Kate Bowler: Hello my friends and welcome back to Everything Happens. Okay I’ve been thinking a lot about aging lately, which is funny because we live in a culture that treats getting older like it is a personal failure. Like every new ache is now something to optimize. Every wrinkle can be erased. Did you know that? Wow, we don’t need to age anymore. Every change in our bodies is just another problem we’re supposed to solve. Just buy one bajillion dollars worth of serums and peptides and life coaching sessions. But here’s what I keep coming back to, aging is a privilege. You may remember that from the first time I said it using maybe a bit more colorful language. It was a moment that I wrote about in my memoir, Everything Happens for a Reason and Other Lies I’ve Loved. And I was in the throes of like the worst of my terrible cancer diagnosis. And I just could not handle people. Complaining about normal body aches. The contrast was just too ridiculous. But… Now that I keep living, thank you, thank you God, thank you medicine, I have to admit I still deeply believe that aging is a privilege. Not because it’s easy, but because the alternative to aging is not ideal. Look, if we’re lucky enough to grow older, we’re also going to have to live through seasons where our bodies are going to experience things. And we’re going to have to find a special kind of grace for that. And for women, one of those seasons is para-menopause and menopause. It is inevitable. It sounds dreadful. And frankly, I’ve been living like an ostrich with my head in the sand to avoid thinking about this. I think this is how my brain worked. I was like, I don’t need more problems. I’m all topped up. Thank you very much. Now I just, I just won’t think about things. But, I know that so many people start getting strange symptoms like exhaustion and anxiety and brain fog and insomnia and whatever frozen shoulder is, which sounds terrifying. Our bodies start changing in ways we do not recognize right when we need them to work. But what if I told you it just doesn’t have to be like this? We can find another way. And that’s where today’s guest comes in. Dr. Mary Claire Haver is a board certified OB-GYN, a menopause society certified practitioner, bestselling author of The New Menopause and The New Paramenopause. And one of the leading voices helping women navigate aging with better evidence, better information and better care. Through her clinical work, her books, she’s got a community of millions online, she’s really helped change the conversation around women’s health. Because when I ask people how they’re navigating uncertainty, so many women have said that they feel completely blindsided by health systems and health symptoms in the middle of their lives. So here’s what we’re going to talk about. We’re going to talk about why women’s symptoms have been dismissed for way too long, what kind of questions they have, what treatments, what practical tools can help move us through a season of life with a little more knowledge and a whole lot more self-compassion. Because reality is so much better than shame. Mary Claire, welcome to Everything Happens. I am like very excited to meet you in real life.
Mary Claire Haver: I am so excited to be here.
Kate Bowler: Your work has truly been a revelation to me. And it’s been-
Mary Claire Haver: In a good way, I hope.
Kate Bowler: It’s been, revelation is the right word. There’s this sense now that like, I’m looking back on stories that friends have told me too, and seeing it in a new light. Like, my friend Christie Watson. She had this moment where she was grocery shopping and all of a sudden she just felt like enormously warm. She thought she was gonna die. She like crawled into the fish freezer and just stayed there. Just be like, someone needs to call 911. Is that kind of experience where someone’s like, what the hell is happening to me?
Mary Claire Haver: You know, did you have children?
Kate Bowler: I have a 12 year old, yeah.
Mary Claire Haver: Did you go into labor or?
Kate Bowler: Mhmm.
Mary Claire Haver: Okay. So, you know, I had delivered, I don’t know, 5,000 babies by the time I had my own and no one could have prepared me for what that, like, I know I’m in labor feeling was. I thought I was in labor several times. I had a lot of Braxton Hicks and stuff. But then when you’re like, oh, this is, this is what’s happening. Like, I think the vasomotor symptoms, the menopausal hot flash is like that, like you have a couple of like, is this what? I don’t know. That’s probably nothing. And then you’re like, oh my God, like, like a page has turned, like when you get that one big contraction, you’re, like I’m having a baby. This is gonna happen. So I think I feel like that you know, when you turn the corner and you have that hot flash. You’re like, this is this is happening. This there’s no going back now. We’re going back now.
Kate Bowler: This is my horrifying new life. Even just the categories are all new to me. I wondered if you could, like, what is paramenopause?
Mary Claire Haver: Good question. So let’s start with menopause and we’ll kind of work our way backwards and forwards. So medically, sadly, menopause is defined as one year after the final menstrual period. Okay. We know that statistically, if you go one year without a period over the age of 45, that that most likely is due to your ovaries have shut down, there’s no more eggs left that are gonna be able to ovulate and you’re not gonna produce those hormones anymore. But basically, if you think of why a woman ovulates, or a girl ovulates, it comes from the brain. So the ovaries are really just clumps of cells. So we have our germ cells, which are where the genetic material is, right? And in utero, they get frozen in something called meiosis one, if remember that word, meiosis from biology. So they start splitting in the first split, and they freeze, and they’re just hanging out there until they ovulate, and then the division occurs fully, and then we end up with like half your DNA in one, you know, and then your partner’s DNA hopefully infiltrates the other side and you make a human, right? That’s half mom, half dad, that’s very simple. Okay, in order for that process to happen, signals have to come from the brain. And so our brain is always looking for estrogen, estradiol, looking for these hormones in progesterone. And when those levels drop off, it starts saying, wait a minute, I need those. Why? Well, biologically we need to ovulate to propagate the species, but also like our brain works better with estrogen on board. So when it naturally dips in the cycle, the brain is like glitching a little bit. That’s why we have more, that’s why have PMS. That’s we have have more emotional symptoms like post ovulation when those estrogen levels decline and the progesterone comes up. And so LH and FSH start pulsing, the signals go to the cells around those germ cells, called the follicular and granulosa cells, and start pumping out hormones. And the whole system restarts. So that process in a healthy woman is very predictable, right? Month after month after month, in a health woman, she should know on day 28 or day 32, she’s gonna have a period and the whole system restarts. And if you look back and we track through all the hormone levels, they’re very consistent. On day 1 it looks like this, on day 8 it looks that, on day 14, on and on and one. We’re born with all of our eggs. That’s what makes us very different than men. Men have a factory in their testicles where they create fresh DNA that gets encapsulated in a sperm every day. Every day, every day, and I forget if it’s thousands, millions, whatever, I don’t study men so, you know.
Kate Bowler: They’re a mystery.
Mary Claire Haver: I just have the vaguest notion of what happens in a testicle. I’m only in charge of two, and that’s my husband. And I have daughters. But they make their stuff fresh every day, and they can keep making it until they die. It gets harder, and I wouldn’t recommend it, but they can father children until death. So women, however, are very different. We’re born with a set amount of eggs. By the time we’re born, we’re already down from the original 45 million to 1 to 2 million through this process called Atresia. And we don’t really understand, go-figure, how atresia actually happens. You know, but it’s more, kind of think of survival of the fittest. We want the healthiest eggs left behind. So we’re born with 1 to 2 million. They lay dormant until puberty. Then we start the ovulation process. It kind of goes wonky for the first year or so, and then things go into stride. And then, so by the time we’re 30, we’re down to about 10% of that original egg supply. So we lose about a thousand through the process of ovulation each month. And then we’re also doing that Atresia thing in the background. So we’re just losing, losing, losing. By the time we’re 40, we’re roughly down to 3% of the original egg supply.
Kate Bowler: Okay.
Mary Claire Haver: Okay. And then by the time menopause hits, no more functional eggs, we’re done, okay? And then we live the next 30 to 40 years without that process happening. Perimenopause, what happens in peri? Every woman has a different threshold, but we reach a critical egg level where the signals from the brain don’t work as well as they used to. They can’t recruit enough eggs to get out of the vault, okay? And so the eggs try, but they can’t quite get it going. And the brain is like… Where’s the estrogen? I’m looking, like it should be here. You know, it’s 4:30, where’s my estrogen surge? Like, I’m used to it. And the ovaries are like, bro, we did what we could. And so the brain flips out and starts sending higher and higher levels of those stimulating hormones, LH and FSH, to the ovary to basically force some ovulations to happen. So we have delays, so it kind of delays. We’ll have a double ovulation, that’s called a loop cycle in some months. Progesterone really struggles to keep up. So what used to look like the EKG is now I take spaghetti and throw it at the wall. And so cycle irregularity happens towards the end of perimenopause, but what happens in the beginning is happening in the brain. So, sleep disruption, brain fog, and mental health changes. So we see about a 40% increase in mental health diagnoses. Now imagine the women who don’t go to the doctor and get the diagnosis. How many women are struggling with like, oh I’m just gonna white-knuckle it with their anxiety and depression. So it takes a huge, our brains take a huge hit during this. So the brain’s basically rewiring to learn how to live and adjust without this predictable hormone level. So perimenopause represents what, I’ve coined “the zone” and I actually stole it from a doctor in New York and I give her credit in the book. The zone of chaos, right? Because it’s not predictable. You’re ovulating whenever and so your periods can be heavier, lighter, more crampy, less crampy, like you can’t predict it anymore. 80% of us will have dysfunctional uterine bleeding, but that’s really towards the end. And so we just, I was never taught to look for the, “I don’t feel like myself.” There’s a whole paper on that presented at the Menopause Society of this like, and they really connected it to the hormone changes in perimenopause. Our levels of serotonin, dopamine, norepinephrine, all are dependent on estrogen levels. And also like how we utilize glucose changes. So you look at Lisa Masconi’s work. You know, in the menopause brain, and how glucose is utilized in the brain changes, and we have a much harder time in the amygdala that controls our emotions, and in the frontal cortex for memory. That is the brain fog and mental health. And so the mental health step does tend to get better as the hormone levels drop and we get more of a steady state, but you know women are getting blindsided, and that’s why I felt so compelled to write the new perimenopause, because I didn’t want anybody to not understand what was happening to them.
Kate Bowler: And if they have, say, I’m just thinking about all those categories in their minds that they probably have a separate provider or like way that they manage it, like anxiety.
Mary Claire Haver: So, say they’ve had a history of depression or anxiety before and they were well controlled with their therapy and medication or whatever combination, and suddenly they’re not, right? Something’s turned the corner. Or nuance it. I’ve never had this before. You know, I see a lot of this rage, anxiety, aggression, like, “this is not me,” and this loss of resilience, right, to like, they built this complicated, messy life and they had it handled. And then all of a sudden, they can’t handle it. And so I’m like, that is where we start. That’s where we need to train our clinicians to start looking at it through the lens of perimenopause.
Kate Bowler: Is any of it covered? Like, I take sleep medication or like I, everyone in my family is on antidepressants. Would some of the medications that people are on kind of like paper over the initial?
Mary Claire Haver: Maybe. Yeah. So maybe, right? And even birth control pills, for some women, for me, suppressed a lot of this, because I was on them in perimenopause, or to manage the symptoms of PCOS. And I did great on them, but when I got off, it was like a truck hit me. And so there are a lot things. Now, let me say this, we know now that long-term use of benzodiazepines and sleep aids, even including anything you have to take long-term for sleep increases your risk of lots of other things.
Kate Bowler: Don’t take this away from me. I totally know you’re right. I think I read something about like the likelihood of Alzheimers…
Mary Claire Haver: And so is chicken or the egg? Is it the meds or the fact that she’s not sleeping?
Kate Bowler: What symptoms do you think surprise people the most?
Mary Claire Haver: We all know about hot flashes, which are the vasomotor symptoms, but the things that blew up the internet, right, were frozen shoulder.
Kate Bowler: What? No. I have friends who are already getting frozen shoulder.
Mary Claire Haver: Frozen shoulder. Great work done. Jocelyn Wittstein, Duke, she’s an orthopedic surgeon, and Vonda Wright, another orthopedics surgeon. We’re like, oh, these 40-year-old women are coming in with frozen shoulder, what is going on? And what Jocelyn saw, Dr. Wittstein saw, was they were on aromatase inhibitors. So not only were they in this menopausal phase, their estrogen was taking completely away due to treatment for breast cancer and this huge percentage of patients were coming in with adhesive capsulitis. So she started combing that, she’s just a brilliant scientist, and what do we do? We start looking through the data to see and found the correlations between aromatases inhibitors just being fully menopausal and the incidence of frozen shoulder and then looking at women who happened to be on HRT and they had a lower incidence. So there’s something really protective about estrogen in the musculoskeletal system. So a lot of fibromyalgia might be undiagnosed musculoskeletal syndrome of menopause. And doctors just didn’t know the connection between estrogen loss and what’s happening in our bones, muscles, and joints with increased inflammation.
Kate Bowler: Can you give me one of those, like, horrifying things where it’s like 80% of people likely experience this…
Mary Claire Haver: So when we pull, you have to remember, in the menopause literature, in academia, really the only thing that’s been studied for the most part has been vasomotor symptoms. HRT was developed to stop a hot flash, no other reason, right? Turns out it also helped bones and there were some long-term benefits with longer lifespan, to a certain degree, and lower cardiovascular disease if you started it early, right, versus not being on it. So, but it was literally developed to just stop hot flashes and women would stop complaining and sleep, you know, and it works great for that. When we polled, so when you look at actual symptoms, so some of the big telemedicine companies are doing, they’re cranking out tons of data. You know, the oura ring and all these wearables are doing all this data collection. Turns out the top symptoms, like hot flashes are usually fifth. Huh. Weight gain. So body composition change. So increasing fat deposits among your abdomen. And if you’re listening, yes, it’s not your fault. This is completely hormonally driven, hi. Do you feel better now? Doesn’t fix it, just knowing it’s there, but it makes you feel that you’re not lazy. Anxiety. You know, mental health changes, sleeplessness, so disrupted sleep. And so we weren’t taught early on that these are direct, like the musculoskeletal stuff. Other things that blow up the internet, itchy ears. So common, they drive people crazy. Palpitations, 45% of patients will have palpitations. But you know it’s really the mental health, the brain fog really lead, you know loss of resilience, not knowing who you are. When we look at the data around jobs, and so women who are employed are having more absenteeism and in the menopause phase. And so it was about one, I think, it was like in the billions of dollars, Mayo looked at this, like what is the cost of women who were missing work due to untreated menopause and what is economic cost of that? And then there’s something Dr. Malone talked about called presenteeism, you make it to work but you’re not functioning at the same level. And that’s mostly because of brain fog. Sometimes hot flashes where you’re just stuck or your period’s so heavy, you’re stuck in the bathroom, and not being able to go sit at your desk or do whatever because you’re bleeding through all the protection that you have. So there’s a lot of things that are really affecting women in the workplace that we could do a whole lot…We just have to manage this. This has to be brought to the forefront.
Kate Bowler: There’s so much, I don’t know if it’s just my algorithm, but my algorithm really wants to sell me supplements about brain fog.
Mary Claire Haver: Okay, this is coming from a doctor with a supplement company. And let me be clear, there is no supplement in the world that will resuscitate your ovaries. Zero. Nothing. So. That is not, you know, supplements should supplement a good, healthy, nutritious diet. And the supplements in my world are things that help me get more fiber or more protein or more building blocks of the nutrition things that I’m struggling to get through food. There is no supplement that is gonna cure your menopause. You’re gonna go through this. Now, you may have slight relief of a few symptoms and good for you if that’s what you wanna do as long as it’s not harmful, but just be aware of some things like get your sexy back or, you know, lose 20 pounds or menopause weight gain, menopausal belly, I would not pay attention to any of that.
Kate Bowler: I think that’s, especially because this lovely community has usually kind of like been, knows the like wide gamut of things that can happen and of course it’s like everybody is always trying to find any way to soften the blow. But I just think having like, um, there’s a kindness to this kind of realism that I think everyone finds very refreshing in listening to you. I wanna go back to the thing you were saying about what a sort of awful confluence it is that women who are in a moment of their lives where they are, they’re caregivers, they have not just learned to function, but over-function with like enormous grace and they have incredibly full lives. They’re likely if they are, like they really put a lot into their career, really just like hopeful to have a nice moment where they get to experience the benefit of all that ambition. Like, what do you think, I’m just thinking of the, like, the story that women are telling themselves at that moment that maybe we could like ease some of the self-hatred that comes from feeling like you’re suddenly coming apart.
Mary Claire Haver: That’s why I do the work I do. I don’t think any woman should go through this without the education, right? And forever, you know, kind of the academic end of the world, really just focused on hot flashes and bitches be crazy. You know? So I joke, I went, well, I stole this from Elizabeth Comen, like it’s the bitches be crazy school of medicine. You know, like, if you can’t figure out of her biology, it’s psychology. So, I mean, I was taught to look at women through the lens of… You know, they tend to be a little emotional, a little bit crazy, a little bit, you know…and it’s just not true. Our hormones, you know, really help with our mental health. And when we lose that buffer, a lot of women were going to suffer and make choices, change things, you know, not be able to function in these incredible lives that they built. And it is sad that in the middle of raising kids or mentoring adults, taking care of our parents. That’s a whole separate podcast. Still wanting to feel hot for a little bit. Yeah, you know, like all of a sudden, like you feel like the wheels are coming off the bus.
Kate Bowler: I just started asking women who were in my mom’s age about what their experience was with…
Mary Claire Haver: How old’s your mom?
Kate Bowler: Uh, my mom is seventy-five. I mean… It was a, that was a generation that often broke into professions for the first time. I mean, my mom was the first woman tenured at her institution. Like just a lot of like first, first, first, really trying to carry forward some of the hopes of second wave feminism. And then when they hit menopause. What did they say? I’m so curious. Their husbands saying immediately, that’s the year your mom went crazy. I mean in a fully like they felt enormous shame, confusion, didn’t hear about any possible estrogen treatment til much later, thought that it might increase breast cancer and was terrified about it.
Mary Claire Haver: Yeah, because WHI was 2002, and that just threw an ax, you know, into conversation, into education. And basically, nothing happened in menopause. You know, that really would move the needle. Lots of research was being done, incredible stuff that was just getting buried in academic journals that, you, know, I think in medicine, it just got easier not to deal with it because somehow it got labeled as dangerous. Um, so we’re just not going to talk about it, you know, like, well, there’s nothing we can do. You just have to get over it.
Kate Bowler: So tell me again about like, because previously there was a very well established story.
Mary Claire Haver: So yeah, like like almost every medical board that dealt with women, right, recommended hormone therapy. Okay. So about what we look at the data on FDA approved because we can’t really track, um, non-FDA stuff like compounded materials. So for at least for FDA, 40% of eligible women were on HRT before the WHI. And so everybody thought that was a reasonable number. And from observational studies, we knew that women who were in HRT tended to have less heart disease, tended to, we knew their bones were stronger. There was no debate there, right? Estrogen makes your bones stronger forever. But they tended to live a little bit longer and have less chronic disease. They kind of slowed the rate of those things happening. So, if you’re a good researcher, as you know, how do we prove that? Observation is just correlation, not causation. We have a randomized placebo control trial, and that’s what the WHO was. The whole purpose of it was, does estrogen prevent heart disease? Okay, so they start collecting data. They have two arms. They have estrogen and progestin, or if you had a hysterectomy, estrogen only, because we need that progestine to protect the lining of the uterus. It’s not negotiable. And then estrogen only arm, and then each of those had a placebo arm. And off they go, collecting data, They noticed a signal in the estrogen plus progestin arm, wasn’t statistically significant, but it approached it, that estrogen, the estrogen and progestine arm had a slight increased risk of breast cancer. Now remember, the average age in the study was 63, not 51, average age of menopause. Why did they start with an older population? Because heart disease takes years. You know, they couldn’t afford, it was already a billion-dollar study, they couldn’t afford to run it for 20 years when a woman would start HRT and then when she would have a heart attack, right? And so to cut costs, they pulled in older women, they had some women in their 70s who were starting HRT for the first time as part of the trial. And so they see this signal, they didn’t see it in the estrogen-only arm. They saw a 30% decreased risk reduction. And, like one guy decides we’re gonna call a press conference and stop the trial. Remember there are multiple centers doing this trial They called them all and said hey, we’re going to publish this paper. Basically at the end of the day saying that as this estrogen plus progestin increases the risk of breast cancer like…wait, we didn’t reach statistical significance. What about this? Look, let’s age match the groups. You know, we are not looking at young versus old…they did they did have 50 year olds in the trial. They call a Press Conference Tell the world estrogen causes breast cancer. And the paper wasn’t even published till 10 days later, so no one could read it. So like, phones are blowing up. There’s no internet back then, right? You know, 2002. Everyone’s calling the doctor’s offices. Oh my God, am I gonna die of breast cancer? They’re throwing their HRT in the trash. What have we done? And that was the genie we could not get back in the bottle. And other medical societies heard it, like, no HRT, we’re not even gonna think about it, talk about it and look at it, you know. And… That stayed that way for 23 years. Yeah, the black box warning went on all estrogen containing products, you know, for menopause, so vaginal estrogen plus systemic, saying it caused heart disease, saying you will have a stroke, saying you’re at risk of death. Black box is for like cyanide. You know, like things that are really, really, really gonna hurt you. Chemotherapy, you now, like that. And not for, vaginal estrogent, it should have never been on there. So multiple papers have been published, but they just never got that virality that. You know, it wasn’t picked up, you know, this was sexy, estrogen and breast cancer. And so you would think that, okay, everyone stopped taking their estrogen, literally almost everyone. A whole generation of physicians never was trained in like reasonable menopause care, you know, in proactive preventative menopausal care. And, then finally, this whole menopause wave, I think it’s Gen X who was like, F this, I am not standing for this, I’m not gonna suffer, I’m watch my mom, like help me. And more papers started getting written and you know menopause society was doing a great job they changed their recommendations in 2022 and so but like ACOG who covers you know ACOG is American College of OBGN American Council of OB-GYN has not changed their menopausal hormone therapy guidelines since 2014.
Mary Claire Haver: You know, there’s a lot of politics involved here, a lot, you know, but at the end of the day, the majority of women, their benefits are gonna outweigh the rest for MHT. And they’re not having that conversation. Because they’re walking into a doctor who’s not trained. Only one out of three OB-GYN programs has any menopause curriculum. Like no one owns women’s health after reproduction ends. We just get lumped into the men’s studies and call it good enough. So what does that look like at the end of the road? Like perimenopause, you’re just hanging on for dear life, trying to figure out your mental health and all the things, and sleep, and manage your life. But how did your mom age? Does she have osteoporosis? Does she heart disease? Is she happy in her 70s? Is she living her fullest life? Or is she plagued by chronic disease? What about in her 80s? What about her 90s? And so women tend to spend much more time than their male counterparts with loss of independence.
Kate Bowler: You’re saying that they age longer…
Mary Claire Haver: But they’re sicker. We live longer, we’re sick, we have more chronic disease, not just because we live longer. And menopause seems to be that turning point. We have much lower risk of heart disease than men until menopausal. And it turns out the lifestyle preventative things are almost all the same. For heart disease, for any cancers, for osteoporosis, for muscle, you know, sleep, stress reduction, good nutrition, lots of plants, lean, you know, and enough protein, however you want to get that in your body, avoiding ultra processed foods, getting therapy when you need it. You know, keeping your blood pressure down, not smoking, just all of that.
Kate Bowler: You’re very into fiber. You are an evangelist for fiber. I’m actually because of you I’m like gonna go check how much fiber I get…
Kate Bowler: …I, uh, is one of the first things you can do to just go get a bone density scan? Because most people haven’t done that.
Mary Claire Haver: Yeah, so, most people have not done that. And this is, I’m gonna be very clear, this is off of the guidelines, okay? So we’re gonna step away on where I think the guidelines need to be re-jigged, okay. So remember, this guideline was more about insurance and payments than knowledge, right? So right now, without risk factors, you’re not gonna have insurance be able to pay for your bone density–without risk factors–until the age of 65.
Kate Bowler: That’s way too long.
Mary Claire Haver: Cow is out the barn.
Kate Bowler: That’s crazy.
Mary Claire Haver: Because, I know from my patients, so again, this is just my experience and in our clinic with our three doctors and four nurse practitioners, when our patients see that bone density and go, oh shit, they are motivated. They start lifting the weights, eating the protein, making sure they’re getting calcium and vitamin D. They are doing the things to build that bank of bone back up.
Kate Bowler: And it is nice to know that you really can build bone density.
Mary Claire Haver: It’s harder as we get older, but you can do it.
Kate Bowler: Cause when I, I mean, it was only a couple of years ago, I got my first bone density scan, but it was like $130. I didn’t realize that there was a person nearby.
Mary Claire Haver: You can pay out of pocked and go get it.
Kate Bowler: You just have to like Google bone density scan and it’ll be…
Mary Claire Haver: Was it good?
Kate Bowler: It was just like, actually it was a really sweet person whose wife had died of the same cancer I had. And the reason why he was doing these scans was he just liked being part of preventative medicine. I thought, anyway, I just, I liked going, I liked feeling like I had a non-number-on-the-scale-related, like just benchmark, and I do it once a year. Is that, like, ish, or is that too much?
Mary Claire Haver: They say two years. That’s more to track loss and gain. Bone grows very slowly, okay? And bone, right, so when we go through menopause, like we have a bone bank that we develop in childhood in like our early 20s and we max out on our bone density probably somewhere mid-20s-ish. There’s some debate on that. So 20s to 30s. And then age and stuff just starts taking that away. And then when we take estrogen away, it wraps. So we have the biggest acceleration of loss in perimenopause, not menopause. Yeah, so I’m like, I get them, I recommend them as soon as they hit my door. They’re coming in for menopause, right, for perimenopause. So I’m, like, everyone should get a baseline. I think it’s really critical to do a body composition, bone density and body composition before you start a GLP-1. So you wanna know what is your bone bank, what is you muscle bank before you start that med because if you’re not getting counsel correctly, you might under eat the protein and not do the lifting required for you to slow that lean mass loss. And when you lose lean mass, muscle bone goes too. And so, you know, I think this is a big thing for preventative care, both the bone density. And I can’t tell you a woman who’s been told she’s fat her whole life because of her weight. And I come in and I’m like, you have the biggest, juiciest muscles and the strongest bones. I am so jealous. Like, and they’re like crying. They’re like, really? I’m, like, yeah, and you’ve got, you know, curves, you have hips. That’s like, that’s beautiful. That’s actually protective. Women with wider hips, like die less.
Kate Bowler: That’s really nice.
Mary Claire Haver: Yeah! Thick thighs save lives. Like it’s a thing. For real. Science!
Kate Bowler: I really like that. I suppose a lot of women have to reconsider that storytelling particularly around, I mean, I just remember it was all cardio, just abs, it wasn’t heavy weights. Heavy weights were gonna give you big muscles…
Mary Claire Haver: No, I can tell you I am the first female in my bloodline to lift weights.
Kate Bowler: I like your bloodline.
Mary Claire Haver: Like there’s no Cajuns out in the swamps or in Nova Scotia or back in France who were lifting weights. Now they may have been doing heavy, you know, my people were farmers and fishermen, you know. They may have lifted some heavy kids, but like they were not purposefully trying to maintain their bone density or their muscle mass.
Kate Bowler: I really like that, because everybody, I mean I think I think a lot of people get stuck on the like five to ten pound these are the intermittent, like just every now and then when they think of it.
Mary Claire Haver: Yeah. It’s like any movement is better than none. Any weight is better than that. I don’t want to say that. Nothing’s worse than sedentary for bones and muscle.
Kate Bowler: But if you were going to magically pick, you’d be like maybe twice a week.
Mary Claire Haver: Straight training at least twice a if not three. Yeah, if you can get it all in, right? A push day, a pull day, and then cardio. Alright. When we look at the data, 150 minutes a week of cardio. So getting that heart rate up moderately, where you can walk and talking’s a little bit of a struggle, but you can do it, okay? If you do that 150 minutes a week from sedentary, it will cut your risk of diabetes and heart disease. 50%, just do that. Can you give me 150 minutes per week, if you do the math, that’s five 30 minute walks, brisk walks a week. And they’re like, I can do that, okay. Weightlifting, how much? So it’s somewhere 60 to 90 minutes a week, and it has to be not the namby-pamby five pound weight. But if she’s starting from nothing, we start with body weight.
Kate Bowler: But what if I have hollow bone disease?
Mary Claire Haver: Then five pounds. But the goal is, uou just want to get stronger. And to get stronger, you have to lift heavier weights. Now again, we’re gonna get sick. We’re gonna travel. We’re going to have to back up. So it’s not like I’m all this, I’m not benching 200 pounds, you know? So I’m benching about 75 pounds for this little framed woman. And you know, like I didn’t do any lifting on this trip. I have to drive back to Telluride, right? I’ll get back in the gym. But like life happens. We get sick, we get injured, whatever. So you just have to remember, it’s okay to go backwards as long as you keep moving forwards. You know, you just need to get stronger. So when you add that all up together, it’s about 250 minutes a week. So to keep the math super simple, if you can give me a 20 minute walk a day and about 15 minutes of weight training, you’re doing really, really good. That’s amazing. And that should be minimum. That should be enough.
Kate Bowler: Okay. I will tell you my secret, my secret bias about like, it’s not even a bias. It was just a block, like a mental block. I like did not want to face this topic. I did not to read about it. I did want to listen to other people talk about it, I have fully blocked out being a compassionate friend about other people.
Mary Claire Haver: I, in my precious 30s, when I was doing my training, we had six hours of menopause in a four-year curriculum. We had six one-hour lectures, and I would roll my eyes and think, oh my God, I don’t wanna be dealing, I wanna deliver babies, I wanna do surgery. Like, if you would’ve told me, like, I didn’t wanna think about it, because my mom, it was this dark, ugly place that she hid in the room and yelled at us. And then they put her on sedatives. So my mom was like on a derivative of phenobarbital for the treatment of her menopause. Yeah, called butasol. And it, you know, but then when it was my turn, I was like, holy fucking shit, this is my life. Like, this was my purpose.
So I get it.
Kate Bowler: Yeah. I think I felt like I…this is not how it works, but I guess I was secretly hoping for cosmic math on like I’ve been through a lot…
Mary Claire Haver: Yeah, you’ve been though a lot, so God is going to spare you.
Kate Bowler: I felt like I was in the hospital so much in my 30s. I felt I’d lost most of my youth already. And everybody else is having a moment where they feel like summer. And I was just feeling haggard and wizened and a million years old. So then getting into 40s, and I’ve had a couple years in a row of good health, then I’m like, great. Now is my time. Let nothing take it away from me. When it’s like, surprise! There’s a horrifying… But I think what I’ve realized is like, every moment of reality is an opportunity to figure out what has happened and what is still possible. And I just really like the concreteness of like, there’s very little that you’re saying that really costs a lot of money.
Mary Claire Haver: Right, and why do we demonize menopause so much? This is a natural phase of life and we’re gonna go through it. But I think not allowing women the education around it, which is why I wrote the book, I don’t want any woman to go through this alone or not have a clue what’s happening and gaslight herself and hop around and multiple doctors who haven’t been trained who can’t connect the dots or see 10 specialists for 10 different problems when there’s one unifying factor here that we’re missing. And so… I just don’t think it’s fair, but I don’t want anyone to fear this. This is natural. This is normal.
Kate Bowler: I really like that. Also, part of embracing education sounds like being just aware that there is an enormous gap between best practices and when it might show up in your average primary care doctor’s office.
Mary Claire Haver: So that’s a huge problem, is we have this gap between educating the population and them being, okay, I’ve got my resources, my tools, now I’m ready to go have an informed conversation and then you hit a closed door. So what do you do? Okay. Well, we have some stop gaps. So one of my big initiatives is we need legislation around mandatory menopause education in all of our clinical training programs, like. It’s ridiculous. Menopause shows up in the ER. Menopause shows up an orthopedic surgery. Menopause shows up and cardiology. Like none of them are getting any menopause education. Yeah. Right, and how this loss of estrogen affects these different specialties. This has got to stop. Like menopause is a longevity event. I really think we need legislation that will mandate that our training programs or any clinician who touches a female after reproduction ends, this has to be part of the curriculum. So, then there’s these great telemedicine companies, who, I’m not being paid, who are developing menopause care, evidence-based menopause care. So, you know, they are speed-educating their providers to make sure they have all the necessary knowledge in order to do menopause care, so I think we have some stop gaps, you know to help us, you now, and then hopefully by the time like my daughter’s 25, she’s a fourth year med student, you know hopefully by this time she’s out and practicing this like in her ER rotation, this will be part of her training. Like how to recognize when, no one’s gonna expect her to treat menopause, but at least say, wow, this panic attack and these palpitations and these hot flashes you’re having are probably your menopause. Like, go see your menopause certified clinician, you know, instead of, yeah, all your labs are normal.
Kate Bowler: Yes, that’s right. People usually get stuck after the, your labs are normal, dot, dot, dot conversation. I just, thanks so much for the encouragement to like fill in the gaps about like just wanting to educate yourself, doing this kind of reading, being willing to start a conversation, if you haven’t had one already.
Mary Claire Haver: We’re seeing this across so many aspects of women’s health. Endometriosis, a woman will go almost a decade before she’s diagnosed. Polycystic ovarian syndrome can look like so many other things, like autoimmune disease. We’re just missing the boat in women’s heath, and thank God for the internet, because that’s where women are educating themselves–some good, some bad, right? But I think it’s so important that whatever, you should never suffer. You deserve to live this beautiful full life and not have this stuff weighing over you, whatever your diagnosis or you know is, and that if you’re a woman seeking care in the health care system, no matter what you have, you need to educate yourself because you may know more than your provider. Especially in the diseases that affect women more than men.
Kate Bowler: Yes, which are dramatically underfunded. It’s such a funny way to end when I use my low voice for sad truths. Yes. Dramatically underfunded. But thank you so much for this conversation. I feel like this was an intervention and I think you handled it. You handled my deep secret reluctance very well.
Mary Claire Haver: It’s coming but it doesn’t have to be. Well one of my things is menopause is inevitable, suffering is not.
Kate Bowler: Yeah so yeah thanks for doing this with me.
Mary Claire Haver: You’re so welcome.
Kate Bowler: If there’s one thing I’m taking away from this conversation, it’s that every time I allow reality to actually sink in instead of ignoring it, I feel better. Information is just that, information. It’s not a verdict, it’s not license to panic, it’s just something that we can use to make the next right choice, to ask better questions, to advocate for ourselves, to take care of our fragile, normal, finite bodies that are carrying us through this very normal, finite, fragile season of life. So if you’re looking for practical help, Dr. Mary Claire Haver’s book on paramanopause is full of very evidence-based guidelines, including really helpful scripts on like–talking to your doctor, figuring out what questions to ask. So we’re going to link to all of her work in our show notes. And here’s just a little blessing for you, if you’re just feeling like your body is…not what you would have picked if you were putting bodies together. It’s just a little blessing for accepting our finitude, our strangeness, our aging as a very normal and you know God-made thing. May you remember that aging is a privilege even on the days when it doesn’t feel like it. May you meet your changing body with more curiosity than criticism. May you find people who listen when you say, “something’s not right.” May you welcome each new birthday with gratitude. And may you take care of your body, not to chase youth, but to give yourself every chance to show up for the life and people that you love. Alright, my darlings, thank you so much for listening, or if you’re watching on YouTube, and if you wanna watch on YouTube, come find me there. This episode is taped on location at the Aspen Ideas Festival Health, and I’m so grateful for that team. They are so kind, so thoughtful, they bring together leaders to expand the mind, move the body, ignite the spirit. Everything Happened Studios has made possible through the generous support of Lilly Endowment. And a huge thank you to my team who I love. They do the impossible every single day. It’s Jess Ritchie and Harriet Putman and Anne Herring and Hailie Durrett, Megan Crunkleton and Katherine Smith. Thank you. This is Everything Happens with me, Kate Bowler.
