Dr. Mary Claire Haver: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality

Dr. Mary Claire Haver (00:00:00)

• Dr. Mary Claire Haver is a board-certified OBGYN and an expert in perimenopause, menopause, and female-specific health.
• Perimenopause and menopause are stages in a woman's life marked by hormonal changes and the eventual cessation of menstruation.
• Perimenopause typically begins in a woman's 40s and can last several years.
• Menopause is the point at which a woman has not had a menstrual period for 12 consecutive months.
• Nutrition:
  • Eat a balanced diet rich in fruits, vegetables, and whole grains.
  • Include lean protein and healthy fats in your diet.
  • Limit processed foods, sugary drinks, and excessive amounts of caffeine and alcohol.
• Supplementation:
  • Consider taking supplements such as vitamin D, calcium, and magnesium.
  • Discuss any supplements you are considering with your doctor.
• Lifestyle:
  • Get regular exercise.
  • Manage stress through techniques such as meditation, yoga, or deep breathing.
  • Prioritize sleep and aim for 7-8 hours per night.
  • Maintain a healthy weight.
• Conversations:
  • Talk to your mother and other women in your family about their experiences with perimenopause and menopause.
  • Have open conversations with your OBGYN about your symptoms and concerns.
• HRT can be an effective way to manage symptoms of perimenopause and menopause, including hot flashes, sleep disturbances, and mood changes.
• The type and dosage of HRT that is right for you will depend on your individual needs and circumstances.
• Timing of HRT initiation is crucial for effectiveness and safety.
• Discuss the risks and benefits of HRT with your doctor before starting treatment.
• Sleep Issues:
  • Establish a regular sleep schedule and stick to it as much as possible.
  • Create a relaxing bedtime routine.
  • Avoid caffeine and alcohol before bed.
  • Keep your bedroom cool, dark, and quiet.
• Hot Flashes:
  • Dress in layers so you can easily adjust your clothing as needed.
  • Use cooling techniques such as taking a cool shower or using a fan.
  • Avoid triggers such as spicy foods, caffeine, and alcohol.
• Inflammation:
  • Eat an anti-inflammatory diet rich in fruits, vegetables, and whole grains.
  • Limit processed foods, sugary drinks, and excessive amounts of caffeine and alcohol.
  • Get regular exercise.
  • Manage stress through techniques such as meditation, yoga, or deep breathing.

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• Perimenopause is the transition phase before menopause, typically starting in a woman's 40s.
• Perimenopause can cause various symptoms, including irregular periods, hot flashes, night sweats, mood swings, and sleep disturbances.
• Menopause is the time when a woman has not had a period for 12 consecutive months.
• The average age of menopause is 51, but it can occur earlier or later.
• Hormone replacement therapy (HRT) is a common treatment for menopause symptoms, but it has risks and benefits that should be carefully considered.
• Lifestyle factors such as diet, exercise, and stress management can also help manage menopause symptoms.
• Eating a balanced diet rich in fruits, vegetables, whole grains, and lean protein is important for overall health during menopause.
• Regular exercise, including cardiovascular and resistance training, can help improve mood, energy levels, and sleep quality during menopause.
• Managing stress through techniques like meditation, yoga, and deep breathing can help reduce menopause symptoms.
• Sleep hygiene practices, such as maintaining a regular sleep schedule, creating a relaxing bedtime routine, and avoiding caffeine and alcohol before bed, can improve sleep quality during menopause.
• It's important for women to talk to their healthcare provider about menopause and discuss the best treatment options for their individual needs.

Menopause, Age of Onset (00:06:26)

• Medical definition of menopause: one year after the final menstrual period.
• Criticizes the medical definition as it excludes women who have had a hysterectomy, IUD, ablation, or PCOS.
• Menopause represents the end of ovarian function and the decline of sex hormone production.
• Average age of menopause in the US is 51 to 52 years old, but normal range is 45 to 55 years old.
• Perimenopause begins 7 to 10 years before the last menstrual period.

Perimenopause, Hormones & “Zone of Chaos” (00:09:50)

• Perimenopause is a transition phase into menopause.
• During perimenopause, the brain's signals to the ovaries to produce estrogen become less effective.
• This leads to irregular menstrual cycles and unpredictable estrogen and progesterone levels.
• The unpredictable hormonal changes during perimenopause are referred to as the "zone of chaos".
• Diagnosis of perimenopause is usually based on symptoms and ruling out other conditions.
• Research on perimenopause is relatively new and has been limited by the lack of studies on female mice in the past.
• The National Institutes of Health (NIH) now requires that female mice be included in studies of mice.
• This increased focus on sex as a biological variable is expected to lead to more research and understanding of perimenopause.

Perimenopause, Estrogen & Mental Health (00:14:42)

• Perimenopause and menopause affect one in five women and can significantly impact their health and well-being.
• Research on perimenopause and menopause is limited compared to pregnancy-related topics, and the exact reasons why ovarian cells become resistant to FSH during perimenopause are not yet fully understood.
• Mental health changes are common during perimenopause due to fluctuating estrogen and progesterone levels, leading to an increased risk of mental health disorders and a higher use of SSRIs.
• Hormone therapy during perimenopause, particularly estrogen, has been found to be more effective than SSRIs in managing depression during this time.
• Perimenopause can cause various psychological shifts, including increased anxiety, loss of executive functioning, cognitive difficulties, and a decline in confidence, which can significantly impact women's careers and overall well-being.

Perimenopause Symptoms; Tool: Lifestyle Factors & Ovarian Health (00:20:04)

• Perimenopause can cause various symptoms such as abnormal periods, fatigue, muscular-skeletal pain, palpitations, and anxiety.
• Blood work, thyroid workups, autoimmune workups, and nutritional deficiency checks are recommended to rule out other underlying conditions.
• A healthier lifestyle, including an anti-inflammatory diet, regular exercise, good sleep habits, and avoiding smoking, can help alleviate perimenopause symptoms.
• Factors that can shorten the life of the ovaries include smoking, not having children, hysterectomy, tubal ligation, chemotherapy, surgery, and inflammatory processes in the abdomen.
• African-Americans tend to go through menopause earlier than Caucasians, while Asians tend to go through it later.

Early Menopause, Premature Ovarian Failure; Estrogen Therapy (00:25:26)

• Early menopause is defined as occurring between the ages of 40 and 45.
• Premature menopause or premature ovarian insufficiency is defined as occurring before the age of 40.
• Untreated premature ovarian insufficiency increases the risk of cardiovascular disease, diabetes, and stroke.
• Hormone therapy can help mitigate the risks associated with premature ovarian insufficiency.
• The dose of estrogen in hormone therapy for premature ovarian failure is higher than that used in menopause hormone therapy.
• Progesterone can be added to hormone therapy to induce a withdrawal bleed and create a sense of normalcy.
• Estrogen levels fluctuate naturally during the menstrual cycle.
• Hormone therapy for menopause uses a constant dose of estrogen to alleviate hot flashes.
• Birth control pills use a different type of estrogen and are designed to prevent ovulation.
• The difference in estrogen dosage between low-dose birth control pills and menopause hormone therapy is not significant.
• The type and dosage of estrogen used in menopause hormone therapy vary depending on individual needs and circumstances.

Dr. Mary Claire Haver: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (00:00:00)

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Contraception, Transdermal, IUDs; Menopause Onset, Freezing Eggs (00:31:31)

• Hormonal contraceptives, such as birth control pills, patches, and rings, prevent ovulation and may slightly accelerate the onset of menopause by about a year.
• IUDs, both hormonal and copper, do not affect the timing of menopause. Hormonal IUDs can thin the uterine lining, leading to fewer or no periods.
• Using birth control that suppresses ovulation may delay the onset of perimenopause and menopause by a maximum of 9 months.
• Freezing eggs for future fertility preservation does not diminish the pool of eggs one would have naturally, and harvesting eggs for freezing or IVF does not affect the timing of menopause.

Women’s Health: Misconceptions & Research (00:38:18)

• Lack of research and communication in women's health, especially menopause and perimenopause, leads to misinformation and confusion.
• Societal views on pregnancy and female health, along with the influence of social media, affect information accessibility and contribute to misinformation.
• Women's health receives limited funding compared to other health research areas, hindering the understanding of sex-specific differences in chronic diseases and the impact of menopause.
• Efforts are underway to establish an Institute for Women's Health and secure funding for research and education in women's health, including menopause.
• Public engagement and advocacy, such as contacting elected officials and expressing support, can significantly impact research funding decisions.

Tool: Diet, Preparing for Peri-/Menopause; Visceral Fat (00:45:01)

• Diet is one of the most important factors in determining inflammation levels.
• Estrogen is a powerful anti-inflammatory hormone, and its loss during menopause increases the risk of inflammation.
• Fiber-rich foods help feed the gut microbiome, slow down glucose absorption, and promote overall health.
• Aim for at least 25-32 grams of fiber per day from various sources like fruits, vegetables, and whole grains.
• Protein intake is also important. Visceral fat, the fat around internal organs, increases during menopause and is linked to chronic diseases.
• Premenopausal women have about 8% visceral fat, which increases to 23% during menopause even without changes in diet and exercise.
• Visceral fat is more problematic for health compared to subcutaneous fat and should be managed for overall well-being.

Tools: Body Composition, Muscle & Menopause, Protein Intake (00:48:31)

• Weight gain during menopause is often due to a change in body composition, not an increase in overall weight.
• Women lose muscle and gain visceral fat during menopause.
• Protein intake is key for maintaining muscle mass and metabolic health during menopause.
• Aim for 1 gram of quality protein per pound of lean body mass per day.
• Starting healthy habits in perimenopause can improve postmenopausal health.
• Women should aim for 80-120 grams of protein per day.
• Protein intake is associated with reduced risk of frailty in women.
• High-quality protein sources are important for providing all essential amino acids.

Menopause: Genetics, Symptoms; Tools: Waist-to-Hip Ratio; Gut Microbiome (00:51:42)

• Genetics plays a significant role in determining the onset of menopause. Knowing the age at which your mother and aunts experienced menopause can provide insight into your own timeline.
• Common symptoms of perimenopause and menopause include changes in body composition, particularly an increase in visceral fat.
• The waist-to-hip ratio is a better indicator of metabolic health compared to weight or BMI. It is calculated by dividing the waist measurement by the hip measurement.
• Other symptoms of menopause include fatigue, sleep disruption, psychological changes such as irritability and reduced resilience, and hot flashes.
• Perimenopause can cause subtle changes such as frustration at work, menstrual changes, vertigo, tinnitus, skin changes, and gut changes.
• The Zoe nutrition study revealed that the gut microbiome undergoes a transition during menopause, shifting from a typical female microbiome to one resembling that of a male.
• Supporting the gut microbiome with fiber, low-sugar fermented foods, and supplements like Lactobacillus and Bifidobacterium may alleviate some symptoms of menopause, including visceral fat reduction and blood pressure improvements.
• Retrospective studies suggest that women who consume fermented foods and follow a Mediterranean-type diet experience better overall symptoms during menopause.

Galveston vs. Mediterranean Diet, Fasting, Tool: Building Muscle (00:58:22)

• Dr. Mary Claire Haver, a medical professional, developed the Galveston Diet to provide comprehensive nutrition education and make healthy eating more accessible and appealing to her patients.
• While intermittent fasting was initially recommended to reduce inflammation during menopause, it became challenging for many women to consume adequate protein within a limited eating window.
• Dr. Haver emphasizes spreading protein intake throughout the day, rather than stacking it in one large evening meal, to support overall health and protein metabolism.
• Eating a healthy diet that includes a healthy fat, a good healthy carb, and a protein with every meal and snack is important for overall health.
• Resistance training is essential for maintaining muscle mass and bone strength and should be done at least three times a week.
• Cardio is not as important as resistance training for overall health and can be reduced or eliminated.
• Many people, especially women, are intimidated by resistance training and don't know how to do it properly.
• It's important to normalize resistance training and show people how to do it correctly so that they can overcome their fears and start reaping the benefits.
• Focusing on eating for health and vitality rather than trying to look a certain way is important for long-term health.

Dr. Mary Claire Haver: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (00:00:00)

• Perimenopause is the transition phase before menopause.
• It can last for several years and is characterized by hormonal fluctuations.
• Common symptoms include hot flashes, night sweats, mood swings, and irregular periods.
• Menopause is the time when a woman's menstrual periods stop permanently.
• It usually occurs between the ages of 45 and 55.
• Symptoms of menopause can include hot flashes, night sweats, mood swings, vaginal dryness, and decreased libido.
• HRT is a treatment option for managing symptoms of menopause.
• It involves taking hormones, such as estrogen and progesterone, to replace the hormones that are no longer being produced by the ovaries.
• HRT can be effective in reducing hot flashes, night sweats, and other symptoms of menopause.
• However, HRT can also have side effects, such as increased risk of blood clots, stroke, and breast cancer.
• There are several lifestyle changes that can help manage symptoms of menopause, including:
  • Eating a healthy diet
  • Getting regular exercise
  • Managing stress
  • Getting enough sleep
  • Avoiding caffeine and alcohol
• Menopause is a natural part of aging, and there are several things women can do to manage their symptoms and stay healthy.

Hot Flashes; Estrogen Hormone Replacement Therapy (HRT), Breast Cancer Risk & Cognition (01:06:29)

• Hot flashes, a common symptom of menopause, are caused by dysregulation of the thermoregulatory center in the hypothalamus.
• Hormone therapy (HT) is the most effective treatment for menopause symptoms, as it replenishes estrogen levels and alleviates hot flashes.
• The demonization of HT is due to misinterpretation of a large-scale hormone therapy trial (WHI study) that initially suggested increased cardiovascular risks but was later found to have flaws.
• Estrogen-only HT is safe for women who have had a hysterectomy, while women with a uterus require a combination of estrogen and progestogen to protect against uterine cancer.
• The WHI study excluded women with hot flashes and had an average age of 63, which is significantly older than the typical age of menopause onset (51).
• The estrogen plus progestin arm of the WHI study showed a non-statistically significant increased risk of breast cancer, but the absolute risk was only 8% per year.
• The estrogen-only arm of the WHI study showed a 30% decreased risk of breast cancer.
• Starting hormone therapy between the ages of 50 to 59 resulted in a 50% decreased risk of cardiovascular disease and death from cardiovascular disease, according to the American Heart Association.
• Estrogen is more effective in preventing cardiovascular disease than curing it and is particularly protective in the intima of the coronary arteries.
• The timing of hormone therapy is crucial, as starting it too far away from menopause may increase the risk of stroke.
• Years of reproductive life plus HRT are associated with higher cognition scores and healthier brains.
• Estrogen is generally neuroprotective, and its decline is correlated with neurodegeneration.

Estrogen HRT, Cardiovascular Disease, Blood Clotting; “Meno-posse” (01:15:36)

• Estrogen does not cause breast cancer.
• Many physicians lack adequate knowledge about menopause and its effects on overall health, particularly metabolic diseases.
• The current medical approach to menopause primarily focuses on genitourinary symptoms, neglecting broader health impacts.
• Antidepressants are commonly prescribed for menopausal symptoms despite limited evidence of their effectiveness.
• Women should have informed conversations with their healthcare providers about hormone replacement therapy (HRT) and its potential benefits and risks.
• Medical education should prioritize women's health, addressing the unique aspects of female physiology and disease burden.
• Expanding the core curriculum in medical schools to include women's health is necessary to improve patient care.
• Cardiovascular disease is a significant health risk for women during menopause, often overlooked due to differences in symptoms compared to men.
• Elevated LDL and lowered HDL cholesterol levels during menopause increase the risk of cardiovascular disease.
• Statins, commonly prescribed for cholesterol management, have not been proven to decrease the risk of primary heart attacks in women.
• HRT can be beneficial if given within the right time frame.
• Non-oral estrogen formulations, such as patches, gels, rings, and sprays, are preferred over oral forms to avoid potential clotting risks, especially for those with a family or personal history of clotting.
• Genetic testing can assess the risk of estrogen-related clotting, but routine screening is not widely practiced.
• The Menasi is a group of healthcare professionals from various specialties who collaborate in menopause care and research.

Estrogen & Testosterone: Starting HRT & Ranges (01:24:00)

• Hormone therapy can improve psychological and physical well-being in women during perimenopause and menopause.
• The optimal timing to start hormone therapy and the ideal dosage for cholesterol and cardiovascular health need further research.
• Testosterone replacement therapy in men is often used to optimize well-being, even if testosterone levels are not low.
• For women with premature ovarian insufficiency, the goal is to reach estradiol levels of around 100 picograms per deciliter.
• Testosterone levels above 90 ng/dL in females may indicate an underlying condition such as a tumor or PCOS.
• The goal for testosterone levels in women is typically between 50-70 ng/dL, balancing symptom relief with potential side effects.
• Testosterone and estrogen exist in both biological sexes and are not exclusive to one gender.

Other Hormones, Thyroid & DHEA; Local Treatment, Urinary Symptoms (01:30:36)

• Menopause is a process involving a decline in multiple hormones, including estrogen, progesterone, and androgens.
• Hormone therapy, such as estrogen, progesterone, and testosterone, can be used to manage symptoms and maintain health during menopause.
• Estradiol is the preferred form of estrogen replacement, as it closely resembles the body's natural estrogen.
• Local hormone formulations, such as vaginal estrogen, have low systemic absorption and are generally safe for use.
• Vaginal estrogen can prevent or treat GSM (genitourinary syndrome of menopause) and recurrent UTIs in menopausal women.
• Vaginal estrogen can help with urge incontinence by relaxing and reducing inflammation in the bladder wall.

OB/GYN Medical Education & Menopause (01:37:57)

• The medical establishment, particularly OBGYNs, may not fully understand the flaws in the large-scale study on menopause discussed at the Watergate Hotel.
• OBGYN board certification exams do not systematically include the latest menopause information.
• The American Board of Obstetrics and Gynecology (ABOG) does not recognize the Menopause Society as a legitimate entity.
• The speaker criticizes the lack of menopause-related content in medical education and suggests that OBGYNs are not adequately trained to care for women after their reproductive years.
• Exciting findings around hormone replacement therapy and the flaws in earlier studies are emerging.
• Studies from Europe and Scandinavia are generally more forward-thinking in terms of menopause research.
• Some of the most forward-thinking research on menopause is coming out of Asia, particularly China, where there are many female researchers.

Supplements, Fiber, Tools: Osteoporosis “Prevention Pack” (01:41:30)

• Nutrition, resistance training, and maintaining muscle mass are crucial for overall health during menopause and perimenopause.
• Supplements like DIM, grape seed extract, and evening primrose oil lack substantial scientific evidence to support their effectiveness in treating menopause symptoms.
• Cognitive behavioral therapy can be beneficial but is not a cure for menopause.
• Supplements like turmeric may help with hot flashes but should not replace estrogen therapy.
• Vitamin D, creatine, and bioactive collagen have positive effects on bone density and muscle health.
• Healthy habits in the 30s and 40s can prevent osteoporosis and muscle loss during menopause.
• Resistance training, using a weighted vest, and adopting healthy habits can effectively maintain bone and muscle health during menopause.
• Dr. Mary Claire Haver recommends a combination of adequate protein intake, resistance training, wearing a weighted vest, taking creatine monohydrate, and considering collagen supplements to prevent osteoporosis.

Collagen, Cellulite, Bone Density (01:46:53)

• Collagen, specifically Verisol collagen, can improve the appearance of cellulite and increase bone density.
• Collagen may be beneficial for bone health, as it has been shown to increase bone density in a small study.
• Osteoporosis is a serious condition that affects many women, and hip fractures can have a high mortality rate.
• Perimenopause and menopause can cause significant challenges and pain for individuals, but many of these challenges can be avoided by taking an aggressive and intentional approach to managing these life stages.
• Hormone replacement therapy (HRT) can play a significant role in improving health and vitality during perimenopause and menopause.

HRT, Vertigo, Tinnitus, Dry Eye; Conditions Precluding HRT (01:51:42)

• Hormone replacement therapy (HRT) may improve sensory functions such as vision, hearing, and reduce symptoms of tinnitus.
• Estrogen's anti-inflammatory properties can alleviate inflammatory conditions around the eyes, potentially improving dry eye symptoms.
• HRT reduces the rate of vertigo in menopausal women by preventing crystals from breaking off in the ear.
• Dry eye is a common and frustrating condition, and HRT seems to decrease its occurrence and severity.
• HRT may not be suitable for women with certain conditions, including hormone-sensitive cancer, undiagnosed dysfunctional uterine bleeding, active blood clots, severe liver disease, or a history of hormone-sensitive cancer (depending on the stage and type).

Polycystic Ovary Syndrome (PCOS) & Treatment; GLP-1, Addictive Behaviors (01:55:27)

• Polycystic ovary syndrome (PCOS) is a prevalent condition often caused by insulin resistance and is associated with obesity.
• Common treatments for PCOS include birth control to manage ovulation and androgen production, and weight loss for obese patients.
• GLP-1 medications can be effective for weight loss in PCOS patients but should be prescribed cautiously due to potential side effects like muscle loss and increased pregnancy risk, requiring contraception discussions with female patients.
• GLP-1 medications can be combined with resistance training and improved nutrition for effective weight management in PCOS patients.
• The hypothalamus, involved in temperature regulation and various drives, may be targeted by drugs that reduce food cravings, potentially impacting other cravings like gambling and alcohol.
• Obesity medicine specialists are enthusiastic about the potential of new drugs for weight loss with fewer side effects, backed by significant research and funding that could revolutionize weight loss treatments.

Post-menopause & HRT, Sustained HRT Usage (02:01:55)

• For women over 60 who have not been on HRT, assess risk factors for cardiovascular disease and stroke before considering HRT.
• Estrogen can provide benefits such as bone protection, protection of the genital urinary system, and skin health, even after the age of 60.
• The decision to start or continue HRT after menopause should be made in consultation with a doctor, considering individual risk factors and benefits.
• HRT can be continued indefinitely if there are no contraindications and the woman continues to benefit from it.

Mental Health, Perimenopause vs. Menopause; Sleep Disruptions, Alcohol (02:04:58)

• Estrogen is the best treatment for mental health issues in perimenopause.
• Progestin, taken at night, can help with sleep disruptions.
• Sleep hygiene is important for good sleep.
• Alcohol tolerance decreases with age and can disrupt sleep.

Male Support; Rekindle Libido (02:09:09)

• Acknowledge that menopause is happening and educate yourself about it.
• Attend appointments with your partner and advocate for her.
• Be supportive and understanding as menopause can affect her brain, bones, heart, kidneys, skin, relationships, and ability to tolerate things.
• Testosterone therapy can help with sexual dysfunction in women during menopause.
• There are two FDA-approved medications for libido: Vyleesi (an injection) and Addyi (a daily pill).
• Testosterone is often the preferred choice due to its multiple benefits and lower cost compared to other medications.

HRT Rash Side-Effect; Acupuncture; Visceral Fat (02:12:46)

• Some women experience skin rashes and hives as side effects of estradiol hormone replacement therapy, particularly with the adhesive in the patch.
• An alternative form of estrogen, such as a gel or cream, may be better tolerated.
• Acupuncture can help manage symptoms of perimenopause and menopause, but it may not be accessible or affordable for everyone and does not address the root cause.
• Visceral fat can be reduced through a multifactorial approach that includes nutrition, exercise, stress reduction, and hormone replacement therapy.

Dr. Mary Claire Haver: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (00:00:00)

• Dr. Mary Claire Haver is an expert on menopause and perimenopause.
• Her book, "The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and the Facts," provides valuable information on the topic.

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