362: Menopause Unmasked w/ Dr. Mary Claire Haver

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Courtney Townley 0:00
Welcome to the Grace and Grit Podcast made for women who want their healthiest years to be ahead of them, not behind them. Join your host Courtney Townley right now as she breaks down the fairy tale health story you have been chasing all of your life into sensible action steps and lasting change.

Courtney Townley 0:28
Hello, my friends and welcome to the Grace to Grit podcast. This is your host, Courtney Townley, as always. Thank you so much for being here for nearly three decades now. I have been helping women, mostly midlife women take better care of themselves with more consistency and ease. And a big reason I’m so committed to that work is because I firmly believe we have tremendous power to influence our health story and the way that we age. And having worked with so many midlife women over the years, I am very familiar with the challenges and frustrations that arrive as women travel through the menopausal transition, and I am a midlife woman, so I am deep in the throes of my own menopausal transition, and I cannot say this emphatically enough, menopause has not gotten the attention that it deserves, until now.

Courtney Townley 1:33
There are people like my guest today, Dr. Mary Claire Haver, who are really making it their message and mission to help women navigate this stage of life with more support than they’ve ever had before. Dr. Mary Claire Haver is a board certified OBGYN. She is a culinary medicine expert, a menopause society certified practitioner and the founder of Mary Claire wellness, a private medical practice that specifically focuses on women in midlife. If you have never heard of her name before, Dr. Haver has taken the internet by storm with her advice for women on how to navigate the path through hormonal change with power, purpose and facts, information that is so long overdue.

Courtney Townley 2:28
So if you’re a woman, or you know a woman, Dr. Havers, newest book, The New Menopause, is an absolute must read, because it provides so much value and better understanding what is really going on in the menopausal transition, and how we can best support it. Because while menopause is inevitable, suffering through it is not so in this interview today, we cover a tremendous amount of ground, but some of the things that Dr. Haver generously shares are things like why she was so compelled to write this book, how to advocate for the care that you need, the different stages of the menopausal transition, the cost of hormonal decline and how we can better support it, the truth about HRT and so much more.

Courtney Townley 3:17
So have a listen, take it in, and if this lands for you, if you get some value from this episode, please share it far and wide so women can get the help that they need to make their second half the best half.

Courtney Townley 3:34
All right, we have so much to talk about, so let’s get into it.

Courtney Townley 3:43
Dr. Haver, welcome to the Grace and Grit Podcast.

Dr. Mary Claire Haver 3:45
Thanks for having me.

Courtney Townley 3:46
Thanks for being here. And I really do want to start with you, especially in this interview with where I end a lot of my interviews, which is with a heartfelt thank you, because the movement that you have ignited around menopausal healthcare is long overdue and so desperately needed. And when I read your book, your new book, The New Menopause, I got really emotional, because I saw my mom in the book. I saw my grandma in the book, I saw myself in the book, and I saw every client I’ve ever worked with in your book.

Courtney Townley 4:20
And you know, when I polled my audience prior to this interview, I told them, you know, throughout questions you want me to ask, and I have to tell you, a large majority of what I got back was just make sure you tell her thank you, like that was the main message. And that’s just such a testament to the work that you’re doing and the importance of what you’re doing. And I also just want to speak to the way that you wrote the book. You normalize rumbles in such a grace filled way, and you educate on solutions in such an understandable way. And you really do such a beautiful job of giving women what I think they are so looking for, which is hope. That their best years truly can be ahead of them and not behind them with the right resources. And this book is so ripe with amazing resources. So thank you. Thank you from the bottom of my heart and from all of my listeners for being here.

Dr. Mary Claire Haver 5:16
Well, you know, I wrote the book for my daughters and for my grandmother, and my grandmother spent the last 10 ish years of her life frail and demented and needing long term care and just not happy, functional human being. My mother’s on that path, and I want better for my daughters. And so this book is trying to give a framework where we can limit the time that these things can happen.

Courtney Townley 5:42
It is. It’s such a relief to read it. And you know, I would like to, I think, ignite this conversation too, with maybe you sharing with listeners as a certified OBGYN, which you are, there’s so many things you could have done a deep dive into and that you could have pursued as a mission or a message. Why this? Like, why this topic?

Dr. Mary Claire Haver 6:08
I saw that there was a huge gap in my knowledge and training and that, you know, to put it in perspective, this, this isn’t a neat you know, it’s so funny when people like, what’s your niche? What’s your niche? I’m like every single woman over the age of 35 like, why is it? It was my frustration with, you know, what I learned in my training programs, and CME is great. You know, there’s just a gap, a total gap, in the gender health gap. You know, how females are treated medically in research studies, and then specifically around our sex hormones, and it is leading to us having longer lives of dysfunction, you know. And I’m like, I’m just one voice, but I’m kind of loud, and who knew my superpower would be to make interesting Tiktok videos about menopause. But you know, there’s a bigger, a bigger picture here of women who can lead a healthier, longer life, if they know these things.

Courtney Townley 7:07
Yeah, I heard an interview you did recently with Marie Forleo, and it was fabulous. And you said in that interview, what that your friend had asked you the question, what if you had been among the 15% yourself, the person who personally had not really experienced the perimenopausal symptoms or menopausal symptoms, that really would have shifted probably the drive to have this conversation. Will you speak to that a little bit?

Dr. Mary Claire Haver 7:36
Yeah, so you know, part of what fueled and motivated me was my banging my own head against the wall with my menopause symptoms. And I was the girl who brought up in the traditional Western, you know, healthcare, that menopause was a natural part of life. Yes, okay, can’t deny that. But that, you know, if I just ate right and worked out, I should have an easy time of it. And, you know, I equated my thinness with good health, which is a whole nother discussion, which was not true. And I had a horrible menopause, horrible and I guess let myself for months trying to say, Oh, can’t be this. It can’t be that, you know, not realizing that all the symptoms I were having were due to my estrogen deprivation and testosterone, so you know. But what if I was one of the lucky 10% 15% who just kind of skated through and stopped having periods and didn’t have any like cliche symptoms? I don’t know if I would have been a passionate about this journey. So as hard as the wall was hit for me, it was probably a good thing, because I was so motivated to help myself and therefore helping millions of other women.

Courtney Townley 8:45
Yeah, well, I hate to say that I’m glad you weren’t a part of that 15% because obviously you could have avoided some unnecessary struggle. But if it birthed this so grateful for it so early in the book, you say that if a woman in perimenopause is not getting top notch care. It’s a matter of life and death, really. And then you go on to share all these incredible stories, like the beginning of every chapter of your book is a testimony of someone you’ve worked with, talking about how she was either misdiagnosed or ignored or gaslit by the medical industry and how difficult it was for her to get good information to treat her symptoms and move into post menopause with success.

Dr. Mary Claire Haver 9:31
So I did that on purpose, because I wanted you know. We picked a very various stories. I wanted women to see themselves in the book and or their or their sisters, or whomever, I wanted them to have a connection with a real person who and realized that they’re not alone. Because what was happening was women were suffering in silence and confusion and then being gaslight and dismissed and just feeling so alone, which I think was compounding the severity of their symptoms. Right? Which it was so awful to feel so isolated and so alone and not understand what was happening to their bodies. So that’s kind of the first part you had a second part of the question.

Courtney Townley 10:10
Well, I was going to lead into with that, just the why is that happening? In terms of there being such a challenge with women having to go to medical providers so many times, or feel like they’re just not getting the help that they need you, because you speak very beautifully in the book to the gap in the education.

Dr. Mary Claire Haver 10:28
So it’s a lack of training, you know? It’s this conflict, perfect storm of how we treat the aging woman, how we value her, the history of medicine and how we’ve we’ve taken care of females throughout time in our healthcare education system with clinicians. How many hours so in medical school I had maybe, and so I trained 30 years ago. I went to school a very long time ago, but maybe one hour of menopause in all of medical school. And then in my OBGYN residency, maybe six hours. And then until 2018 I was an OBGYN Residency Program Director in Charge of the curriculum, so I know exactly. And we get the papers from the American Board of OB GYN, and you must teach your learners this. And there was just the the briefest, most clinically insignificant section on menopause. It just got shoved in the box with everything else taking priority, and most of our training was around reproduction and so and you know, part of it is also why does all of women’s health, which is more than her breast and uterus, by the way, get dumped in the lap of the poor, busy gynecologist like you have enough to do, delivering babies and surgeries and pap smear and keeping the reproductive system healthy.

Dr. Mary Claire Haver 11:43
But like, what about my brain, my bones, my general urinary system, my skin, my hair, my teeth, my eyes, how that’s all being affected by this? In a perfect world, this would be a normal part of training for 100% of medical students, of learners, of clinicians, of any clinician who touches the female. But that’s not happening. It’s not happening. I can’t tell you how many times go see your gynecologist, goes to your gynecologist, goes to your gynecologist. We’ve segmented this so so poorly, and so women are suffering because of it. So right now, statistically, the end of they did a study in 2023 woman goes into her healthcare provider clinicians office saying, okay, cliche, symptoms of menopause. There’s no denying, I have no periods and I have hot flushes. Boom. Only 10% right now will be offered treatment, 10% and if she is offered treatment of any of any kind, four to one, it’s an antidepressant. Four to one, and she says, I’m not depressed. And they’re like, there’s nothing I can do for you. That’s a problem.

Courtney Townley 12:46
It’s a huge problem. And so can you speak a little bit to maybe the bright side of what’s maybe happening now, to to remedy that like and I do realize it’s a much bigger issue than just the gap in education, it’s a gap in funding, it’s a gap in research, right? There’s all of these places where we have been really miss served guidelines. Yeah, absolutely. And so what is happening to sort of remedy that right now?

Dr. Mary Claire Haver 13:16
So we so there are political organizations around menopause, not political, but like the menopause mandate. And, you know, there’s these organizations being developed to promote menopause care that are helping to push legislation so that we have mandatory dollars being spent on women’s health, you know, on the gender health gap, on menopause care. So that’s happening. The second push is putting pressure on the American College of OB GYN, American Board of OB GYN, to mandate menopause CME as a very, you know, robust part of CME training continuing, you know, for those of us who are out and have to get recertified every year, and then for in the training program. So we’re working on that, you know. And then, of course, where the really groundswell is going to happen is women educating themselves and demanding the conversation. And so that’s what the book is. The New Menopause is about. Yeah,

Courtney Townley 14:13
and you do such an incredible job on social media. So if you don’t follow Dr. Haver on social media channels, she’s a wealth of knowledge there and then. Is that? Is it true that, like through the questions you were being asked and just the the frustration you were sensing among the people you were interacting with on social media, that you felt the need for this book, in terms of women, were lacking this very information,

Dr. Mary Claire Haver 14:37
right? So I’m like making videos, you know, six, seven times a day, posting continuously. And then people would be like, Wait, where was that video on frozen shoulder? And you know, most of what I’ve learned about menopause, outside of hot flashes, was informed by you, you know, by my followers, by people who saw listen and ask the questions. And then, you know, when 10,000 people ask. You in Your DMS. And I’m not exaggerating about frozen shoulder and menopause, you start looking, you know, and you I don’t automatically dismiss. I get curious. I go dig, and then I find, and then I share on social media. So I just needed a place to put all that together that I was learning. And then I met the menopause and started interacting with other people like me this don’t have yet. They’re getting there as big of a following and like, Finally I’m not screaming into the void. Finally I’m seeing people like minded who are like, this is a ridiculous and we got to change this. And so that kind of just bubbled up into, let me write this book so I can get it all in one place.

Courtney Townley 15:38
Yeah, you’re not just lifting the women needing this knowledge, but you’re also lifting other professionals who can speak to this and help to spread that message. And that’s what you mean by the menopause. Yes, will you clarify that for people who don’t know what it is?

Dr. Mary Claire Haver 15:53
So it was a joke. It is a group of really a more multi specialty. So it’s urologists, cardiologists, of course, OBGYN nurse practitioners, family medicine doctors, aging specialists. We have, oh, endocrinologist, of course, we have oncologists who have just banded, it’s a group chat. And so we wrote the rebuttal together for the lancet article that kind of came out, you know, on a national, you know, international stage. And basically said menopause isn’t a big deal. We’ll get some therapy. You’ll be fine. And we were like, Oh, hell no. And so we wrote the rebuttal. So through that friendship of writing a paper together, and, you know, respecting each other’s thoughts and opinions, we’ve just bonded, and we’re now just kind of this little group where we’re always sending medical articles back and forth and and really supporting each other’s work and practices.

Courtney Townley 16:46
And then we get to benefit from all that, yeah, which is fabulous. So let’s talk a little bit about why women seek out help, because we’re talking about a large span of years between perimenopause and post menopause, and a lot of menopausal symptoms are sort of turned into a cliche, right, of just hot flashes or mood swings or being difficult to deal with, right? There’s so much, there is so much happening. Because I think you you express so beautifully that the estrogen literally affects literally everything in the human body. There’s receptors everywhere. So can you speak to some of the things that women are seeking out help for, or they might be experiencing and they’re looking for solutions to,

Dr. Mary Claire Haver 17:32
Right? And they may not realize it could be related to their menopause. And so if we, like, break it down, head to toe and go or, you know, in general, organ system by organ system. Let’s start with the brain. So the top, so our brain, we have mental health changes. So we see a four fold increase in new diagnosis of mental health disorders, specifically depression and anxiety. And we also see brain fog, so we see cognitive deficits beginning to start the brain the chaos of perimenopause. So pre menopause, we have a very EKG, like, predictable rise and fall of our hormones. And healthy woman, like, outside of PCOS, that will, like, on day 14, you know, this is going to happen on day 28 this is going to happen. It does ebb and flow throughout the month, but the next month it’s going to look very much the same, you know, barring pregnancy or nutrition stuff. So the brain likes that. The brain likes uniformity.

Dr. Mary Claire Haver 18:22
You know, the hypothalamus is constantly sampling for estrogen in our blood, and when it gets low, it sends a signal to the pituitary, saying, talk to the ovary, tell them, let’s get this going this month. Let’s get that estrogen back up through the process of ovulation. We increase our estrogen so that goes month after month after month until we reach a critical threshold of our egg supply. So remember, females are born with all of their eggs. Men make theirs fresh every day. Okay? There’s, you know, they make their germ cell. It’s called germ cells fresh every day in their testicles. Okay?

Dr. Mary Claire Haver 18:51
So kick men out of the equation. We are stuck with the amount we’re born with, one to 2 million. By the time we’re 30, we’re down to 10% by the time we’re 40, we’re down to 3% this is why fertility decreases with age in a female, okay, so when we run out of eggs, that is menopause. So in Peri we reach some kind of a critical threshold, and it’s different for each of us, where those signals coming from the brain don’t work as well, because the quality of the eggs is down and the number is down, so we become resistant to those signals, and the the hypothalamus gets pissed off, and it says, I told you to where is my estrogen? I’ve been waiting. And the pituitary is like, I sent the signal. And hypothalamus says, Send more. So then the pituitary gets kicked back into gear and sends more and more and more stimulating hormone to get that little, poor little egg out that month this. So that’s a delay.

Dr. Mary Claire Haver 19:44
We see delay so cycles become disrupted as far as timing, and then the estrogen levels tend to surge, because there’s so much FSH and LH there, so we have much higher estrogen levels, and then they plummet to much lower than they ever were in our premenopausal years. Then progesterone never quite. It’s to where it used to be. So we end up with these an ovulatory cycles, meaning we don’t ovulate as regularly, and this goes on and on and on in this very much chaotic zone the brain hates that. Okay, not only are our neurotransmitters, the signals that jump from brain cell to brain cell that control depression, anxiety, thought process, all the things those are affected by the levels of hormone levels, and also the synapses are like fried, because the hormone levels are changing so rapidly, okay, and so not consistently, and that’s leading to all these brain changes. Okay, it’s very real. It’s not normal. It’s not, you know, it is natural, but you do not have to suffer so, and it can lead to tremendous changes in a way a woman’s brain functions. It’s completely rewired through this process.

Dr. Mary Claire Haver 20:49
So secondly, let’s go down to the heart palpitations, actually, and now a recognized basal motor symptom like hot flashes, our palpitations, women are going to the ER thinking they’re having a panic attack or a heart attack. You know, heart is pounding out. Nothing will stop it. She can’t she’s sweating, she’s anxious. She can’t figure out what’s going on. And no one in the ER is trained to say, I mean, they rule out the bad stuff, right? Which is what their job is. But they never say, this might be your menopause. What they say is, there’s nothing wrong with you, not by taking antidepressant or an anti anxiety medication.

Dr. Mary Claire Haver 21:23
So another thing, if we go to the lungs asthma, new onset asthma, it’s a typical asthma, or worsening asthma. Estrogen is a powerful anti inflammatory hormone. Our gut microbiome completely changes through the menopause transition, more bloating, more visceral fat deposition, decreasing our liver. Oh my gosh, how we process lipids. Triglycerides can go up. LDL, cholesterol usually goes up with no changes in diet and exercise, just based on the menopause transition, how we manufacture or how we process blood sugar and insulin resistance increases. So all of a sudden you’re just chipping along, eating what you eat, doing what you do, nothing’s changed. And your a 1c jumps, or your homo IRR score for insulin resistance jumps. And so you’re like, wait a minute. They’re like, Oh, it’s just a part of aging, yes, but it’s accelerated dramatically in menopause.

Dr. Mary Claire Haver 22:14
You know, men get to age like this. We age like this, so when we lose our sex hormones and so musculoskeletal. 80% of us will suffer from the musculoskeletal syndrome of menopause, arthritis, arthralgias, frozen shoulder capsulitis. It goes on and on and on. Women who are on HRT have much lower incidences of these diseases. Women on HRT have lower insulin resistance. Women on HRT have lower visceral fat deposition. So this is the data that women need to know, not just estrogen causes breast cancer,

Courtney Townley 22:47
Right? And so can we speak to that for a second? Because this estrogen causes breast cancer is a very real concern for a lot of people. The Women’s Health Initiative, you do a beautiful job speaking to that in the book. Can you summarize it just, I know it’s a meaty topic, but can you summarize it here, just so people understand where that idea came from.

Dr. Mary Claire Haver 23:06
So the Women’s Health Initiative was an amazing study. It was the first time aging women were significantly studied in the history of medicine. Okay, it was a billion dollar study in the 90s. That’s a huge amount of money. We were so excited. And basically we knew from observational evidence that women on HRT, and the number one HRT at the time was Premarin and Provera, okay, so not unusual. They studied that medication had lower incidence of cardiovascular disease and lower overall mortality. So the study was designed to say, well, is that an artifact? Because women on HRT tend to be healthier and wealthier, therefore they’re not going to have as much heart disease. Or is this really the medication? So to do to prove these things, we do randomized control studies. Right?

Dr. Mary Claire Haver 23:49
We do two age match. You know, we match socioeconomic. Two groups of women, half are on placebo, half are on the on the drug being studied, there were two groups, because women with hysterectomy did not need the progesterone. They did estrogen only. Okay, so off we go. We’re so excited, um, because we’re studying heart disease outcome, we start, we average the age at 63 so we’re starting with a much older population than a woman starting HRT typically. Okay. Also, they excluded women with hot flashes because they were worried that they would know if they had the medicine or not versus placebo, because their hot flashes would stop. So they excluded 85% of women with hot flashes. So there’s only the 15% who didn’t have many symptoms. Okay, that’s a problem, all right?

Dr. Mary Claire Haver 24:38
And you start much older, so they start measuring, they don’t see any difference in heart disease. So okay, again, this is much older. They saw in the estrogen and progesterone only arm, a very slight increased risk of breast cancer, extremely slight. And it was none in the first five years, none, if you only did five. There’s a therapy, you know, there’s many nuances to it, and in estrogen only arm, they saw improvement in the risk of breast cancer versus placebo. Okay?

Dr. Mary Claire Haver 25:10
So they they stopped the study. They call a press conference. So it’s not the data set. We’ve got great information coming from the data set. It’s how you interpret it and manipulate the data. They press conference at the Watergate Hotel in DC before anyone got a chance to read the study. They hadn’t even released it and said estrogen causes breast cancer. It was the number one medical news story in 2002 it changed the history and the course of women’s health for a generation. It scared the crap out of people, even though that data has been walked back, estrogen is protected for breast cancer, there seems to be a slight, very small issue with the progestin, and it really depends on the dose of formulation and the type.

Dr. Mary Claire Haver 25:52
When other studies have been done in other countries. That’s not, that’s not news making estrogen causes breast cancer is news. Making 80% of women, 40% of women, 30 to 40% of women were on HRT at the time of the study, okay? And doing great. And then 80% of those threw their stuff in the trash. I never touched it again. So what’s the aftermath of that? When I talk about that, yes, they’re now suffering hot flashes, night sweats. Now they’re going on antidepressant sleep medications, beta blockers for their palpitations, yada yada yada. Okay, they’re also ending up in nursing homes at a much higher rate. They’re also ending up frail and demented. Okay? And this is stuff that we this is preventative, and so my goal with the book is not just to stop the hot flashes. Yes, of course, that’s important, but it is to decrease these long term risks of living without our hormones.

Courtney Townley 26:44
Yeah, I’ve heard you speak to in fact, I think this morning I saw a post that you made about women are living longer than men, and yet our health is not as robust as men.

Dr. Mary Claire Haver 26:58
So to where we spent 20 to 25% of our whole lifespan in worse health than our male match counterpart. They live and get sick real fast and die. Boom. Right now, this is not all men, and I don’t want to offend anyone who’s taken care of their father for a long time, but in general, men live a healthier life, more productive life and independent life, and then have a shorter course of needing long term care and then die quickly, where women have a much more protracted poor quality of life before death. And that is what we’re trying to avoid.

Courtney Townley 27:32
And it’s only been like within the last 100 years that women have really lived long enough right to experience have

Dr. Mary Claire Haver 27:38
really experienced menopause. Yeah. On average, on average, yeah. On average, yeah. The average life expectancy did not go much past the natural age of menopause, you know, for until the industrialization era. So yeah, about 100 years. So let’s talk

Courtney Townley 27:54
a little bit about testing, because it is and your again, your book really illustrates this in so many different ways, how nuanced the diagnosis is, and also the route that someone takes to treat it. But what are women’s options for testing in terms of knowing where they are hormonally? This is the this is part of the trick, right? Part of the challenge.

Dr. Mary Claire Haver 28:16
There is no good blood, urine or saliva test to tell you if you’re perimenopausal, not consistently. Okay, okay, so I would not waste money on tests that promise that that there’s no clinically relevant data to suggest that these things are helpful at this point, I would love one. I think one is coming. You know, it’s just with those crazy, wild fluctuations, these one time, two times, three time. Tests are not really going to be diagnostic. We’re great at post menopause. I could do a blood test and tell you if you’re post mepausal With in two minutes. Okay, but perimenopause? No, we make the diagnosis of perimenopause by listening to the patient, believing what she says is true and real and happening to her, not automatically dismissing her as being stressed out or needing some water or more sleep, and then ruling out overlapping things like hypothyroidism or autoimmune disease, inflammatory disorders, nutritional deficiencies, etc, not, not a great use of money to do a lot of hormone testing and perimenopause. Save your money.

Courtney Townley 29:16
Okay, good to know. So the hormone replacement therapy, which you call menopausal hormone therapy, correct? Like, that’s the term that you like to use, yeah, can you describe what it is? I mean, I just because, for listeners who may not know, like, they’ve never even heard of that as an option, they don’t know how it affects their system. What are hormones? What is hormone therapy, and what are maybe the sources of it that are available to us to help us get through this period with more ease and grace.

Dr. Mary Claire Haver 29:48
So I’ll try to keep it simple, because the book goes way, way deep into this, and it’s complicated, but we have so when, when most of us say hormones, remember, we have dozens of hormones in our body. Vitamin D is a hormone. Um, you know, we have insulin and we have glucagon, and we have all these hormones, hormones, nothing but a chemical messenger that goes from one gland to an organ. Okay, our sex hormones are generally what we when we’re talking about menopause. What are the hormones produced by our ovaries? Estrogens, progestogens and androgens, which includes testosterone.

Dr. Mary Claire Haver 30:22
Okay, so those are the three main kind of types in the estrogen family. The main biologically active estrogen in our bodies, pre menopausal is estradiol. Okay, when we talk about body identical, just think estradiol. That is what our ovaries make. Now, naturally, we also make something called estrone, which is created in our fat cells, typically from the peripheral conversion in very low levels. So we’ll never, never, never be as biologically active, or unless you’re I’ve never seen it be a clinically significant level, you know, and and it’s the but then it becomes the main hormone in our body, even at its low levels, menopausal because our ovaries died, they don’t work anymore. So we can’t make estrus. We don’t make much, clinically significant estradiol, and then estriol is what’s made in the placenta when we’re pregnant, for those of us who ever have a pregnancy.

Dr. Mary Claire Haver 31:11
Now, some of the naturalists, I don’t know, I don’t want to pin I don’t want to demonize anything, but some physicians and clinicians are prescribing estrone and estriol, as in the forms of bias, to try us. But we don’t have any clinical data for efficacy or safety, so most of us in the menopause who use evidence will use estradiol as our main estrogen when we’re trying to replace it. Okay, because I just want to give you back the water you were drinking right now. The best thing I ever could have done was take out an ovary at 25 and re implant it at 50 and just let that sucker, you know, last till you die. But we’re not doing that’s nothing. That’s the perfection. HRG is a very poor stepchild for that. You know, it’s better than nothing.

Dr. Mary Claire Haver 31:57
So progestogens, that’s going to be progesterone, is our main progesterone produced by the ovaries, and so we usually give that back in the form of oral microdized progesterone. Progesterone, in its natural form, is a humongous molecule, and it doesn’t go through the skin very well. So if you still have a uterus and you are getting a progesterone cream compound, it it probably is not protecting the lining of your uterus adequately. And I would, I would, I would ask your physician to switch you to the oral micronized progesterone. And so that just shows the look of education and knowledge on a fault, you know, on the side of the clinician who’s trying to do their best, but doesn’t really understand how that works. And then we have our androgens, mostly testosterone. And so when I’m giving my patients testosterone, I’m giving her the biologically similar testosterone. I’m not giving her any synthetic options. I’m trying to go with as much, you know, as is close to what her body was used to getting.

Courtney Townley 32:53
When it comes to the estradiol, which is it, would you say that’s the most commonly prescribed? Like, that’s what you’re prescribing the most the forms of it. I know a lot of people get confused about because there’s an there’s oral, there’s patches, there’s transdermal. Can you speak a little bit to those?

Dr. Mary Claire Haver 33:11
Yeah, so we have oral and non oral, okay? Oral is pills, tick pill, right? Non oral is everything else, patch, gel, cream, ring trochee pellet injection. Okay, those are the main ways to get it in your body. And maybe God’s going to make something else new, but whatever, um, some have estradiol, some have synthetic forms. It just, just depends. The FDA approved options which are going to be covered by insurance are the patch, which is my favorite way to prescribe it, because it’s transdermal and it’s a steady state the vaginal ring, which I love, again, steady state, but very expensive, and most of my patients, it’s cost prohibitive. I even choose not to use it because I’d rather spend my money. I can get a pouch for 20 bucks. Then it works great. So and then the then the compounded option creams, trophies, there’s a spray. Sorry, I forgot the spray and the gels are FDA approved as well. And so again, that’s personal preference, what your body reacts to. Some people with the patches have a reaction to the glue. You know, they’ll have an allergic type reaction. So I’m glad we have options. But you know, typically I start with that patch for my patients.

Courtney Townley 34:18
And can we talk about who hormone replacement therapy is for, and maybe who it’s not for, anyone who wants it. The message is so clear in your book that it is for a large, you know, a large group of women. And then, of course, there are always outliers, people that that can’t take hormone replacement therapy.

Dr. Mary Claire Haver 34:36
So if you have a tumor that is harmful to you, that is being fed by estrogen, bar progesterone or testosterone, this is not for you. Okay. You need to get that treated. And then once you’re done with your course of treatment, it is an option, possibly, and it really depends on age, stage, etc, okay, it’s a nuanced conversation. If you have horrible liver. Disease, severe liver disease, that is where we metabolize estrogen in our body. Not for you, okay, you’re not. It’s going to be a very nuanced conversation, possibly having to go extremely low dose because you’re going to run higher levels. It’s a very, very difficult conversation, okay, if you’ve had a if you’re being treated or had a recent stroke or a blood clot, that’s a new you know, again, we need to get that managed and taken care of before we begin therapy. And if you just don’t want it, that’s fine. I respect your decision, but I hope that decision is made on facts and not fear and on true information, and that if that’s what you choose for your body, I 100 it’s your body, your body, your choice. 100% respect that.

Courtney Townley 35:42
Yeah, and how would a woman? Because I do know of women who have gone on HRT and not felt their best, they didn’t get the sort of the magical, maybe recovery that that a lot of other women were experiencing, and maybe that’s because they weren’t being properly treated, right? That could definitely be a possibility. But how would you know if, if it wasn’t working for you? Like, what are some of those signs, or they may be at the wrong dose?

Dr. Mary Claire Haver 36:10
So, you know, we usually do it based on symptoms, right? So you were feeling x y and z or having x y and z in your blood work, like, I’ll often track cholesterol levels, you know, see how we’re doing, and you’re not feeling better, you’re not sleeping still, you’re whatever I tell my patients this trial and error, we have tons of options. And so, are you not absorbing? We need to check levels. Are you, you know, is this not the right formulation for you? Are we too high on this, too low on that? I mean, it is a balance, a dance. And what works for you at 40 may not work at 50, and so, you know, it’s a constant touching and touching base with your patient. How’s she feeling? What’s going on to make sure that she’s being managed properly. Are we missing something else that we assumed was menopause, right? You know, is there also a thyroid order? Just, you know, she also have hypothyroidism? Does she also have an autoimmune disease. So is there something overlapping?

Courtney Townley 37:03
Yeah, absolutely. Can we talk a little bit about because, yes, the HRT, which I think so many women are learning so much through you, and for me, I know it’s because I was told by my provider that I wasn’t a candidate, because I do have a blood clotting disorder. And following you and reading so much of the research, it’s, it’s so clear that with the right form, I am a candidate, and I have to go into it cautiously, but, but I can still use it, and that that is so refreshing to me, because it was one of the first things I panicked about when I was diagnosed in my 30s. What am I going to do when I hit menopause?

Dr. Mary Claire Haver 37:40
You know, so that that was, yeah, my niece, my niece, had a massive PE last week, and, like, out of state, she had just moved to for grad school, and I flew up there, and, you know, immediately I was thinking the same things for her, like, how are we going to manage her bleeding? Because she’ll be on blood dinners for months, you know, her vaginal bleeding. How are we going to manage her menopause when the joint comes up to do the sick thing. Yeah? So, yeah. So, yeah. These are real things, you know. And these are really, this is precision medicine. So this is not cookie cutter. These are intense conversations.

Courtney Townley 38:13
Yeah, on that note, because it is precision medicine, and it’s also right, there’s a lot of Intel, like in the information that needs to be taken in and considered to properly treat a woman. So again, it comes back to the provider and finding providers who can help support women through this. So what are our avenues for that? Because this is a source of massive frustration for a lot of my clients, is they aren’t. They don’t know where to go and they they don’t know what to ask.

Dr. Mary Claire Haver 38:40
So we’re not right now you have about a 10% chance of being able to walk into your PCP or OBGYN office and have an informed conversation about menopause. So that’s a problem. Okay, so what do you where do you find the 10% Ask, ask your friends, have they had a good menopause experience? Did they have an informed, you know, pros and cons conversation with their healthcare provider. That’s probably the best thing. Go to that person, okay?

Dr. Mary Claire Haver 39:04
Number two, go to the menopause society, menopause.org and look for a certified provider. This is not just any provider you they must be certified. That means they took the test. They took the time to study and pass this very difficult test to show that they had basic knowledge on menopause care, okay, and safety.

Dr. Mary Claire Haver 39:23
So three on my website, at the pause life, we have testimonials from our providers, I mean, from my my followers, and they wrote testimonials, and we just organized them by state and city. So that’s that’s another thing. See if something resonates with you, if there’s someone in your area.

Dr. Mary Claire Haver 39:42
Number four is, I’m going to start a training program for clinicians soon, but that’s not out yet, you know, hopefully we’ll have that out, sure, so that I can help fix the problem. You know, use everything I’ve learned to teach other clinicians. They’re asking, they’re like, I want to do this too, and so I’m working on that. And. Then there’s some great telemedicine providers. There are companies that have been designed 100% to take care of menopausal patients. They saw the gap. They saw the need. These were actually female, female founded companies that had struggled with their own menopause and said,

Dr. Mary Claire Haver 40:14
We got to do this better. And it’s just so impressive to me that they did this. So they don’t pay me to say this, by the way, and they’re all in the book, and I have them if you go to my Instagram or Tiktok to my Lincoln bio, I have a menopause empowerment guy, 100% free. 14 pages of how to find a doctor, what to ask, what blood work, etc.

Courtney Townley 40:31
Beautiful, perfect. And I also want to note that in the book, you actually provide resources for how to advocate for yourself in your doctor’s office, questions to ask, forms you can fill out to help relay your symptoms to your provider, things of that nature, which I think is immensely helpful. What would you say to the population that says that hormone replacement therapy, or menopause in general, is over medicalized like it’s an over over prescribed, over hyped up. It’s not a Yeah, it’s not as big an issue as we’re making it out to be. Yeah, what do we say to them? Okay?

Dr. Mary Claire Haver 41:09
So presbyopia, which is why I wear glasses, is a natural part of aging, and no one gives you shit for wearing glasses, right? I can’t see without them. I function better with them. I wouldn’t be able to be a functional human being and work without my glasses. What about erectile dysfunction? Is a completely natural part of life. Are we over medicalizing the treatment of erectile dysfunction with the 17 different medication options available to treat male impotent? You know what? You know I’m like so, so here’s what’s happening. So, yeah, okay.

Dr. Mary Claire Haver 41:40
So you say you only 6% of women in the US right now who are eligible are receiving menopause hormone therapy. Tell me how that’s over medicalized. That involves blows my mind. She is on a blood pressure medicine, a cholesterol medicine, a sleeping medicine, a anxiety medicine, a depression medicine, 5678, we’re doing polypharmacy instead of treating the root cause. When you hear the word over medicalized, you remember that that is the old menopause. That is a very small subset of some very powerful people who have a vested interest in keeping you small and not functional. And The New Menopause is about you living your best life on your own terms with all of the tools available to you, and taking those tools away is a crime.

Courtney Townley 42:27
Absolutely. I love you so good. All right, can we talk a little bit about lifestyle in terms of things that we know help to promote a woman traveling through this phase of life with a little bit more grace and ease. Not to say that she wouldn’t need supplemental support or pharmaceuticals, but what are the main points that you love to stress to win?

Dr. Mary Claire Haver 42:51
On this front, get enough protein. You’re right. You’re probably not eating enough protein to support your muscles, staying strong as you age, do the heavy lifting. I grew up in the 80s, you know, I’m 56 next month, or I’m doing the math very soon. And, and, you know, I grew up doing cardio. I just did cardio. I was a cardio queen. I ran. I did aerobics. You know, in the early 2000s I was doing Beachbody. And, well, the 2000 10s, you know, and starting to do some stuff with a little bit of weights here and there, but it was all about being fat, trust me, okay.

Dr. Mary Claire Haver 43:26
And then I start realizing, oh my god, I’m so high risk for osteopenia, what the hell? And that the musculoskeletal unit works together, and I don’t want to be like my grandmother and trail and can’t lift or take care of herself and is bound to a bed. No, you know, so I am, you know, more protein, more heavy lifting, less cardio and so, and really focusing on nutrition, I just like good nutrition was like porn, you know, when you see it. And so, no, educate yourself. You know, get off the internet of Tiktok to learn about nutrition. Go and pick up a nutrition textbook. So and really learn because we didn’t learn it in med school. And I just was like, Well, don’t eat hamburgers or whatever, you know. And also that recognizing that Obesity is a disease, chronic disease, and rather than a fault, a personal failing of someone you know absolutely and so it’s multifactorial, and menopause adds another level of complexity to that. And so women who are kind of maintaining all of a sudden cross the threshold to obesity through menopause. And this is real, and this is happening, and this is not your fault. And so, you know, getting the GLP ones, if that’s what’s going to get you healthy. I’m not, you know, I don’t think they’re for everyone they I think they’re being used in med spas too much without proper guidance. But I do think they are really powerful tool. If that’s something that you’ve done everything you can and it’s not working,

Courtney Townley 44:46
yeah, and with the right things like alongside of that,

Dr. Mary Claire Haver 44:50
absolutely. I mean taking HRT or GLP one on its own is not a miracle. Okay, if you want a little young and healthy life, you must eat the right things. You must move your. Body in the right ways. You might consider supplementation. You must lower your stress levels. You must prioritize yourself your health, and put up boundaries, you know, or you are not going to do well as you age.

Courtney Townley 45:11
Yes, I love that you mentioned that the stress management piece, because all of it’s stress right? Like that stress bucket, it can get full in so many possible ways, and so taking ownership of how that bucket is being full, getting filled up, I think is so powerful. So you mentioned supplementation, and I just want to briefly touch on it, because I know this is a question that I get a lot from clients. What are the things that you recommend a woman over 40 take? Like, are there non negotiables in terms of supplementation? Things that you just say every woman should be on.

Dr. Mary Claire Haver 45:40
I wish that everyone could get what they needed nutritionally through food. That would be perfection. That’s how we were developed, right? But we it is so hard to do it. So a non negotiable, I think, is vitamin D. 80% of menopausal women, you know, are vitamin D, not just low, I mean deficient. And so, you know, when a woman comes in, especially in Perry, and she has this laundry list of complaints. I’m immediately checking a vitamin D level because it’s just active in so many body processes that we have, and getting her back up to a healthy level, which for in my clinic, is over 60 and so, so, you know, vitamin D, I think, is huge. It’s hard for us to get enough in our diet, unless you’re eating salmon all day, you know.

Dr. Mary Claire Haver 46:22
And you just we are not able to get enough through sun exposure, and if we are, we’re damaging our skin, you know, you’re robbing Peter to pay Paul um, women, by and large, are not getting enough protein in their diet again, and sometimes I’m recommending supplements while they adjust their nutrition. It’s hard to go from eating the standard Western diet to eating an anti inflammatory diet. That’s protein forward overnight, it’s and it is a transition. So supplements are really helpful there to to, you know, up your protein intake, but not use it as a, you know, just as a crutch until you can manage changing your dietary habits over time, right? Because you’re much more likely to be successful if you do it slowly and then consistently.

Dr. Mary Claire Haver 47:01
And so fiber women are only getting maybe 10 grams of fiber per day. We need 25 minimum, probably 30. And so using a fiber supplement. I mean, gosh, there was a great study that came out, I think, the British Medical Journal, looking at cognition scores and fiber intake. And it was, it was nutrient dietary fiber plus supplements, and in men and women, and they showed much higher cognition scores, and people who ate higher fiber. I mean, these are the things that people need to know. And so if you you know, I just tell my patients, get a nutrition tracker, eat healthy for two weeks, come back and let’s look at it.

Dr. Mary Claire Haver 47:32
And so we’re looking at how much magnesium was she getting, how much calcium in her diet, how much you know fiber, how much you know omega three, Fatty Fatty Fatty acids. And then we’re like, Okay, what would be some easy hacks for you to get these back in your diet? Let’s, let’s make those changes. Now, when we’re still struggling, we’re going to add in a supplement. Because always, when we’re trying to do Whole Foods to get those nutrients, often those whole foods are packed with a bunch of other stuff that’s good for you. And so it’s always better to try to get your nutrition for food. And we only supplement where there’s a gap. There is no great supplement that is a menopause cure. So nothing’s going to resuscitate your ovaries. We have not figured it out yet. Believe me, science is trying, and there’s great research going on right now, but right now, you know, I’ve seen a million there was one, some kind of bacteria you’re supposed to eat that’s going to someone sent me that’s going to reverse your menopause. Help me? Jesus, if it sounds too good to be true, it probably is. And so what supplements might do is have the way that your body’s responding to this estrogen deprivation make it respond a little bit better.

Courtney Townley 48:33
Yeah, yeah. I love that. I love that point. And I love the point too, of just like being careful of doing your due diligence of research and looking like taking advice from really qualified professionals, because there is a whole market now, menopause is slapped as a label on everything, because they know that it sells, because women are desperate for the information and hungry for that,

Dr. Mary Claire Haver 48:55
yeah, yeah, and they’re, they’re being preyed upon. So, you know, in full disclosure, I have a supplement business, you know, I sell fiber, I sell Omega three, I sell some tumor so, you know, but again, get it. Get it from food, if you can. That is the mantra here, yeah, and we only supplement.

Courtney Townley 49:10
Trust is something that I buy from you. I may not trust it from, you know, some other sources that I find online.

Dr. Mary Claire Haver 49:15
I appreciate your trust. Yeah, I appreciate your trust because I do formulate them myself, and I test them. And, you know, I do all the things.

Courtney Townley 49:21
So, yeah, I have no doubt you do. If you could go back and tell your 40 year old self something about going into the phase of life that you’ve passed through these last What did you say, 17 so so many years? What would you tell her?

Dr. Mary Claire Haver 49:37
Like, what would you what would you say to her? Number one, educate yourself about menopause. Don’t take it for granted. You know, the more you know, the more you’re prepared, the better this is going to be for you. Number two, nutrition over calories. Really learn about nutrition, and don’t worry so much about calories. Don’t worry about the curves you have. Number three, strong over skinny. You know, we there’s a. Threshold which we pass that leads us into decline and disability, and that starts in middle age. And so banking that muscle and bone strength in your youth in your 30s is going to pay off in the long run. So much better. Number four, aging is a privilege, and this can be the best time of your life, but it does take some work. And you know, I am healthier, I am wealthier, I am happier, I have better relationships, I have better boundaries, but all because I completely changed my focus and shift on on health and happiness.

Courtney Townley 50:31
Yeah, When did that happen for you? Just out of curiosity, like, where in your…

Dr. Mary Claire Haver 50:37
Okay, so if you know my personal history, so I’m one of eight kids my mom and dad, my parents had eight children. My oldest brother died of leukemia when I was nine. So that was childhood leukemia. My next brother died when I was 10 years ago, next year, and he was 56 so I will almost be as old as he was when he passed away from liver failure. My next brother died five years later, from 20 in 2020, from esophageal cancer, stage four, esophageal cancer with multiple. And so, you know, I have some pretty and I have multiple cousins, aunts, uncles, everyone has cancer. So I’ve got bad juju, you know, like there’s, there’s some, there’s something there. And so I may not have the privilege of getting older, and everything I do is based on me trying to live as long as I can. I have two daughters, and I want to be there. I want to be there for them and watch them. They’re becoming incredible adults, and I’m so proud of them, and I just love them so much, and I just want to be there for them and not have what I went through with my brothers. You know them have to go through that with me, or at least delay that for as long as I can,

Courtney Townley 51:45
Absolutely. Yeah, well, I think that’s a beautiful note to end on. I mean, truly, thank you so much for your time today. I really do admire you, and I so deeply appreciate just who you’re being in the world and what you’re doing. Thank you. So I also just want to say to people listening that this book, this book is yes, of course, for the woman transitioning through perimenopause and into post menopausal years, but it’s also for women in their 20s, and it’s for husbands and partners and business owners to understand this transition of life and what it entails, so we aren’t just ignoring and dismissing a very real challenge that’s showing up for women. So I think everyone should go out and buy it, and I think it’s a great gift for a lot of people.

Dr. Mary Claire Haver 52:37
Yeah, so people are giving them to their doctors. They’re taking them to their gynecologist. I’m like, Oh, my God.

Courtney Townley 52:45
I don’t know how you can read the book and not think that, right? I mean, I have an amazing provider. I really, I trust her wholeheartedly. But still, it’s like, you, you know, reading the book, I’m like, oh, I want to give this to everyone who I am in that level of relationship with, in terms of deciding my future with my health, because there’s just so much that I that is in there that is worth knowing. So, yeah, so thank you. Thank you for your time. Thank you for being here and yeah. I hope you have a lovely rest of your day.

Dr. Mary Claire Haver 53:16
Thank you.

Courtney Townley 53:23
Thank you for listening to the Grace and Grit podcast. It is time to mend the fabric of the female health story, and it starts with you taking radical responsibility for your own self care. You are worth the effort, and with a little grace and grit, anything is possible you.