A (2:15)

Plus unique.

B (2:16)

Just like Mom. Explore the full Lenox Spice village collection@lenox.com spicevillage and now a quick break from our sponsor, Miracle Gro. Life is digitally distracted and time starved, but gardening is the perfect way to unplug it isn't just about plants. It's about trading the digital noise for a quiet way to reconnect with yourself. Whether you're in an apartment or you've never even touched a shovel, don't let self doubt stop you. With 75 years of expertise, Miracle Gro takes the stress out of the process and makes it pure Joy. Head to miraclegrow.com to check out all of their easy to use products and start your growth journey today. Hey everyone, it's Sophia. Welcome to Work in Progress. Welcome back to Work in Progress, friends. Today we are joined by a doctor who I am just so inspired by because she's managing to make very complex science that affects all of us ladies feel like something we can tackle together. By 2030, more than a billion women worldwide will be post menopausal. Yet for most of modern medicine, menopause has been treated like an afterthought. Women struggle with symptoms from sleep disruption and brain fog to metabolic shifts and cardiovascular risk. Yet most doctors receive little to no training in menopause care, leaving millions of us to navigate this transition with limited or no guidance. And while you might not be in menopause, are you in perimenopause? Do you know? Do any of us know? How do we know? Nobody tells us anything. But Dr. Mary Claire Haver is here to help tell us what we need to know. Indeed, she's among a group of physicians that is really working to change our experience with this part of life that all of us go through. She's a board certified OB gyn, She's a certified menopause practitioner, and she's become of the most widely followed educators in midlife women's health. Her best selling book, the New Menopause ignited a broader public conversation about this stage of life and its follow up. Her latest, the New Perimenopause turns attention to the earlier, least understood and most disruptive phase of the transition. Fun fact. She also was involved in producing balance with our Work in Progress friend Jeannie Mai, who you heard from earlier this year. We're going to talk all things women's health, how we take care of ourselves, how we even know where to start, and what she's learned along the way. Dr. Mary Claire Haver is here with us. I'm just so excited that you're here. We got a little bit of time together. I can't believe it's almost been a year and a half.

A (5:21)

Year and a half, yeah.

B (5:23)

At the. It would have been the 2024 big live hello Sunshine event. And you came to speak to all these women about kind of the wild west of our bodies. Right. Like we're 51% of the population on earth, but for some reason we barely get studied. We don't get many medical research dollars. And we all hit a point in life, whether it's pre or postpartum or pre or during menopause, where doctors basically say, oh, that's just part of aging as a woman. Meanwhile, the men don't have to do that. So I'm just so excited that you are here to talk us through some of this. Before we jump into, you know, present day and your, your history as a doctor though, I want to go back in time a little bit because.

A (6:17)

Sure.

B (6:18)

Particularly I think so many of the guests on the show are these impressive people with these impressive careers. And so many women, and especially young women I interact with are wondering how to know what they're destined for or if they're on the right path. So I always like to ask the impressive women I sit with, if you got to go back in time and interact with your younger self, you know, little you at 8 or 9 or 10 years old, would you see like, would you see aspects of the woman you are today in her? Do you think she'd recognize herself in you?

A (6:54)

No, no, not at all. No. I was brought up in South Louisiana. I'm one of eight kids and my mom and dad are great. I love them. However, they just wanted me to marry well. Like that was the. And I did so, you know, I did hit the marriage lottery. But like they weren't concerned about me having a career or going, going to college. I mean, my mother went for a year for secretarial science at 18, but my dad got married at 19, you know, and they just kind of felt like that would be a path for me. I mean, my dad was like, she's pretty so she'll be okay, you know, like, and not, not to, like, not my parents, like they supported me studying, going to college and everything, but it was like marking time until I met my husband. So, you know, and going to college would give me a chance to meet a person who also went to college who, you know, take care of me for the rest of my life. So that just wasn't in their realm of thought, you know.

B (7:57)

Wow.

A (7:57)

And so eight year old Mary Claire, nine year old Mary Claire wanted to be a ballerina or a cheerleader or an actress, you know. And so I kind of thought about nursing somewhere down the line. Cause one of my aunts was a nurse. But it just, that wasn't I wasn't smart. Like, I did not, like, blow the top off of high school. I was an average student. I never applied myself. I showed up, you know, I was into drama and cheer, you know.

B (8:23)

Yeah.

A (8:24)

For extra curricular activities. I was not an athlete. And then my parents went through bankruptcy right around my senior year of high school. They had to move to another state to try to start a new business. Everything got disrupted. And that is when, like, the lightning bolt of, you have to figure this out, like, no one's coming to save you. And that's when I went to college. Totally at the local college in the town I grew up in. Walked to school, didn't have a car, and just really buckled down and applied myself. And lo and behold, I was smart. Wow.

B (9:01)

Yeah.

A (9:01)

I mean, I made good grades. If I applied myself, I'd get an A. And I was like, this is cool. So, you know, all those dopamine hits, I just kept chasing the good grades.

B (9:10)

I think that's so interesting because. And look, the. The social aspect of school is great. I. I did all of it, too, and loved it. But isn't it funny that women have been historically encouraged to, like, go make friends, go be popular. Like you said, go find a really good guy, and the guys are supposed to be popular and get good grades and pursue a career.

A (9:33)

Right.

B (9:33)

You know, yes. Find the right partner, but you better start a business. And it really does feel like our sort of peer group has. Has been the sort of generation or two generations that have been shifting that. When you went from, you know, starting college, local school, walking to school, as you said, when was that? Lsu or did you transfer to lsu? No, it was.

A (10:00)

It was. It was called USL at the time, so it was in Lafayette, Louisiana. It's now ull, so they've changed the name. University of Louisiana, Lafayette. Most people know them as the RA in Cajuns because we have a really unique mascot. So it's actually the second biggest university in Louisiana. It just happened to be a mile from my house, you know, where I was living, so. And I had a great experience there. Like, my undergrad is geology. Eventually I changed three or four times, but I graduated in geology and went to work for an oil company for a year and a half before I met my husband, and then went to medical school at LSU after that.

B (10:36)

Wow. So what was it? As you say, you know, it's a series of light bulb moments. Right. Like, nobody's coming to save you. You know, you can. Yes, you can eventually marry well, as you did, but you Also kind of have to embody Cher and be like, mom, I am a rich man.

A (10:52)

Yeah, exactly.

B (10:53)

You gotta be the one.

A (10:54)

I've got this.

B (10:56)

So what was it that shifted you to obstetrics and gynecology? Like, how'd the pivot happen?

A (11:03)

I started working. So, you know, like, I was working part time for oil companies as an undergrad because of my degree path. And so I was getting a taste of what life would be like after. And I was coming to the realization of, I don't think I want to do this long term, but I'm kind of stuck in this path, and I'm very close, and I have all these scholarships. Like, let me just get the degree and figure this out. And so I graduated, got a scholarship to go study geology for a semester in New Zealand. So it kind of pulled me away from everybody and expectations, and I had this incredible adventure in New Zealand. And while I was down there, that was my, like, I don't want to do this forever. Like, this was cool. I love the math and the science and the, you know, I love the rocks, but I don't want this to be my career. And so my host family were all doctors, and they were like, you should think about medicine. With their New Zealand accent, Kiwi accent. And I was like, really? And they're like, well, you're obviously can do math and science. Like, this is, you know, does it interest you? I'm like, yeah, it always kind of has. And they're like, take the mcat. See what happens. And so I went, you know, finished that, went back to the US I was going to start a PhD in geology, turn that down, went to work because I had to eat and, you know, was meeting my husband while I was taking the MCAT and applying to

B (12:27)

medical school all at the same, wow, what a trip. So, okay, we fast forward and you're in the OBG world.

A (12:36)

Yeah. Do.

B (12:39)

Do you. Was there a particular patient experience, like a pattern that you kept seeing that made you realize something important was overlooked?

A (12:50)

Yes. And it. But it wasn't until much later. And so I had imposter syndrome. I probably still have it, right?

B (12:57)

We. I think we all do.

A (12:58)

I was in medical school waiting to be tapped on the shoulder to say, we've made a mistake. You know, you shouldn't actually been here. So I was like. And even in my residency, I was a yes girl. I did everything right. I blew the top off my boards. I won a war. You know, I was like, yes, yes, yes, yes, yes. Just going flat out, would never question the system never. Like, I wasn't that girl. And so it took getting out, going into clinical practice, and really getting to know my patients, you know, So I was so fortunate to work in a small town with a huge medical center, and so many of my patients were my friends, my neighbors, my mom group friends. We ran marathons, we had, you know, wine nights. We had. And then, like, all of the researchers at the university were my patients too. So I'm. I know these women. I know their lifestyles. I know. And all of a sudden, we're aging. We're aging together. We had babies together, and then we're raising kids together. And now we're going through perimenopause together. And like, the wheels are coming off the bus for all of these women, almost all of them. And that's when the pattern recognition started. Like, something's not right. Something's not right. Something's not right. And I, like, I know because I know them, I know their habits. I know the intimacies of their lives. I've been taking care of these women for 10, 15 years now. And something is external to her, you know, what actually was internal, but, like, not everyone's going nuts at the same time, you know?

B (14:27)

Right.

A (14:27)

And these were women who had built incredible lives, complicated lives, but they were managing them right. And then all of a sudden, they'd lost their resilience. So that's when. And then it happened to me. And so that's when I was like, lightning bolt, something's going on. We're not doing this right. And I started doing deeper dives into the science and literature and realized there's data out there, but no one's connecting the dots.

B (14:51)

Right. Well. And one of the things I've learned from folks like you and other friends of mine in the world of sciences is that there is so little training in medical school about women's health and this time in life specifically.

A (15:08)

Yes.

B (15:08)

And. And so in a way, you as a doctor have to be a. A figurative fisherman. Like, you've got to go out and catch all the fish and then look at them yourself. And it's like, well, if we know this is the pattern, why isn't it in the books? Like, why aren't we teaching everyone this stuff?

A (15:27)

So that's a great question. Not only are we not teaching the biologic predictability of what's happening with this massive hormonal change, we're also, we're taught that women are. Tend to be a little bit crazy. You know, the. It's all in her head they tend to somaticize psychological conditions. So it's a double edged sword. We're not teaching the actual biological truth. And then we're filling in that gap with, well, you know, this is just what women do at this age. You know, she's a little crazy. I mean I, I laugh and call it the be crazy school of medicine. I stole that from Elizabeth Cohen. But I love that, you know, like, you know, she's a little crazy. This is just her time, you know.

B (16:07)

I don't think it's a coincidence though that as women get wiser, much more independent, much more capable of saying no, when we've been reared our whole lives in existence to say yes, that that's when they start to tell us we're crazy. And that's when they start to tell us we've we're out of our prime or we're not hot anymore. Like I look at the 50 year old women in my life and they're so hot and so smart and so successful and so chic. I'm just like, speed up my clock, I'm ready to get. And, and I realized this whole societal thing is such a lie. And the lie coincides with a medical shift that they can dismiss us for.

A (16:48)

One of the most beautiful things I feel about the menopause transition is that women suddenly are able to peel back and focus on themselves. Like they're giving themselves permission and agency to prioritize themselves first because they have to, right? Because no one's coming to save them. And then when you see that work for them and then they step into who they're meant to be instead of this person who's going to serve everyone else that they're like in, like, what do I need? What is my priority? How am I going to be happy? It's the most incredible thing.

B (17:27)

And now a word from our sponsors who make this show possible. Friends, I've learned that the best gifts aren't the ones you grab at the last minute. They're the ones that become part of someone's everyday life. In my home, the kitchen has always been the center of everything. Family gatherings, traditions and recipes that somehow manage to taste better when they're made together. A new conversation piece in my kitchen. You know it. It's the viral Lenox Spice village. It is a charming set of 24 hand painted little houses, each one holding a spice that you actually use. It is super cute and very practical. And the colors on all of these little things, oh my goodness, they just are so precious and so beautiful. Lenox has been bringing timeless design into homes for generations, and the Spice Village feels like one of those pieces that just stays. It's not tucked away, it's not forgotten, it is used and loved. I think I might order a set for a friend's housewarming or it would be a unique Mother's Day gift. Once you'll see it, you'll want one too. Discover the full Lenox Spice village collection@lenox.com SpiceVillage it's getting warmer out and I have been doing a little spring reset with my closet lately. I love a spring cleaning and I'm really focusing more on quality over quantity, building a wardrobe of pieces that are well made, versatile and easy to reach for every day. Which is why I keep coming back to Quince. The fabrics feel elevated, the fits are thoughtful, and the pricing actually makes sense. Quince makes beautiful everyday pieces using premium materials like 100% European linen, organic cotton and super soft denim with styles starting around $50. Their spring pieces are lightweight, breathable and effortless. The kind of things that you can throw on and instantly look put together. We love that around here. That same focus on materials carries over into their accessories too. Quince works directly with safe, ethical factories and cuts out the middlemen so you aren't paying for brand markups. I spent all winter in my quince wool half zips and as the temperatures get warmer they're linen tops are replacing those as my go to the fabric feels sustainable but still easy to wear and at such a great price. And in those tricky spring days where it's suddenly really cold at night. Yeah, I put my half zip right over my linen top and I'm good to go. Refresh your wardrobe with quince. Go to quince.com work for free shipping on your order and 365 day returns. Good news, they are now available in Canada too. That is Quince.comqU I N C E.com work to get free shipping and 365 day returns. Quince.com work. You're welcome friends.

C (20:35)

Xolair Omalizumab is proven to significantly reduce allergic reactions if a food allergy accident happens. Xolair 150mg is a prescription medication used to treat food allergy in people 1 year of age and older to reduce reduce allergic reactions due to accidental exposure to one or more foods while taking Xolair. You should continue to avoid all foods to which you are allergic. Don't use if you are allergic to Xolair. Xolair may cause a severe life threatening allergic reaction called anaphylaxis. Tell your doctor if you have ever had anaphylaxis. Get help right away if you have trouble breathing or if you have swelling of your throat or tongue. Xolair should not be used for the emergency treatment of allergic reactions including anaphylaxis. Xolair is for maintenance use to reduce allergic reactions, including anaphylaxis while avoiding food allergens. Serious side effects such as cancer, fever, muscle aches and rash, parasitic infection or heart and circulation problems have been reported. Please see xolair.com for full prescribing information. Ask an allergist about Xolair. This is an advertisement for Xolair, paid for by Genentech and Novartis.

B (21:45)

And now a break from our sponsor, Miracle Grow. Let's be real. We're all feeling a little digitally distracted and time starved lately. We're craving real connections and ways to unplug. And honestly, gardening is the ultimate way to do this. It isn't just about plants. It's about trading the digital noise for a quiet win. As you pour your energy into helping something grow, you're pouring a sense of calm and connection back into your sense of yourself too. If you're in an apartment or you've never even touched a shovel, don't let self doubt stop you. With 75 years of expertise, Miracle Gro takes the stress out of the process and makes it pure joy. And let me tell you what, I can confirm this. From the garden I love spending time in outdoors in Los Angeles to my little potted plants where I grow herbs indoors in New York, I love working with plants and I love Miracle Gro because whether I'm doing something in the soil or potting something in the apartment, Miracle Gro takes the best care of my plants. So my plants can help take care of me. And here's the big secret. Most people think water and sunlight are enough. But no, no. Your plants actually need more to truly thrive. Whether it's starting with the right soil foundation or giving plants the boost they need to stay vibrant with plant food, our friends at Miracle Gro have all the essentials to make growing simple and stress free. Head to miraclegrow.com to check out all of their easy to use products and start your growth journey today. The shift I'm seeing in all the women I know in their 40s and 50s is incredible. I'm curious for you, you know, as an actual doctor, you know, we're all out here watching it happen, but you, you know, specifically what's happening. When you started to dig into the science, what surprised you the most about what was known and what still wasn't?

A (23:56)

So that there were estrogen receptors throughout the body. Like, I had a pretty good idea of hot flashes. I didn't actually understand the neurokinin receptor and kiss and like, now they've mapped out why we have hot flashes. But I was taught that women would, due to menopause, okay, not just due to aging, have hot flashes and have cycle disruptions, which might be heavy periods, and their general urinary system would take a hit. Nothing about their skin, their. And osteoporosis, yes, but nothing about their muscles, their joints, their skin, the itchy ears, their mental health, the incredible hit our mental health takes. Headaches, the brain fog, these sleep disruptions, like that was all external to menopause. And when I saw the paper where they mapped the estrogen receptors, the G coupled estrogen receptors throughout the body, I literally sat there and stared at it for an hour and was like, how did I not know this? I can't tell you how many times I have found a paper, found research, found an article, found a graph, and thought, how did I not know this Perimenopause. I thought the ovaries went through this gentle decline until they petered out at the end. No idea about the zone of chaos. And that paper was published in 1996.

B (25:16)

No. Oh, my goodness. Okay. Can you walk our friends at home through this? Because for our people, and I'm going to really pick your brain on the latest book later, but for our friends at home, Dr. Mary Claire has written an incredible book. Your first is the New Menopause, which I think really opened up a lot of eyes. And the second book, I'm so excited because I got a copy too, is the new Perimenopause. And to your point, it seems like perimenopause is the word you hear on everybody's mouth lately, but we haven't known a ton about it. And what is this zone of chaos? I've heard it described not as the way you. You said it, the idea that it's a steady decline, but it's more of a cliff that really disrupts our bodies. Is that accurate? Do you have a better way to put it? For us, it's.

A (26:13)

It's more of fluctuation. So let, let me explain. Let's go back to pre menopause before menopause enters the chat. Okay. In a normal, healthy woman who has regular cycles, so that's about 80% of us right. Your ovulation is driven by your brain, not your ovaries. The ovaries do not act autonomously unless there's a tumor or something. Okay? The ovaries just sit there and wait for instructions. We females are born with all of our egg supply. So if you're XX and everything's healthy and working like play, and you're born, by the time you're born, you've got 1 to 2 million eggs, okay? That is your set for life. And then you are going to lose them all the way through puberty through a process called atresia. And then we're going to start ovulating. We'll lose a bunch to the ovulation process. So time we're 30, we're down to about 10% of our egg supply, roughly. And by the time we're 40, we're down to about 3%. And menopause, full menopause represents no more eggs. Okay, so why do we ovulate? There is a command center in our brain called the hypothalamus. And just imagine it has a little finger measuring estradiol, the natural estrogen produced in our ovaries each month that ebbs and flows. Right. Most women have seen the cycle where we peak estrogen mid cycle at ovulation, and then it peters off. When that drop off occurs, the brain's like, where's that estrogen going? I need it back. I want it back. And so it starts sending signals to a second gland called the pituitary, which pumps out something called LH and fsh. Those are two hormones that bind to the cells around the eggs that produce the sex hormones estrogen, testosterone and progesterone.

B (27:51)

Okay?

A (27:52)

So perimenopause begins when we reach a critical egg threshold level, we are down to X amount. And that the signals coming from the brain don't work as well. The ovaries become resistant because there's not enough eggs to respond and recruit enough follicles to make enough hormones.

B (28:11)

Okay, so they're, they're going, oh, I better hold on to this. It's like a little stress response.

A (28:16)

So the brain is like, hey, I sent the signal. Where's my estrogen? And the ovaries were like, we, we tried. We just can't respond. So the brain flips out, starts pummeling the ovary with higher and higher levels of stimulating hormone until it can force those few eggs left to ovulate. So what happens is instead of that beautiful EKG, 28 day, month after month curve in a premenopausal woman, you know, on day six, you're doing this. On day 12, you're ovulating. On day 18, your progesterone is going to go up. Like it is so predictable. Month after month. Now it's like ovulation's delayed. You might have two ovulations in a 28 day cycle. Progesterone can never keep up. So what used to be very predictable looks like chaos. We end up with higher estradiol levels than we've had outside of pregnancy. You know, and so. And then they crash. And so instead of this beautiful pattern, it's like crazy, crazy, crazy on the way down. Like a roller coaster all the way down until we run out of eggs. That becomes chaos. You know what doesn't like chaos? The brain. And so our neurotransmitters, how we. If you look at Lisa Moscone's work, she mapped out estrogen receptors and glucose uptake and how we massively up regulate our estrogen receptors in at least the first 10 to 15 years of perimenopause and menopause. Because the brain is like, I have to get estrogen. I need more receptors to grab whatever's floating around. And glucose uptake really becomes sporadic in the amygdala, where our emotional centers are, and also in the frontal lobes, where we consolidate memories. So that is where the first signs of perimenopause typically are. Not cycle of regulation are not hot flashes are. I don't feel like myself. I'm not sleeping. I'm having new anxiety and depression.

B (30:03)

I'm having brain fog.

A (30:05)

So the brain is the first thing to signal that you're going through it. That is what we were never taught. That is still not being taught on a regular basis. So when women come in and complain of these things, no one knows what to do.

B (30:19)

Wow. Wow. I. I wish they could take portions of your book and just insert them into the medical textbooks because clearly people need it. Now I'm curious about this. And, and one. One little side note that makes me kind of giggle, you know, because as you said, we get dismissed. Women get dismissed as being emotional or a little crazy or how could a woman lead when she's got all these hormones? And I remember it's been neat to see some men who are doing, you know, love, love, your love, the women in your life, better content on the Internet. And one guy made a video that made me giggle. And he said, what women go through every month for. For us hormonally would be aging 125 years 1 week out of the month, every month. Like, if you don't think these women have proven that they can lead, like, we would die. Men would die. And it really. It really made me giggle because I thought, thank you so much for acknowledging that. My curiosity, because of what you're explaining and what you said earlier. Women manage so well. You know, we. We can really carry those full cups of water, and they might spill a little bit, but we're. We're really capable of carrying everybody's stuff. And then to your point, this shift happens, and suddenly there's more spillage.

A (31:37)

Yeah.

B (31:38)

How. How do you recommend women start to take stock? Because, for example, you know, I'm curious about this stuff. I was kind of like, well, how do I know? And I had one doctor say to me, if you're asking if it's happening or not yet, it's not happening, because you'd know. And I was like, that's the metric. Like, for real? That's the metric. So I found a new doctor, started doing really regular testing all through my cycle, and it turns out my hormones are still in a pretty good pattern. They're in a great pattern. And they were like, sorry, if you're feeling anxious or your. Your brain fog is up, it might just be because the world's burning, like, you don't have an excuse yet. And I was like, damn it. I was kind of hoping I did. But. But how do we know? Because the mystery feels tough. And I, you know, I want to acknowledge not everybody can go do regular testing like I can with my great health insurance.

A (32:31)

Right. So certainly, if, you know, there's some really, like, standout things, like if your cycles were regular and now they're not, and you're having all these other symptoms. Check. Yes. Okay. What if they're still regular? Right. Like, you were that part. How do we know the difference? Testing, you know, blood testing is really, really hard. Like you said, it's very expensive. You have to do it multiple shifts throughout the month. Not everybody can afford that. That is not typical. What we do in our clinic is we look at the constellation of symptoms. We have a tracker, we have a scoring system that's been validated by the Australasian Menopause Society looking at, does she have brain fog and musculoskeletal pain and general urinary symptoms and blah, blah, blah, blah, blah, blah, blah. Okay, now we're going to do blood work to rule out hypothyroidism, vitamin D deficiency, low ferritin autoimmune, you know, like like, we're doing tons of blood work, not so much hormones for us. And I'm ruling out or in, because all this can be happening at the same time. And then we have a frank discussion about we can do a trial of hormone therapy and see what gets better. Okay. And then we can talk about other, you know, forms of therapy. And we never leave lifestyle out of it.

B (33:48)

So.

A (33:49)

So many women find that the lifestyle they'd set up, which worked in your, you know, worked for a premenopausal woman. Suddenly there's holes and gaps we're seeing that are, you know, you're not, you're not actually optimized once your hormones start fluctuating.

B (34:04)

And what are the lifestyle changes that can kind of refill those holes?

A (34:09)

Well, nutrition is huge. Okay. And so when we look at, you know, in our clinic, we're looking vitamin D. It's so hard to get enough through your, through diet. You know, we're checking vitamin D levels and we're checking iron. We're looking at inflammatory markers, like high reactive, high sensitivities to react protein. You know, like, what are we missing here? Why is she not able to live her best life, you know, when she was before? Right. And there's no external stressors that have popped up out of nowhere. Stress reduction, sleep optimization, you know, making sure she's got all the sleep hygiene stuff, like if her sleep is disrupted. We focus on that first.

B (34:46)

Yeah.

A (34:47)

So because if you're not sleeping, nothing else is working. So, you know, bricking your phone, like I got a brick breaking your phone off of social media at certain hours of the day, getting into therapy, if she needs it, like giving her permission to go and do these things. And these things actually work. Yeah. And then hormones are just a part of the toolkit. They're not, you know, for some women, they feel like they are the thing. But I have to say, for a lot of our patients, they're just one part of a bigger scheme of how to kind of refocus, reprioritize and make sure you've got everything optimized so that you can live the next 30, 40 years of your life in your best health.

B (35:29)

Well, it's interesting. One of the things I'm hearing you say is to your point, people will say, oh, maybe I need HRT or oh, maybe I, whatever the fix is. But when you use the constellation metaphor, that really clicks for me. Because the way I, I think about it as you're giving the list is essentially, we have to learn to take care of ourselves. The Way we take care of our families. Good sleep, good food breaks, brain breaks, where you're just entertained, getting outside to play, you know, making sure that certain things about your environment are incredibly conducive to. To expansion rather than contraction. Things that come naturally to us for our kids, for our partners, for our families. But we usually put ourselves on the back burner.

A (36:21)

I mean, for me, it was, you know, leaving a job that no longer served me.

B (36:26)

Can you expand on that?

A (36:28)

So I was a very successful OBGYN in all the traditional sense of the word. I did the surgeries, delivered the babies, you know, did the. And I loved. I loved it. If babies came between eight and five every day, I would still do it. Then everything changed at the hospital. New administration, a lot more administrative burden. They were bringing in multiple levels of administrators above us. The paperwork was getting outrageous. For every hour that I saw patients, I was doing two hours of pajama work at home of finishing charts and stuff that just wasn't tenable. Plus the acuity of the patients, really sick patients, it just was getting. And the sleep deprivation from calls nightcall was really taking a toll on me. And I had to have a come to Jesus of how else can I be my best self and pay my bills and meet all my family's needs but not kill myself? I was taking years off my life with that job, but it was a job. But I signed up for this. The guilt and the shame of walking away from this prestigious position at a large academic institution where everyone loved me and I was so popular to go and like, field of dreams, like build a menopause clinic, you know, like, I didn't know if anybody would come see me, so. But I just, like, my heart of hearts knew this is not sustainable and this hospital system does not have another option for me, so I can't keep doing this. And my husband, super supportive, you know, but just the whole thing, you know, you've. You've built this life and suddenly you can't manage the life anymore. So, like, giving myself permission to walk away from was the scariest thing I've ever done professionally, but it is absolutely the best thing I've ever done in my life.

B (38:13)

That's incredible because I am practicing my

A (38:15)

best medicine right now with my patients.

B (38:18)

Well, and interestingly, you're. You're practicing personally your best life, and then your work is your best work. I am. And that. That's a double permission slip, I would think for anybody listening to this.

A (38:32)

I am 57 years old. I'll be 58 soon I have two grown healthy daughters who are thriving. So like, I don't worry about my normal mom worries, but you know, like, they are off on a great path, you know, and I have a 30 year relationship, 33 years, 30 married, you know, with the same person. And we're not going anywhere. You know, we're in this together. And so, but like I'm having, I have better relationships, we have better sex, I have better, you know, a better work life balance. I have better everything. And it's like. And I thank menopause for all of it.

C (39:11)

Wow.

B (39:12)

And now a word from our sponsors. Friends, I've learned that the best gifts aren't the ones you grab at the last minute. They're the ones that become part of someone's everyday life. In my home, the kitchen has always been the center of everything. Family gatherings, traditions, and recipes that somehow manage to taste better when they're made together. A new conversation piece in my kitchen. You know it. It's the viral Lennox Spice Village. It is a charming set of 24 hand painted little houses, each one holding a spice that you actually use. It is super cute and very practical and the colors on all of these little things, oh my goodness, they just are so precious and so beautiful. Lenox has been bringing timeless design into homes for generations. And the Spice Village feels like one of those pieces that just stays. It's not tucked away, it's not forgotten, it is used and loved. I think I might order a set for a friend's housewarming or it would be a unique Mother's Day gift. Gift. Once you'll see it, you'll want one too. Discover the full Lenox Spice village collection@lennox.com

C (40:27)

SpiceVillage Xolair Omalizumab is proven to significantly reduce allergic reactions if a food allergy accident happens. Xolair 150mg is a prescription medication used to treat food allergy in people 1 year of age and older. To reduce allergic reactions due to accidental exposure to one or more foods while taking Xolair, you should continue to avoid all foods to which you are allergic. Don't use if you are allergic to Xolair. Xolair may cause a severe life threatening allergic reaction called anaphylaxis. Tell your doctor if you have ever had anaphylaxis. Get help right away if you have trouble breathing or if you have swelling of your throat or tongue. Xolair should not be used for the emergency treatment of allergic reactions including anaphylaxis. Xolair is for maintenance use to reduce allergic reactions, including anaphylaxis, while avoiding food allergies. Serious side effects such as cancer, fever, muscle aches and rash, parasitic infection or heart and circulation problems have been reported. Please see xolair.com for full prescribing information. Ask an allergist about Xolair. This is an advertisement for Xolair paid for by Genentech and Novartis.

B (41:39)

It's getting warmer out and I have been doing a little spring reset with my closet lately. I love a spring cleaner and I'm really focusing more on quality over quantity, building a wardrobe of pieces that are well made, versatile and easy to reach for every day. Which is why I keep coming back to Quince. The fabrics feel elevated, the fits are thoughtful, and the pricing actually makes sense. Quince makes beautiful everyday pieces using premium materials like 100% European linen, organic cotton and super soft denim with styled starting around $50. Their spring pieces are lightweight, breathable and effortless. The kind of things that you can throw on and instantly look put together. We love that around here. That same focus on materials carries over into their accessories too. Quince works directly with safe, ethical factories and cuts out the middlemen so you aren't paying for brand markups. I spent all winter in my quince wool half zips and as the temperatures get warmer they're linen tops are replacing those as my go to the fabric feels sustainable but still easy to wear and at such a great price. And in those tricky spring days where it's suddenly really cold at night. Yeah, I put my half zip right over my linen top and I'm good to go. Refresh your wardrobe with quince. Go to quince.com work for free shipping on your order and 365 day return returns. Good news, they are now available in Canada too. That is Quince.comqU I N C E.com work to get free shipping and 365 day returns. Quince.com work. You're welcome friends. And now a break from our sponsor, Miracle Grow. Let's be real. We're all feeling a little digitally distracted and time starved lately. We're craving real connections and ways to unplug. And honestly, gardening is the ultimate way to do this. It isn't just about plants, it's about trading the digital noise for a quiet win. As you pour your energy into helping something grow, you're pouring a sense of calm and connection back into yourself too. If you're in an apartment or you've never even touched a shovel, don't let Self doubt stop you. With 75 years of expertise, Miracle Grow takes the stress out of the process and makes it pure joy. And let me tell you what, I can confirm this. From the garden I love spending time in outdoors in Los Angeles to my little potted plants where I grow herbs indoors in New York. I love working with plants and I love Miracle Gro because whether I'm doing something in the soil or potting something in the apartment, Miracle Grow takes the best care of my plants. So my plants can help take care of me. And here's the big secret. Most people think water and sunlight are enough. But no, no, your plants actually need more to truly thrive. Whether it's starting with the right soil foundation or giving plants the boost they need to stay vibrant with plant food, our friends at Miracle Gro have all the essentials to make growing simple and stress free. Head to miraclegrow.com to check out all of their easy to use products and start your growth journey today. Okay, so question for our friends at home. You know, I know there are women listening to us talk who feel dismissed, who felt unheard at the doctor when they bring concerns. What would you say are the most most important ways women can advocate for themselves? You know, do we need to be keeping let's say a 30 to 60 day journal of symptoms gripes, whatever it is to bring in.

A (45:42)

And in the new perimenopause we have a tracker, symptom tracker and that you can keep track, you know, so that we all tend to forget and get nervous in that little 10 minute visit. So like to prepare and I have a lot of this on blogs, on our website. But you know, big key takeaways. Call ahead. Do they do menopause care and pray to God that they're honest? You know, do they prescribe hormone therapy? You know, red flag is if. No, I don't believe in it. Well, it's not Santa Claus. So you know, not everyone needs it or does it but you know, is it even something they're willing to discuss? Okay, that's not your doctor. You have to be prepared to find someone who will take care of you.

B (46:20)

You.

A (46:22)

So how do you do that? Call ahead and ask. Ask your friends. Menopause Society. Menopause.org has a website. I'm a certified provider on that. Look for the certified providers. That means we took the test

B (46:34)

go

A (46:34)

to and it not necessarily ob gyn. Menopause Society certifies tons of nurse practitioners, tons of internal medicine, family medicine. Like someone who really had an interest into endocrinologists you know, it's not necessarily, necessarily going to be your ob. On our website, we have thousands of testimonials from my followers and we organize them by city and state. That might be helpful. There's great online options now, too. Companies built actually like MIDI and Alloy to serve, you know, menopausal women seeing this gap and realizing there's an opportunity here. So they built these platforms. So, like, don't assume you're awesome OB GYN who delivers your babies and took great care of you. Who knows enough. They probably. They were never taught in residency. I promise they. It's not in our cmes for acog. Not, not anything, you know, significant. And so unless they sought training outside of what's handed to them by obgyn for the American Board, I wouldn't count on them being able to take care of you. They might, but it's not a guarantee.

B (47:37)

You know, I've seen this, and I know we're, we're talking perimenopause and menopause, but I've really seen this. Also for some of some younger friends who have been dealing with getting endometriosis diagnoses, my girlfriend Julianne's been really public about it and, you know, she's a phenomenal performer and host, and so she's been able to get a lot of attention. I just worked with a great girl on a movie. He was talking to me about it and just the experience. So many women at that stage are

A (48:09)

going years and years to make a diagnosis.

B (48:12)

Yes. So would you say that some of the things that you have learned to offer women in terms of how to track their journey to discover whether or not they're in perimenopause yet would you say that some of that advocacy could also be helpful to them if they may be dealing with trying to get to the end of an endometriosis diagnosis?

A (48:32)

Absolutely. Endometriosis, fibroids, you know, pretty much any condition that primarily affects women. 80% of autoimmune diseases is women go years and years and years before and how many times were they diagnosed with anxiety or depression? Or you're just stressed out rather than you have endometrial tissue, which is basically a tumor growing outside of your uterine cavity and attacking, you know, causing inflammation

B (48:58)

all over your body.

A (49:00)

It could be anywhere in your body. It's usually in the pelvis. But I mean, I've seen in the, or on the diaphragm, around the heart capsule. Like, like, it's crazy.

B (49:09)

It's crazy. It's really Crazy. You know, it. It makes me think a lot about a conversation I recently had with one of our mutual friends, Jeannie Mai. We were together on the podcast when Balance was premiering, and. And you offered such great medical expertise to that docu series. And one of the things I found really fascinating about that was that the two women who were so central to the story, I'm reminding my friends at home, because obviously, you know, this. You helped make it. These incredible monks, these spiritual teachers, were really able to track the changes in their personal experiences of. Of their days in their own bodies, because their days were so regimented and identical always. And so many of us in this modern era, you know, we've got six jobs and a side hustle and families and travel. It's hard to track well. But you all really helped through telling their stories, I think, illuminate this reality for so many people. How was, you know, you took a big gamble leaving your practice and opening your clinic, and then you took a big gamble getting into this world and helping produce a docu series. How was that experience for you as a doctor? Because you are a caretaker and you are, in ways, a detective. And then you got to put your detective work essentially into, like, a mystery movie. Was it fun?

A (50:39)

So my. In. My assistant calls. I'll never forget this. So this was 20. The. The book New Menopause has not come out yet. You know. Oh, wow. And I had written. Yeah, so this was pre. Maybe we were about to come out with it, but. And hey, there's these two Jane monks. I didn't even know what a Jane monk was at the time, you know, who want to do this documentary. They're going to film a document about perimenopause. And I was like, what? You know, and we set up a zoom call, and these two beautiful women with their white robes on their bun, you know, their hair slicked back, but the minute they opened their mouths and they were so sincere and so genuine, they had actually produced a documentary on trafficking. And so that had won some awards. So they had experience. And, you know, I was like, this is probably crazy for me to say yes to this, but I feel like we need to do this. Like. And working with them was they brought in the most awesome team. They came to my home, we shot in my house. You know, we spent a whole day together. They came to the clinic, they interviewed a couple of my patients, and it was just incredible. And then, you know, it took years to, like, edit and produce and multiple. You know, I think it's four parts now, and it is so fantastic. It is telling such an amazing story, and I'm just so proud to be a part of it.

B (52:02)

Yeah, it's so cool. I can't believe you got the call before your first book was published. I didn't know that little detail.

A (52:09)

Well, I had done Galveston Diet, but that was, you know, a couple years before that.

B (52:14)

Yeah, I mean, I guess the first, specifically.

A (52:17)

Yeah. Menopause.

B (52:18)

Yeah. This world. We're gonna dive into your next book in our next episode, but before I let you go today, I have to you, you've continued to be a trailblazer for women and for yourself, which, as I said earlier, is a great example of signing your own permission slip. Your new book is out in the world tomorrow. I'm curious from this vantage point. I know you've checked so many boxes, but I know I know you as this amazing, creative person. I know you're going to have more. So what right now feels like your work in Progress the last 30 years.

A (53:00)

So, you know, I don't want to call it longevity. I don't like that word. But right now, when McKinsey did this survey and they. They dug through the research and they figured out that women live 20% of their lives in poorer health and, you know, less healthy than their male counterparts. And half of that time is in post menopause, and we don't age the same. Like, men tend to live a more fulfilled life and die quickly. Women tend to have this protracted loss of independence, either through frailty, you know, loss of bone, loss of muscle, or dementia, and then heart disease as well that causes them to live this life. And so that happened to my grandmother and my mother. And, you know, both of my grandmother. Mother had horrible frailty, horrible osteoporosis, multiple fractures, and dementia at the end of it. And I remember mom taking care of my grandmother and saying, I won't do this to you. I don't want this for you. And it happened anyway. And I feel like so much of what she's gone through was preventable, but she never got the right advice. She never was taught to focus on the right things. The only thing that woman was told was to be thin and be thin and you'll be okay. And so she did. She dieted. My mother was on a diet at

B (54:23)

80, you know, like, oh, gosh.

A (54:26)

Never lifted a weight. I. Those memes coming out right now. I'm the first of my bloodline to lift a barbell. That is great. You know, I'm the first in my bloodline to have a professional degree. I'm the first in my bloodline to do a lot of, you know, to be able to support myself without a husband. I have a husband. But I absolutely could do it on my own. And you know, I refuse this. I refuse for this to be the reality for my daughters.

B (54:50)

Yeah.

A (54:51)

So the next book I think is like, is a. How do we age well, you know, how do we shorten that time? I want to be a benefactor and not a burden. How do we shorten that time where we. I lose my independence. My dad, he was telling jokes three days before he died. We all gathered around. It was this beautiful end of life thing. My mom, it's going on for years, you know, like, she didn't want this. She didn't deserve this.

B (55:21)

Yeah. And if, and if we can break the cycle in their honor, our daughters get to do it differently.

A (55:29)

Yeah.

B (55:30)

Shouldn't we be thriving? Not just reducing suffering. And, and it seems to me that whole mission is to center not just the betterment of women, but they're thriving.

A (55:43)

Thriving. Right. Because I really feel like this is the time where we could really change the world. Right. Like first we change our family, then we change our community and then when we're like in our 50s and 60s is when we change the world.

B (56:01)

Yeah.

A (56:01)

And so, so that is. But we're like being hamstrung by menopause or cardiovascular disease or diabetes or aches and pain, you know, whatever. 20% of the workforce in the UK of females quit their jobs due to menopause when you're supposed to be leaning in and doing the things the C suites.

B (56:24)

And by the way, when your expertise is at its highest, that, yeah, it's, it's, it's a version of brain drain and it sucks and we're going to put a stop to it.

C (56:48)

Xolair omalizumab is proven to significantly reduce allergic reactions if a food allergy accident incident happens. Xolair, 150 milligrams is a prescription medication used to treat food allergy in people 1 year of age and older to reduce allergic reactions due to accidental exposure to one or more foods while taking Xolair. You should continue to avoid all foods to which you are allergic. Don't use if you are allergic to Xolair. Xolair may cause a severe life threatening allergic reaction called anaphylaxis. Tell your doctor if you have ever had anaphylaxis. Get help right away if you have trouble breathing or if you have swelling of your throat or tongue. Xolair should not be used for the emergency treatment of allergic reactions, including anaphylaxis. Xolair is for maintenance use to reduce allergic reactions, including anaphylaxis, while avoiding food allergens. Serious side effects such as cancer, fever, muscle aches and rash, parasitic infection or heart and circulation problems have been reported. Please see xolair.com for full prescribing information. Ask an allergist about Xolair this is an advertisement for Xolair paid for by Genentech and Novartis.

B (57:58)

When I'm choosing a Mother's Day gift, I always ask myself, will this still matter a year from now? And that is why I love the Lenox Spice Village. It is a charming set of 24 hand painted spice jars, each one shaped like a little house house. It is beautiful, it's actually useful, and it brings a little joy into the everyday, which honestly, is where the best moments live. Buying a meaningful gift can be a challenge sometimes, but the Spice Village feels practical and thoughtful and enduring.

A (58:29)

Plus unique.

B (58:30)

Just like Mom. Explore the full Lenox Spice village collection@lenox.com

D (58:36)

SpiceVillage this episode is brought to you by 20th Century Studios. The Devil Wears Prada 2 only in theaters 5-1-20 years after the generation defining classic, Meryl Streep, Anne Hathaway, Emily Blunt and Stanley Tucci return to the heeled streets of New York and the halls of Runway magazine. In its next chapter, the industry has changed, scandal dominates, and power always comes at a price. Don't miss the Devil Wears Prada too. Only in theaters May 1st. Get tickets now.

B (59:10)

And now, a quick break from our sponsor, Miracle Grow. Life is digitally distracted and time starved, but gardening is the perfect way to unplug. It isn't just about plants, it's about trading the digital noise for a quiet way to reconnect with yourself. Whether you're in an apartment or you've never even touched dishevel, don't let self doubt stop you. With 75 years of expertise, Miracle Grow takes the stress out of the process and makes it pure Joy. Head to miraclegrow.com to check out all of their easy to use products and start your growth journey today.

A (59:44)

This is an iHeart podcast.

B (59:46)

Guaranteed Human.