

[Dr. Mary Claire Haver]

Well, okay. But it's, like, less likely, right?

[Cara]

Totally. I mean. Yes. There's a very interesting Venn diagram overlap there that no one ever talks about.

[Vanessa]

I didn't expect that, like, this conversation to really turn a corner like that and head in that direction.

[Dr. Mary Claire Haver]

Now, there are androgen receptors in the vulva as well. So we know that women who use, like, DHEA and the vagina, which converts to estrogen and testosterone, you know that they have increased blood flow. You know, blood flow is everything to arousal. So, like, Viagra helps, Sildenafil helps with arousal. In men, they usually don't have a libido issue. It's like they can't get the blood where it needs to go there long enough, right?

[Sponsor Voice]

Yeah.

[Dr. Mary Claire Haver]

And so women tend. Can have that as well. But, like, just getting more blood flow, what I see in my patients is they finally get in the mood, everything's great. It's taking forever for the orgasm, right? What, like, what used to take two minutes is now taking five or 10 or whatever. And it's not at the same intensity that it used to be. Testosterone seems to be helpful for that, too. And so, you know, we have to hit these things from multiple different levels, increasing blood flow, making the environment conducive to this, lots of lubrication, vaginal estrogen. I think vaginal estrogen should be in the water, you know, like. Like we would. Every vagina needs estrogen. The end. Like, and if you can't make your own, we gotta put some there. So it's gonna decrease the rate of UTIs. It's gonna save Medicare billions of dollars. All of us have GSM to some form when we go through menopause. And remember that HRT is a microdose. It was dosed to stop a hot flash. We don't need very much to do that. It doesn't approach our physiologic ranges as a premenopausal woman.

[Vanessa]

Right.

[Dr. Mary Claire Haver]

And so we tend to not get enough penetration into the general urinary system to really get your vagina back to its, you know, vagina, urethra, bladder. All of that tissue is connected. So testosterone, estrogen, there's receptors all over in that area. So, I mean, I. I replace my hormones, like seven ways.

[Cara]

Okay, But I have a question. On the one hand, we are taught that, you know, vaginal estrogen is not that systemically absorbed. And so, you know, you can use it.

[Vanessa]

Right?

[Cara]

Okay, but then like the warning on the box when you put your patch on. Well, no, no, not that warning. We're going to talk about that warning in a second. I'm talking about the warning, like, don't touch your dogs because your dogs get like. What's the actual deal with absorption?

[Dr. Mary Claire Haver]

Okay. They have, literally, for the gel, like, for the estrogel. They have taped humans together for 10 hours, zero transfer. If you wait the three minutes or whatever. There's never been a single case of transference in testosterone.

[Cara]

And yet, you know, that warning I'm talking about, it's bananas. It's like crazy, crazy.

[Dr. Mary Claire Haver]

There's so much hypothetical that hormones are dangerous. You know what's dangerous? Tylenol. You know, I'm like, you want to die? Take a lot of Tylenol and you'll have this long, horrible course of liver failure, and there's nothing we can do about it. You know, like.

[Vanessa]

Like, Mary Claire, you're scaring the crap out of people. Don't, don't, don't go there. Don't go there. We're talking about vaginas and estrogen and all of the beautiful things about vaginas and estrogen. Wait, so here's my question for you. You're talking to someone. They've got the metabolic, weight gain. They are, like, feeling they're Weaker. They don't want to have sex with their partner.

[Cara]

Sounds great, Vanessa. You're really livening up this conversation.

[Dr. Mary Claire Haver]

My typical patient.

[Vanessa]

Yes, that's what I'm saying. What is my typical patient? Because you, like, come in with your cape with the big M on it, and you're like, superhero menopause, like, I'm gonna save you. Taught. What does that sound like?

[Dr. Mary Claire Haver]

First thing I do is listen, and I just let her talk it out. I have an hour with my patients for a new patient visit. I let her just dump everything on me, and I'm like, okay. And then we talk about the things that are likely related to menopause or not likely related to menopause.

[Vanessa]

Right.

[Dr. Mary Claire Haver]

And then I say, we're gonna try this. If you're willing. We'll go through the risks and benefits. We'll go through all the different ways we can put it in our body. You know, gels, creams, patches, pills, rings. You know, we'll talk about estrogen, progesterone, and testosterone all in that visit. And then we give her a trial and see how she does. And we'll say, let's see what. So we do. We have a whole, like, scoring system where we look at her symptoms and then we have her track her symptoms over the next six weeks. What's getting better? How many times does this bother you? Whatever. And like, and for patients just knowing that they're not crazy, that there's a cause of this, that they didn't do anything wrong, that, you know, to have very realistic expectations of what hormone replacement can and can't do when they're just so appreciative to. To have someone to talk to and, you know, are they going back to be their 25 year old self? No, but, like, they're just getting so many parts of their life back in a way that they can manage this beautiful life they built that is falling apart. That, you know, and knowing that in postmenopause the brain fog tends to get really better, the mental health stabilizes for so many. Sleep does not get better. Oh, well, you know, we got lots of things to help with that. You know, we kind of, you know, we talk about libido, sex life, all the things.

[Cara]

Okay, but question about placebo effect, because there's so much power in having the conversation, being heard, being seen, being validated.

[Dr. Mary Claire Haver]

Do you know what the placebo effect is in Viagra?

[Cara]

Help us understand. Yes, yes. So help us understand.

[Vanessa]

Like, wait, the rest of us don't. What is the placebo effect?

[Cara]

Vanessa?

[Dr. Mary Claire Haver]

Yeah, I Mean, so some of the, like, people who poo poo testosterone for libido talk about the placebo effect, and especially because it's a mood. Right. Libido is in the brain. And when we look at, like, Viagra, the men on Viagra had incre. You know, just. Just opening that pathway to allow yourself to think about it, and it's okay. Like, takes down another barrier for both men and women.

[Cara]

Yes.

[Dr. Mary Claire Haver]

And so, you know, I'm like, if it works, it works. And yay, you know.

[Cara]

Right, Right. So I guess the question I'm getting at is we know the value of having these conversations. I mean, it's obvious your books are best sellers week after week after week because people are so excited to be in this conversation. You've said this several times in your book on this podcast, but I think it deserves a spotlight. It's not just you. You are so good about crediting the family of people that you have surrounded yourself with. Not everyone is great at doing that. You are great at doing that. And there is a huge world of you who are changing the landscape and you are making this accessible for people. They're talking about it. So my question about placebo is really, like, okay, for the uninitiated who are coming in, who've never had this conversation, you get to have these amazing aha moments with people all the time. Right. How do you factor that in when you are trialing hormone therapy? Because some of it must be, I've been seen, I already feel better. So, like, how do you. How does that factor in? How do you change doses accordingly and things like that?

[Dr. Mary Claire Haver]

So we usually for symptoms. So I tend to titrate to a hot flash.

[Cara]

Got it.

[Dr. Mary Claire Haver]

Right. And so we usually titrate for vasomotor symptoms or something that's really easy to pinpoint. I have them, I don't have them. Right. Hard to titrate to mental health, Hard to titrate to brain fog, but I can titrate to a hot. That's what I was taught to do. Right. Then we check a level at six weeks out. Why? Because the level that it takes to stop a hot flash is less for most women than it takes to grow bone. So if one of her big priorities is bone health, I'm going to check a level. You know, so I'm. I'm not a great absorber of the transdermal estradiol package. It did stop my hot flashes at the highest dose, but I checked my levels three times because I'm me. And I was like, shoot, I'm only like at 25, 26, you know, barely above the, you know, range. But I'm not near where they saw the best protection of bone, you know, so any amount of estrogen is beneficial to bone. Any amount. We've proven that. But like there is a sweet spot and it's about 60 to 80, you know, 50 maybe of the best bone protection. So that's like a concrete number we can shoot for. Now, again, not everybody likes that much estrogen. It might cause breast tenderness. You know, again, nuance, open fright discussions. What are your goals? There's no placebo for bone growth. Right. Everybody's going to lose bone as a woman after menopause, 100% of us. And it really just depends on what you started with and what your exercise and nutrition factor.

[Cara]

I will say I used to do transdermal patches and I did a social media post that I. It's probably a year later I still get emails about because I'm also a sweat yoga person and I could see my patch lifting after my yoga classes and either I was over absorbing or under absorbing after that would happen. And so I had no idea to think about that and to mention that to my gynecologist. And when I did, she was like, duh, you should not be on the patch, you should be on a gel. And it was sort of fascinating. And I still get incoming from that post of people saying thank you. I never thought to even mention it. So all these tips and tricks that you give are amazing. We could spend another year with you. Yes. Picking your brain and all that. But I think what we'll do is we'll leave it here and point people to all of your resources, which include your newest book, the new Perimenopause, and your social channels. And I will say on a personal note, Vanessa and I share an agent with you whom we love. So quick, shout out to Heather. And I just want to end by thanking you and sort of the, the posse of people who are really. You're really changing the world for women and men. And men. Because by women being able to acknowledge what's happening and talk about it, it's like what happens in the twin and teen world. When it comes out and it's in conversation, everything gets better. And sometimes it's awkward and sometimes it's hard and sometimes it's uncomfortable, but it is always better. So thank you, thank you, thank you for joining us.

[Dr. Mary Claire Haver]

You're welcome. So happy to be here.

[Vanessa]

Thank you so much for listening. You can email us with questions, feedback or episode [e-mail] if you want to

[Cara]

learn more about what we do to make this whole stage of life less awkward for everyone involved. Our parent membership, our school health ed curriculum, our keynote talks and more are all at less Awkward.

[Vanessa]

And if you want products that make puberty so much more comfortable, visit myumla.com.

[Sponsor Voice]

You're listening to this podcast so I know you've got a curious mind. Here's a helpful fact you may not know yet. Drivers who switch and save with Progressive save over $900 on average. Pop over to progressive.com answer some questions and you'll get a quick quote with discounts that are easy to come by. In fact, 99% of their auto customers earn at least one discount. Visit progressive.com and see if you can enjoy a little cash back. Progressive Casualty Insurance Company and affiliates national average 12 month savings of $946 by new customers surveyed who saved with Progressive between June 2024 and May 2025. Potential savings will vary.