Transcript of The #1 Menopause Doctor Masterclass: How to Lose Belly Fat, Sleep Better & Stop Suffering Now! Dr. Mary Claire Haver

That is a big breakthrough. That right there. I'm going to jump out of my seat, Dr. Mary Claire Haver, because the number of people listening right now that are going to be like, Holy shit. Wait a minute. Yeah. Maybe I need to go in and ask for these tests and understand what's really going on with my body.

I went through the end of perimenopause and menopause and was absolutely blindsided and started digging into the science and the literature. I was just shocked. It was a little bit rage of, What are we doing? I'm supposed to be helping these women, and these women are suffering.

Right now, 1. 2 billion women are in perimenopause or menopause. Whether or not you're experiencing this personally in your life right now, I guarantee you someone in your life is.

It's not just weight. This is heart disease, dementia, diabetes, and stroke, and musculoskeletal pain, her entire quality of life. Their libido takes a hit sense of worth. One in five women are quitting their jobs. A lot of marriages break up. We're ignoring this.

So you're a doctor. Physician? And you are realizing, wait a minute, how I was taught to treat my patients going through menopause or even to handle yourself going through perimenopause, menopause. This isn't working.

No. Across the menopause transition, a woman can expect to have a 40% increased risk of a new mental health disorder, either anxiety or depression or even ADHD symptoms. But we're just telling her, Oh, you're depressed, and here's an antidepressant. Oh, you're not sleeping, here's a sleep aid. No one's knowing to connect the dots.

So many women are going to connect with this, whether they're in perimenopause or about to be. And how do you know if you are? What are the three stages? What are so many of the symptoms? Oh, my gosh, they go, ignore, they go, misdiagnosed. We think it's something else. I'm so excited. I'm going to jump out of my chair.

Hormon therapy not only is safe but preventative and beneficial. Why aren't we talking about why doesn't the world shop this from the rooftops? I promise you, you walk into nine out of 10 doctors' offices today. Good, board-certified, well-meaning, loving, caring, incredible doctors, and they have it totally wrong on menopause and hormone therapy.

Nine out of 10.

I've talked to now thousands of clinicians, How much menopause training did you get in medical school? We maybe got a one-hour lecture. One hour on menopause. This is affecting 100% of women who live long enough for the last third of their lives.

That blows my mind. So if you're 36, you're 41, you might be having anxiety, depression, all of these other things happening. So you go in for that, and you're not checking your hormones. You're not thinking, Am I in perimenopause? So you go in for that. You're thinking, I'm anxious. You're going to treat it for that.

But nothing's changed in my environment.

And all these different things are happening to us. And we're going into doctors who aren't for the most part, trained in menopause. So we're not getting our hormones checked, probably not getting the correct test, or they think, Oh, you're in your 30s, your 40s, you're too young, and you're getting treatment for a symptom. Whereas what we could be doing and why your work is having such a profound impact on so many people is in our 30s, in our 40s. We're going to talk about this, but understanding the underlying thing. Where are all of our hormones at? Where is our estrogen at? Could that be causing these other things that we think, and so many women are taking it to an identity level of, Oh, I have this, I have that. I'm diagnosed with this, I'm diagnosed with that. But never actually the underlying thing that could impact whether you have any of those other things or not. There are so many girls and women of all generations listening to the show. When we look at the data, it's all generations. And one of the things that moves me to tears is when a woman will share it with her daughter, and then she'll share it with her grandma, and then she shares it with her girlfriend.

Whether you're a a man or a woman, menopause is going to affect you because it's going to affect 50% of our society. Right now, whether you or someone you love is experiencing perimenopause, which can start at 30 or even younger, or menopause, which can typically start in your 40s, 50s, or 60s, there is so much conflicting information about the subject. So few doctors are well-trained, and there's so many things our mothers didn't tell us or even know about it. And it's time that you feel informed about what's going on with your body, your brain, and your hormones. Today is your Menopause Masterclass, and you're going to lead this episode with your own Menopause toolkit, equipped with the info and tools you need that I know are going to impact your life today. Whether it's how to sleep better, understand what's a menopause myth and what's the truth, lose belly fat, or stop suffering Finally, my guest today, many call her the top menopause doctor on the planet, Dr. Mary Claire Haver, is going to take us from feeling powerless to powerful on everything your doctor forgot to mention on topics, including the exact tests you need to ask your doctor for during your next visit, the three stages of menopause, on what's actually happening in your body, on your changing hormones, on hormone replacement therapy, including the risks versus the benefits.

Should you do it? How and when? On belly fat and weight gain linked to menopause and what you can do about it right now, and on the surprising symptoms happening to so many women that go untreated and overlooked by the majority of doctors who just aren't as well-informed as they could be. Today is a master class from the master of menopause herself. Dr. Mary Claire Haver is a board-certified obstetrics and gynecology specialist and certified menopause practitioner from the Menopause Society. She's also a certified culinary medicine specialist from Tulane University, a best selling author of multiple books, including her brand new book, The New Menopause. She's also the founder of the Mary Claire Wellness Clinic. She's a mom of two, a wife, and a woman on a mission who says that while menopause is inevitable, suffering doesn't have to be. And she is here to help you and me today. I love a truly life-changing episode. I am so excited for this one today. Whether you're listening for yourself or because someone that you love shared this episode with you, I want to welcome you to the Jamie Kern Lima Show podcast family. And today, we are shedding light on everything your doctor forgot to mention to you about menopause.

And for everybody new to this episode, can you do me a favor? If you like the show and the guests that I bring you, please hit the subscribe or follow button on the app you're listening or watching on. It truly means the world to me. And thank you. I want to remind you, this episode is not just for you and me. Please share this with every single woman that you know, because what you are about to hear will change your life and hers. Welcome to the Jamie Kern Lima Show. Oprah, how have you defied the odds?

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Jamie, you're so inspiring. Jamie Kern Lima. Dr. Mary Claire Haver. Welcome to the Jamie Kern Lima Show. Thank you for having me. I am so excited you're You are impacting millions and millions and millions of women as we speak. And it is just an honor to have you here. I am so excited for this episode. We are not wasting a second. And I just want to open with asking you your mission and the work that you are doing to help so many women who are, in so many ways, either feeling lost or powerless or just suffering or trying to figure out what's going on with their bodies. Can you share for you personally? I know that this is really personal work for you and a passion of yours.

I didn't realize what I didn't know, and I was the expert. I was the board-certified OB/GYN. I blew the top off of my boards. I was a straight A student. I checked every box. When I went through the end of perimenopause and menopause and was absolutely blindsided and started digging into the science and the literature that had not been taught to me, I was just shocked. It was a little bit of rage of, What are we doing? I'm supposed to be helping these women, and I don't have the tools to do it. And these women are suffering. So my mission began, I started like you with zero social media followers. We all start with nothing, right? No one inherits a social media following. And So I just tentatively started talking about, I really started in the nutrition space, talking about weight gain and menopause, nutrition and menopause, because that was my biggest shock, was someone who always had been privileged all of a sudden had this... I was dealing with weight gain in new places that I had never experienced before, and all the tricks that had worked before, stopped working, and all the advice I had given to patients wasn't working for them and also wasn't working for me.

So that took me down all these rabbit holes. And as the conversation around weight gain and menopause the more I learn, the more I realize it's not just weight. This is heart disease, dementia, diabetes, and stroke, and musculoskeletal pain, and her entire quality of life. And what I realized is that the vast majority of women have this pivot at menopause where they have this loss of resilience, this loss of them, this loss of self, this loss of their libido takes a hit, their sense of worth. One in five women are quitting their jobs. And through the menopause transition. A lot of marriages break up through this point. And I thought, we're ignoring this, and we're treating it. It is a natural phase of life, but it is one that needs to be really understood. And I thought, I'm stealing the quote, but if not me, who? And if not, and when? Now. Let's do it now. Let's just start talking about it.

So you're a doctor. Physician? And you are realizing, wait a minute, how I was taught to treat my patients going through menopause or even to handle yourself going through perimenopause, germanypause. This isn't working. Can you take us through that moment? Because I think what you're going to share so many people can relate to because it's been their experience going to the doctor. They go in and then they get a prescription for something that has nothing to do with what they're going through. And then they're still suffering. And this is just so insightful for you to shed light on your experience as to the doctor realizing, wait a minute, how I was trained and what I know so far isn't working for my patients. It's not working for myself.

I was taught that menopause caused three things: hot flashes, Some genital urinary symptoms, dryness, recurrent bladder infections, et cetera. And your bones got weak. You lose bone mass as you age. And that was it. And if you wanted to treat those things, you treated them almost in isolation. We didn't look at the root cause, the estrogen decline. I learned nothing about estrogen's effect on the cardiovascular system, on the brain, on the musculoskeletal system, on the lungs, on the kidneys, on the gut. When I realized it's all tied together, and really in OB/GYN, we mostly focus on just vasomotor symptoms, which are hot flashes, basically. If you just treat just hot flash, you only consider hot flashes to be the pinnacle of treatment of menopause, we're really doing a disservice to women. The more I talk about it, the more women are like, Oh, my God. Really, when I was researching for the new menopause, women would reach out to me on DM, social media, or in my clinic, Could my frozen shoulder be related to menopause? Could my eczema be related to menopause? Could my recurrent UTIs be related to menopause? Could my loss of libido be related to menopause?

I would say, instead of saying, No, no, no, I'd say, Let me get back with you. And really, as a clinician, what shocked me was the data is there and very, very clear, but no one's talking about it or sharing it on a larger platform. I thought, women are suffering needlessly, and we're not addressing really what's happening. For the mental health changes, for example, which 40% of us have across the menopause transition, a woman can expect to have a 40% increased risk of a new mental health disorder, either anxiety or depression or even ADHD symptoms. We have the psychological impact and the cognitive impact. But we're just telling her, Oh, you're depressed, and here's an antidepressant. Oh, you're not sleeping, here's a sleep aid. Oh, you're having musculoskeletal pain, take some non-steroidal. And no one's knowing to connect the dots because we're not training them. She's walking out with six, seven prescriptions to treat each of the symptoms of her menopause. It's a whole paradigm shift to think, let's stabilize and/or replace her hormone levels and see what gets better. And then we'll address the rest after.

To have this epiphany as a doctor and then looking at the industry and also just your own experience. Can you share? Because I know so many women are going to connect with this, whether they're in perimenopause or about to be or don't even know if they are yet. We're going to dive in, by the way. And how do you know if you are? What are the three stages? What are so many of the symptoms that, oh, my gosh, they go missed, they go ignored, they go misdiagnosed. We think it's something else. And I'm so excited. I'm going to jump out of my chair. Okay. But before I get into that, can you share just a little bit about your own experience of perimenopause for you personally, and then also menopause. And how was your experience with your own doctors you were going to at the time?

So I was on continuous birth control pills, meaning I skipped the placebo week and just suppressed my periods. For my entire reproductive life, I've suffered from polycystic ovarian syndrome, and I had the thin kind that doesn't respond to dietary changes as well. I did great with it. I felt great. I felt much better than I did when I was off of them. Of course, I had fertility issues. Both my kids were fertility babies, and thank God they're here. I've had miscarriages and all the things. But I have two healthy, beautiful, perfect children, and thank God. When I was about 48, I was making the decision with my practitioner. My nurse practitioner who I had worked closely with, was my doctor. I said, I think I'm going to get off the pill and see where I'm at. Let's get some blood work and see where I am in my menopause journey. Because I was thinking about bone density and hip fracture risks moving forward, not thinking about cardiovascular disease and mental health and all that. At the same time, my second oldest brother, my oldest brother died when I was nine from leukemia. My second oldest brother was very ill from hepatitis and HIV.

And there was a lot of back and forth for his end of... I didn't really think it was end of life. It was, But multiple hospitalizations for this complication and that complication. I get a call when I'm... I just stopped the pill and my body's trying to figure out where it's at. I get a call in the OR, so I'm operating, and they called three, four, five times. So the scrub, whoever was circulating, picked up my phone, put it to my ear, and they said, Your brother's in a coma, and you should come home. I remember, and I just repeated what they out loud to the OR team. And they called one of my colleagues to come down because I was really struggling. I had to finish the surgery. I'm not going to let the patient die. But you could tell my brain was distracted. And they were like, Okay, we're going to call in Dr. X. One of my colleagues came in. We got to where we knew the patient was going to be fine. I got through the critical part of the surgery, and he's like, I'll close, scrub out, go home. I rush home.

Home is 4 hours away, so to my hometown. He had had a stroke, and they were going to move him home for hospice. That was really hard. I called my husband and the kids. They start coming towards Louisiana because we were in Texas. I'm also in menopause or very late perimenopause. I don't realize it. I'm going through this incredible grief process, this man that I just worshiped and loved, but had to love him through some poor health choices. Despite his choices, I still had to love him and then now deal with his death. We had this beautiful death, three days, all the family and friends at the bedside singing. Of course, he's in a complete coma, and my sister and I are doing all the physical care for him. She's a hospice nurse. Then just the devastation when he passed, and I didn't realize it, but I was also having hot flashes, night sweats, depression. My brain wasn't functioning the way it should, but I was so overwhelmed with grief, I couldn't realize it in myself. So we get through the funeral, we go home, and a couple, three months go by, and I'm struggling, struggling, struggling with weight all of a sudden.

I'm starting to put on weight in my midsection. I'm not sleeping. I'm getting up in the middle of the night, and I'm like, Okay, you're just depressed. Bob died. Everything's fine. And certainly the grief was a part of it. We get to about month six. I'm still really struggling with weight and really sleep disruption and snapping at my kids and just being really short and just don't feel like myself. I realized my grief is lifting. This is not grief anymore. This is something else going on. I was like, Wait, when was my last period? It was six months ago. I couldn't even diagnose myself, Jamie. I was the expert. And rushing to Dora, my nurse practitioner, and we get blood work. And yeah, my levels were all fully menopausal. And I was like...

We need to pause for a super brief break. And while we do, take a moment to share this episode with every single woman that you know, because this information can truly change your life and hers. In life, you don't soar to the level of your hopes and dreams. You stay stuck at the level of your self-worth. When you build your self-worth you change your entire life. And that's exactly why I wrote my new book, Worth: How to Believe You are Enough and Transform Your Life for You. If you have some self doubt to destroy and a destiny to fulfill Phil, worthy is for you. In worthy, you'll learn proven tools and simple steps that bring life-changing results, like how to get unstuck from the things holding you back, build unshakable self-love, unlearnt the lies that lead to self-doubt, and embrace the truths that wake up worthiness, overcome limiting beliefs and imposter syndrome, achieve your hopes and dreams by believing you are worthy of them, and so much more. Are you ready to unleash your greatness and step into the person you were born to be? Imagine a life with zero self-doubt and unshakable self-worth. Get your copy of worthy, plus some amazing thank you bonus gifts for you at worthybook.

Com or the link in the show notes below. Imagine what you do if you fully believed in you. It's time to find out with worthy. Who you spend time around is so important as energy is contagious, and so is self-belief. And I love to hang out with you even more, especially if you could use an extra dose of inspiration, which is exactly why I've created my free weekly newsletter that's also a love letter to you, delivered straight to your inbox each and every Tuesday morning from me. If you haven't signed up to make sure that you get it each week, just go to jamiekernleema. Com to make sure you're on the list, and you'll get your one-on-one with Jamie weekly newsletter and get ready to believe believe in you. If you're tired of hearing the bad news every single day and need some inspiration, some tips, tools, joy, and love hitting your inbox, I'm your girl. Subscribe at jamie kharanleema. Com or in the link in the show notes. Do you struggle with negative self-taught? Living with a constant mental narrative that you're not good enough is exhausting. I know because I spent most of my life in that habit.

The words you say to yourself about yourself are so powerful. And when you learn to take control over your self-taught, it's life-changing. And I wanted to give you a free resource that I created for you if this is something that could benefit your life. It's called Five Ways to Overcome Negative Self Talk and Build Self Love. And it's a free how-to guide to overcome that negative self-taught to build confidence and develop unshakable self-love so that you can dream big and keep going in the pursuit of your goals. Don't let self-sabotaging thoughts hinder your progress any longer. It's time to rewrite the script of your life, one filled with self-love, resilience, and unwavering belief. If you're ready to take charge of your narrative, build unwavering confidence and empower yourself to persevere on the path to your dreams, you can grab your free guide to stop overthinking and learn to trust yourself at jamiekernleema. Com/resources, or click the link in the show notes below. And now more of this incredible conversation together.

I couldn't even diagnose myself, Jamie. I was the expert. And rushing to Dora, my nurse practitioner, and we get blood work, and yeah, my levels were all fully menopausal. And I was like, What? I'm too young. I'm 48. What's happening? And no, I was absolutely fully menopausal. I didn't even know the normal age range of menopause. That's how little education I had. I knew the average age was 51, and I thought I had till 51. I had taken care of women like this my entire career. I realized I was a terrible menopause doctor. What do I not know? And that took me down the rabbit hole. My The change of my mind on... So I went on HRT extremely reluctantly because I thought it would increase my risk of breast cancer.

Hormone replacement therapy.

Yeah, hormone replacement therapy. And I was terrified to do it because there's so much cancer in my family. But I was like, I can't live like this. So if it takes a couple of years off my life, it's a gamble, but I'd rather have a better quality. I cannot live like this. Something got to go. Go on hormone replacement therapy immediately. The world calms down. I'm sleeping again. The weight was another story. Sorry, that's a whole other book. But I felt like I got my resilience back, my ability to cope with what was in front of me. Then I went to my first menopause conference, and it was in New York, or actually it was in Santa Monica. I was going to present about nutrition and menopause. It was lots of experts there, women I'd never met who I was starting to follow. This was the beginning of the menopause. I see Avril Blooming and Sharon Malone and Dr. Carol Taveras on stage talking about the safety of hormone replacement therapy and how wrong the women's health initiative was and how many of those things have been walked back. I was tears. My daughter was with me.

She was applying to medical school. Tears falling down my eyes. And she's like, Mom, are you okay? I'm like, Katherine, I didn't know. I didn't know. I didn't know. This is my job. I am the expert. I did not know that for the vast majority of women, especially at this age, hormone therapy not only is safe but preventative beneficial. And why aren't we talking about why doesn't the world shop this from the rooftops? And that was really like, that was the moment, the light bulb, where I was like, this is my mission. This is my mission to share this as far and wide as I can.

Because you had the aha moment that you're this incredible doctor, and you're like, I didn't even know these things. And then you're watching three other doctors talking about their research on hormone replacement therapy. You're seeing how it impacts you. And you're like, why isn't this being talked about? Why don't people know about this?

Know how safe it is. I promise you, you walk into nine out of 10 doctors' offices today. Good, board-certified, well-meaning, loving, caring, incredible doctors, and they have it totally wrong on menopause and hormone therapy.

Nine out of 10. Why do you think there's so little information out there? And nine out of 10 doctors, you say, have got it wrong. Why do you think there's just so little information?

So when I look I've talked to now thousands of clinicians, how much menopause training did you get in medical school? Because in the US, we do a four-year medical school curriculum. Then we go off and do our specialty training, which is 3-10 years, depending on what you do. How much did you get? We maybe got a one-hour lecture, one hour on menopause. This is affecting 100% of women who live long enough for the last third of their lives. This is not a niche boutique. This is all of us. I got one hour of the most basic, basic, basic information in medical school. Then I go into my OB/GYN residency, a four-year curriculum, and over 50% of the time is spent in obstetrics, very important, super proud of what I learned. I spent four years learning how to deliver babies safely and all the complications and how to shepherd someone through a healthy pregnancy and deliver in the postpartum and everything. Then everything else gets shoved in the gynecology box, and that includes pediatric gynecology, that includes reproductive endocrinology, getting people pregnant, seeing people with having chromosomal disorders and how we manage that, down syndrome, how that all affects females.

Menopause got shoved into a tiny, the smallest little sliver in a tiny box. We got six hours of lectures in four years of curriculum. We had no menopause clinics, no clinically relevant menopause training. Then in my last year, we had the women's health initiative being released, and basically anything clinically... Hormotherapy was taken off the table as an option, unless in the most severe cases, and you really tried to do everything else before you give her hormones because we were all terrified that we would give her breast cancer. And it was never true. Never true.

We're going to dive into hormone replacement the therapy, into the myths, into the truth, into every option that exists, into what you do right now, day to day, all the applications. Who's it for? Who's it not for? When do you start? How long do you do it? I'm excited about I'm not sure what you're thinking about this, but I want to just tap into something you just said that blows my mind. So your four-year medical degree, one hour of menopause training, and then your four-year specialty in OB/GYN, six hours. Six hours. Six hours. So seven hours total in eight years. In eight years. How common is that? What is the average, would you say, across every doctor?

It's very common. If menopause Menopause. So in an OB/GYN residency, if menopause is included, it's an elective. So like a menopause clinic. There are menopause... It's getting better, but we have a very long way to go.

And tell me if this perception is accurate or not. But when I think about doctors, because there are so many just rock star, amazing, good-hearted, hardworking, incredible doctors who are day in and day out treating their patient. They don't have time to go be doing a whole bunch of other.

To get, you have to step outside of the box of your training. So I am board certified. I have remained board certified by reading 114 articles a year and taking a quiz on each one to make sure I understand. So the American Board of OB/GYN puts out a beautiful set of articles on the latest and new updates and everything, and probably less than 3% have anything to do with menopause. And a lot of them are elective because we subspecialize in OB-GYN. So a lot of people do just surgery or just obstetrics or high-risk OB or whatever. And so you can even opt out of the few menopause articles that are out there. So the American College of OB-Gene, the American Board of OB-GYN, I mean, I hate to call them out for this, really have not prioritized it. The Menopause Society, which I did not know existed until three years ago, was a rogue group of clinicians who said, Hey, no one's focusing on menopause. They started their own society and started making their own guidelines. The American College of OB/GYN and the Menopause Society are not connected. In 2022, the Menopause Society updated their Menopause Hormone Therapy Guidelines away from the old It's probably going to be dangerous.

Give her the smallest amount for the shortest time possible, too. Probably beneficial for most women. We've got a window of opportunity for cardiovascular disease, probably. There's no age at which you have to stop. But ACOG's guidelines have not been updated since 2014. They still say the exact same thing. So most OB-gens don't even know about the Menopause Society. They think they're doing a good job because that's what they were taught, and they passed. That was me. But all of a sudden, you realize Wait, I maybe don't know what I'm doing. Your patients are coming in with questions or, God forbid, a video of me or a medical article I tell them to print out and hand to the clinician. But they are so busy. I mean, things in medicine with the corporatization and administrative burden have just gotten to the point where the burnout is terrible in multiple areas of medicine. You cannot lay the fault. This is a systemic problem. These are good doctors working really hard doing what they were trained to do, and they just don't They just don't have the time.

They just don't have the time. We're going to link to the Menopause Society and every other resource, by the way. And we're also going to dive into in this conversation, how do you prepare for your appointments? How do you know the questions to ask? What test should you ask your doctor for? We are going there today, which I'm so excited about. But I just want to call this out because we already have a challenge in our country, and I would say every country around the world, but we have a challenge where if we are fortunate enough to have what we consider a great doctor that our insurance actually covers, there's still a very high probability they've had little to no training on menopause.

Clinically relevant menopause training.

For everyone listening right now, a lot of people start experiencing perimenopause symptoms in their 30s, or it could be younger, it could be... And then menopause. I want to break this down for everyone because, again, as a woman going into a doctor, we're not learning finding these things. I also think sometimes there's now so much information online, so much of it's not vetted, that in a single Google, we can all read all about the wrong info and not know if that's right. And we go to our doctor who maybe if we're blessed, is amazing, but they don't have time or they actually don't have the experience. So I want you to break this down, and I'm so grateful to have you here today doing this for each one of us. But can you break down the three stages? Sure. Perimenopause, menopause, postmenopause. What are they? How do we know if we're in them?

All right, let's start with menopause, and then we're going to work our way backwards and forward. Okay. So menopause, guess what? Is one day in your life? One day. Everything after is postmenopause till the end of your life. And then the 17, 10 years-ish prior to that is perimenopause. Menopause is medically defined, and this is a problem, as one year after the final menstrual period. But it represents something much bigger than that. It represents the end of the production of hormones from your ovaries. What most women don't understand, and what I love to teach, is that we're very... Females are different than males in multiple ways, but let's talk about endocrinology. Females are born with all of their eggs. You were born with a set amount of egg supply, and your maximum egg supply was when your mother was pregnant with you at five months gestation. And then they start going through a process of a trezure, which is an aging process, so that the healthiest eggs survive, right? And then when we start ovulating at 11, 12, 13, 14, however old, to get that one egg to ovulate We lose about 10,000 in the process.

So Jamie was born with 1-2 million eggs. And by the time you were 30, you were down to 10% of that, about 120,000 on average. By the time you were 40, you were down to 3% of your original surprise.

3% of your eggs left by 40.

Yes, on average. Okay. And then menopause represents no more eggs. And how do we ovulate? What is that process? Actually, ovulation begins in the brain. So there's a gland in our brain called the hypothalamus, and it is constantly checking the blood every day for estrogen levels. And when the estrogen levels get low as in a normal cycle, so most women have seen the normal menstrual cycle hormones where we have a surge of estrogen mid-cycle and then progesterone surges on the second half. And that is like a very EKG-like ebb and flow that goes month after month after month, no problem in a healthy woman. When you get to perimenopause, we reach that critical egg threshold. We're just down to enough where the signal is coming from the brain saying, Hey, give me the estrogen. Stop working as well. So the ovaries can't respond. They don't have enough of the eggs because around each egg are something called follicular cells and granulosa cells, and that's where the hormones are produced. So we're running out of those units. So the hormones go down from the brain saying, Give me, give me eggs, give me estrogen. And the eggs are like, I don't have enough.

Sorry. And then the brain goes, Wait, I need my estrogen. So it makes higher hormone levels coming from the brain. And that's when we get into the chaos. So what used to look like this beautiful EKG every month now becomes chaos. Estrogen levels surge higher than we've ever seen in your whole life, and then they crash. And progesterone never gets where it used to be. So it used to look beautiful is now spaghetti. I literally take a pile of spaghetti and throw it off the wall. And that is what your hormones are doing for a 7-10 year process until you just run out of all the eggs, then everything flat lines for estrogen and progesterone.

So many questions here. I know you've been mentioning heart disease, diabetes, all these different conditions. And what so many people know is that when you don't have your hormones balanced and when you go through menopause and you may be deficient in hormones, it can impact and potentially cause so many other things.

Multiple organs.

Multiple organ systems.

It accelerates the aging process. So our ovaries age twice as fast as most other organs in our body. And when we lose the benefit, so estrogen turns out, is insanely protective of our liver, of our joints, of our brains. Kidneys, gut, all of it. We work better as humans, female humans, with estrogen on board. It's just the way it is. That gets taken away, goes chaotic and gets taken away. Let's go organ system by organ system.

This is starting in perimenopause.

It's starting in perimenopause. In perimenopause. And really, for a lot of women, the symptoms are worse, especially mental health and cognition in perimenopause. Our brains hate chaos. Our brains love to know there's a system. Everything's working. This is coming, that's coming, and it's It's going to go over and over and over again. In perimenopause is when we see the most rapid expanse of bone loss, the most rapid expanse of muscle loss, and the most rapid increase in mental health changes in the forms of anxiety and depression, and where we see the worst brain fog. All of that tends to stabilize. We get this rapid expansion and then stabilization in postmenopause. Still not great. Then we go back on to normal aging.

When you're estrogen, your brain's saying, We need more estrogen, then it's surging, then it's plummeting.

So guess what? Estrogen and progesterone, and as well as testosterone, actually directly affect our neurotransmitters, dopamine, serotonin, norepinephrine, gabba, all these important chemical signals in our brain that keep us functioning. So there's this fascinating study that just got released, and I'm researching for the new book right now. And it's called, I Just Don't Feel Like Myself in Perimenopause. And they actually quantified it, and it stopped me in my tracks.

We need to pause for a super brief break. And while we do, take a moment to share this episode with every single woman that you know, because this information can truly change your life and hers. Who you spend time around is so important as energy is contagious, and so is self-belief. And I love to hang out with you even more, especially if you could use an extra dose of inspiration, which is exactly why I've created my free weekly newsletter that's also a love letter to you, delivered straight to your inbox each and every Tuesday morning from me. If you haven't signed up to make sure that you get it each week, just go to jamiekernleema. Com to make sure you're on the list, and you'll get your one-on-one with Jamie weekly newsletter and get ready to believe in you. If you're tired of hearing the bad news every single day and need some inspiration, some tips, tools, joy, and love hitting your inbox, I'm Your Girl, subscribe at jamiekernleema. Com or in the link in the show notes.

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So there's this fascinating study that just got and I'm researching for the new book right now, and it's called I Just Don't Feel Like Myself in Perimenopause. And they actually quantified it. And it stopped me in my tracks because I was like, Wait, this is what my patients are telling me. And now they've done a study, and this is a thing. I just don't feel like myself is good enough. Because forever, I mean, besides the lack of education in menopause, the other systemic problem is that there is a bias that women tend to somaticize A biological process. So basically what's coming from... They don't recognize that as biology. They think it's psychology that's causing the problem.

They think it's all in my head. All in her head. It's all in my head.

Yeah. Or doctors think it's all in her head. Women just go through this. This is the age. But no one ever stopped to say, Why are all women going through this at this age?

I want to call it something really big because I don't want it to be missed at all. So if the average age of menopause, you're saying it's about 51?

51 for For us, for Caucasians. Actually, Asian is a little bit, tiny bit older, African-American women, a year and a half younger, Southeast Asian women, 46, 48 is the average age of menopause. So if Perry, when the brain is like, Am I right? It 7 to 10 years before that, it is completely reasonable for a woman in her 30s to be waving a flag going, I'm not sure what's going on, but I don't feel okay.

Here's the big aha I'm having right now that may be a big aha as well for everyone listening. So if You're 36, you're 41. You might be having anxiety, depression, all of these other things happening. So you go in for that. And you're not checking your hormones. You're not thinking, Am I in perimenopause? So you go in for that.

You're thinking, I'm anxious.

You're going to treat for that.

But nothing's changed in my environment. And all these different things are happening to us.

And we're going into doctors who aren't, for the most part, trained in menopause. So we're not getting our hormones checked, probably not getting the correct test. Or they think, Oh, you're in your 30s, your 40s, you're too young, and you're getting treatment for a symptom. Whereas what we could be doing and why your work is having such a profound impact on so many people is in our 30s, in our 40s. We're going to talk about this, but understanding the underlying thing. Where are all of our hormones at? Where is our estrogen at? Could that be causing these other things that we think, and so many women are taking it to an identity level of, Oh, I have this. I I have that. I'm diagnosed with this. I'm diagnosed with that. But never actually the underlying thing that could impact whether you have any of those other things or not. That is a big breakthrough.

It is a huge breakthrough.

That right there. I'm going to jump out of my seat, Dr. Mary Claire Haver, because the number of people There are people listening right now that are going to be like, Holy shit. Wait a minute. Maybe I need to go in and ask for these tests and understand what's really going on with my body. Because what they think is going on with their body might just be a symptom of something else that's not being treated or even recognized.

So in the new menopause, which was really driven by my followers, people asking me questions, Could this be related to my menopause? Instead of saying, No, I was like, I don't know. Let me dig. We have 77 symptoms in this book. And I go through the why and the pathophysiology. These things were, I didn't make this up. These are actual papers written. But because menopause is in the word, they tend to be buried in obscure journals. Let me give you some perspective here from a medical standpoint. When you go to PubMed, which is the database for peer-reviewed medical journal articles, right? So as a physician, as a clinician, as a researcher, this is where I go to find the good stuff, right? And I type in the word pregnancy. We have 1. 1 million articles come up. Amazing. Important. That is brainpower research, NIH dollars. To generate that research takes money, takes investment, takes time, takes commitment. Okay, let's type in the word menopause. Knowing more women will go into menopause than have children, then be pregnant. It is right now about 98,000. So more than 10 to one. Difference. Okay. Let's type in the word perimenopause.

I did this yesterday. 6,800. More women will go through perimenopause than menopause because we're going to lose some due to accidents or and timely deaths. That's where we are.

And one of them will go through perimenopause.

And if you think about what that represents, focus, the whys, the hows, the wens, and that is what we're fighting to change.

So Dr. Mary Claire Haver's book, The New Menopause, her upcoming book, The New Perimenopause, which I am also equally very excited about. I want to ask you, because this is a shocker, you say there's over 70 symptoms. Most of us, we think, Oh, hot flashes, and that's it. And then, right, that's what the doctor asked. That's what I was taught.

That's what you were taught. And then in a few years, your bone density will check bone density at 65. Oh, and then something might happen, your vagina get dry. But we got some cream for that.

Yeah. Okay, share with us, because so many people are listening are like, I feel like they're- Lightning bolts are going off.

Yes.

Share with us some of the symptoms that so many women share with you they have, and they didn't realize, Oh, my goodness, this is a symptom of perimenopause, or this is a symptom of menopause. It could be.

I'm going to go top to bottom, so keep my head straight because you know menopause. So brain. Our brains, we have psychological changes, and then we have cognitive changes. In the psychological change, we have a 40% increase in mental health problems, usually anxiety and/or depression, across the transition through perimenopause. Now we know some incredible data coming out of Australia that stabilizing those hormones with hormone therapy is better to treat her than giving her an antidepressant or the traditional treatment for anxiety and depression, that she deserves a trial, and maybe the two can work together. If you have a patient who's like, Listen, something is wrong. Nothing has changed in my... Because I'm like, Death in the... All the stressors. She said, No, I handling my life. I had it, and now I don't. I've lost my resilience. I'm anxious. I'm snapping. I can't sleep. My mind is racing. I'm getting up in the middle of the night with a Rolodex of every bad thing I've ever done in my life, every mistake I've made, every person whose feelings I hurt, and I can't turn it off. And this is not normal for me. And what we weren't trained to do as clinicians is listen to the woman saying, This is not normal for me.

And I was taught to think, This is just what women I've gone through. And I think it's absolute bullshit now that I've gone through it. And it wasn't fair. It wasn't fair.

Can you talk about... I want to ask you about a WW in a second. This is a big one. I'm telling you. But really quick, can you share, too? Because I know frozen shoulder.

So we'll keep going through.

Keep going because I want everyone to know.

Cognitive brain fog, word salad, forgetting. I just saw a politician being made fun of for word salad. I'm like, She's in menopause. Give her a break. One in five women in the UK are quitting their jobs because of untreated menopause. We think one to 10 or more in the US. This is a big deal. These women are high functioning, leaning into their jobs, empty nesting. They're ready to give all their knowledge and expertise and wisdom, and then suddenly they're absolutely hamstrung by the cognitive changes associated with menopause. Good news there is that it does tend to stabilize, but it could take a few years. And so many walk away away from a career because they just don't feel like they can do their jobs. I'm talking surgeons, lawyers, school teachers. And how many marriages are being affected by this? How many relationships with my daughter? My daughter joked that I survived mom's perimenopause when I was a… You survived my teenage years while I survived your perimenopause. I was like, That really wasn't fair. For us to both be going through that at the same time. Then as we moved down the musculoskeletal system, so My dear friend Dr. Vonda Wright, incredible clinician, she's writing a book called Unbreakable right now.

She wrote the paper, The Musculoskeletal Syndrome of Menopause. There were two researchers from Duke University a couple of years ago, a couple of years ago, and it was the head of the OB-GYN Department and the head of the orthopedic surgery department. There's some lure here, but I think they were at lunch in the cafeteria or something at the hospital. We're talking about all the frozen shoulder and the ages, and they're like, Do you think that could be related? They just pulled charts and did a review study and found, wow, yeah, it's definitely elevated in this menopause situation. And if they're on hormone therapy, they have it less, less frequently, less often. They could not get it published in a single orthopedic journal, but they got it published in a menopause journal, and it set the world on fire. Then Vonda Wright went in and wrote another paper all about detailing the pathophysiology and all the mechanical things, and everyone went crazy because no one in the orthopedic world could recognize that frozen shoulder is absolutely Absolutely related to the loss of estrogen. So besides that, arthralgia's joint pain. In my world, in the menopause, we think that probably a significant, maybe 80% of fibromyalgia is actually misdiagnosis, and it's really Musculoskeletal syndrome of menopause.

Wow.

Yeah. Then if we look at the gut, so work done by Zoe out of the UK, they collected still samples on a billion, not a billion, but several thousand women across the menopause transition and looked at the gut microbiome and saw, my God, across the transition, she loses diversity of her gut. She loses the healthy bacteria, and her gut now looks like a man's. We enjoyed all this protection, this better health, this slower track to cardiovascular disease and gut health and brain health. And now we blow past the men.

And get dysbiosis can impact every part.

Yeah, every part. How you metabolize drugs, how your brain functions, where the serotonin is made. I mean, it all works together. So our genital urinary system, we, Rachel Rubin did her study. They looked at a chart review and said, if we went into the nursing homes and gave every single woman vaginal estrogen prophylactically, we could prevent 50% of Eurocepsis hospital admissions and save these poor women. Incontinence, urgency, frequency, and recurrent urinary tract infections. The number one treatment for a woman, if you No one hears anything but this today. For recurrent UTIs in her perimenopause journey is not recurrent antibiotics. It is vaginal estrogen, giving your body back the hormone that kept those tissues healthy. Treat the root cause. Besides the cosmetic things, the skin and the hair, and we lose 30% of our collagen in the first five years of menopause.

Wow. And we're going to dive into hormone replacement therapy as well. Can just This high level, can hormone replacement therapy and getting your hormones back to where they are ideal, can that, in most cases, resolve most of these things you just listed?

Yes, that's what it's looking like. I mean, we are still aging, and no one denies that. We're still going to have certain disease processes. But all hormone therapy is going to do is put you back on the track that you were on and just take menopause out of the equation. I joke, nothing is better than your 25-year-old ovaries, and I can't put those back inside of you. Hormone replacement therapy is good, but it's not perfect. Not the same doses work for everyone. We have a lot of trial and error in how we prescribe it. But my goodness, in my clinic and all the women who stopped me in the bathroom in every airport in America, telling me how it gave them the courage to ask or taught them how to find a clinician who's educated. Then they were able to go and determine for them, make a decision for themselves if this was right for them and how So many aspects of their life are better that they didn't realize would get better because they didn't know that whatever they were suffering from could have been related to menopause is unbelievable to me.

It's such new information also for so many women And I want to just highlight one thing you mentioned earlier as well about our eggs. We're all born. We're all born with the full number of eggs we're ever going to have in our ovaries. And you said by the age of 30, 90 % of them are gone. We only have 10 % of our eggs. And then you said by the age of 43 %.

Three %. Three % of our eggs are left.

And then you said by the age of 43 %? 3 %. 3 % of our eggs are left. I want to call this out because in my journey of my husband and I trying to get pregnant, and I had many miscarriages and went through fertility And I'll never forget sitting down and seeing the chart. I had no idea that our eggs declined so quickly and that we lose so many of them. And I remember making the decision vision in my 30s to do egg retrieval because I'm like, Oh, my goodness. At this point, I think at that point, I had 5 % left, and I was like, Wow. And then the quality also can rapidly decline. The quality declines as well. Can you just share, and we're going to dive in deep into hormone replacement therapy. I want to talk about how estrogen, you guys, estrogen impacts literally almost every part of your body.

In a positive way for most of us, yeah.

So I'm excited to dive into that. But there are so many girls and women of all generations listening to the show. When we look at the data, it's all generations. And one of the things that moves me to tears is when a woman will share it with her daughter, and then she'll share it with her grandma, and then she shares it with her girlfriends. And it's overwhelming. So I'm just thinking of the number of women who need to know this right now. But your advice, Dr. Marie-claire Haver, on the optimal age, if a woman is going to freeze her eggs or decide to do embryos, whatever she decides is best for her. And when should she do it? When can she still do it? If she's sitting there and going, Wait, I'm 40 right now. Wait, I have 3% left. Should I do it now? What is your advice?

The sooner the better, and find someone who knows what they're doing. So a reproductive endocrineologist, because those are average numbers, right? My sister-in-law got pregnant spontaneously at 41. My best friend in high school got pregnant spontaneously at almost 42. But those are pretty rare. And they have healthy children, thank God. And those are my nieces, and I love them. But that is really, really rare. So you can't cling to that story and think, Oh, that'll happen to me. Nature does not care. So many things are out of your control. So if you're thinking about it, if you're going to not decide to have children right now for whatever reason, career, job, education, if you're getting into your mid-30s, you should go and You don't want to be evaluated. You don't want to be blindsided by the fact that you're going to struggle. You want to know ahead of time because that fertility doctor can do several rounds of tests and be able to tell you, Okay, these are your chances, percentage-wise. If I were and say, If you choose to retrieve now or maybe wait, you've got a couple of years. If you're going to try spontaneously to get pregnant.

But there, Dr. Natalie Crawford does a tremendous amount of education around this topic. I can't recommend following her enough. She has a new book coming out to and went through her own fertility journey. So not only is she a medical expert, but she really, really, really gets it because she went through it.

I want to talk about the tests we should ask our doctors for, and I want to dive deep into hormone replacement therapy. Sometimes we're people-pleasers, or we let our doctors give us an answer because they're busy and we don't speak up, or we get the feeling like what we just shared, even though it was vulnerable, maybe wasn't taken seriously in our appointment. And can you share what WW is? Yeah. Okay. And then what do we do about it if we feel like it's happening to us?

So this actually happened to me when I was a resident. So I was an intern, which is your first year out of medical school. And I was freaking out as an intern, just praying to God, I have all this responsibility now, and please don't let me kill anyone. And you're just really anxious all the time. I was not the overconfident, jerk doctor. I was double, triple checking, just so aware of my patients and how they felt and always trying to feed back on their energy and see, are they understanding me? I'm so excited. It's my first day in gynecology clinic. I just done a block of labor and delivery so that you do these little month long rotations. I just left the labor unit where I was delivering babies all night. It was so great. So much fun, so much energy. Then I go into gynecology, which is very serious, and I have my weight code on. I pull a chart, and I see this woman, and she's in her mid-forties, and she has a laundry list of complaints. She's not sleeping, her libido's off. She's got some aches and pains. She's gaining weight. She has some nausea, her hair's thinning, just a laundry list.

I'm like, Wow, why is she in gyne clinic? We're here for the vagina and the uterus. And cycles are still regular, but she's just not feeling right. So my upper level who's in charge of me, right? So they don't just let us loose as interns. We have to check everything out with her. So I have a chief resident come down the hall, happened to be male, happened to be from South Texas. In his cowboy boots with his long white coat. Really nice guy. Now, I don't want to blame him because this was a systemic problem. He's got, What'd you got? I said, Ms. Smith, she's a 45-year-old with a complaint. She's like, Hmm, did you have her thyroid checked? And I said, Yeah, she had a couple of months ago, and it was normal. And he asked about a couple of labs. I was like, No, while these are normal. And he goes, Okay, I think you got a WW. He got Texas accent, I'll never forget this. I said, Excuse me? And he said, Now, don't write this in the chart. But we called out a WW. I said, What's that? And he said, That's a winding woman.

I said, Okay. And he said, Pat her on the knee. Get a couple more They're probably going to be normal. But this is just what women go through, and they like to complain at this age. And that stuck with me. Is this true? Is this a thing? We never wrote it in the chart. No faculty ever said this to me. This was a resonant information hand down. So I forgot about the story. Then when I was writing the new book, it bubbled up in my memory, and I thought, Oh, my God, I need to be honest with the world and have them realize the mentality behind. And I thought, Is this something specific to the self? Someone I taught him that. No one makes this stuff up. So I asked around the country as my platform has grown, I asked other clinicians, and they're like, Oh, yeah. Madame Dolores in Miami, TBD, Total Body Delora in New York. And whiny-giny on the West Coast. So this is a thing, this lure of women who just come in their mid-30s, mid-40s and complain about a lot of stuff. And women just like to whine and complain because they're not happy with their lives.

So And it took me 20 years to realize that woman was in perimenopause. And to this day, I have to pull myself back from that training when a woman comes in with a lot of complaints, I have to stop the process in my brain that says, Oh, she... No. Believe her. Your job is to believe her. Why would she come in here with this list? You must believe her. You owe that to her because because you were a terrible doctor for 20 years for those menopausal women that you didn't know how to treat. So this is your job. Believe her and get to the bottom of this.

I'm just thinking about all the women that get that sense that they're doctors thinking something like that, and then they leave not believing themselves.

Yeah. I've seen the videos of the women crying in their cars after the doctor's appointment, and I thought, I think I've done that to someone probably more than once. And I'm sorry, but I'm going to do better now.

I know you shared how part of your mission is when you think of your it's harder for her to never have an appointment like that.

No. Well, one's in medical school, so she's calling me or I get text. Anytime menopause is mentioned, she's keeping me up to date on what they're learning. And I think she knows a little bit more than a couple of her professors just because of osmosis for being around me. But I do think it's getting better. I think it's getting more recognized, but I do think we have a very long way to go. But we have a whole generation, probably for all time, of women who haven't been taken seriously, who the medical establishment has not truly understood everything that menopause can affect and how it can affect a woman's life. We deserve better. We are It's centuries of research, centuries. That is my quest. I wrote a Citizens Guide to Menopause Advocacy with six policy, and with Jennifer Weiswilfe, who is incredible. She's a NYU lawyer who does a lot of writing for women's health policy. We came up with a guide, and it's on our website, for the basic woman sitting on the couch in Ohio, if you're out there listening to us, you can do something about this. Policy number one is mandatory menopause education for all medical students.

Any clinician who touches a woman needs to know this and how it affects, if you're an orthopedic surgeon, how it affects your specialty. If you're a neurologist, how it affects your specialty. Just going into this blindly and assuming women are little men and that our change in hormones don't affect multiple organ system is ridiculous. But the first thing we have to do is change the way we educate.

I think so many people listening to us right now are going to start by changing the way they educate themselves. I've always felt that if we are able, we really have to take charge of our own health care.

I think especially in this time of your life, you must be the CEO of your own health care. You must advocate for yourself. It is not enough to depend on the people in charge to do the right thing.

It can be well-intended. They just might not know. They don't know. I want to dive in to hormone replacement therapy, and I want to talk about our menopause toolkit. How do we build one? How do we know what test to ask for? So many questions about finding the right doctor, especially if you feel like yours isn't. Remember, this episode is not just for you and me. Please share it with every single woman that you know because it can change her life, too. Coming up, this conversation is so incredible, and you all can't seem to get enough of Dr. Marie Claire Haver and this Menopause Masterclass. So we are continuing this conversation and diving even deeper. I am so excited. You're not going to want to miss part two of our conversation with Dr. Mary Claire Haver, where we are tackling your changing hormones and hormone replacement therapy. That's coming up in the next episode of the Jamie Kern Lima Show. If you loved today's episode, please click the follow or subscribe button for the show on your app and give it a five-star rating or review. And again, please share this episode with everyone you believe in.

Share it with another person in your life who could benefit from it. Post it and share it with others online or in your community who just might need the words and tools and lessons in this episode today. You never know his life you're meant to change today by sharing this episode. And thank you so much for joining me today. Before you go, I want to share some words with you. Couldn't it be more true? You right now, exactly as you are, are enough and fully worthy. You're worthy of your greatest hopes, your wildest dreams, and all the unconditional love in the world. And it is an honor to welcome you to each and every episode of the Jamie Kern Lima Show. Here, I hope you'll come as you are and heal where you need, blossom what you choose, journey toward your calling, and stay as long as you like because you belong here. You are worthy, you are loved, you are loved, and I love you. I can't wait to join you on the next episode episode of the Jamie Kern Lima Show. In life, you don't soar to the level of your hopes and dreams.

You stay stuck at the level of your self-worth. When you build your self-worth, you change your entire life. And that's exactly why I wrote my new book, Worthy: How to Believe You are Enough and Transform your Life For You. If you have some self doubt to destroy and a destiny to fulfill, worthy is for you. In worthy, you'll learn proven tools and simple steps that bring life-changing results, like how to get unstuck from the things holding you back, build unshakable self-love, unlearnt the lies that lead to self-doubt, and embrace the truths that wake up worthiness. Overcome limiting beliefs and imposter syndrome. Achieve your hopes and dreams by believing you are worthy of them and so much more. Are you ready to unleash your greatness and step into the person you were born to be? Imagine a life with zero self-doubt and unshakable self-worth. Get your copy of worthy, plus some amazing thank you bonus gifts for you at worthybook. Com or the link in the show notes below. Imagine what you do if you fully believed in you. It's time to find out with worthy. Who you spend time around is so important as energy is contagious, and so is self-belief.

And I love to hang out with you even more, especially if you could use an extra dose of inspiration, which is exactly why I've created my free weekly newsletter that's also a love letter to you, delivered straight to your inbox from me. If you haven't signed up to make make sure that you get it each week, just go to jamiekernleema. Com to make sure you're on the list, and you'll get your one-on-one with Jamie weekly newsletter and get ready to believe in you. If you're tired of hearing the bad news every single day and need some inspiration, some tips, tools, joy, and love hitting your inbox, I'm your girl. Subscribe at jamiekernleema. Com or in the link in the show notes. And please note, I'm not a licensed therapist, and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional.