In 2023, 85% women are complaining of

menopausal symptoms, 10.5% are receiving

treatment or therapy. I mean, it would

be as if your testicles traveled up and

died at 51. That's the equivalent.

Let's get started. Dr. Mary Claire Haver

renowned menopause expert

with more than 2 million followers

helping countless women through their

menopause experiences. Menopause is

inevitable, suffering is not. But, a

woman is more likely to be prescribed an

antidepressant for her menopause than

hormone therapy. Women by the thousands

are like, "Oh my god, I had no idea."

That's when I realized no one's talking

about this. So, here's their laundry

list of symptoms. We've categorized

about 70. So, there's brain fog, changes

in her sexual function

weight gain But, here's the scary

things, and the studies have been done.

We see either a new onset or worsening

of depression, anxiety, bipolar, ADHD,

risk for cardiovascular disease and

diabetes increases, recurrent urinary

tract infections, which is a major cause

of death for women. They're suffering in

silence, and I was one of those women. I

want to see my grandkids one day. I want

to watch these women I've raised grow up

and, you know, be the women they're

meant to be, and that choice might get

taken away from me if I'm not careful.

But, there's lots of things that we can

do. For example, we see a dramatic loss

of muscle mass. Focus on strength

training. This is going to determine

your longevity as you age. Strength over

skinny.

What about your diet?

I developed a program for my patients,

and it's not rocket science. It's

Whether you're a man or a woman,

menopause is going to affect you because

it's going to affect 50% of our society.

And there is 1.2

billion women being affected by

menopause right now. And whether you're

a man or a woman, most of us don't have

the answers. How do we help? How do we

talk about it? What is it? How does it

affect the human body? If you're in a

relationship with a woman that's in

perimenopause, which can start at 30 up

to a woman that is currently going

through menopause in her 40s or 50s or

60s, what should you do to support her?

What can she do to support herself? This

subject of menopause has exploded in

public conversation, thankfully. But,

there's still so many unanswered

questions. And that's why today I

invited one of the leading voices on

menopause globally onto my show. Even as

a man that won't go through menopause

myself, but has a partner and a mom that

certainly will, there's something that

everyone can learn from this. And I

implore all men who maybe clicked on

this episode or was sent this link to

listen.

Please, just listen.

Because you can learn something, too.

And for everybody new to this channel,

can you do me a favor? If you like what

we do here, you like the guests we have

on, and you like the show that we bring

to you, can you hit the subscribe

button? It is the single thing and the

only thing I'll ever ask of you. I would

love you to join us on this journey, and

if you do, I will repay you, and that is

a promise. Do we have a deal?

Thank you.

Dr. Mary Claire Haver,

why do you do what you do?

You know, I started out in medicine

the way most people do. You know, I

wanted to help people.

And in our training and school, we get

to have a little taste of all the

different specialties. And my very last

rotation in my third year was OBGYN. And

I really liked surgery. I really liked

some of the surgical subspecialties, so

I thought that would be my path. But

then, when I delivered my first baby and

all of that rush of emotion and dopamine

and how beautiful that whole process

was, I knew that that was going to be my

calling.

And so I did the traditional 4-year

residency and loved it and really did

well and went into private practice. Um

after about 3 years of doing the private

practice route, I realized I missed

being in academics. I wanted that

ability to do research and be around

students and teach as well as take care

of patients. So, I went back

on as faculty. And everything was going

great. I was very successful. I was, you

know, doing pap smears and babies and

birth control and all the things a

traditional OBGYN does, and then I was

aging as my patients were aging, too.

And when I got to my 40s, I realized

that there was a big gap in my education

and knowledge around menopause. So, I

started researching. Most of my patients

were coming in, the pain point was

weight gain. And they were like, "I'm

not doing anything different. I'm

working out. I haven't changed my diet."

And that little voice in my head was

like,

"Work out more, eat less." You know, we

tend to move less. We tend I was just

going with the script that had been

handed to me

for years that calories in, calories out

is the only way. And, you know, in

medicine in the US, we have very little

background in nutrition. We learn

nothing in medical school, very little

in residency as far as what nutrition

actually is and how it can affect our

bodies. And so,

I started struggling with my own

menopause. My patients were all

struggling, and I decided to go back to

school to learn more about nutrition

because I felt that there was a big

piece missing here because this weight

gain was mostly centered around the

midsection, and I was learning about

visceral fat and subcutaneous fat and

the differences and what's going on with

our muscle mass, and I'm like, "There's

a much bigger picture here than just

calories in, calories out."

So, in my I enrolled at Tulane

University in their culinary medicine

program, and just my mind was blown by

how much I didn't know as far as

nutrition and inflammation and aging and

how it all affects, but where was this

menopause piece?

And

so I took everything I learned and I

developed a little program for my

patients,

um which became the Galveston diet, and

it really was just a passion project for

me. And then I started talking about it

on social media and realized that as my

social media presence grew and the

conversation got bigger and bigger, that

there were so many women suffering.

Probably the majority of women in

menopause were suffering not just from

weight gain, but from musculoskeletal

issues, mental health, brain fog, you

know, skin changes, hair changes, nail

changes, and I just kept doing deeper

and deeper dives and realizing no one's

talking about this. No one's talking

about the multi-organ system, you know,

failure that a lot of women are going

through, and they're suffering in

silence, and physicians aren't helping.

We're not trained. And so, I thought And

my It's really my kids who I have two

daughters. One's 23, she's in medical

school right now, and she's um she's

actually here with us. And then, um the

other is 20, and

they were like, "Mom, you've you've got

the social media presence. You really

need to use it for good." And that's

kind of where that conversation exploded

for me on social media and where I

realized by reading the comments

what a much bigger pic you know, what

was really happening in the menopause

world and how we need to bring it to the

forefront.

For people that don't understand

menopause,

Mhm. um they might think it's that it's

a small issue affecting a small group of

people. But, how many women are are

affected currently by perimenopause,

menopause, and postmenopause?

Sure. So, right now, about a third of

the female population of the world is in

peri, full, or postmenopause.

Um

you do not It's not optional. All of us

go through it. And because we have such

individual expressions of how it affects

our bodies, what we know now is that

there are estrogen receptors in every

organ system of our body. And when those

levels start declining, we see a very

wide variety of a spectrum of of

syndrome where it used to just be

thought it was a few hot flashes and

some night sweats. Maybe your sleep's

disrupted. Your genital urinary system

is going to take a hit. Um your bones

are going to get weaker. But, what we

know now is how much it's affecting our

mental health, our capabilities, our

skin, our bones, our kidneys, you know,

vertigo, tinnitus, frozen shoulder.

Anytime I post about those on social

media,

the internet explodes. And women by the

thousands are like, "Oh my god, I had no

idea." You know, and just the validation

piece was so huge for them to make

because they've been dismissed for so

long and told it's all in their head.

And if we think about from sort of peri

to postmenopause, what is that sort of

typical And I know that's a tricky word

to use, but what is the

ab sort of average typical age range?

And then also, what is the sort of more

um

possible age range? So, it could start

between this age and this age. So, it In

the US and in most of Europe, the

average age of menopause, which means 1

year after your last menstrual period,

is 51.

Perimenopause, which is when your body

recognizing recognizes there's some

declining estrogen levels and you're

beginning to be symptomatic, can start 7

to 10 years before that. So, normal

menopause is still 45 to 55. Mhm. And

so, if you do the math and back that up

7 to 10 years, it is completely

reasonable for a 35-year-old woman to

begin to experience some of the symptoms

of perimenopause.

So, let's start with what is it? Um and

I would love you to explain this to me

like I'm a 10-year-old.

Okay.

Because I'm sure there's a lot of people

that are both men and women that aren't

fully So, we're going to talk about

gonads, right?

What's gonads? Gonads are um where our

So, in men, it's the testes and where

you're making your genetic material to,

Okay. you know,

uh where you're making sperm, right? And

in a female, it's going to be ovaries,

her ovaries. So, the difference big

differences between male and female and

how that process happens is that

males make their genetic material fresh

constantly. The minute they go through

puberty until basically they die unless

they have some medical issue.

Females on the other hand, our eggs

develop while we're in utero in our

mothers. So, while we're in the womb,

we're she's 5 months pregnant with us,

we have our maximum eggs that we're ever

going to have. And those are meant to

last us until we go through menopause.

And so, they lay dormant until we go

through puberty and then they wake up

again and we start ovulating. So, we

have this monthly in a healthy person

cyclical, you know, hormones rise and

ebb and flow with our cycles each month.

We have a period, you get pregnant, you

don't get pregnant, and the whole

process starts over again.

Well, because we're born with that egg

supply, through time we're decreasing

the amount

and the quality of those eggs. So, when

a woman hits the age of 30,

um she is down to about 10% of the egg

supply that she had at birth. And when

she's 40, it's down to about 3%.

And so, and it gets harder and harder

for that ebb and flow of the natural

hormones to do its job and we start

seeing fluctuations in her periods and

then organ systems that are beginning to

notice the lack of estrogen. Estrogen is

a really powerful anti-inflammatory

hormone in most of our body systems. So,

the musculoskeletal syndrome of

menopause is really starting to be

talked about quite a bit now and we're

looking at things like frozen shoulder,

arthralgias, generalized aches and

pains, and most physicians aren't aware

of this. You know, most know about hot

flashes and night sweats and sleep

disruption, but now that we're really

opening the conversation as to how many

organ systems are affected, we are

seeing people coming out of the woodwork

just so happy to know that they're not

crazy and they're being validated.

And what's happening at these sort of

three stages? So, we have the

perimenopausal stage, which is, from

what I've understood there, when

estrogen levels start to drop. Right.

So, we start seeing

disruptions in the force. So, instead of

that nice monthly estrogen surge with

ovulation and then the progesterone goes

up, we start the elongation sometimes or

they even get closer together. I call it

the zone of chaos. What used to be a

very reproducible, dependable system

starts failing. So, some women will have

irregular periods, meaning they're

spacing out, they're skipping periods.

Others will have really heavy periods

like like, you know, hemorrhagic almost.

Um and again, individual um

the way the body reacts to this is very

individualized from patient to patient.

Doctors love

something that follows a list, a

checklist, right? You know, we have all

these complicated things we have to

learn and we have these checklists, but

menopause, it's like pinning the tail on

a moving donkey. And in perimenopause,

the it's very, very chaotic. Estrogen

surges, then it goes away for a while.

Like a woman in perimenopause can feel

completely fine for a few months,

everything goes haywire, then she's fine

again, you know, and not only is her

estrogen declining, her testosterone is

declining as well. So, we're seeing loss

of muscle mass, we're seeing changes in

her sexual function,

we're seeing decreased strength, you

know, there's some some really good

studies showing how testosterone also

affects our mental health and our

cognition as well.

Why does this happen?

From this a sort of like an evolutionary

or So, the anthropologists have looked

at this heavily and there's we're only

there's only a couple of species in the

world that go through menopause. Humans

are one. There's a species couple of

species of whales and I think they've

now discovered one of the giraffes

species of giraffes can do it, but the

by and large, most mammals will

die while they're still ovulating. You

know, like they're not going to go

through a menopause.

Um

and so, there's something called the

grandmother hypothesis where there was

an evolutionary advantage for women to

survive if she stopped the ability to

have children at some point. Now again,

you have to temper this with

humans have prolonged their lifespan and

their healthspan because of modern

medicine. So,

probably when we evolved, we weren't

living this long. You know, a woman my

age was pretty rare. I'm 55. And so, you

know, it it's hard to say. I think we

have outlived how we were genetically

built. And so, we're living longer and

being forced to like deal with the

consequences of that. So, so then the

next stage is menopause. Mhm. Um

So, menopause itself is really that it's

just really one day in your life. It's

when you can throw the hammer down and

say, "I'm never going to ovulate again.

I'm done." And so, if a woman's over the

age of 45 and she hasn't had a period

for a year, that's the definition. Okay?

Now, it gets confusing because what if

she's had a hysterectomy or doesn't

bleed because of a surgery or an IUD or

something? Well, then we can't use her

periods to help judge and that's where

we start doing blood work to see, you

know, where she is in her menopause

journey. And then postmenopause is the

rest of your life.

You know, the hot flashes might go away.

Night sweats might go away.

Brain fog might get better, but pretty

much everything else is going to

continue to progress in a very linear

fashion until you die without estrogen

replacement.

To put it lightly, you seem somewhat

dissatisfied with the current set of

answers that

um the medical field, but just society

at large are offering for women in

the sort of peri- and post- and

menopausal phase of their life. And I've

sat here with a lot of women who are

experiencing menopause

at one stage or the other and they also

seem to be at a loss for answers. Mhm.

Um I was sat here two days ago with um a

very, very successful woman who,

you know, has all the resources in the

world and she basically can and and this

is someone that has all the answers.

People come to her because she has the

answers. And the one thing she doesn't

seem to have answers on, in her own

words, in her life at the moment, is

menopause. She's rummaging around the

internet, Googling things, finding

contradictory information. And when you

sat down, you you you had that same

energy like you feel like women have

been, dare I say, let down by a system.

I think the medical system is letting

them down. I think society is letting

them down. Our our value and our worth

in medicine,

you know, I came through this wonderful

training program. I'm very proud of what

I learned. I'm very proud of the care

that I gave except

I was a horrible menopause provider for

probably 15 years.

I knew what I knew.

I relied on my training and I didn't

look outside of the traditional confines

of training.

This is such a systemic problem

that

I mean, I'm going to tell you a story

and this is this is true

and it's embarrassing, but I think it

needs to be said cuz I think it really

highlights

how women are treated in medicine.

Um

When I was in training, we had these

upper level residents. So, we have a

hierarchy where you have different years

of training. So, I was in the early

years, maybe my first year, and we had

these clinics that we would run

um to take care of patients. And so,

we have obstetrics and we have

gynecology as like divisions in our

training. So,

in gynecology, everything gets lumped

together. Pediatrics, menopause. We had

no specific menopause clinic. I maybe

got 6 hours of lecture in a 4-year

curriculum.

And so, we'd have these women coming in

in midlife and they had multiple

complaints.

They didn't feel good, they weren't

sleeping, they were gaining some weight,

they were, you know, aching, that, you

know, just this laundry list of things

that were a little on the vague side.

And

my upper levels

would say, "Oh gosh, good luck with

that. You've got a WW

on your hands."

And that was code. We never wrote that

in the chart. This was not taught to me

by faculty. This was just kind of a

handed down in the lore of training. And

a WW was a whiny woman.

And that was code. And now

I know that she was perimenopausal

suffering from her list of symptoms of

now which we've categorized about

they're they're they were frustrated

because they they didn't think they

could help her. Now, remember the

Women's Health Initiative,

which was a study that was supposed to

do a lot of good for women. It was

originally designed

um and it was stopped in 2002. That was

the end of my training program was 2002.

So, I'm I come from one of the last

groups of physicians in the US that were

ever trained in hormone replacement

therapy and then it the rug was pulled

out from under us.

So, the WHI, there were mistakes, there

was misinformation in the reporting,

and there was uh misinterpretation of

the results. All of that has been walked

back, re-looked at. We know that for the

vast majority of women, hormone

replacement therapy is safe and

effective and can give a woman her life

back um if she chooses to take it. But

that option has been taken off the table

for the vast majority of women. And

recently, I just saw the numbers,

85% of women will come in complaining of

what we know now, this was in 2023,

FDA looked at the numbers,

85% women are complaining of menopausal

symptoms.

10.5% are receiving treatment or therapy

today.

Is there something in you that feels

somewhat,

even though you're a doctor, somewhat

let down by the medical system

um or skeptical about the medical system

for personal reasons? I

Yeah. I I'm one of those women. You

know, I thought I'd be one of those

girlies who would just breeze through

menopause because I was thin.

And I was, you know, thin meant healthy.

I still, you know, that mentality was

alive and well when I trained and

through most of my practice. I I came

through a very fat phobic, you know, uh

training

and medicine as a as a whole is very,

um,

biased against weight people's weight.

And

so

now that I've done a deep dive into

nutrition and done a deep dive into

menopause and really sat there and

listened to patients

and realized that, you know women who

were gaining weight with menopause, you

know, they've done nothing different.

They're still exercising. They're eating

the same. The only thing that's changed

for them

is their hormones.

And they're being categorically

dismissed at multiple doctor's visits or

worse

here's their laundry list of symptoms.

The root cause is menopause, but it's

not recognized.

And one medication could have taken care

of everything, but they're going to

seven, eight, nine different specialists

on seven, eight, nine different

medications to handle each symptom.

Whereas all they needed

was just to get her hormones back and

she would feel amazing and be able to,

you know, age the way she should.

When we talk about the potential

um

health implications of women that are

going through menopause, it's not just

WW. Right. It's much more, um

That's how she feels though. And that's

how she's categorized probably by people

around her.

But the there's real health consequences

and life altering health consequences,

life span reducing health consequences.

Yes. What are those? So, we know that a

woman's risk and and the studies have

been done. It's not just aging. Of

course, aging plays into this, but when

you add in menopause as an independent

risk factor, her risk for cardiovascular

disease increases.

Her risk of diabetes increases. Her

insulin resistance starts going haywire

immediately.

Your your listeners and your, you know,

people who watch on YouTube will be

shocked. I'm going to say, "How many of

their cholesterol levels shot up in

their 30s and 40s with no changes in

diet and exercise?"

You know, we see cholesterol levels

changing skin, hair, teeth, the dental

changes, the inner ear changes, the

vertigo is incredible, the frozen

shoulder is legion. Um What's frozen

shoulder? Frozen shoulder is an adhesive

capsulitis of the shoulder joint. And it

is very common in menopause. So,

estrogen has this amazing

anti-inflammatory effect, especially in

our bones and joints and muscles. And

frozen shoulder is super common and it

takes about 2 years of therapy to get it

to break up. So, the capsule that is

right over the bone where the muscles

attach becomes encapsulated and adhesed

and stuck. And so, you have to get in

there and break it up and do lots of

training. So, like a woman wouldn't be

able to reach behind her back to do her

bra.

She that's one of the things or you go

to take a picture with your girlfriends

and you can't

put your arm or you can't lift your arm

above here.

That's one of the one of the studies

that I, you know, presented. A lot of

the stuff I do on social, I'll present

the studies because I like to I like to

have data. And, you know, I'll get

10,000 comments

on, "Oh my god, that happened to me.

That happened to me. That happened to

me." Not that I can fix it

but at least they know

this is something that it's not your

fault. You didn't do anything. Your just

estrogen levels dropped, which led to

increasing inflammation in those joints.

And have they seen that there's a a

reduction in life span in women that go

through menopause that aren't treated in

a certain way? So, we know that, um,

women on HRT have a lower all cause

mortality. What's HRT? Hormone

replacement therapy or menopause hormone

therapy. So, in the studies that have

been done, the observational studies and

in the WHI, women who were on hormones

um, especially beginning early in their

menopause. Okay? So, estrogen

there is a window of opportunity for

reduction of some of this burden of

disease and it is very in starting in

perimenopause or within the first 10

years of your menopause.

That's the sweet spot for being able to

decrease your risk of diabetes, decrease

your risk of cardiovascular disease and

dementia.

When we go beyond that, we start losing

those benefits because estrogen is

better at prevention than cure.

And so, my my medical school daughter

was like, "Mom, I'm never going to be

without estrogen. I'm going to start in

perimenopause. Like I'm not going to be

one of those women who's ever off

estrogen." Of course, she's my daughter

and listens to me on social media all

day. So, she's a little biased, but she

says, "Why why can't we get to that

point where we have no gaps in our

estrogen supply? We just support

starting in perimenopause, you know,

offer it to all women. Not all women

will choose it and I support that, but,

you know, we're not having the

conversation and they're not being given

the choice." So, what age would you your

daughter would you advise her to start

at

hormone replacement therapy if she so

chooses? So, I would say, um, we start

checking levels and we start looking

probably in late 30s. Certainly if she

starts having any symptoms out of the

normal, you know, she's living her best

life, you know, doing all the right

things for her health and all of a

sudden she's not sleeping well or she's

having aches and pains or she's

noticing, you know, changes in her body.

Most women can tell you

"Something was wrong. I couldn't put my

finger on it, but I knew that something

in something in me had changed and I

wasn't responding to things the same

way. You know, their mental health had

changed or, you know, the way their gut

had changed, their gut health." You

know, just just there's barely an organ

system that's not affected by this.

I sometimes wonder cuz, you know,

there's the person going through it and

then there's those around them.

And they might know themselves that

something's wrong, the person that's

going through perimenopause or

menopause, but the people around them

won't understand typically Mhm. what's

going on with that person. So, they'll

they might do their old WW thing, that's

a, you know

or they might label them something else.

They might misdiagnose it as another

man's health predicament. I remember a

woman in my life who when whose behavior

changed around this age and I didn't

know about perimenopause or menopause.

It's in hindsight now that I look back

and go, "Oh my god,

everyone around this person thought they

had bipolar or something."

Right. I mean

it it

it's probably contributing to divorce

rates, maybe in a good way. You know, at

this time

I I one of the positive things I see

about menopause is that

women are

cutting the things in their life that

don't make sense anymore. They're not

putting up with

you know, as a society we tend to take

on everyone's burden and um, you know,

take on the emotional labor in a lot of

relationships, take on the

organizational labor. And I see because

they're struggling so much with just

staying afloat, they're able to just

quickly say, "No, I'm not doing this

anymore. You know, you need to pick up

whichever relationship they're in.

You need to pick up your your end of the

bargain here. You know, I can't do all

of that organizational labor, the

emotional labor. And I've I have a

patient who's a divorce attorney and she

said, "I really think a significant

percentage is of this divorce is

menopause and either they're

prioritizing what's important to them or

they're not getting the support that

they need."

And

How can we give them the support that

they need? So, I think it's important

that we talk about it. I encourage every

single patient I have, all my followers

on social media, tell your story.

Tell your story to anyone who will

listen. Tell your daughters. Tell your

nieces. Tell your sons. Tell your loved

ones. Like make this a normal part of

the conversation so that we see it

coming, we understand what might happen

and that no one feels crazy and alone

when they're going through it.

And then we need to do a much better job

in our medical system of providing

support for these women in whatever way

they need it. Be it hormones, non

hormones

cognitive behavioral therapy, you know,

there's lots of things that we can do.

Not just hormone therapy is not the cure

all for everything. We have to support

the whole toolkit, right? We have to

prioritize our sleep.

Get the exercise that we need. Focus on

strength training when a lot of us in my

generation never did that. We were

aerobics, you know, focused on being

thin and small. It's time to be strong.

You know, this muscle mass that you have

is going to determine your longevity and

your functionality as you age and

menopause is, you know, that loss of

estrogen and testosterone is tearing our

muscle units apart, which is leading to

osteoporosis as well. I want to go

through that whole toolkit, um,

but I also want to just before we move

there

understand why women

don't sometimes communicate that they're

going through perimenopause or

menopause. What is the Is there a stigma

associated with talking about it? Yeah,

I think there's shame and stigma

associated with aging, with females

aging and then you're you're layering on

this loss of fertility. And in the

medical field, when you look at funding

in the US for research studies women's

health, like I think it's 55 billion in

the National Institutes of Health in the

US, you know, for all research studies.

And that's outside of what pharma is

funding. And women's health gets about

15 billion. And the majority of that is

spent on getting people pregnant keeping

them pregnant

you know, and fertility issues.

Menopause gets, I think, 15 million.

Jesus Christ. Yeah. It's like .03%

if I did the math correctly

of

all

you know, are we not as important as we

were when we were fertile? Do our lives

not matter?

It's ridiculous to me. When we can

intervene and help and how give these

women a longer life and a better quality

of life. And how many women is that? I

know we said a as a fraction earlier on

or a percentage, but that's like I think

in your book I read it's 1.2 billion

women by the end of this year.

Yeah.

And there's what, 47 million new

entrants

into this sort of perimenopausal

postmenopausal

category every year?

1.2 billion. Billion. Right. And how And

so many of them

have no education at their fingertips,

have nowhere to turn,

are, you know, 85% are going in to their

health care provider's office

complaining, "Help me." And being turned

away and leaving with more questions

than answers and only 10% are even

having the discussion for hormone

replacement therapy. And then if they're

given it, they're so terrified because

of the misrepresentation of the Women's

Health Initiative, they're convinced

they're going to get cancer.

And that that study's been completely

dismantled and walked back. We have good

information that came out of that study,

but, you know, the the the the thought

that estrogen causes breast cancer is

the worst thing that came out of that

study because it's not true.

The mental health implications is what I

really want to get into the the hormone

replacement therapy and all that stuff,

but the mental health implications for

women. Do we see an increase in

depression and those and the

consequences of depression, I guess?

Depression, anxiety, bipolar, um the

entire spectrum, ADHD. So, we see either

a new onset

or worsening of disease. So, I'm telling

my patients or I'm telling people on

social media, you may have done fine and

done well with your depression on your

SSRI. Don't be shocked if it is no

longer working at that level. You either

have to increase the dose. So, no one

right now is advocating for primary

therapy of depression to be estrogen

replacement, but we do know from the

studies that it is a very powerful

adjunctive tool.

And that it can be preventative for new

onset depression if you start in

perimenopause. Women who start hormone

therapy in perimenopause have a lower

incidence of new onset depression in

their menopause. Suicidality?

So, I've looked at these numbers and

COVID's kind of skewing things cuz we

did see increased suicide rates, but we

definitely see an uptick especially in

Caucasian women, not so much in women of

color in the US in the perimenopausal

menopause time frame.

Inflammation. Mhm. What is What is

inflammation? Sure.

So, inflammation,

there's there's it's there's chronic

inflammation and there's acute

inflammation. So, acute inflammation is

what we need to survive.

It is the body's reaction to a foreign

invader basically or to an injury or an

illness. So, you twist your ankle,

right? And so, we injure that tissue,

these chemical messengers are spread

from the injured tissue which basically

tells our immune system, "Send blood

that way. Send the the, you know, white

cells and the red cells and you know,

all the cells that are going to fight

and heal this. You're going to swell,

you're going to have pain that's going

to keep you off of that joint so that it

can heal, right? So, acute inflammation

also happens when we get viruses and

other illnesses.

Chronic inflammation is this low-grade

kind of under the radar inflammation

that's happening in the background. So,

autoimmune disease is a lot of chronic

inflammation, but we also see aging

itself, you know, we can't change the

fact we're aging, but menopause

dramatically increases the amount of

chronic inflammation that a female will

go through just based on the lack of

estrogen and testosterone in her body.

I'm trying to figure out why the lack of

estrogen

and the drop in estrogen causes

inflammation. So, it turns out estrogen

is a really powerful anti-inflammatory

hormone. So, we're just like removing

that protective blanket and now you're

you're just aging faster because of it.

Ah, okay. So, we need to make sure that

we reduce inflammation by any means

necessary. And that was the sort of the

one of it was the second component of

the Galveston diet, anti-inflammatory

nutrition. If I wanted to have a low

inflammation diet, you said there about

the sugar. Is there anything else that

I've got to be aware of or avoid or

choose in a supermarket?

Sure. So, I try to teach the principles

in the form of let's add things in

rather than restrict because

then we get into eating disorders and

so, what keeping tabs on your added

sugars, keeping those less than 25, but

fiber. And that's one thing most people

are not paying attention to. How much

fiber are you getting in your diet per

day? And most women are getting about 12

g per day and the minimum we should be

getting is 25. Vitamin D is another huge

one. About 85% of my patients and women

in menopause are vitamin D deficient,

not just low, I mean deficient. We are

protecting our skin against sun damage,

of course. We're staying indoors more,

we're on our screens all the time, but

we're also our gut's changing and our

ability to absorb vitamin D is

decreasing. So, making sure that you are

checking your vitamin D levels regularly

and supplementing when you need to or

eating foods rich in vitamin D. That's

another one. And does vitamin D reduce

inflammation? Yes. Okay. So, vitamin D

is a it's a it's a vitamin, but it's

also a hormone and it has multiple

functions in the body. And so, vitamin D

deficiencies are linked to lots of

chronic diseases. You're more likely to

have hypertension, diabetes, stroke, you

know, all of the top seven of 10 causes

of death in women. And so, keeping those

low it's also mental health, you know,

it lots of vitamin D receptors in the

brain. And so, you know, first thing I

do is check a vitamin D level on my

patients when they come in. So, many of

my nutrition-based or medical or doctors

that I've spoken to on this show have

spoken about fiber especially in the

last like 6 months.

You know, people

historically speak a lot about protein

and all these kinds of things, but for

some reason everyone seems to be talking

about fiber all of a sudden.

So, fiber does lots of things for us. It

slows down the absorption of glucose

into the bloodstream. Ah. So, that keeps

our insulin levels lower over time.

It feeds our gut microbiome, soluble

fiber. So, there's two types of fiber.

There's soluble and insoluble. So,

insoluble is what kind of when you mix

up a fiber supplement, you see the stuff

precipitate down to the bottom. That's

the insoluble fiber. That's what pulls

water into the gut and kind of moves

things quicker through the colon.

Soluble fiber dissolves in water. That's

the cloudy part. That is the food for

our gut microbiome. That is the

prebiotic. You don't need a prebiotic if

you're getting enough fiber in your diet

per day.

And so, keeping that gut microbiome fed

and healthy and happy is going to do a

multitude of things. Like that kind of

data is exploding right now in the

research world as to where the gut

microbiome, how to keep it healthy and

what organ system it affects.

Um our our gut microbes make these

things called oxybutyrates which are

then absorbed into the bloodstream and

and people who have high levels of

oxybutyrates are actually healthier and

have less coronary artery disease, less

dementia, less less everything. So, it

really nutrition, when I talk about the

menopause toolkit,

hormone therapy is just one very small

part of the puzzle, but nutrition should

always be first. Like it doesn't matter

how many hormones you take if you're not

covering your your nutritional bases the

way you should.

And what are some sort of fiber-dense or

fiber-rich foods that are in, you know,

every supermarket? Avocado,

chia seeds, nuts, berries,

your cruciferous vegetables, things that

are crunchy, that's fiber. That's making

the crunch. Apples, you know, um there's

so many. Don't find much fiber in uh

lean meats or any. So, it's going to be

your fruits and veggies

and seeds and nuts. Asparagus, tomato,

spinach, celery. Uh asparagus, celery,

yes. Tomato, not so much. Just think of

things that, you know, the crunch is

usually from the fiber. Mhm. Okay.

Fasting. Mhm.

I'm a fan. It's not for everyone.

It's not a great way to lose weight. The

data on weight loss is conflicting at

best. You can eat a lot of things that

will undo the goodness of fasting in

your eating window if you're not

careful.

And so,

um

the there's good data though on

neuroinflammation and fasting and on

systemic inflammation and fasting. So, I

recommend fasting for the systemic

inflammatory benefits. And we do see

some really nice lowering of insulin

levels overall from fasting.

There's so many different types of

fasting people talk about.

So, when I'm teaching fasting to my

students or to my patients, I recommend

the 16:8. So, that's where Mark

Mattson's data. So, that's 16 hours of

fasting in a row followed by about an

8-hour eating window. Now, for other,

you know, again, it's individualized.

Some people do great with a 14-hour

fast, you know, the 15-hour fast. 16 is

just kind of something to shoot for. And

if someone's going to consider

incorporating fasting into their life,

give yourself about a 6-week

trial, you know, don't just try to go 16

hours without food if you've never done

it before. Your body will adapt. And so,

the advice I got and what I do and what

I teach now,

so, I used to break my fast about 6:00

in the morning before I exercised. So, I

pushed that window to 6:15 and I did

that for, you know, three or four days

until it felt normal, natural, I wasn't

hungry. Then I moved it to 6:30 and then

I just kept bumping that window out in

15-minute increments

over weeks and by week five, I remember

sitting at my desk and I have my lunch

ready to go and I was still at the

hospital at the time and saying, "Oh my

god, I made it. It's noon and I don't

feel bad, you know, like So, I had just

slowly slowly let my body adapt and

adjust and then I've been fasting, gosh,

since 2015, probably 2014.

And

and it's just a normal natural part of

my life. I don't even think about it

anymore. Have you noticed any effects of

that? You know, I do so many things.

Yes, it's hard to tell. And so, it's

hard to tell, but initially, I do find

when I'm fasting, the clarity of my

thought is much better. I get much more

work done. It's when I do my best

research. It's when I do my best

communicating with my followers is in

the morning. You'll often if you follow

me on social, I'm always in my pajamas

with a cup of coffee um before while I'm

getting ready for work cuz I just get so

excited about something I learn and I

want to share it with everyone. And so I

do find that once I break my fast the

synapses tend to not work as quickly for

me. I was thinking about this through

like an evolutionary lens why fasting

makes sense and why this sort of

narrative that we're meant to have

breakfast, lunch, and dinner. You know,

maybe breakfast at That's a social

construct. There's really not great

science. Now, there are humans that will

do better by eating more meals more

frequently and that's why I say

fasting's not for everyone especially if

it triggers an eating disorder. If you

have diabetes or you have, you know,

hypoglycemia, fasting may not be for you

but most people can do it successfully.

And so I really encourage people to

experiment with it and see how they do.

I was wondering if I was trying to think

through like an evolutionary framework

and I was thinking about how in our

hunter-gatherer past

Mhm.

we would have Meals were not available

24/7.

Yeah. And we would have needed like a

really focused brain to go out on the

hunt. So this explains why when we're

like hungry our brain's working better.

It almost seems like there's more I

don't know oxygen or nutrients in the

brain.

tends to work better using the ketones

for fuel than uh glucose. So the glucose

is the preferred fuel in the body, you

know. And um but but when they did

studies, they were animal studies so

take this with a grain of salt but you

know, when they did the mazes, you know,

the animals tended to get through the

maze quicker and learn quicker when they

were fasted rather than after they were

fed. They're a little lazier.

Ketones you can also use ketones as an

energy source if you use the keto diet.

You can. You can. Um but I think, you

know,

when Mattson and and that those

researchers were doing their work their

research in Alzheimer's and dementia,

you know, there was no keto diet. They

were just knowing that people were

utilizing ketones for fuel which is a

normal natural process. We sleep. And so

we burn through the glucose in our

bloodstream then we burn up what's in

our liver in the you know,

gluconeogenesis and then it switches to

fat to burn for fuel.

And so um now there's people who like to

take exogenous ketones. I've I've never

experimented with that. I don't, you

know, that's I don't have any literature

menopause to support that use.

And the third component of the Galveston

diet is this idea of fuel refocus.

Right. So that's looking at, you know,

food

uh we're looking at the macro and

micronutrients. So I'm really going hard

on fiber and vitamin D and magnesium and

things that we tend to as a gender be

deficient in especially with menopause.

So I'm really trying to highlight those

things to make sure instead of counting

calories, let's see how much vitamin D

you're getting every day. Let's see how

much fiber you're getting every day.

And is there a certain sort of ratio of

foods that we should be having in terms

of So I originally developed Galveston

diet for weight loss, you know, um

but if I had to write it over again. So

I went really heavy on fats, you know,

healthy fats, lower on carbohydrates and

20% protein. Um but I think if, you

know, doing it again the way I'm

counseling my patients now is I'm going

much higher on protein. What I've

learned since that book was written was

how important protein intake is to

maintaining muscle mass. I'm also

talking a lot about creatine. Um and and

there's some nice studies done in in the

we call it the elderly 65-year-olds and

and above I'm 9 years from that right

now and so and how creatine

supplementation just creatine

supplementation on its own well combined

with weight lifting we're seeing bigger

gains in the menopausal patient.

Postmenopausal patient, yeah.

Bigger gains in muscle

Bigger muscle mass and strength. Yeah, I

was going to ask you about this whole

muscle mass um point. Why is muscle mass

so sort of pertinent to this

conversation? So what we're Well, what

we know in menopause is that, you know,

aging combined with menopause we see a

dramatic loss of muscle mass with the

menopause process. And so in that first

10 years of menopause we could lose up

to 10 sometimes 15% of our muscle mass.

And that muscle mass is going to

determine your resistance to sugars. So

your insulin resistance is really tied

to your muscle mass. Your functionality,

your ability to recover from a fall. Um

and the other thing is what most people

don't understand is the musculoskeletal

unit acts as one.

So when we have low muscle mass, you are

dramatically increasing your risk of

osteoporosis. Now right now, this might

shock you but 50%

of females

will have an osteoporotic fracture

before they die.

And this is almost completely

preventable.

What is an osteopathic fracture?

is when we lose the density of our bones

through So estrogen So all of our life

we remodel our bones, right? We chew up

bone and we lay down new bone. And so we

reach our maximum bone density as

females at about age 35 and then it

slowly starts to decline through the

aging process. And then when we get to

menopause, it dramatically we see a just

massive loss of bone.

So this loss of bone makes the bone

weaker and much more likely to fracture

when it when we fall. And so

if you fall and break your hip

in menopause

30% of women with surgery will die in

the first year.

70% will die without surgery.

And that year is marked by horrific pain

and not being able to move and just

really really miserable people. And so

and so much of this is preventable.

Going on hormone therapy, getting

adequate exercise, doing the resistance

training, eating the protein, adding in

the creatine, making sure you're getting

enough vitamin D is going to be huge at

protecting our my population from this

happening as we age. We can prevent the

majority of this.

I want to talk specifically then about

this hormone replacement therapy you

mentioned there. There's you also

referenced the study previously which

sort of scared people. Yes, the Women's

Health Initiative, yeah.

And that study suggested that there was

an increase in breast cancer if someone

did hormone replacement therapy.

So let's break it down. Um originally

the study was designed to see if we knew

it from observational studies was

hormone replacement therapy going to

truly be protective for cardiovascular

disease. That was the function of the

study

in women who took it versus women who

did not. We knew from observational

studies that yes, they had a much lower

risk of death from cardiovascular

disease and and all cause mortality as

meaning death from any cause as well as

um heart disease in itself. Okay,

atherosclerotic heart disease.

So

but that's observational. The way to

prove these things is to do a randomized

controlled study versus placebo. So

finally finally This is 1998. Women were

getting money. Like there was a new

female head of the National Institutes

of Health. They were funding this study.

This was so exciting. Women were lining

up in droves to sign up for it but

because the end game was to prove

whether or not it was protective for for

cardiovascular disease, the average age

of the patient was 63 years old.

So that they could see if it was going

to affect heart disease because women

tend to get that in their 60s and 70s,

right?

So

they recruit, they develop develop two

groups. We have women with uteruses and

women without women who had had

hysterectomies or were born without

uteruses. And so each of them had a

placebo arm and then a medication arm.

When you don't have a uterus, you don't

absolutely have to have progesterone.

When you have a uterus, it's required to

give a woman progesterone as well or

progestin as well to protect the lining

of the uterus from the estrogen.

Unopposed estrogen can cause endometrial

cancer but we can negate that by giving

her progesterone. You following me? So

we have an estrogen only arm and an

estrogen and progesterone arm and they

each have a placebo. So off we go. Let's

take our meds. Let's take our placebo

and let's start measuring.

What they saw in the estrogen plus

progesterone arm after 2 years was a

very slight increased risk of breast

cancer versus placebo.

Now, you have to understand there's a

difference between absolute risk and

relative risk.

So the relative risk went from So the

absolute risk went from four out of a

thousand women per year

to five out of a thousand women per

year. So one out of a thousand women

treated in the estrogen and progestin

arm

developed breast cancer where over

placebo.

That is a 25% relative risk increase.

Mhm. And that is the that is the

statistic that set the world on fire.

So the researchers held a huge press

conference at the Watergate Hotel in DC.

Every major news outlet with This is

before the internet and and announced

that estrogen causes breast cancer. Now

remember, these women were on estrogen

plus the progestin which is called

Provera.

The estrogen only arm continued for a

few more years because the women on

estrogen only not only did they not see

an increased risk of breast cancer, they

had a I think it was a 20% decreased

risk of breast cancer. Relative? Re of

Yeah, relative risk. And the relative

mortality went down 40%. So and we think

it's because estrogen feeds a breast

cancer cell but it doesn't cause breast

cancer. We are highest levels of

estrogen are in pregnancy and it's so

rare to ever be diagnosed with breast

cancer. And a healthy breast cell has

estrogen receptors and all that estrogen

receptor positive means is that that

breast cancer cell went from healthy to

cancer through a mutation but retained

its estrogen receptors. And so we can

use those receptors against the cancer

cell to treat the breast cancer. So that

study has been walked back. Multiple

studies have been done, but like the the

whole mindset has not changed. Myself,

as an OB/GYN, was still the lowest dose

for the shortest amount of time and only

in women where absolutely nothing else

is helping her hot flashes. Menopause

was defined by the vasomotor symptoms.

That's it.

You know, vaginal estrogen, which is

just putting estrogen locally in the

vagina. So, one of the biggest things we

see in a huge amount of patients, like

well over 50%, is something we call

genital urinary syndrome of menopause.

And it is the bladder, the vagina, and

all of the tissue in between all has a

lot of estrogen receptors. And we take

the estrogen away, that tissue becomes

very thin, we lose elasticity, we see

recurrent urinary tract infections. The

most likely treatment to help a woman in

menopause with recurrent urinary tract

infections, which is a major cause of

death for women,

is vaginal estrogen. And it's safe for

everyone, even with breast cancer. And

so, even that option is taken off the

table for so many women who are

suffering needlessly with horrible,

painful intercourse,

dryness, you know, recurrent UTIs. And

it's just such a simple thing to help a

woman and fix, and they're not being

offered that treatment. Is vaginal

estrogen the only form of administering

estrogen? So, we have No. So, when we

look at hormone replacement therapy, we

have

oral and non-oral medication. We have

like steroids is a good way to think of

it. So, say you have a rash and you go

to your pharmacy and you pick up a you

know, cortisone cream. That's That's

local therapy, right? So, vaginal

estrogen cream, there's pills, there's

there's different ways to put it in the

vagina, but that's considered local

therapy. It's not absorbed systemically.

We're just treating it kind of at the

moment. Systemic therapy is when it's

treating everything, our brains, our

bones, our genitourinary, so you know,

from the inside out. And so, you can

adjust it. There's creams, there's

patches, there's rings, there's pellets

that are now available. There's multiple

ways to get this medication into your

body.

And what's the most popular form of

administering administering

hormone replacement therapy?

So, it depends on the country. So, in

the UK, it tends to be a gel or a cream,

which is where most GPs, if you can get

one that will follow the guidelines and

prescribe it. I think it's the most

easiest pharmacologic option to get in

the UK. In the US, it tends to be the

patch for the non-oral form. We also

have pills available as well. There's a

caveat with estrogen pills. There's

something whenever we ingest anything,

food, medication, goes into our stomach,

into the intestines, and then it gets

picked up by the portal hepatic

circulation, the liver. And so, the the

portal vein goes straight to the liver

for processing. And when that bump of

estrogen or testosterone, typically,

hits the liver, we see some problems

with And for for testosterone, it's

liver toxicity, and for estrogen, we see

bumps in our clotting factor. And so,

you'll see a lot of women who are

terrified of hormone therapy because of

this potential risk of blood clots. They

either have a genetic risk of blood

clots, or a gene, or they've had a clot

in the past. But if they avoid oral

estrogen and go with a non-oral form,

like the patch or the ring or or even a

pellet, then we bypass the liver, and we

don't have the increased risk of

clotting.

Are there any other side effects? You

know, in life, there's no such thing as

Of course.

free lunch.

And so, um

it

estrogen, so we have to look at each.

So, when we look at hormone replacement

therapy, we have our estrogens, we have

our androgens, which would be

testosterone,

DHEA, and androstenedione, and then we

have our progesterone, which is uh the

bioidentical form progesterone. There

are synthetic progestins available, but

I tend to just prescribe the

progesterone. And so, each of them has

issues that may happen. So, with

estrogen,

you can see headaches. So, that's kind

of a red flag for us. We worry. We can

see migraines getting worse, so those

are patients you have to be really

careful with going low dose. Um you can

see unexplained So, 40% of patients on

menopausal hormone therapy will have

vaginal bleeding.

Doesn't mean it's a period. We have not

woken your ovaries up, they're gone. We

are just stimulating that tissue um in

the lining of the uterus, and it's

bleeding a little bit. It's usually

self-limited. It can go away on its own.

If it persists past several months,

we'll get ultrasounds to make sure we're

not missing a polyp or something there.

But um it's it's one of the things I

warn my patients about. So, things I

worry about, you know, headaches, some

women, depending on the formulation. So,

for the patch, it has an adhesive,

right, to get it to stick to your skin.

And there's a probably 10% of women will

have some kind of an allergic reaction

to the adhesive. So, then we have to

look for alternative forms. So,

thankfully, there are multiple forms on

the market. And for patients, we have to

do some trial and error to find out not

only which formulation's going to work

best for her, but also what dosing is

going to work best for her. So, if I was

a menopausal woman and I came to you and

I said, I need help. You get I mean, you

must get thousands of messages like

that.

Thousands of messages a week, probably.

And you know,

I walked into your practice, where would

you start with me? So, I start by

letting you tell your story. I tell my

story, and it's a typical story that you

hear.

Right. Yeah. What happens next?

Symptoms. So, I will we'll get blood

work. Sometimes I'm getting hormones to

see if if I'm not clear where she is in

her journey, I may get blood work to

help me define if she's peri- or

postmenopausal, especially if she's had

a hysterectomy.

Um I'll get a lot of blood work around

checking her thyroid. A lot of things

look like menopause, right? So, you

know, fatigue and night sweats, that

might be hypothyroidism. Weight gain,

hypothyroidism. Autoimmune disease, all

this rheumatoid arthritis. I want to

make sure I'm not missing something else

that looks a lot like perimenopause. So,

I'm doing blood work around that.

Nutrition deficiencies, vitamin D,

her basic labs for her blood count and

her electrolytes. I'm I'm doing this

full panel, okay?

But then I'm beginning to treat

immediately. And so, we have a

discussion around her sexual wellness.

Is she struggling with desire? Then

we'll have a discussion around

testosterone. Um

So, I'm struggling. I've got my desire's

gone. Okay. So, it's very common. So,

when we talk about female sexual

function, there's kind of five buckets

why a woman would be suffering or not

happy, okay? One is a relationship

disorder, and no amount of medication

really helps with that. So, we want to

make sure she's in a good place with her

relationship, supportive partner, all

that. So, we we have a discussion about

that. Then there's an arousal disorder,

where that's what most men are treated

for when they talk about libido issues.

It's really nothing's wrong here.

They're struggling to maintain an

erection. And so, we use Viagra and

those type of medications for that. For

So, if a woman has an arousal disorder,

vaginal Viagra can be helpful for that.

So, we we talk about that. We talk about

orgasmic disorders. Some women have

About 10% of women will never have an

orgasm in their life.

Imagine if that was 10% of men. I think

it would be a national emergency. I

think there would be, you know,

we would divert military funding in the

US to get this fixed. And it's just

something we don't talk about or offer

much help. And so, then that leaves

desire. So, most women who are in secure

relationships, love their partner, miss

that part of the intimacy that they used

to have, that desire to initiate, that

desire, yes, this seems like a good

idea. That goes away with menopause a

lot. And so, for those women,

testosterone might be helpful, or

there's a couple of FDA-approved

medications as well, Addyi and Vyleesi.

And so, we have talked about costs and,

you know, how to get it prescribed. And,

you know, testosterone, there's no

FDA-approved option for women. So, quite

often I will have to compound that

medication for them at a local

compounding pharmacy versus going to

Duane Reade or a CVS or a Walgreens to

pick it up using their insurance.

So, I know that you that you're coming

from the UK, our health systems, you

know, are a little bit different. But

because my reach is so large now, I try

to include, you know, all the different

health systems when I'm talking about

your options. Give me a case study of a

patient that walked into your door and

Gosh, you know, I have Okay, I had a a

patient who

came in

and

uh

her name is Michael.

And she didn't mind me saying it cuz

we're really good friends. And she came

in and typical, overweight, not

sleeping, some brain fog issues, some

major joints aching, aches and pains,

all the things.

And um

sweetest woman, absolutely adored her

husband, you know, like um but was

struggling with desire as well. So, we

started her, you know, I developed a

nutrition plan for her. She hired a

personal trainer. She got to the gym.

She got serious about, you know,

lifting.

Um she started on hormone therapy, and

she is my biggest cheerleader, you know,

on social because she's constantly She's

lost probably about 60 lbs of body fat

cuz we get to measure her. So, in my

clinic, I have a in-body scanner where I

can measure muscle mass and visceral

fat. So, it's not just the number on the

scale. I'm able to tell them. So, she's

probably gained maybe 10 lbs of muscle,

lost a tremendous amount of fat. She

feels amazing. She has this beautiful,

you know, she's back to her intimacy

level that she desired so much before.

She is absolutely thriving on all

aspects, and she's constantly sharing

her studies her her story online so that

other women can learn that they don't

have to suffer as well. And she just

can't believe

the thing that makes her angry is that

she

didn't come sooner, and that she

suffered for so long without looking for

help. And she couldn't find it. She came

from San Antonio, which is about a 3 and

1/2 hour drive to come and see me.

So, here's the scary thing for me, or

it's honorable. I have patients, so I

have this menopause clinic I started 2

years ago. And I have a waiting list

that's longer than this wall. And women

are flying in regularly to come and see

me, which is such an honor, and I'm so

grateful that they trust me. But it's

ridiculous that they can't find

menopause care

in their backyard. You know, that they

have to get on a plane to come and see

me because they cannot find care

wherever they are. So, I've started a a

a list of providers on my website that

my followers recommend where they found

good menopause care. They write a

testimonial and we just compile them and

we just look online to make sure it's a

real doctor and they have a phone number

that works. You know, um and then the

the North American Menopause Society,

now called NAMS, um now called The

Menopause Society, they rebranded, has a

list of certified providers on their

website as well.

I got an email sent to me after

listening to one of the episodes on this

podcast from what appears to be a very

helpless husband. It was a very very

very long email and they'd said that one

of the conversations we'd had on this

podcast about menopause at one point had

really helped them, but the key question

that remained for that person was

when does a supporting partner

know how and really at what point to

help? Because, you know,

no male partner wants to turn around to

their wife and go, "I think you've got

menopause." and starts diagnosing them.

But they also don't want to just sit

back and be quiet.

I think

you

it's usually begins with something you

can't quite put your finger on.

She's reacting differently. She's not as

resilient as she used to be. She's not

managing situations the same way. And

I think once we start taking the shame

and the stigma out, him suggesting that

perhaps this is menopause will not cause

her to fly off the handle. I think, you

know, normalizing this conversation,

removing the stigma, it might make

everyone go, "Oh, I mean, I didn't

realize it in myself." You know, I

thought it was grief related and and I

was like, "Wait, when was my last

period?

When was my last period?"

Uh

Oh.

I think I'm in menopause. I mean, I was

And then I was like, "Oh god,

menopause." You know, even for myself it

was such a negative connotation. I had

that Sex and the City episode in my head

when Samantha thought she was in

menopause and how horrible it was for

her and then

it turns out she wasn't and everything

was better again and I'm like, "Gosh, is

this

You know, first of all, I applaud him

for wanting to try to do something

because so many, you think women don't

understand what's going on. And so,

uh one bravo for wanting to be helpful.

Two,

say it with love. Say it gently. Let's

and then find a provider or find a

healthcare provider to go in and start

the conversation. And I one of my best

my best visits with my patients are when

their partners come.

And that the conversation is held

together.

And it really opens their minds, you

know, to what's going on in her body and

helps understand like what we can do

therapeutically, what needs to be done

at home. This is a special time for her.

She's going to need extra help. We're

going to get through this. You know, it

doesn't have to destroy your sexual life

or your relationship or whatever. It

definitely can take a toll if left

untreated. But you know, bless him for

doing it. Like we talked about a little

bit earlier, you know, there's probably

a fair amount of dissolutions of

relationships because no one's talking

about this process and what it could do

to someone.

This might be a really stupid question.

Um but I'm no

I'm no uh I don't ask a lot of stupid

questions.

Do men go through anything like this?

So, there's a lot of debate about

menopause. Um

the short answer is not really.

We see

men's testosterone levels peak at about

age 19 or so or there and then this very

slow kind of down tick until they

stabilize at about age 35 to 40 and then

they stay stable for the rest of their

lives. But there's a difference between

in there's a big variation from man to

man

where the curve the shape of the curve

looks the same.

But as far as

normal men's range is from 236 to about

a thousand. So, there's a big, you know,

man to man variation.

And there is a lot of men who are

supplementing when they come in on the

low end and they're feeling a lot

better. Now, this is not my area of

expertise. This is not, you know, I just

read a lot of this research, you know,

on testosterone and men are included in

it and so they are finding that they are

having better cognition, feeling better,

having more energy, etc.

But there is no manopause.

Their testicles don't stop working. I

mean, it would be as if your testicles

shriveled up and died at 51. That's the

equivalent.

Gosh.

I do have to say

at the start of this conversation when

you said if that was happening to men

the reaction would be different. I have

to say I think I agree.

I think that because it's one side of

the population, I think it's kind of

been overlooked over the last 10, 20, 30

years. Mhm. Um but if it was

And men or both genders, I think it

would be a different response. And so

much

of what women were going through in

menopause were dismissed as

psychological.

Mhm.

And I really had multiple times in their

life, you know, it's all in her head. We

never said it's all in his head. That's

not a thing on the wards. You know, it's

all in her head was very much alive and

well in my training and a long a lot of

my practice. I I find myself now

even having to pull myself back a little

bit just because that was ingrained so

much to always look for the

psychological reason. I mean, women A

woman right now in 2023 is more likely

to be prescribed an antidepressant for

her menopause

than

hormone therapy.

Multiple reasons for that. The way we

were trained, the way we were taught to

to approach a woman's medical issues and

also the fear uh unfounded fear around

the Women's Health Initiative and what

it did to

you know, physicians feeling confident

about prescribing hormone therapy.

Is there anything else that you do on a

day-to-day basis in your life that um

you we haven't talked about yet? Is

there any sort of apps or tools

I really like Headspace. I know there's

some good meditation apps. I really

thought meditation was woo-woo and

not

anything that, you know, I I would just

sit there and and my brain would be

bouncing all over the place. But once I

went through menopause and suffered so

horribly from the mental

side effects and the death, you know,

all of this happening at once uh to me

with my brother's death, aging parents,

teenage girls in the house, you know,

and realized something's got to give.

And so, I hired like a counselor, you

know, I went to therapy. And she

recommended um

getting an app to help guide me through

meditation and that has really turned

the needle for me. Really? Yeah. How?

I you know, carving out that it's just 5

or 10 minutes in the morning to

think of what I'm grateful for, focus on

that gratitude, you know, and I love

teaching that to patients and to my

followers of of really putting yourself

first, you know, the thought of you have

to put your own oxygen mask on first

before you can go take care of your

family and all the other things on your

plate.

And just

giving my brain that time to just relax

and let it flow and just let the

thoughts, you know,

and just focus on on me for that. That's

really made a huge difference for me.

What role does sleep play in all of

this?

So, sleep disruption is massive massive

massive in perimenopause and menopause.

And

when we don't sleep we see everything. I

I tell patients if you're not That's the

thing we need to work on first. We need

to get you sleeping because nothing's

going to work until your body is able to

restore itself. That's when we That's

when we build muscle. That's when, you

know, our our brain resets. That's when

our our whole body, you know, and if

you're having disrupted sleep

and you're waking up at 3:00 in the

morning and your brain is racing, I

mean, everything is worse. Your cortisol

levels spike, your insulin resistance

goes up, your, you know, everything gets

worse. And so, when my patients come in,

we focus on sleep first

and nutrition pretty much. And if Easier

said than done though, right? Sleep.

If the estro

if their sleep disruption is due to

hormones, then it's such an easy fix. I

just give them back the water they were

drinking and they sleep again. Where the

struggle is if someone's never been a

good sleeper, then that's probably out

of my area of expertise. I'm going to

send them to a sleep medicine

specialist. One of the things that we

now see a correlation is a sleep apnea

even in a thin patient in menopause in

women.

We're seeing a big bump in the sleep

apnea rates in women who are um

they don't even have to have a weight

problem.

And what is sleep apnea? That's when