August 7, 2023 • 48 mins
Everybody is talking about menopause.
From Oprah and Drew Barrymore to Erika Jayne, Chris is ready to jump in on this conversation.
Dr. Mary Claire Haver, Board-Certified OB/GYN and Tik Tok menopause aficionado joins Chris to answer every question we have.
See omnystudio.com/listener for privacy information.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
This is the most dramatic podcast ever and iHeartRadio podcast.
Chris Harrison here coming to you from the home office
in Austin, Texas. I am unbelievably excited about the show today,
And when I tell you what the subject matter is
going to be, You're maybe going to be scratching your head.
(00:21):
But the entire show today is dedicated to menopause, something
that every woman who walks this earth is going to
go through. But it's something that as I have kind
of dove into this, have realized that a lot of
people don't know a lot about it. They don't know
what to look for when it's coming, what it means, why,
(00:45):
And it is kind of astounding to me and shocking
and terrible that we all don't know more men and women.
But I know you might be thinking, Chris, you're a
middle aged man, you're going to be talking about menopause. Yes,
I am, because I know my audience and I know
this is an important topic. And there are a lot
(01:08):
of people that go on social media and they talk
like they're nutrition experts, they talk as if they know
and these people kind of get passed off as experts. Well,
I made sure that we had the foremost expert. This
woman is active on social media, but she is BORED
(01:29):
certified obgyn has practiced for many years. She is also
a mom, also a wife. She is a published author.
She has an incredible book called The Galveston Diet. I'm
talking about doctor Mary Claire Haver, and she was nice
enough to join us so we could dive in and
(01:49):
allow me to ask everything about menopause, joining me now
from her home in South Texas, just down the road
from where I am here in Austin. Doctor Mary Claire
have thank you so much for joining me.
Speaker 2 (02:04):
Thanks for having me now.
Speaker 1 (02:05):
I know you do a lot of this now between
social media, TV, you name it. You probably don't sit
down with a lot of middle aged men to discuss menopause.
Speaker 2 (02:17):
Not very often occasionally, but it's one of the most
enlightening conversations for me because I really get to see
it from your perspective and it really helps me guide
you know, fifty percent of the population, because you are
affected just as much as we are. Because everything's changing
in our bodies, in our minds and how we're you know,
(02:39):
interacting with the world through this menopause process, and that's
affecting your relationships as well.
Speaker 1 (02:44):
And while I know just enough to be dangerous, I
will admit that I have cheated because I am engaged
to a beautiful woman, Lauren Zema, I am raising a
beautiful woman, Taylor, my daughter. They gave me some very
important questions that they wanted to ask. And my team
here at iHeart on the most dramatic podcast ever, is
(03:04):
probably ninety five percent women, so they had questions. It
was amazing when we started talking about menopause doctor, how
many women were lining up that had questions. And it's
something they're all going to go through. It's something you
think that we would all, but especially women, would be
so knowledgeable about, and we're not. Why is that?
Speaker 2 (03:29):
You know, there's several reasons, everything from society, to medical
education and training to you know, asism, and so if
you look at in medicine, which is you know what
I'm an expert in, I can tell you from my
own obgi N residency training, which was amazing, I've learned
(03:50):
so many important things. But there was a just a
sliver of time spent on menopause and I thought nothing
of it at the time, to be honest, And there's
also that little bit well a lot of of it's
kind of in her head. You know, like when a
woman and a man with the exact same symptoms walk
into the er, say with chest pain, shortens of breath,
(04:12):
some classic symptoms of a heart attack, she's much more
likely to have a delayed diagnosis and to be thought,
you know, have a mental health diagnosis rather than a
heart attack. And that is just kind of how we're trained,
and so that that's a problem. Number Two. We have
the kind of classically medically recognized symptoms of menopause, hoplaches
(04:34):
and night sweats, you know, changes in the female anatomy,
et cetera. But what we're learning now is that there
are probably forty plus symptoms that can raise their head
in menopause and they're not recognized as being classically menopausal
from a society standpoint. You know, look at the Golden Girls.
(04:55):
They are my age, you know, I love that show.
They were amaze. I mean, Blanche was still teaching right,
and it's like they were old ladies in my head,
you know, the haircut, the outfits and the way they
approached life and health. I mean, they were wonderful. But
just this kind of dismissal of this is the end
of your life when we're going to spend a third
(05:17):
of our lives a third, we're going to live thirty
to forty years in this menopausal state, and there's so
much we can do to improve our lifespan and our
health span throughout it.
Speaker 1 (05:27):
Well, what I found interesting is you mentioned going through
med school, and you are a board certified obgyn. You
have practiced for many many years, worked with women, delivered babies,
you name it. But from what I understand of your story,
it wasn't until you went through menopause that you realize
that the advice that you had been giving all those
many years probably not the best. Is that fair?
Speaker 2 (05:50):
That is very fair. If someone came in with severe
hot flashes, I knew what to do, okay, format, therapy, conversation,
et cetera. But most of the patients, the number one
complaint that they had in my office, and when I
talked to other menopause specialists and looked at, you know,
thousands of years of patient data, the number one complaint
really is weight gain and body composition changes like new
(06:13):
weight gain in places you never had it before, and
you really haven't changed your diet and exercise. So the
advice that I'd been taught to give, that I gave
for years was work out more weight less. We slowed
down a little as we get older. I mean I
cringe when I think of the things that came out
of my mouth, and then it happened to me so embarrassingly. Yes,
my entry into this menopause world, into doing more research
(06:35):
and trying to understand what's going on and why do
I have such a gap in my education was around
pretty cosmetic reasons of just some unwanted weight gain that
was making me unhappy. But what I didn't realize, I
mean it was just the tip of the iceberg. And
when I when I you know, cracked over in the
top and started, you know, ice diving, I was like,
wait a minute, there's so many things here, cardiovascular disease risk,
(06:58):
you know, neurodegenerator these like Alzheimer's and dementia, and hip pain,
bone pain, joint pain, every organ system and our bodies
affected by this.
Speaker 1 (07:07):
I mean, it makes sense. It makes sense that we are,
you know, one kind of living organism and everything is
tied together in our bodies. Of course it's going to
all be affected. I mean, it would be crazy not
to and it's going to affect people in different ways.
And so I'm right. I'm glad that not only you
had this awakening, but now that there is And don't
get me started on social media. There's plenty of bad
(07:28):
things out there, but people like yourself that are knowledgeable,
that can now speak out and just normalize this conversation
that we're having.
Speaker 2 (07:37):
I feel like the biggest contribution I've made to this
menopause conversation is trying to normalize it and just validating people.
My DMS just blow up with and I can't give
personal medical advice, you know, it's against the law. I
mean to practice medicine in another state, and so but
I'm just trying to calm people down, like, yes, this
absolutely could be could be related to your menopause. Here's
(07:58):
the questions you can ask your health care, here's the
you know, medications you might want to think about. Here's
some supplements that might help, you know. Just trying to
get everybody on an equal playing field so that they
can make an informed choice.
Speaker 1 (08:09):
I was looking at I was trying to find because
I wrote it down, I can't remember where it was.
The quote you just posted on your social media about
the validation of what you're going through, if you're going
through menopause, having those symptoms validated, And I love the
quote that you put up.
Speaker 2 (08:25):
Like every woman deserves to have validation of what she's
going through is real. And then in a decision whether
she chooses or not to pursue certain pharmaceutical options, that's
that's up to her. But you know, so much of
that's being taken off the table for so many women
for at least the last twenty years.
Speaker 1 (08:42):
So what I'm going to do today is think of
me as the arbitrary voice for all the amazing women
in my life. And so they lined up, I mean,
pages of questions. So I'm going to jump in with
the most important women in my life, vers all my
beautiful fiance Lauren Zema. She asked, what is para menopause?
Speaker 2 (09:08):
That's a wonderful question. So most, you know, most people
women men will understand that menopause represents kind of the
end of your fertility. You're not gonna have periods anymore,
and you're something about hormones might stop functioning like they
used to. So when in actuality what happens. There are
three kind of phases of this menopause journey. We have perimenopause,
(09:29):
we have menopause, and then we have post menopause, and
I'll well, let me define those for your followers. So
menopause is really just one day in your life. It's
kind of that you go up and then you go down.
And so menopause represents the last day that your ovaries
will ever function. There's no more estrogen to be produced.
There you've run through all of the eggs that you
(09:51):
were born with and there's you know, nothing. Everything after
that point is postmenopause, got it. Menopause represents a seven
to ten year time period when that function doesn't just
shut down overnight. It is kind of a degradation. So
we're born with all of our eggs, right you guys,
aren't you know? If you're born with the opposite gonads,
(10:15):
you make your stuff fresh every day. Good for you?
Speaker 1 (10:17):
Yeah, ask Robert de Niro, who's still making babies at
a one hundred and four.
Speaker 2 (10:21):
Yeah. And we are born with all of our our
gonads are set. We're done, locked and loaded, ready to go,
and we start losing eggs at about five months in utero,
so we start, you know, So we're born with a
certain amount. By the time we're thirty, we're down to
about ten percent of what we were born with, and
then when we're forty, we're down to about three percent.
(10:41):
And those germ cells represent the ovarian production of estrogen, progesterone,
and some testosterone as well. And so perimenopause is when
you become symptomatic from this choo choo train that's getting
harder and harder to chug to get those last few
eggs you know, on market, so to speak. And the
quality of those eggs is decreasing as well, which is
(11:04):
why we see more down syndrome and other chromosome latinormalities
as a one gets older and has children. So perimenopause,
you know, if the average age of menopause in the
US is somewhere around fifty one, okay, but it's still
very normal between forty five to fifty five fifty six
two for that to be normal, And then you do
the math backing that seven to ten years back. So
(11:26):
somewhere between thirty five and forty five, a woman will
probably start noticing. She may not put her finger on
it or recognize it as perrymenopause, but something is changing
in her body without any rule, increase in stress, no nutrition, diet,
you know, like everything's going, She's living her best life.
And then you know, outside of just aging, which does
(11:47):
its own magic to us, you know.
Speaker 1 (11:49):
That it does. So this Laura and I very much
believe in kind of preventive medicine. Have taken care of yourself,
your diet, gut health, et cetera. And I had this
question a couple of times from not only Lauren, but
my young producer Kendall, who's on the line with us
right now, and they both kind of ask the same
question of what do I need to be doing for
(12:11):
my hormones while I am in my mid twenties, while
I am in my young thirties. Are there things I
can do that will help alleviate or just help me
get through menopause later?
Speaker 2 (12:22):
Sure, so, how you show up in perimenopause, your baseline
health status, those habits that you are locking in the place,
is going to determine for most women, how much, how
many symptoms you have, how serious your menopause is, how
life disruptive it is, as well as attenuate some of
those cardiovascular risks that seem to accelerate and neurodegenitive risks
(12:44):
as we get older. So for my children, you know,
my girls are nineteen and twenty two. They live and
breed this stuff unfortunately because they're you know, my kids,
but they understand that they need to lock these health
habits and now so that it's much easier, they'll have
an easier menopause. We can't. We haven't figured out yet
(13:06):
how to prolong the shelf life of the ovaries, like
if when that happens, and there's some research being done
for that to delay menopause.
Speaker 1 (13:12):
Interesting, that's probably.
Speaker 2 (13:15):
The thing that will improve quality of life, lifespan and
health span and a female more than anything else, is
if we can delay menopause.
Speaker 1 (13:23):
You're already outlasting us anyway. How much longer do you
want to be exactly?
Speaker 2 (13:27):
You know for evolutionists or life maybe this happened so
that we didn't outlive men for so long. You know,
we already outlived five to seven years, but take away menopause,
we'll live forever.
Speaker 1 (13:41):
But I don't doubt that. Okay, So the last question
from l Z and again remember where this is coming from.
I'm going to read it in her voice. Doctor, I'm
afraid is my vagina going to dry up? Will I
be vadryina?
Speaker 2 (13:59):
That's awesome.
Speaker 1 (14:00):
That is a medical term that LZ invented by vagarina.
Speaker 2 (14:04):
More than likely, yes, so, but it's absolutely preventative. I mean,
it's preventable, preventable. So we we have our vagina, our vulva,
our all of our you know, bladder, all that tissue
you know, basically from the pubic bone to the to
the spinal cord is all super estrogenized. And when our
estrogen levels began declining in perimenopause, some more than others,
(14:26):
we will see a decrease in the amount of mucus
we produce, the amount of mucus we produce with relations,
as well as loss of elasticity. The tissue gets really
thin and really irritated, and for a lot of women,
probably forty to fifty percent, you will have severe atrophy
with you know, dramatic pain and being uncomfortable with relations
(14:46):
to the point where libido goes out the window because
it hurts and you don't want to do it. Fortunately,
there are safe, efficacious, and reasonably priced medication that can
absolutely prevent that, and that is vaginal estrogen. And so
we just put we'll give you back the water you
were drinking, and we put it in the vagina where
you need it. And there's no that's the one. There's
(15:08):
no increased versus of blood clots breast cancer at People
with a blood clot with breast cancer can absolutely safely
use this formulation of estrogen to keep that area healthy.
It's the number one most effective treatment for recurrent bladder
infections in menopause, not antibiotics, vaginal estrogen.
Speaker 1 (15:27):
Probably because of Hollywood and you know, just the old
you know scene we've seen, whether it was Golden Girls
or every movie with middle aged women. You think hot
flashes and menopause. So I want to dive into this
a little bit because my daughter, actually Taylor, who's nineteen,
had a very interesting question. She's heard about hot flashes,
(15:48):
but how much does your body temperature actually rise?
Speaker 2 (15:51):
Oh that's such a good question, Thank you, Taylor. Okay,
so it's about one to three degrees okay, like fever.
So you know, think about it. We're ninety eight point
six is the average, you know, tent right, and then
if we get up to one hundred, one hundred, one
hundred and one, one hundred point six is a fever.
Speaker 1 (16:08):
Yeah, that's a solid fever. If you're at one hundred
hundred one, basically have.
Speaker 2 (16:11):
A short term fever, and then your body, in an
effort to cool itself, will dilate all the blood vessels
of the skin, usually in a hot flash scent, typically
the central area, so the head, the next, shoulders, chest, back, groin,
and dilate those blood vessels, which just drives the heat
out and you just sweat like crazy, and then you're
freezing because you're so wet. You know, your temperature goes
(16:33):
back to normal, but you're soaking wet. So yeah, it's
about one to three degrees.
Speaker 1 (16:37):
Danielle an amazing woman who works with me. Why does
your body go through this? Why are you having hot
flashes with menopause? What's actually happening?
Speaker 2 (16:48):
Yeah, So there's a thermoregulatory center in our brain that
controls our body temperature, and that's the mechanism by which
we have a fever, which is a physiologic response to
an infection or medication, you know, adverse reaction whatever. We
don't know exactly how it happens, but there's something to
do with declining estrogen levels. Estrogen kind of stabilizes that
(17:12):
temperature center, and when you take that estrogen away that
it just becomes erratic and starts going off on its
own without the usual chemical signal.
Speaker 1 (17:21):
I saw in your social media. Sorry to be uh,
you know, peeping on you, but you were talking about
this nightgown that you created because your hot flashes have stopped.
Speaker 2 (17:31):
Yeah, but I'm still hot.
Speaker 1 (17:33):
Your body's still hot. So is that something you have
to worry about? Once the hot flashes stop, your your
body temperatures is still like cooked.
Speaker 2 (17:41):
So you're inspiring me for my next TikTok, Like, here
are the things that hormone therapy did not help me with? Okay,
And definitely my hot flashes, the ones that woke me
up at night, that pulled me out of a meeting
that you know, embarrassed me in public, are gone. But
I'm just in general hotter all the time, And so
I was always freezing, freezing, bundled up under the covers,
(18:03):
going to bed with sweatpants. My husband's very excited. I'm
not wearing a sweatpants to bed anymore. And that I
like have this great nightgown I've worn for years, and
I just cut the arms out of it, like wear
it like a trucker because I was so hot at night. Still, so,
hormon replacement therapy can do so many wonderful things for
our bodies, but it's not I can't give you back
(18:23):
your twenty five year old ovaries, right, you know that,
And that's okay. I think most women are fine with that.
They're not expecting that, but they just want to be
able to sleep and get on with their lives.
Speaker 1 (18:43):
Hannah asked, how do you know when you are actually
in menopause?
Speaker 2 (18:49):
That's a really good question. So if you were a normal,
regularly menstruating person, Okay, yeah, period every month and suddenly
that stops. If you're over the age of forty five
and you have not had a cycle when it was
regular before for a year, that is the definition of menopause.
As far as using clinical symptoms to make the diagnosis, now,
(19:12):
say you've had a hysterectomy or an ablation or some
procedure or surgery where you don't have periods anymore. Well,
sometimes just on the symptoms we can make the diagnosis
and your age. You know, clinically, there is a blood
test that we can use to diagnose complete menopause, that
postmenopausal state but because hormones fluctuate so wildly in pery menopause,
(19:34):
we don't really have good blood you'urine saliva tests to
diagnose that. It's a clinical diagnosis. So you need a
menopause friendly provider who knows what they're doing, who's willing
to talk to you, help untangle some of the other
diseases that kind of look like perimenopause, like hypodiroidism or
an autoimmune disease. You know, when I'm doing blood work,
hormones is not the first thing I check in a
perimenopausal woman. It's thyroid, it's nutritional deficiencies. It's a blood
(19:59):
count to look for a name, you know, based on.
Speaker 1 (20:00):
Her symptoms, you're speaking of a normal period. Blair asked
a very interesting question. Does the age you get your
period effect when you start menopause? For example, if you
started your period very late in life, does that mean
menopause will come later.
Speaker 2 (20:16):
Yes, it's not a huge contributor, but we do see
that women who go through and I think it's before
the age of eleven, tend to have earlier menopause than
women who don't, and then therefore going through later. Because
again we're born with the finite amount of eggs, and
so if you kind of let them sleep for longer,
(20:38):
you'll have more that'll last you in your mix. Sure
it's not huge. There's a lot of environmental things that
go into what you know, genetics, exposure to certain chemicals,
you know, different things that affect when we go through menopause.
Speaker 1 (20:51):
Well, you talk about that exposure to chemicals and just
different foods and how our foods have changed. And again
I'm a big believer in diet and gut health and
all that young. Can you start menopause and have you
seen that number change over the years, like, for example,
I went through this with my daughter. Is like, girls
are hitting puberty quicker. You know, whether it's the milk,
(21:13):
whether or whatever you want to say, it is things
have changed and they're happening faster.
Speaker 2 (21:17):
That's a good question. So we definitely know that women
girls are going through menarchy or puberty earlier than they
did one hundred years ago. Isn't that is a fact.
We think it's improved nutrition actually, so like one hundred
years ago, you know, the famine and all those things,
and then they're also have more body fat now and
(21:38):
that is leading to higher estrogen levels, which is contributing
to this earlier puberty. So we think on the back end,
we haven't seen that age of menopause change quite yet.
They're kind of driven by two different things. So we
know that smokers go through menopause early. So that's a
(21:59):
definite something that we know is not good for us
and attacks our.
Speaker 1 (22:03):
Body reason six thousand, seven ninety two not to smoke, definitely.
Speaker 2 (22:07):
You know, surgery is a risk factor, radiation, chemotherapy, those
are all risk factors for earlier menopause. I've seen menopause
in their twenties and it's rare, but you have certain
autoimmune conditions that will attack the o reason destroy them
before their time. So premature menopause is before the age
of forty, and that's about two percent of the population.
Speaker 1 (22:28):
And is that a reason for concern? Is it? Obviously
you would get it checked out.
Speaker 2 (22:32):
So you know, estrogen is a protective hormone in so
many organ systems in our bodies. Definitely in our brains
and our hearts and the blood vessels of the heart
and our bones, and you know our female organs. When
you go through menopause earlier and you are not replaced
with hormone replacement therapy. You have a much higher risk
(22:52):
of cardiovascular disease, stroke, diabetes, inflammatory conditions, osteoporosis than a
woman who went through five ten years later. So those
it's really serious. If any of your listeners have gone
through premature menopause, they have got to see a physician
who knows what they're doing and get on hormone replacement therapy.
(23:13):
You know, there's definitely there's risks of being on any
medication correct and we've all known about the breast cancer
risk and that's been walked back. It's a very small
risk and it's really up to the patient and her
family history, et cetera. But they're a risk of not
being on hormone replacement therapy, which is the conversation I'm
trying to bring to the table interesting.
Speaker 1 (23:33):
Everyone to know does menopause because you hear a lot
about this. It's right up there with I would say,
just if hot flashes are one, sex drive would be two.
That everybody talks about. It's the old cliche, does menopause
affect your sex drive?
Speaker 2 (23:47):
Yes, we definitely see one of the cardinal symptoms of menopause,
and it's not for everyone, but it is much more common,
is less sexual feelings is the way that we kind
of describe it. So this is probably a topic that
most of your followers will be interested in. So when
we talk about sexual function in a woman, there's usually
(24:09):
five buckets of areas that she is going to have issues,
and they can overlap. So the first is a relationship issue.
So if you're not happy, you don't feel supported, you
feel like whatever, you know, you're not happy with the partner.
That's normal that you're not going to want to have sex. Okay.
Then there is pain, if it hurts, we got to
fix that, you know before we address So then there
(24:31):
leaves desire, arousal, and orgasm. So desires what happens in
the brain. Arousal is the physiologic response to a stimulus,
so all the things that happen in the pelvis to
get you ready, the things elongate, blood gets engorged, just
like in a man. And then there is orgasm. So
(24:52):
so we kind of address each of those. They have
different treatment options. Most women who are in a nice relationship,
they love their partner, they want this, you know, they
miss it. They want to go back to the level
that they were. They're just feeling really sad about it.
That's a pure desire issue. And so there's a couple
of medications that can be helpful. Again, it's a complicated pathway.
(25:13):
There's some great books out there and great podcasts on
this whole subject. But Addie and va Lasi. Again I'm
not paid by these people, but are two medications at
increase dopamine in the brain. They are FT approved and
but they are pretty expensive and not covered by insurance.
But some patients go that route. And then testosterone can
actually be helpful, especially in postmentopause, for a woman, to
(25:34):
help her be more reactive to the stimulus that she
wants and get that part of her life back.
Speaker 1 (25:40):
Because I guess so another one of my I won't
I won't name her because I don't know if she
wants her name on this one, but she said, you know,
it feels like I can't orgasm as easily anymore. And
obviously this is if you're if you're to that point
and you're and you know you're just not orgasm and
clearly you are wanting this, you're stimulated, and you're just
reaching that right.
Speaker 2 (26:02):
And so that's a whole different class and different medications.
What happens is a lot of people are like, oh
my gosh, give me to saucer and I just need
that to fix me, and that's not going to help
in certain conditions. So I always have that conversation with
my patients. And there's a wonderful book called Come as
You Are by doctor Emily Nagowski, who really does a
(26:23):
deep dive on this subject. So any person who's struggling
with this and wants that back in their life and
is feeling kind of broken, then that's a wonderful book
to read because it really helps lay out what your
treatment options are and really makes you feel.
Speaker 1 (26:37):
Like you're not alone. Whatever publicist came up with the
title of that book's yeah, well done. Come as you Are.
Diet is so important. So I just went to this
medical conference. Again I'm a bit of a nerd, and
I was listening to these doctors who are kind of
rearranging the way they're thinking about medicine instead of you know,
(27:00):
you get sick, you do this, you get cancer, you
do this, trying to look ahead of all this and
obviously gut health and diet is a huge part of it.
What I found interesting is what you said about menopause
and doctors and students only getting about an hour's worth
of knowledge. They said the same thing about diet.
Speaker 2 (27:19):
Nutrition. Yeah.
Speaker 1 (27:20):
Nutrition shocked me and stunned me that they just back
in the day and even now maybe are still just
not spending much time on nutrition and how huge that is.
And so my question is are there things that women
could be eating, drinking? What can they be doing that
will help the inflammatory issues?
Speaker 2 (27:42):
Absolutely? And I wrote a whole book about it.
Speaker 1 (27:45):
It's called The Galveston Diet. Everybody, Just so you know.
Speaker 2 (27:48):
I went back to school. I was so frustrated with
my lack of knowledge and so hungry from no pun
intended for more information and wanted to better myself. You know,
I just felt pulled and drawn to do like on
my own dime. I found this culinary medicine program at
Tulane and you know, enrolled and it took about eighteen
(28:09):
months and I had to like fly around to go
do different labs and different coursework, and it just was
the best thing ever. And I was like, gosh, we
should have taught this at medical school. You know, this
would really really help, and so much of it is
preventative and really putting a framework around nutrition. We might
get an hour of nutrition you know, lectures in our
medical school and residency training. My daughter started med school
(28:32):
a couple of weeks ago and her undergrad degree is
in nutrition science. So like, honey, you're doing it right, you.
Speaker 1 (28:38):
Know, I mean, especially what we know now, I mean,
I get it. You know. Ten twenty years ago, we
all thought it was about medicine and pharma and all that.
But now right now we know it is so linked
to our nutrition in our gut health.
Speaker 2 (28:50):
Right. So like top tips for someone in perimenopause and
menopause are look at how much fiber you're getting in
your diet, you know. And one way to do that,
and it's pretty effective is download a free nutrition tracker.
I'm not trying to you know, stress anyone out or
give them, you know, neurosis about it if this is
(29:10):
going to trigger something and you don't do it. But
so many of us it's like using cash instead of
a credit card. You don't really know what you're eating.
You think you're eating healthy, and I thought I was
eating healthy for a long time. It said healthy on
the bag. So okay, So track your fiber intake, how
much you really getting through your food. And we should
be getting at least twenty five grams of fiber in
(29:32):
our diet per day, and a mix of soluble and
insoluble fiber. You know, insoluble fiber is what bulks up
our stool and makes it kind of run through quicker.
But the soluble fiber is dissolvable, and that's what feeds
our gout microbiome and keeps it healthy. And so, and
when you're eating food sources, you know, from various foods,
then you're getting so many other vitamins, minerals and nutrients
(29:54):
you know that are part of that fiber package. So
make sure you're getting twenty five grams of five in
your diet per day. Number two, watch the added sugars
and food. So, I know, the whole keto movement kind
of threw all sugars. All sugars are bad. What fruits
and vegetables were you know, that's probably, you know, not
the healthiest way you better option. Sure it's a way
(30:14):
to lose weight, but at what cost. And so when
you lose fruits and vegetables, you were losing a tremendous
amount of nutrients. And so my nutrition professor is like, well,
Mary Claire, nobody got fat eat and blueberries, you know exactly.
It's kind of a cowboy. But you know that on
with me, like why are we demonizing fruits and vegetables
(30:38):
when we there's so many things in our diets that
we're eating routinely that could probably be you know, done
in very much moderation and replacing that with fruits and vegetables.
So added sugars are the sugars added in cooking and
processing and alcohol, and so limiting those to twenty five
grams per day or less. So that's not saying never
you can't have a cookie or no celebrate birthday or
(31:01):
however you want to do that. But women who consistently
less than twenty five grams of out of sugars per
day have less visceral fat, better menopause symptoms. You know,
everything is better in there.
Speaker 1 (31:12):
Right two, diabetes, you name it, all of it. This
next question is kind of specific to their diet. Amy,
who I do know very well, dear friend of mine.
(31:32):
She's forty nine, breaking into that fifty club. Clearly going
through metopause. Eating etamammy salmon and having sex has helped
my Hot flashes is this normal.
Speaker 2 (31:44):
Absolutely, So the sex is optional and love it, do
it for sure. It's a great way to stress relief.
But atamammy is rich in phytoestrogens. And so we've looked
at women throughout the world and hot flushes specifically, and
women in Asia have less hot flashes than women who
(32:06):
are Eurocentric. Interesting, and we think it's because their diets
are so rich in phytoestrogens. So phyto estrogen is an
estrogen like compound found in foods, and so the soy
kind of got a bad rap because of, you know,
possible links to breast cancer that has never played out. Actually,
women who have diets rich in natural soy who eat
(32:27):
out of mammy or soybeans on occasion have lower risk
of breast.
Speaker 1 (32:30):
Cancer and probably fatty fish with good oils and etcetera, exactly.
Speaker 2 (32:34):
The omega threes. Definitely, the fatty fish with the good
oils is going to decrease your risk of hot flashes.
Speaker 1 (32:42):
So a couple more symptom questions. Sadie brought this up
apparently a Beverly Hills housewife fan. She said, Erica Jane,
a Beverly Hills housewife, claims she lost weight thinks to menopause.
Is this the truth? And can menopause just as easily
make you lose weight as gain weight.
Speaker 2 (33:00):
So here's what we know. Women tend to gain weight
as we age. It's more to do with getting older
and loss of muscle mass and replacement of that muscle
mass with fat. And so I don't talk about what
I try not to talk about weight in terms of
the scale. I talk about muscle mass and fat mass
and visceral fat to be specific. So subcutaneous fat is
(33:23):
the fat we've known our whole lives. It's under our skin.
It gives us curve cell you like. We don't like it.
It's cosmetically distressing, but it's really unless it's a lot,
it's not that dangerous. Visceral fat starts really expanding in menopause.
That is the fat inside of our abdomen, our momentum
rocks around our internal organs, and that fat is pro
inflammatory and linked to hypertengen, diabetes, stroke and all the
(33:44):
chronic diseases. It makes you feel terrible and look kind
of pregnant. And so so many women are seeing an
increase in their abdominal circumference where they never had it before.
You know, and that is causing in resistance, increasing inflammation levels.
And so some of those nutritional things I talked about,
the added sugars, the fiber, actually, probiotics and tumoric have
(34:08):
been shown to help bring that visceral fat level down
and decrease inflammation markers.
Speaker 1 (34:13):
You mentioned something, you just said it right there, and
you also said this on social media. I found it
very interesting, again, just kind of being in this world
and loving this science behind it, especially with women, the
percentage of muscle you lose as you age, and correct
(34:34):
me if I'm wrong, But what you were saying is,
don't just worry about the scale, don't worry about how
much you weigh, don't just worry about jumping on a treadmill.
Think about gaining some muscle and keeping that sustaining that
muscle as you get older. And that is huge for
a woman.
Speaker 2 (34:50):
That is one of the biggest lessons I've learned through
this whole journey that I've been on, you know, learning
nutrition classes, look at talking to other experts, you know,
figuring out what Peter A. T Is trying to say,
you know, and applying that to us as females. When
you add in the endocrine aging through menopause, and what
we see in menopause is acceleration of the muscle mass loss,
(35:13):
which is immediately replaced. You know, the scale may be
you know, whoever the housewife is. She may be like,
I'm doing great, I'm doing great. But if she's replacing,
you know, losing muscle mass and replacing it with fat,
she's not healthier. She won't live as long.
Speaker 1 (35:28):
Because muscle weighs more than fat.
Speaker 2 (35:31):
And so my own workouts have changed. For twenty five years,
thirty years, I worked out to be thin. That was
my goal. I wanted to look a certain way. I
wanted to fit in certain clothes. I had skinny privilege.
And now if I could do anything like your twenty
five year olds, your staffers, my kids are much better
about this than I was at that age. They are
not so focused on being thin. They know they need
(35:51):
to be strong. When they work out, they lift weights.
You know, they're not just running or doing aerobics or
doing something cardio. They know that that's part of it.
But they recognize the importance of muscle training and keeping
it up.
Speaker 1 (36:03):
And ladies don't worry. Everyone says, oh, I don't want
to bulk up you're not gonna bulk not Arnold Schwarzenegger,
don't worry about it.
Speaker 2 (36:10):
Well, bulk up. No, it's important.
Speaker 1 (36:13):
Alexandra has a very interesting issue. She says, my hair
is thinning, but I'm also growing a beard. What's up
with that?
Speaker 2 (36:22):
That is just one of the most common things that
I hear in menopause is you're losing hair from places
you want it, but it's popping up in new places
where you never had it.
Speaker 1 (36:31):
I will say, this is where men and women are equal.
We typically I know I have a good head of
hair thanks to my mom, but typically we lose our
hair up top pretty early and then it just starts
going elsewhere back, so we'll talk about.
Speaker 2 (36:45):
The chin hair and the hair the new hair that
we don't want. That's usually hormonal, and so as our
estrogen levels decline, our liver stops making something called steroid
hormone binding globulin. It's basically a protein carries our sex
hormones around, and when they're bound to the protein, they're
not active. And so even though your levels might be
(37:06):
the same, if you don't have as much as that protein,
the activity of some of those hormones is going to
be higher, and so we see in this transition, the
activity of our androgens gets higher, even though are levels
or maybe lower or the same, and that's leading to
new fun I have one right here that I always
do surveillance for on my chin, and so so there. Fortunately,
(37:28):
we have lots of cosmetic ways to rid ourselves with
those peskiers and or just pluck them and get on
with your day. But hair loss on your head is
a little more complicated because there's multiple things that can
cause that. We have genetic issues, nutritional issues, of course,
hormone issues. I have a YouTube video if anyone cares,
where I talk about all the ways women can lose
hair and all the different treatment options. Sometimes it takes
(37:49):
a visit to a dermatologist to figure out what's really
going on.
Speaker 1 (37:52):
Another symptom that is often not talked about. But she asked,
I sometimes leak urine or can't make it to the
back through me in time. Is this something I just
have to live with?
Speaker 2 (38:02):
Absolutely not, no. So Urinarian continence can be one of
the most devastating hallmarks of menopause because it's so life
disruptive and it's frankly embarrassing, and so there is basically
three buckets of incontinents. Again, one is stress in continence,
which is you cough, you laugh, you sneeze, you put
pressure on the bladder and it leaks where it used
(38:24):
to not. You used to be able to go out
with your girlfriends, laugh, tell a story and you wouldn't leak.
And that is an anatomic issue. You have overridden the
pressure valve that held the urethra up, and having babies, smoking,
being overweight, that's all contributing factors. And loss of hormones
from menopause. So for some patients, just getting them on
hormone therapy or putting estrogen back will help strengthen that
(38:45):
tissue back up where you can hold that valve back.
Then there's urging continents, which is an autonomic spasm of
the bladder. You're not telling your brain to do anything,
it just kind of sometimes it's a key in the
lock or there's some kind of a trigger, but you
feel like you have to go and you run to
the bathroom immediately and it's just running down your leg.
And so that is treated with medication to relax the
(39:07):
walls of the bladder. And then there's a neurogenic bladder.
Pretty rare, usually in diabetics or spinal cord injuries where
you lose the ability your brain cannot get the signal
that the bladder's full and you need to be And
so most women have stress or urge, your combination of
the two. And there's fortunately EU rogoncologists who can help you.
They're a specialist and what I did and they did
(39:28):
more training to help you kind of figure out what's
going on and get you the right treatment.
Speaker 1 (39:33):
I'm not sure if this came with the hot flash issue,
but Lisa asked, what can I do if I have
trouble sleeping, which is something else that probably comes with
the hot flashes and everything.
Speaker 2 (39:45):
Yes, sleep disruption is one of the top complaints more
than hot flashes and so, and it's complicated definitely. If
your hot flashes are waking you up, then sleep then
you know, hormone replacement therapy really really helpful for you.
There's a lot of you know, environment things that you
can do, like cooling the room and things that I
(40:07):
kind of took for Randa before that. I absolutely have
to have the right pillow, the right blanket, the right
night down, the right you know. I also my alcohol
tolerance in menopause has gone away, and one glass of
wine and I will not sleep. And that is a choice.
If I choose to drink, I'm choosing to not sleep.
Speaker 1 (40:25):
And you know what's coming.
Speaker 2 (40:28):
I know what's coming. And so you have to prioritize
your sleep and menopause. Like you have to prioritize your muscle.
You have to prioritize your sleep or it's going to
go away. And so hormon therapy can go a long way.
I sleep beautifully now as long as I don't drink.
But again, sleep's more complicated. There's you know, you have
to make sure you have all the sleep hygiene things
done same bedtime. You know. I did a podcast with
(40:52):
a sleep specialist and.
Speaker 1 (40:53):
Especially treatise like we are children when you have kids, right,
you swear by that schedule, do not get off the
scale schule.
Speaker 2 (41:00):
Yeah, I swear by the schedule lab at.
Speaker 1 (41:02):
The same time.
Speaker 2 (41:03):
Baby. I mean that's us.
Speaker 1 (41:05):
Now it all comes full circle, doesn't it. Okay? Can
I be a guy for two seconds?
Speaker 2 (41:12):
Sure?
Speaker 1 (41:13):
Do men go through a similar yeah, menopause.
Speaker 2 (41:18):
So I've looked at this data and the main way
that we make to sascer one, both men and women
about fifty percent and a woman is from the adrenal
glands for androgens, and then we make out some in
about half or in the ovaries, and so men it's
(41:39):
mostly from the testicles and then some from precursors from
the adrenal glands as well. We see your peak for
men at about nineteen and then it kind of gently
drifts down to about forty, and for the vast majority
of men from forty till death it remains about the same.
What happens is is a very large intervariability of taesoscer
(42:03):
levels between men. Where normal is two hundred and I
think fifty six to about one thousand. Okay, most men
don't feel okay till they're about four hundred, so that's
still a pretty wide window for sure variability. And so
aging does a lot to us. And so you're kind of,
you know, living your best life going about and then
(42:24):
the aging factors kicked in. You know, you're getting older,
things are slowing down. Sometimes a little extra testosterone can
help you improve performance, feel better, you know, muscle, performance, brain,
all the things.
Speaker 1 (42:37):
Like estag everything.
Speaker 2 (42:39):
There are testosterone receptors throughout our body. And so this
is not my area of expertise, So there's not a manopause. No,
we do see a gentle decline and then a kind
of a stabilization about age forty. But for some men,
testosterone supplementation in physiologic ranges can be really helpful to
help them feel better and perform and function better.
Speaker 1 (43:01):
I'm not going to say he deserves a book, but
if you could go back and write your husband a
pamphlet how to guide to help you and be there
for you as you're going through menopause, are there some
things that you would tell other men that, gosh, are
going to be going through this with their significant other.
Speaker 2 (43:21):
That's such a good question. I went through So I
was on birth control pills for most of my perimenopause,
so mine was kind of mass okay, and then I
came off. And then if you read my book, one
of my brothers passed away, and so I was going
through this like horrific life event and perimenopausal. I was
(43:42):
gaslighting myself. He didn't know what the hell to do
with me. I mean I was not sleeping, sweating, flashing,
crying dramatic. I mean everything. My brother died in and
I was like crying all the way home. From work,
I go to clinic and patch myself together and take
care of patients and go be the you know, then
come home and move the whole way home. And I
didn't even recognize my own perim. I thought I was
(44:04):
a dang. I just thought I was crazy and grieving.
And then one day, like the grief got better and
I was like, you know, I realized I wasn't a
sad whatever, but I was still miserable. I felt horrible.
That joint pain for me was like, Okay, I'm dying,
something is wrong, and he's just tiptoeing around, scheduling a
lot of you know, trips out of town.
Speaker 1 (44:25):
You know, just like just scared to death. He's scared
to death.
Speaker 2 (44:29):
So I think, I think the more we talk and
the more we educate, and the more women get on
board with being able to recognize their own symptoms and
empower and educate themselves, and then their partners getting on board,
I think it's going to make I really hope it's
going to decrease the divorce rate at this age, you know,
and so so much of divorces lack of communication and
not understanding where the other person's coming from. And so
(44:52):
I mean, there was also a really rough time in
our marriage as well. I'm sure we just weren't communicate.
Speaker 1 (44:56):
It's like a stranger moves in.
Speaker 2 (44:59):
Yeah, yeah, so he didn't know what to do. He's
just living his life. You know. Everything's fine.
Speaker 1 (45:05):
So and some of this stuff can be embarrassing. So
maybe the takeaway is for both sides communicate, communicate, try.
Speaker 2 (45:12):
But I think if you were to touch me on
the shoulder and said, could you be menopausal? I would
have killed him, you know, because of this negative stereotype
of menopause at the time.
Speaker 1 (45:21):
I dare you, so, I guess your advice would be
keep your head down and playing a bunch of golf yourself.
Speaker 2 (45:33):
You know, there's there's great books out there, you know.
Open the conversation. I think though, the conversation needs to
start with her and her saying something in my body
is changing. You know. I can't tell you. I have
a menopause clinic.
Speaker 1 (45:46):
Now.
Speaker 2 (45:46):
That's all I do. I don't do babies or surgery.
I just take care of menopause patients and probably fifteen
to twenty percent of them will bring in a loved one,
usually their partner, who just want to hear it. Who
just want to be part of this solution, who want
to be helpful, and it's really just touches me so
much to see that.
Speaker 1 (46:05):
You mean, it's not like it, but I guess it's
somewhat like going through childbirth, where when you go through
it all together and you hear it all and you're
educated at the same time, it makes sense. Yeah, and
it probably allows the communication to flow a little bit better. Doctor.
I can't thank you enough. I have absolutely loved this,
(46:25):
believe it or not. I don't know if that's weird
or not, but I've really enjoyed our conversation.
Speaker 2 (46:31):
Well, thank you. I love talking about this. It's my passion.
Speaker 1 (46:34):
You are phenomenal at it the way you articulate it
and put it in these bite sized pieces. And by
the way, just if you don't want to just listen
to me, talk to the doctor. Find her on Instagram
because you put up so much good stuff. I know
you're on TikTok as well. I'm not, but find you
on TikTok. Clearly you have YouTube videos at doctor Mary
Clare on Instagram. You also have the book The Galveston Diet.
Speaker 2 (46:58):
And our website is undiet dot com.
Speaker 1 (47:00):
Okay, Galvestondiet dot com and are you working on another book?
Speaker 2 (47:05):
I am. So it's called The New Menopause, and take
everything I just said in the last hour and expand
it times one hundred and I really want it to
be a critical resource guide for patients and partners and
loved ones to understand what's out there, what's available, what
the symptoms might be. It's something you would hand a
(47:26):
twenty thirty year old so she's ready, you know. Remember
that it's like what to expect when you're never going
to expect again. Right.
Speaker 1 (47:33):
Uh. And by the way, what a great thing, because
it is as we started this whole conversation, it is
astounding to me that we don't do more to educate
women for something that you are all going to go
through and we just kind of blindly and hopefully maybe
your mom's mentioned something, and that's how you that's how
you get educated. So hopefully you are kind of breaking
(47:53):
down that barrier and knocking down that wall so at
least at the very least you can see what's coming
and underst stand it when it hits. That's it, doctor,
Thank you, thank you so much for the time, for
the knowledge, and we need to do this again, I'd
love to. We will continue this conversation because it is
incredibly important. So thank you so much.
Speaker 2 (48:14):
Okay, take care, Thanks for listening.
Speaker 1 (48:16):
Follow us on Instagram at the most Dramatic pod ever,
and make sure to write us a review and leave
us five stars. I'll talk to you next time.
This is the most dramatic podcast ever and iHeartRadio podcast.
Chris Harrison here coming to you from the home office
in Austin, Texas. I am unbelievably excited about the show today,
And when I tell you what the subject matter is
going to be, You're maybe going to be scratching your head.
(00:21):
But the entire show today is dedicated to menopause, something
that every woman who walks this earth is going to
go through. But it's something that as I have kind
of dove into this, have realized that a lot of
people don't know a lot about it. They don't know
what to look for when it's coming, what it means, why,
(00:45):
And it is kind of astounding to me and shocking
and terrible that we all don't know more men and women.
But I know you might be thinking, Chris, you're a
middle aged man, you're going to be talking about menopause. Yes,
I am, because I know my audience and I know
this is an important topic. And there are a lot
(01:08):
of people that go on social media and they talk
like they're nutrition experts, they talk as if they know
and these people kind of get passed off as experts. Well,
I made sure that we had the foremost expert. This
woman is active on social media, but she is BORED
(01:29):
certified obgyn has practiced for many years. She is also
a mom, also a wife. She is a published author.
She has an incredible book called The Galveston Diet. I'm
talking about doctor Mary Claire Haver, and she was nice
enough to join us so we could dive in and
(01:49):
allow me to ask everything about menopause, joining me now
from her home in South Texas, just down the road
from where I am here in Austin. Doctor Mary Claire
have thank you so much for joining me.
Speaker 2 (02:04):
Thanks for having me now.
Speaker 1 (02:05):
I know you do a lot of this now between
social media, TV, you name it. You probably don't sit
down with a lot of middle aged men to discuss menopause.
Speaker 2 (02:17):
Not very often occasionally, but it's one of the most
enlightening conversations for me because I really get to see
it from your perspective and it really helps me guide
you know, fifty percent of the population, because you are
affected just as much as we are. Because everything's changing
in our bodies, in our minds and how we're you know,
(02:39):
interacting with the world through this menopause process, and that's
affecting your relationships as well.
Speaker 1 (02:44):
And while I know just enough to be dangerous, I
will admit that I have cheated because I am engaged
to a beautiful woman, Lauren Zema, I am raising a
beautiful woman, Taylor, my daughter. They gave me some very
important questions that they wanted to ask. And my team
here at iHeart on the most dramatic podcast ever, is
(03:04):
probably ninety five percent women, so they had questions. It
was amazing when we started talking about menopause doctor, how
many women were lining up that had questions. And it's
something they're all going to go through. It's something you
think that we would all, but especially women, would be
so knowledgeable about, and we're not. Why is that?
Speaker 2 (03:29):
You know, there's several reasons, everything from society, to medical
education and training to you know, asism, and so if
you look at in medicine, which is you know what
I'm an expert in, I can tell you from my
own obgi N residency training, which was amazing, I've learned
(03:50):
so many important things. But there was a just a
sliver of time spent on menopause and I thought nothing
of it at the time, to be honest, And there's
also that little bit well a lot of of it's
kind of in her head. You know, like when a
woman and a man with the exact same symptoms walk
into the er, say with chest pain, shortens of breath,
(04:12):
some classic symptoms of a heart attack, she's much more
likely to have a delayed diagnosis and to be thought,
you know, have a mental health diagnosis rather than a
heart attack. And that is just kind of how we're trained,
and so that that's a problem. Number Two. We have
the kind of classically medically recognized symptoms of menopause, hoplaches
(04:34):
and night sweats, you know, changes in the female anatomy,
et cetera. But what we're learning now is that there
are probably forty plus symptoms that can raise their head
in menopause and they're not recognized as being classically menopausal
from a society standpoint. You know, look at the Golden Girls.
(04:55):
They are my age, you know, I love that show.
They were amaze. I mean, Blanche was still teaching right,
and it's like they were old ladies in my head,
you know, the haircut, the outfits and the way they
approached life and health. I mean, they were wonderful. But
just this kind of dismissal of this is the end
of your life when we're going to spend a third
(05:17):
of our lives a third, we're going to live thirty
to forty years in this menopausal state, and there's so
much we can do to improve our lifespan and our
health span throughout it.
Speaker 1 (05:27):
Well, what I found interesting is you mentioned going through
med school, and you are a board certified obgyn. You
have practiced for many many years, worked with women, delivered babies,
you name it. But from what I understand of your story,
it wasn't until you went through menopause that you realize
that the advice that you had been giving all those
many years probably not the best. Is that fair?
Speaker 2 (05:50):
That is very fair. If someone came in with severe
hot flashes, I knew what to do, okay, format, therapy, conversation,
et cetera. But most of the patients, the number one
complaint that they had in my office, and when I
talked to other menopause specialists and looked at, you know,
thousands of years of patient data, the number one complaint
really is weight gain and body composition changes like new
(06:13):
weight gain in places you never had it before, and
you really haven't changed your diet and exercise. So the
advice that I'd been taught to give, that I gave
for years was work out more weight less. We slowed
down a little as we get older. I mean I
cringe when I think of the things that came out
of my mouth, and then it happened to me so embarrassingly. Yes,
my entry into this menopause world, into doing more research
(06:35):
and trying to understand what's going on and why do
I have such a gap in my education was around
pretty cosmetic reasons of just some unwanted weight gain that
was making me unhappy. But what I didn't realize, I
mean it was just the tip of the iceberg. And
when I when I you know, cracked over in the
top and started, you know, ice diving, I was like,
wait a minute, there's so many things here, cardiovascular disease risk,
(06:58):
you know, neurodegenerator these like Alzheimer's and dementia, and hip pain,
bone pain, joint pain, every organ system and our bodies
affected by this.
Speaker 1 (07:07):
I mean, it makes sense. It makes sense that we are,
you know, one kind of living organism and everything is
tied together in our bodies. Of course it's going to
all be affected. I mean, it would be crazy not
to and it's going to affect people in different ways.
And so I'm right. I'm glad that not only you
had this awakening, but now that there is And don't
get me started on social media. There's plenty of bad
(07:28):
things out there, but people like yourself that are knowledgeable,
that can now speak out and just normalize this conversation
that we're having.
Speaker 2 (07:37):
I feel like the biggest contribution I've made to this
menopause conversation is trying to normalize it and just validating people.
My DMS just blow up with and I can't give
personal medical advice, you know, it's against the law. I
mean to practice medicine in another state, and so but
I'm just trying to calm people down, like, yes, this
absolutely could be could be related to your menopause. Here's
(07:58):
the questions you can ask your health care, here's the
you know, medications you might want to think about. Here's
some supplements that might help, you know. Just trying to
get everybody on an equal playing field so that they
can make an informed choice.
Speaker 1 (08:09):
I was looking at I was trying to find because
I wrote it down, I can't remember where it was.
The quote you just posted on your social media about
the validation of what you're going through, if you're going
through menopause, having those symptoms validated, And I love the
quote that you put up.
Speaker 2 (08:25):
Like every woman deserves to have validation of what she's
going through is real. And then in a decision whether
she chooses or not to pursue certain pharmaceutical options, that's
that's up to her. But you know, so much of
that's being taken off the table for so many women
for at least the last twenty years.
Speaker 1 (08:42):
So what I'm going to do today is think of
me as the arbitrary voice for all the amazing women
in my life. And so they lined up, I mean,
pages of questions. So I'm going to jump in with
the most important women in my life, vers all my
beautiful fiance Lauren Zema. She asked, what is para menopause?
Speaker 2 (09:08):
That's a wonderful question. So most, you know, most people
women men will understand that menopause represents kind of the
end of your fertility. You're not gonna have periods anymore,
and you're something about hormones might stop functioning like they
used to. So when in actuality what happens. There are
three kind of phases of this menopause journey. We have perimenopause,
(09:29):
we have menopause, and then we have post menopause, and
I'll well, let me define those for your followers. So
menopause is really just one day in your life. It's
kind of that you go up and then you go down.
And so menopause represents the last day that your ovaries
will ever function. There's no more estrogen to be produced.
There you've run through all of the eggs that you
(09:51):
were born with and there's you know, nothing. Everything after
that point is postmenopause, got it. Menopause represents a seven
to ten year time period when that function doesn't just
shut down overnight. It is kind of a degradation. So
we're born with all of our eggs, right you guys,
aren't you know? If you're born with the opposite gonads,
(10:15):
you make your stuff fresh every day. Good for you?
Speaker 1 (10:17):
Yeah, ask Robert de Niro, who's still making babies at
a one hundred and four.
Speaker 2 (10:21):
Yeah. And we are born with all of our our
gonads are set. We're done, locked and loaded, ready to go,
and we start losing eggs at about five months in utero,
so we start, you know, So we're born with a
certain amount. By the time we're thirty, we're down to
about ten percent of what we were born with, and
then when we're forty, we're down to about three percent.
(10:41):
And those germ cells represent the ovarian production of estrogen, progesterone,
and some testosterone as well. And so perimenopause is when
you become symptomatic from this choo choo train that's getting
harder and harder to chug to get those last few
eggs you know, on market, so to speak. And the
quality of those eggs is decreasing as well, which is
(11:04):
why we see more down syndrome and other chromosome latinormalities
as a one gets older and has children. So perimenopause,
you know, if the average age of menopause in the
US is somewhere around fifty one, okay, but it's still
very normal between forty five to fifty five fifty six
two for that to be normal, And then you do
the math backing that seven to ten years back. So
(11:26):
somewhere between thirty five and forty five, a woman will
probably start noticing. She may not put her finger on
it or recognize it as perrymenopause, but something is changing
in her body without any rule, increase in stress, no nutrition, diet,
you know, like everything's going, She's living her best life.
And then you know, outside of just aging, which does
(11:47):
its own magic to us, you know.
Speaker 1 (11:49):
That it does. So this Laura and I very much
believe in kind of preventive medicine. Have taken care of yourself,
your diet, gut health, et cetera. And I had this
question a couple of times from not only Lauren, but
my young producer Kendall, who's on the line with us
right now, and they both kind of ask the same
question of what do I need to be doing for
(12:11):
my hormones while I am in my mid twenties, while
I am in my young thirties. Are there things I
can do that will help alleviate or just help me
get through menopause later?
Speaker 2 (12:22):
Sure, so, how you show up in perimenopause, your baseline
health status, those habits that you are locking in the place,
is going to determine for most women, how much, how
many symptoms you have, how serious your menopause is, how
life disruptive it is, as well as attenuate some of
those cardiovascular risks that seem to accelerate and neurodegenitive risks
(12:44):
as we get older. So for my children, you know,
my girls are nineteen and twenty two. They live and
breed this stuff unfortunately because they're you know, my kids,
but they understand that they need to lock these health
habits and now so that it's much easier, they'll have
an easier menopause. We can't. We haven't figured out yet
(13:06):
how to prolong the shelf life of the ovaries, like
if when that happens, and there's some research being done
for that to delay menopause.
Speaker 1 (13:12):
Interesting, that's probably.
Speaker 2 (13:15):
The thing that will improve quality of life, lifespan and
health span and a female more than anything else, is
if we can delay menopause.
Speaker 1 (13:23):
You're already outlasting us anyway. How much longer do you
want to be exactly?
Speaker 2 (13:27):
You know for evolutionists or life maybe this happened so
that we didn't outlive men for so long. You know,
we already outlived five to seven years, but take away menopause,
we'll live forever.
Speaker 1 (13:41):
But I don't doubt that. Okay, So the last question
from l Z and again remember where this is coming from.
I'm going to read it in her voice. Doctor, I'm
afraid is my vagina going to dry up? Will I
be vadryina?
Speaker 2 (13:59):
That's awesome.
Speaker 1 (14:00):
That is a medical term that LZ invented by vagarina.
Speaker 2 (14:04):
More than likely, yes, so, but it's absolutely preventative. I mean,
it's preventable, preventable. So we we have our vagina, our vulva,
our all of our you know, bladder, all that tissue
you know, basically from the pubic bone to the to
the spinal cord is all super estrogenized. And when our
estrogen levels began declining in perimenopause, some more than others,
(14:26):
we will see a decrease in the amount of mucus
we produce, the amount of mucus we produce with relations,
as well as loss of elasticity. The tissue gets really
thin and really irritated, and for a lot of women,
probably forty to fifty percent, you will have severe atrophy
with you know, dramatic pain and being uncomfortable with relations
(14:46):
to the point where libido goes out the window because
it hurts and you don't want to do it. Fortunately,
there are safe, efficacious, and reasonably priced medication that can
absolutely prevent that, and that is vaginal estrogen. And so
we just put we'll give you back the water you
were drinking, and we put it in the vagina where
you need it. And there's no that's the one. There's
(15:08):
no increased versus of blood clots breast cancer at People
with a blood clot with breast cancer can absolutely safely
use this formulation of estrogen to keep that area healthy.
It's the number one most effective treatment for recurrent bladder
infections in menopause, not antibiotics, vaginal estrogen.
Speaker 1 (15:27):
Probably because of Hollywood and you know, just the old
you know scene we've seen, whether it was Golden Girls
or every movie with middle aged women. You think hot
flashes and menopause. So I want to dive into this
a little bit because my daughter, actually Taylor, who's nineteen,
had a very interesting question. She's heard about hot flashes,
(15:48):
but how much does your body temperature actually rise?
Speaker 2 (15:51):
Oh that's such a good question, Thank you, Taylor. Okay,
so it's about one to three degrees okay, like fever.
So you know, think about it. We're ninety eight point
six is the average, you know, tent right, and then
if we get up to one hundred, one hundred, one
hundred and one, one hundred point six is a fever.
Speaker 1 (16:08):
Yeah, that's a solid fever. If you're at one hundred
hundred one, basically have.
Speaker 2 (16:11):
A short term fever, and then your body, in an
effort to cool itself, will dilate all the blood vessels
of the skin, usually in a hot flash scent, typically
the central area, so the head, the next, shoulders, chest, back, groin,
and dilate those blood vessels, which just drives the heat
out and you just sweat like crazy, and then you're
freezing because you're so wet. You know, your temperature goes
(16:33):
back to normal, but you're soaking wet. So yeah, it's
about one to three degrees.
Speaker 1 (16:37):
Danielle an amazing woman who works with me. Why does
your body go through this? Why are you having hot
flashes with menopause? What's actually happening?
Speaker 2 (16:48):
Yeah, So there's a thermoregulatory center in our brain that
controls our body temperature, and that's the mechanism by which
we have a fever, which is a physiologic response to
an infection or medication, you know, adverse reaction whatever. We
don't know exactly how it happens, but there's something to
do with declining estrogen levels. Estrogen kind of stabilizes that
(17:12):
temperature center, and when you take that estrogen away that
it just becomes erratic and starts going off on its
own without the usual chemical signal.
Speaker 1 (17:21):
I saw in your social media. Sorry to be uh,
you know, peeping on you, but you were talking about
this nightgown that you created because your hot flashes have stopped.
Speaker 2 (17:31):
Yeah, but I'm still hot.
Speaker 1 (17:33):
Your body's still hot. So is that something you have
to worry about? Once the hot flashes stop, your your
body temperatures is still like cooked.
Speaker 2 (17:41):
So you're inspiring me for my next TikTok, Like, here
are the things that hormone therapy did not help me with? Okay,
And definitely my hot flashes, the ones that woke me
up at night, that pulled me out of a meeting
that you know, embarrassed me in public, are gone. But
I'm just in general hotter all the time, And so
I was always freezing, freezing, bundled up under the covers,
(18:03):
going to bed with sweatpants. My husband's very excited. I'm
not wearing a sweatpants to bed anymore. And that I
like have this great nightgown I've worn for years, and
I just cut the arms out of it, like wear
it like a trucker because I was so hot at night. Still, so,
hormon replacement therapy can do so many wonderful things for
our bodies, but it's not I can't give you back
(18:23):
your twenty five year old ovaries, right, you know that,
And that's okay. I think most women are fine with that.
They're not expecting that, but they just want to be
able to sleep and get on with their lives.
Speaker 1 (18:43):
Hannah asked, how do you know when you are actually
in menopause?
Speaker 2 (18:49):
That's a really good question. So if you were a normal,
regularly menstruating person, Okay, yeah, period every month and suddenly
that stops. If you're over the age of forty five
and you have not had a cycle when it was
regular before for a year, that is the definition of menopause.
As far as using clinical symptoms to make the diagnosis, now,
(19:12):
say you've had a hysterectomy or an ablation or some
procedure or surgery where you don't have periods anymore. Well,
sometimes just on the symptoms we can make the diagnosis
and your age. You know, clinically, there is a blood
test that we can use to diagnose complete menopause, that
postmenopausal state but because hormones fluctuate so wildly in pery menopause,
(19:34):
we don't really have good blood you'urine saliva tests to
diagnose that. It's a clinical diagnosis. So you need a
menopause friendly provider who knows what they're doing, who's willing
to talk to you, help untangle some of the other
diseases that kind of look like perimenopause, like hypodiroidism or
an autoimmune disease. You know, when I'm doing blood work,
hormones is not the first thing I check in a
perimenopausal woman. It's thyroid, it's nutritional deficiencies. It's a blood
(19:59):
count to look for a name, you know, based on.
Speaker 1 (20:00):
Her symptoms, you're speaking of a normal period. Blair asked
a very interesting question. Does the age you get your
period effect when you start menopause? For example, if you
started your period very late in life, does that mean
menopause will come later.
Speaker 2 (20:16):
Yes, it's not a huge contributor, but we do see
that women who go through and I think it's before
the age of eleven, tend to have earlier menopause than
women who don't, and then therefore going through later. Because
again we're born with the finite amount of eggs, and
so if you kind of let them sleep for longer,
(20:38):
you'll have more that'll last you in your mix. Sure
it's not huge. There's a lot of environmental things that
go into what you know, genetics, exposure to certain chemicals,
you know, different things that affect when we go through menopause.
Speaker 1 (20:51):
Well, you talk about that exposure to chemicals and just
different foods and how our foods have changed. And again
I'm a big believer in diet and gut health and
all that young. Can you start menopause and have you
seen that number change over the years, like, for example,
I went through this with my daughter. Is like, girls
are hitting puberty quicker. You know, whether it's the milk,
(21:13):
whether or whatever you want to say, it is things
have changed and they're happening faster.
Speaker 2 (21:17):
That's a good question. So we definitely know that women
girls are going through menarchy or puberty earlier than they
did one hundred years ago. Isn't that is a fact.
We think it's improved nutrition actually, so like one hundred
years ago, you know, the famine and all those things,
and then they're also have more body fat now and
(21:38):
that is leading to higher estrogen levels, which is contributing
to this earlier puberty. So we think on the back end,
we haven't seen that age of menopause change quite yet.
They're kind of driven by two different things. So we
know that smokers go through menopause early. So that's a
(21:59):
definite something that we know is not good for us
and attacks our.
Speaker 1 (22:03):
Body reason six thousand, seven ninety two not to smoke, definitely.
Speaker 2 (22:07):
You know, surgery is a risk factor, radiation, chemotherapy, those
are all risk factors for earlier menopause. I've seen menopause
in their twenties and it's rare, but you have certain
autoimmune conditions that will attack the o reason destroy them
before their time. So premature menopause is before the age
of forty, and that's about two percent of the population.
Speaker 1 (22:28):
And is that a reason for concern? Is it? Obviously
you would get it checked out.
Speaker 2 (22:32):
So you know, estrogen is a protective hormone in so
many organ systems in our bodies. Definitely in our brains
and our hearts and the blood vessels of the heart
and our bones, and you know our female organs. When
you go through menopause earlier and you are not replaced
with hormone replacement therapy. You have a much higher risk
(22:52):
of cardiovascular disease, stroke, diabetes, inflammatory conditions, osteoporosis than a
woman who went through five ten years later. So those
it's really serious. If any of your listeners have gone
through premature menopause, they have got to see a physician
who knows what they're doing and get on hormone replacement therapy.
(23:13):
You know, there's definitely there's risks of being on any
medication correct and we've all known about the breast cancer
risk and that's been walked back. It's a very small
risk and it's really up to the patient and her
family history, et cetera. But they're a risk of not
being on hormone replacement therapy, which is the conversation I'm
trying to bring to the table interesting.
Speaker 1 (23:33):
Everyone to know does menopause because you hear a lot
about this. It's right up there with I would say,
just if hot flashes are one, sex drive would be two.
That everybody talks about. It's the old cliche, does menopause
affect your sex drive?
Speaker 2 (23:47):
Yes, we definitely see one of the cardinal symptoms of menopause,
and it's not for everyone, but it is much more common,
is less sexual feelings is the way that we kind
of describe it. So this is probably a topic that
most of your followers will be interested in. So when
we talk about sexual function in a woman, there's usually
(24:09):
five buckets of areas that she is going to have issues,
and they can overlap. So the first is a relationship issue.
So if you're not happy, you don't feel supported, you
feel like whatever, you know, you're not happy with the partner.
That's normal that you're not going to want to have sex. Okay.
Then there is pain, if it hurts, we got to
fix that, you know before we address So then there
(24:31):
leaves desire, arousal, and orgasm. So desires what happens in
the brain. Arousal is the physiologic response to a stimulus,
so all the things that happen in the pelvis to
get you ready, the things elongate, blood gets engorged, just
like in a man. And then there is orgasm. So
(24:52):
so we kind of address each of those. They have
different treatment options. Most women who are in a nice relationship,
they love their partner, they want this, you know, they
miss it. They want to go back to the level
that they were. They're just feeling really sad about it.
That's a pure desire issue. And so there's a couple
of medications that can be helpful. Again, it's a complicated pathway.
(25:13):
There's some great books out there and great podcasts on
this whole subject. But Addie and va Lasi. Again I'm
not paid by these people, but are two medications at
increase dopamine in the brain. They are FT approved and
but they are pretty expensive and not covered by insurance.
But some patients go that route. And then testosterone can
actually be helpful, especially in postmentopause, for a woman, to
(25:34):
help her be more reactive to the stimulus that she
wants and get that part of her life back.
Speaker 1 (25:40):
Because I guess so another one of my I won't
I won't name her because I don't know if she
wants her name on this one, but she said, you know,
it feels like I can't orgasm as easily anymore. And
obviously this is if you're if you're to that point
and you're and you know you're just not orgasm and
clearly you are wanting this, you're stimulated, and you're just
reaching that right.
Speaker 2 (26:02):
And so that's a whole different class and different medications.
What happens is a lot of people are like, oh
my gosh, give me to saucer and I just need
that to fix me, and that's not going to help
in certain conditions. So I always have that conversation with
my patients. And there's a wonderful book called Come as
You Are by doctor Emily Nagowski, who really does a
(26:23):
deep dive on this subject. So any person who's struggling
with this and wants that back in their life and
is feeling kind of broken, then that's a wonderful book
to read because it really helps lay out what your
treatment options are and really makes you feel.
Speaker 1 (26:37):
Like you're not alone. Whatever publicist came up with the
title of that book's yeah, well done. Come as you Are.
Diet is so important. So I just went to this
medical conference. Again I'm a bit of a nerd, and
I was listening to these doctors who are kind of
rearranging the way they're thinking about medicine instead of you know,
(27:00):
you get sick, you do this, you get cancer, you
do this, trying to look ahead of all this and
obviously gut health and diet is a huge part of it.
What I found interesting is what you said about menopause
and doctors and students only getting about an hour's worth
of knowledge. They said the same thing about diet.
Speaker 2 (27:19):
Nutrition. Yeah.
Speaker 1 (27:20):
Nutrition shocked me and stunned me that they just back
in the day and even now maybe are still just
not spending much time on nutrition and how huge that is.
And so my question is are there things that women
could be eating, drinking? What can they be doing that
will help the inflammatory issues?
Speaker 2 (27:42):
Absolutely? And I wrote a whole book about it.
Speaker 1 (27:45):
It's called The Galveston Diet. Everybody, Just so you know.
Speaker 2 (27:48):
I went back to school. I was so frustrated with
my lack of knowledge and so hungry from no pun
intended for more information and wanted to better myself. You know,
I just felt pulled and drawn to do like on
my own dime. I found this culinary medicine program at
Tulane and you know, enrolled and it took about eighteen
(28:09):
months and I had to like fly around to go
do different labs and different coursework, and it just was
the best thing ever. And I was like, gosh, we
should have taught this at medical school. You know, this
would really really help, and so much of it is
preventative and really putting a framework around nutrition. We might
get an hour of nutrition you know, lectures in our
medical school and residency training. My daughter started med school
(28:32):
a couple of weeks ago and her undergrad degree is
in nutrition science. So like, honey, you're doing it right, you.
Speaker 1 (28:38):
Know, I mean, especially what we know now, I mean,
I get it. You know. Ten twenty years ago, we
all thought it was about medicine and pharma and all that.
But now right now we know it is so linked
to our nutrition in our gut health.
Speaker 2 (28:50):
Right. So like top tips for someone in perimenopause and
menopause are look at how much fiber you're getting in
your diet, you know. And one way to do that,
and it's pretty effective is download a free nutrition tracker.
I'm not trying to you know, stress anyone out or
give them, you know, neurosis about it if this is
(29:10):
going to trigger something and you don't do it. But
so many of us it's like using cash instead of
a credit card. You don't really know what you're eating.
You think you're eating healthy, and I thought I was
eating healthy for a long time. It said healthy on
the bag. So okay, So track your fiber intake, how
much you really getting through your food. And we should
be getting at least twenty five grams of fiber in
(29:32):
our diet per day, and a mix of soluble and
insoluble fiber. You know, insoluble fiber is what bulks up
our stool and makes it kind of run through quicker.
But the soluble fiber is dissolvable, and that's what feeds
our gout microbiome and keeps it healthy. And so, and
when you're eating food sources, you know, from various foods,
then you're getting so many other vitamins, minerals and nutrients
(29:54):
you know that are part of that fiber package. So
make sure you're getting twenty five grams of five in
your diet per day. Number two, watch the added sugars
and food. So, I know, the whole keto movement kind
of threw all sugars. All sugars are bad. What fruits
and vegetables were you know, that's probably, you know, not
the healthiest way you better option. Sure it's a way
(30:14):
to lose weight, but at what cost. And so when
you lose fruits and vegetables, you were losing a tremendous
amount of nutrients. And so my nutrition professor is like, well,
Mary Claire, nobody got fat eat and blueberries, you know exactly.
It's kind of a cowboy. But you know that on
with me, like why are we demonizing fruits and vegetables
(30:38):
when we there's so many things in our diets that
we're eating routinely that could probably be you know, done
in very much moderation and replacing that with fruits and vegetables.
So added sugars are the sugars added in cooking and
processing and alcohol, and so limiting those to twenty five
grams per day or less. So that's not saying never
you can't have a cookie or no celebrate birthday or
(31:01):
however you want to do that. But women who consistently
less than twenty five grams of out of sugars per
day have less visceral fat, better menopause symptoms. You know,
everything is better in there.
Speaker 1 (31:12):
Right two, diabetes, you name it, all of it. This
next question is kind of specific to their diet. Amy,
who I do know very well, dear friend of mine.
(31:32):
She's forty nine, breaking into that fifty club. Clearly going
through metopause. Eating etamammy salmon and having sex has helped
my Hot flashes is this normal.
Speaker 2 (31:44):
Absolutely, So the sex is optional and love it, do
it for sure. It's a great way to stress relief.
But atamammy is rich in phytoestrogens. And so we've looked
at women throughout the world and hot flushes specifically, and
women in Asia have less hot flashes than women who
(32:06):
are Eurocentric. Interesting, and we think it's because their diets
are so rich in phytoestrogens. So phyto estrogen is an
estrogen like compound found in foods, and so the soy
kind of got a bad rap because of, you know,
possible links to breast cancer that has never played out. Actually,
women who have diets rich in natural soy who eat
(32:27):
out of mammy or soybeans on occasion have lower risk
of breast.
Speaker 1 (32:30):
Cancer and probably fatty fish with good oils and etcetera, exactly.
Speaker 2 (32:34):
The omega threes. Definitely, the fatty fish with the good
oils is going to decrease your risk of hot flashes.
Speaker 1 (32:42):
So a couple more symptom questions. Sadie brought this up
apparently a Beverly Hills housewife fan. She said, Erica Jane,
a Beverly Hills housewife, claims she lost weight thinks to menopause.
Is this the truth? And can menopause just as easily
make you lose weight as gain weight.
Speaker 2 (33:00):
So here's what we know. Women tend to gain weight
as we age. It's more to do with getting older
and loss of muscle mass and replacement of that muscle
mass with fat. And so I don't talk about what
I try not to talk about weight in terms of
the scale. I talk about muscle mass and fat mass
and visceral fat to be specific. So subcutaneous fat is
(33:23):
the fat we've known our whole lives. It's under our skin.
It gives us curve cell you like. We don't like it.
It's cosmetically distressing, but it's really unless it's a lot,
it's not that dangerous. Visceral fat starts really expanding in menopause.
That is the fat inside of our abdomen, our momentum
rocks around our internal organs, and that fat is pro
inflammatory and linked to hypertengen, diabetes, stroke and all the
(33:44):
chronic diseases. It makes you feel terrible and look kind
of pregnant. And so so many women are seeing an
increase in their abdominal circumference where they never had it before.
You know, and that is causing in resistance, increasing inflammation levels.
And so some of those nutritional things I talked about,
the added sugars, the fiber, actually, probiotics and tumoric have
(34:08):
been shown to help bring that visceral fat level down
and decrease inflammation markers.
Speaker 1 (34:13):
You mentioned something, you just said it right there, and
you also said this on social media. I found it
very interesting, again, just kind of being in this world
and loving this science behind it, especially with women, the
percentage of muscle you lose as you age, and correct
(34:34):
me if I'm wrong, But what you were saying is,
don't just worry about the scale, don't worry about how
much you weigh, don't just worry about jumping on a treadmill.
Think about gaining some muscle and keeping that sustaining that
muscle as you get older. And that is huge for
a woman.
Speaker 2 (34:50):
That is one of the biggest lessons I've learned through
this whole journey that I've been on, you know, learning
nutrition classes, look at talking to other experts, you know,
figuring out what Peter A. T Is trying to say,
you know, and applying that to us as females. When
you add in the endocrine aging through menopause, and what
we see in menopause is acceleration of the muscle mass loss,
(35:13):
which is immediately replaced. You know, the scale may be
you know, whoever the housewife is. She may be like,
I'm doing great, I'm doing great. But if she's replacing,
you know, losing muscle mass and replacing it with fat,
she's not healthier. She won't live as long.
Speaker 1 (35:28):
Because muscle weighs more than fat.
Speaker 2 (35:31):
And so my own workouts have changed. For twenty five years,
thirty years, I worked out to be thin. That was
my goal. I wanted to look a certain way. I
wanted to fit in certain clothes. I had skinny privilege.
And now if I could do anything like your twenty
five year olds, your staffers, my kids are much better
about this than I was at that age. They are
not so focused on being thin. They know they need
(35:51):
to be strong. When they work out, they lift weights.
You know, they're not just running or doing aerobics or
doing something cardio. They know that that's part of it.
But they recognize the importance of muscle training and keeping
it up.
Speaker 1 (36:03):
And ladies don't worry. Everyone says, oh, I don't want
to bulk up you're not gonna bulk not Arnold Schwarzenegger,
don't worry about it.
Speaker 2 (36:10):
Well, bulk up. No, it's important.
Speaker 1 (36:13):
Alexandra has a very interesting issue. She says, my hair
is thinning, but I'm also growing a beard. What's up
with that?
Speaker 2 (36:22):
That is just one of the most common things that
I hear in menopause is you're losing hair from places
you want it, but it's popping up in new places
where you never had it.
Speaker 1 (36:31):
I will say, this is where men and women are equal.
We typically I know I have a good head of
hair thanks to my mom, but typically we lose our
hair up top pretty early and then it just starts
going elsewhere back, so we'll talk about.
Speaker 2 (36:45):
The chin hair and the hair the new hair that
we don't want. That's usually hormonal, and so as our
estrogen levels decline, our liver stops making something called steroid
hormone binding globulin. It's basically a protein carries our sex
hormones around, and when they're bound to the protein, they're
not active. And so even though your levels might be
(37:06):
the same, if you don't have as much as that protein,
the activity of some of those hormones is going to
be higher, and so we see in this transition, the
activity of our androgens gets higher, even though are levels
or maybe lower or the same, and that's leading to
new fun I have one right here that I always
do surveillance for on my chin, and so so there. Fortunately,
(37:28):
we have lots of cosmetic ways to rid ourselves with
those peskiers and or just pluck them and get on
with your day. But hair loss on your head is
a little more complicated because there's multiple things that can
cause that. We have genetic issues, nutritional issues, of course,
hormone issues. I have a YouTube video if anyone cares,
where I talk about all the ways women can lose
hair and all the different treatment options. Sometimes it takes
(37:49):
a visit to a dermatologist to figure out what's really
going on.
Speaker 1 (37:52):
Another symptom that is often not talked about. But she asked,
I sometimes leak urine or can't make it to the
back through me in time. Is this something I just
have to live with?
Speaker 2 (38:02):
Absolutely not, no. So Urinarian continence can be one of
the most devastating hallmarks of menopause because it's so life
disruptive and it's frankly embarrassing, and so there is basically
three buckets of incontinents. Again, one is stress in continence,
which is you cough, you laugh, you sneeze, you put
pressure on the bladder and it leaks where it used
(38:24):
to not. You used to be able to go out
with your girlfriends, laugh, tell a story and you wouldn't leak.
And that is an anatomic issue. You have overridden the
pressure valve that held the urethra up, and having babies, smoking,
being overweight, that's all contributing factors. And loss of hormones
from menopause. So for some patients, just getting them on
hormone therapy or putting estrogen back will help strengthen that
(38:45):
tissue back up where you can hold that valve back.
Then there's urging continents, which is an autonomic spasm of
the bladder. You're not telling your brain to do anything,
it just kind of sometimes it's a key in the
lock or there's some kind of a trigger, but you
feel like you have to go and you run to
the bathroom immediately and it's just running down your leg.
And so that is treated with medication to relax the
(39:07):
walls of the bladder. And then there's a neurogenic bladder.
Pretty rare, usually in diabetics or spinal cord injuries where
you lose the ability your brain cannot get the signal
that the bladder's full and you need to be And
so most women have stress or urge, your combination of
the two. And there's fortunately EU rogoncologists who can help you.
They're a specialist and what I did and they did
(39:28):
more training to help you kind of figure out what's
going on and get you the right treatment.
Speaker 1 (39:33):
I'm not sure if this came with the hot flash issue,
but Lisa asked, what can I do if I have
trouble sleeping, which is something else that probably comes with
the hot flashes and everything.
Speaker 2 (39:45):
Yes, sleep disruption is one of the top complaints more
than hot flashes and so, and it's complicated definitely. If
your hot flashes are waking you up, then sleep then
you know, hormone replacement therapy really really helpful for you.
There's a lot of you know, environment things that you
can do, like cooling the room and things that I
(40:07):
kind of took for Randa before that. I absolutely have
to have the right pillow, the right blanket, the right
night down, the right you know. I also my alcohol
tolerance in menopause has gone away, and one glass of
wine and I will not sleep. And that is a choice.
If I choose to drink, I'm choosing to not sleep.
Speaker 1 (40:25):
And you know what's coming.
Speaker 2 (40:28):
I know what's coming. And so you have to prioritize
your sleep and menopause. Like you have to prioritize your muscle.
You have to prioritize your sleep or it's going to
go away. And so hormon therapy can go a long way.
I sleep beautifully now as long as I don't drink.
But again, sleep's more complicated. There's you know, you have
to make sure you have all the sleep hygiene things
done same bedtime. You know. I did a podcast with
(40:52):
a sleep specialist and.
Speaker 1 (40:53):
Especially treatise like we are children when you have kids, right,
you swear by that schedule, do not get off the
scale schule.
Speaker 2 (41:00):
Yeah, I swear by the schedule lab at.
Speaker 1 (41:02):
The same time.
Speaker 2 (41:03):
Baby. I mean that's us.
Speaker 1 (41:05):
Now it all comes full circle, doesn't it. Okay? Can
I be a guy for two seconds?
Speaker 2 (41:12):
Sure?
Speaker 1 (41:13):
Do men go through a similar yeah, menopause.
Speaker 2 (41:18):
So I've looked at this data and the main way
that we make to sascer one, both men and women
about fifty percent and a woman is from the adrenal
glands for androgens, and then we make out some in
about half or in the ovaries, and so men it's
(41:39):
mostly from the testicles and then some from precursors from
the adrenal glands as well. We see your peak for
men at about nineteen and then it kind of gently
drifts down to about forty, and for the vast majority
of men from forty till death it remains about the same.
What happens is is a very large intervariability of taesoscer
(42:03):
levels between men. Where normal is two hundred and I
think fifty six to about one thousand. Okay, most men
don't feel okay till they're about four hundred, so that's
still a pretty wide window for sure variability. And so
aging does a lot to us. And so you're kind of,
you know, living your best life going about and then
(42:24):
the aging factors kicked in. You know, you're getting older,
things are slowing down. Sometimes a little extra testosterone can
help you improve performance, feel better, you know, muscle, performance, brain,
all the things.
Speaker 1 (42:37):
Like estag everything.
Speaker 2 (42:39):
There are testosterone receptors throughout our body. And so this
is not my area of expertise, So there's not a manopause. No,
we do see a gentle decline and then a kind
of a stabilization about age forty. But for some men,
testosterone supplementation in physiologic ranges can be really helpful to
help them feel better and perform and function better.
Speaker 1 (43:01):
I'm not going to say he deserves a book, but
if you could go back and write your husband a
pamphlet how to guide to help you and be there
for you as you're going through menopause, are there some
things that you would tell other men that, gosh, are
going to be going through this with their significant other.
Speaker 2 (43:21):
That's such a good question. I went through So I
was on birth control pills for most of my perimenopause,
so mine was kind of mass okay, and then I
came off. And then if you read my book, one
of my brothers passed away, and so I was going
through this like horrific life event and perimenopausal. I was
(43:42):
gaslighting myself. He didn't know what the hell to do
with me. I mean I was not sleeping, sweating, flashing,
crying dramatic. I mean everything. My brother died in and
I was like crying all the way home. From work,
I go to clinic and patch myself together and take
care of patients and go be the you know, then
come home and move the whole way home. And I
didn't even recognize my own perim. I thought I was
(44:04):
a dang. I just thought I was crazy and grieving.
And then one day, like the grief got better and
I was like, you know, I realized I wasn't a
sad whatever, but I was still miserable. I felt horrible.
That joint pain for me was like, Okay, I'm dying,
something is wrong, and he's just tiptoeing around, scheduling a
lot of you know, trips out of town.
Speaker 1 (44:25):
You know, just like just scared to death. He's scared
to death.
Speaker 2 (44:29):
So I think, I think the more we talk and
the more we educate, and the more women get on
board with being able to recognize their own symptoms and
empower and educate themselves, and then their partners getting on board,
I think it's going to make I really hope it's
going to decrease the divorce rate at this age, you know,
and so so much of divorces lack of communication and
not understanding where the other person's coming from. And so
(44:52):
I mean, there was also a really rough time in
our marriage as well. I'm sure we just weren't communicate.
Speaker 1 (44:56):
It's like a stranger moves in.
Speaker 2 (44:59):
Yeah, yeah, so he didn't know what to do. He's
just living his life. You know. Everything's fine.
Speaker 1 (45:05):
So and some of this stuff can be embarrassing. So
maybe the takeaway is for both sides communicate, communicate, try.
Speaker 2 (45:12):
But I think if you were to touch me on
the shoulder and said, could you be menopausal? I would
have killed him, you know, because of this negative stereotype
of menopause at the time.
Speaker 1 (45:21):
I dare you, so, I guess your advice would be
keep your head down and playing a bunch of golf yourself.
Speaker 2 (45:33):
You know, there's there's great books out there, you know.
Open the conversation. I think though, the conversation needs to
start with her and her saying something in my body
is changing. You know. I can't tell you. I have
a menopause clinic.
Speaker 1 (45:46):
Now.
Speaker 2 (45:46):
That's all I do. I don't do babies or surgery.
I just take care of menopause patients and probably fifteen
to twenty percent of them will bring in a loved one,
usually their partner, who just want to hear it. Who
just want to be part of this solution, who want
to be helpful, and it's really just touches me so
much to see that.
Speaker 1 (46:05):
You mean, it's not like it, but I guess it's
somewhat like going through childbirth, where when you go through
it all together and you hear it all and you're
educated at the same time, it makes sense. Yeah, and
it probably allows the communication to flow a little bit better. Doctor.
I can't thank you enough. I have absolutely loved this,
(46:25):
believe it or not. I don't know if that's weird
or not, but I've really enjoyed our conversation.
Speaker 2 (46:31):
Well, thank you. I love talking about this. It's my passion.
Speaker 1 (46:34):
You are phenomenal at it the way you articulate it
and put it in these bite sized pieces. And by
the way, just if you don't want to just listen
to me, talk to the doctor. Find her on Instagram
because you put up so much good stuff. I know
you're on TikTok as well. I'm not, but find you
on TikTok. Clearly you have YouTube videos at doctor Mary
Clare on Instagram. You also have the book The Galveston Diet.
Speaker 2 (46:58):
And our website is undiet dot com.
Speaker 1 (47:00):
Okay, Galvestondiet dot com and are you working on another book?
Speaker 2 (47:05):
I am. So it's called The New Menopause, and take
everything I just said in the last hour and expand
it times one hundred and I really want it to
be a critical resource guide for patients and partners and
loved ones to understand what's out there, what's available, what
the symptoms might be. It's something you would hand a
(47:26):
twenty thirty year old so she's ready, you know. Remember
that it's like what to expect when you're never going
to expect again. Right.
Speaker 1 (47:33):
Uh. And by the way, what a great thing, because
it is as we started this whole conversation, it is
astounding to me that we don't do more to educate
women for something that you are all going to go
through and we just kind of blindly and hopefully maybe
your mom's mentioned something, and that's how you that's how
you get educated. So hopefully you are kind of breaking
(47:53):
down that barrier and knocking down that wall so at
least at the very least you can see what's coming
and underst stand it when it hits. That's it, doctor,
Thank you, thank you so much for the time, for
the knowledge, and we need to do this again, I'd
love to. We will continue this conversation because it is
incredibly important. So thank you so much.
Speaker 2 (48:14):
Okay, take care, Thanks for listening.
Speaker 1 (48:16):
Follow us on Instagram at the most Dramatic pod ever,
and make sure to write us a review and leave
us five stars. I'll talk to you next time.
Hosts And Creators
Lauren Zima
Chris Harrison
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