Transcript of Your Menopause Masterclass Pt 2: How to Lose Belly Fat, Sleep Better & Stop Suffering Now! Dr. Mary Claire Haver

You've asked for it. Actually, you pretty much demanded it. Back by popular demand, one of the top menopause doctors in the world, Dr. Mary Claire Haver is here in this part 2 Menopause Masterclass episode where we're tackling your changing hormones and hormone replacement therapy. We are going there with everything you want and need to know. Whether today 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. Can you explain our key hormones and which ones change and what that means for us?

In perimenopause, that whole system goes chaos. Then in postmenopause, estrogen progenic flot line to almost undetectable levels.

With the average age of menopause defined by the day you stop menstruating, 46 to 55, then 7 to 10 years before that, we enter perimenopause and our hormones start going haywire. One of the biggest, biggest brand new pieces of information for so many people that you say nine out of 10 doctors don't even get this right. So many women have symptoms when their hormones are off that might look like mental health things, anxiety. It could be- Floating, weight gain. Floating, sleep disturbance, weight gain, heart issue. Then we go and we get that thing treated, but we never get our test done to go, Well, wait a minute. Is Is it that my hormones are off that are causing these other things? And so we have, I'm going to guess, millions and millions of people being treated for symptoms.

Right, on multiple medications. On multiple medications. When no one knew enough to say, Let's do some blood work to rule out. Let me walk you through the patient experience. We put out the fire of her menopause first with hormone therapy.

Estrogen, progesterone, testosterone. For someone who's like, I've never had mine checked. Right now, 1. 2 billion women are in perimenopause or menopause. And whether or not you're experiencing this personally in your life right now, I guarantee you someone in your life is. I want to break this down for exactly what we should do because there's a number of people that can only afford to go through insurance. So many, even women in my life, wouldn't have the courage to aggressively ask a question. You say nine out of 10 doctors probably don't understand hormones or hormone replacement therapy. So they might be getting advice on a symptom, but not actually on the cause. Those three hormones, estrogen, I know you call it estradiol. That's estrogen, right? Same thing. Okay, estrogen, progesterone, testosterone. Why should she care? And what do we do?

I mean, if you feel great and your quality of life is not affected, you're good. But that's not most women. Most women, there is something not right. If you're like, I'm not my best self, and I deserve to be.

Something's off.

Something is off. Your wonderful OB-Gene, your wonderful family medicine doctor who has done incredible care, might not know enough to be able to help you or not know how. You deserve better than that. How to find a doctor who takes insurance, how to find online providers. 30% of women will have palpitations as a symptom of their menopause. Then we have visceral fat, the intraabdominal fat that wraps around our organs. All of this could be preventable. A healthy libido, that that is suddenly gone.

Hormone replacement therapy. I remember people saying hormone replacement therapy can cause cancer. What's a myth? What's the truth? What is it?

Who needs it? Myth number one.

Can you explain the difference between bioidentical hormone replacement therapy?

Not every woman will choose hormone therapy or is a candidate, to be clear. But she's not getting the choice. No one's having the conversation with her by and large. She has to literally go through incredible mazes and hoops to find someone who will even talk to her about it. And that is the problem. That's where we're feeling, women.

When a woman walks into her doctor, what does she need to ask? Those three questions you listed are huge. I want everyone to pause the episode, rewind it, write those questions down, share this episode with every girl and woman right now. I'm thinking about the woman right now who maybe her insurance covers very few doctors, and she's trying to figure out, what do I do? Would it be wise to first look?

Another trick which has worked. Two things.

So everyone pause the episode, rewind, write that down, bring it into your doctor. I love preventative stuff. I love it. What options are there exactly for Hormone replacement therapy. We have so many. What ones you use right now, how you apply them. Who's the candidate? Who's not? You put a cream in your vagina. Yes.

We have pelvic floor physical therapy. Most women have no idea it even exists, and it is literally the best thing. Women deserve that conversation. We have great studies showing safety and efficacy of topical estrogen for the skin.

Is it covered by insurance?

Things have to be FDA-approved to be covered by insurance. Now, you can get it for the vagina, and some women are choosing to put a little on their face. On their face. It's actually wonderful for women who have urgency and frequency, so they have to pee a lot. This is a new thing.

Do you personally use vaginal estrogen?

I do. I started having delayed orgasms. Then I started having to get up to pee again in the middle of the night. I tell that story not to embarrass myself, but to be like, I didn't even realize it was still too taboo.

Is there something you can use that speeds up orgasm? Because I'm telling you right now, we are not getting this info from our doctor. You use the patch. What all of those typically cost? I'm going to go into how we find coupons.

Let me be clear, you can be healthy without hormone therapy, but it is harder.

You clearly say for you, and you've been very definitive about who's a candidate, who's not, that the rewards can far outweigh the risks.

I'm living my best life. I get up every morning excited. I feel better than I did in my 30s and 40s. I have better relationships. I have better boundaries. I'm a better businesswoman. I'm a I'm a better doctor. I'm a better mother. I'm a better wife. I'm having better sex. I want everyone to have this.

Whether you're 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 are 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, and 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 It's a 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. And I want to remind you this episode is not just for you and me. Please share this with every single woman 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 odd?

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Jamie Kern We're in Lima. When we talk about hormones, this is going to be a brand new topic for a lot of people. It's not part of the thing they maybe tend to focus on in their day-to-day life. For every girl and woman listening in particular, can you explain our key hormones and which ones change and what that means for us? Sure.

In the female human body, Actually, men and women have the same sex hormones. We just have different levels. So men have estrogen, women have estrogen, men have testosterone, women have testosterone. We actually females have four times the amount of testosterone than we do estradiol when we're in our reproductive years. Testosterone is the We have a precursor for estrogen. That testosterone gets an enzyme attached to it that flips over a carboxyl chain and turns it into estradiol. So without testosterone, we would not have estradiol in our body. So women think of testosterone typically as It's a male hormone, but it's actually one of the most important hormones in our body as well. Then we have progesterone. In a normal menstrual cycle, when we're ovulating regularly and we're having this ebb and flow of hormones, we have hormones start out low. You start your period, that's day one. Hormones, estrogen and progesterone start out low. And then we see a rise in our estradiol level towards ovulation. Then it drops down again. And then we have a second little bump towards the end of the 28-day cycle. And then in the second half After we ovulate, we see that spike in progesterone.

And that repeats itself month after month after month. And for some women, even that fluctuation that we normally have can be devastating with premenstrual dysphoric disorder, with crampss, with headaches. Lots of things can affect women, but most women can manage it no problem. Thank God we have treatment therapies for when your ebb and flow is causing problems in your life, we can help you with it. We've gotten pretty good at that. In perimenopause, that whole system goes chaos, right? But estradiol level is bouncing around like you have this roller coaster effect on the way down till you completely lose your eggs for both estrogen and progesterone. And then in postmenopause, estrogen and progesterone flat line to almost undetectable levels. And that FSH and LH from the brain stay high for the rest of our lives, which is how we diagnose menopause or postmenopause. So that's it in a nutshell.

In a nutshell. And I know big pictures zooming out, and this can vary woman by woman. It can vary based on a number of factors. But with the average age of menopause defined by the day you stop menstruating for a year, that day, can range 46 to 55 normal curve for when we enter menopause. And then seven to 10 years before that, we enter perimenopause. And when our estrogen can start decreasing or surge or plateau and our hormone Hormones start going haywire. One of the biggest, biggest brand new pieces of information for so many people that you say nine out of 10 doctors don't even get this right. It's so newly being talked about. You talk about this in detail in your book, The New Menopause. This is such a big thing that so many women have symptoms when their hormones are off that might look like mental health things, anxiety. It could be- Loading, weight gain. Floating, sleep disturbance, weight gain, heart issues. I mean, the number of symptoms. And then we go and we get that thing treated, but we never get our test done to go, Well, wait a minute. Is it that my hormones are off that are causing these other things?

I'm going to guess, millions and millions of people being treated for symptoms.

On multiple medications. On multiple medications. No one knew enough to say, Let's try, let's do some blood work to rule out. When a patient comes to my clinic, let me walk you through the patient experience. Now, again, I've stepped away from the insurance model so that I'm not going to be told by an insurance company what I can and can't do because they don't recognize menopause, really. Medicare doesn't even have a menopause code. Okay, if you realize this. I get to practice medicine the way I want to and I need to. I spend an hour with my first patient, with each new patient, getting to the bottom of it. We've done a ton of paperwork beforehand, and I do a lot of blood work. But if she's in perimenopause, knowing that that's a huge chaotic hormonal zone, it depends on what day, what time of the day, where she is. It's not going to really be diagnostic for me. It's wonderful for postmenopause because we know high FSH, low estrogen, she's there. But in peri, I'm ruling out autoimmune disease, nutritional deficiencies. A lot of these symptoms can be caused by other diseases. I want to make sure I'm not missing anything.

In my clinic, I've diagnosed lupus, I've diagnosed iron deficiency, vitamin D deficiency, and 80% of my patients. I'm making sure she's optimized. We put out the fire of her menopause first with hormone therapy. Now, in Perry menopause, we have two options. We can either override the system with something like a birth control pill or the dose is high enough in a birth control pill to suppress the occasional ovulation until the brain shut down. We're good, which is how birth control pills work, and there's problems there, and we can talk about that. Or we support give her menopause hormone therapy doses, which in our clinic are bioidentical. We're giving her just estradiol and progesterone, the exact same thing her ovaries used to make, feeding back to the brain, telling it to calm down. Calm down. It's okay. We've got some estrogen on board. Don't send these crazy signals to the ovaries. Not enough to... You're still doing what you're doing in the background, but we seem to be taking away the drama out of it. We're seeing the mental health challenge is getting better, the brain fog clearing up, the sleep is improving, especially with progesterone.

And then in postmenopause, it's actually easier to treat because you're starting from scratch. Where in perimenopause, we're trying to pin the tail on a moving donkey. Remember, because there's all chaos going on.

So your hormones, estrogen, progesterone, testosterone. For someone listening right now who's like, I've never had mine checked, and I've gone into my doctor, I'm 45 or 55 or 35. I've gone in with these other I have symptoms happening. I've gotten treatment or medication for them. But actually, I wonder, what if the underlying issue is actually my hormones? What does she do? I want to break this down for exactly what we should do, because there's a number of people that can only afford to go through insurance. There's also people who are trying to figure out, how do I get free resources and learn more about this? There's also So many of us. I had this experience very recently, actually. But anyway, it was an unrelated type of a doctor appointment. But I watched as the doctor was in and out so fast. He must have been in the room under 60 seconds. And I'm not shy anymore, so I will keep asking questions, and he had no time. And I just remember thinking to myself, so many, even women in my life, wouldn't have the courage to aggressively We ask a question because we're just like, Okay, okay.

And then we don't. So I think of every woman listening who's in all types of situations right now with her doctor where maybe- What are her best options? She can't afford to go to someone where it's out of pocket, things like that. So just We already zoomed way out. Can you share just top level, why should she care about where those three hormones are at, and especially estrogen, how it can impact every part of her health, mental health, physical health, even though you say nine out of 10 doctors probably don't understand hormones or hormone replacement therapy. So they might be getting advice on a symptom, but not actually on the cause. Why exactly should she care, and everyone listening care about those three hormones, estrogen. I know you call estradiol. That's estrogen, right? Same thing. Okay, estrogen, progesterone, testosterone. We Why should she care? And what do we do?

I mean, if you feel great and your quality of life is not affected and you are not having crazy hemorrhagic periods, you're good. But that's not most women. Most women, there is something not right, at least in my clinic and in my experience and the people who follow me on social media. So if you're one of those women out there and you are like, I'm not my best self, and I deserve to be. Like something's off. Something is off. Unfortunately, this is probably a big problem why we're not diagnosing perimenopause is one, we weren't taught anything about it, and two, we don't have a great blood test. It takes someone who can rule out other overlapping causes and then realize eyes based on her symptoms, this constellation of symptoms, this most likely is perimenopause, let's do a trial of treatment and see how you feel, see what gets better, and then go from there. How do you find that unicorn? Because your wonderful OB If your wonderful family medicine doctor who has done incredible care, might not know enough to be able to help you or not know how. And just be under the assumption, this is just what women go through, you'll be fine in a couple of years.

You deserve better than that. So The Menopause Society has a list of certified providers on their website. It's not perfect, but it is a definite place to start. We have a resource for our patients online called the Menopause Empowerment Guide. It's a 14-page PDF, completely free with how How to find a doctor, who takes insurance, how to find online provider. This is a really niche thing I think is pretty cool. There are some very affordable online telemedicine clinics that have been built, and I've gotten to be friendly. Don't pay me to say all this stuff, but I am friendly with them because I vetted what they do to make sure if this comes out of my mouth that it's legit and I'm not going to harm a woman who's seeking help. But if you can't find anyone in your community, there are wonderful telemedicine options that are very affordable. And Midi takes insurance that are built simply to serve the woman in perimenopause and menopause and help you determine if you're a candidate for a trial of hormone therapy and see how you feel from there.

If we're deficient in estrogen, can you talk about... Because I think this is a huge revelation for so many people. Estrogen can impact almost every organ part of your entire body.

Just about every organ system is In your body.

Can you share with us, if we are out of balance in estrogen, what are some of the common things that can impact?

Sure. So quality of life issues, brain fog, risk of dementia increasing, but the immediate things, brain fog to where you don't feel like... You feel like you're developing dementia. You are worried about your job at work. You are not functioning normally, okay? And you are waking up scared that something's wrong with you. That's the most extreme form. Mental health challenges that are extremely affecting your life, your relationships, your ability to function. You deserve to not have that happen to you. Palpitations. Let's go to the heart. Palpitations. Oprah Winfrey tells a fabulous story. Well, bad for her, but extremely liberating for women who realize that happened to me. We now know that vasomotor symptoms include palpitations. Palpitations that 30% of women will have palpitations as a symptom of their menopause. You go to the cardiologist, you get your full workup, everything looks normal, you deserve a workup. But then they're like, Well, that's just what you're going through. When I tell you the percentage of women whose palpitations are completely gone by replacing her hormones is incredible. Lever, most women's cholesterol with no changes in diet and exercise Their LDLs will shoot up, their HDLs will drop a little, and their total cholesterol numbers will increase.

And they have done nothing different. And it is absolutely shocking to them that this is happening. Outside of familial hypercholesterolemia. That's a different thing. But this is a woman who always had normal cholesterol. And then all of a sudden, somewhere in her late 30s and 40s, you see this sudden uptick. And every time she goes back, it's higher, higher, higher. And she's following all the dietary guides, and she's doing everything she should. But it was her menopause that caused this. New New onset of prediabetes. Never had an issue with your blood sugars before, all of a sudden in perimenopause. And all of these are leading to the increasing risk. Before menopause, women enjoy much lower risk of cardiovascular disease than men. And through the menopause transition, we pass them up and our risks go up. And then we have visceral fat, which is cosmetically distressing and no woman likes it. But visceral fat, the intra-abdominal fat that wraps around our organs. My patients used to come in to me for their Well Woman exams and grab their tummies in their little paper gowns and say, What is this? I never had this. And I would say, 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 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, 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.

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My patients used to come in to me for their Well Woman exams and grab their tummies in their little paper gowns and say, What is this? I never had this. And I would say, Park further. Take the stairs. Eat less. Work out more. Because that was what I was taught to do. I had no idea that the loss of estrogen was driving, was increasing inflammation and driving fat to the abdomen. You know, women with debilitating musculoskeletal pain. Eighty % of us will have a change, musculoskeletal pain. And for like 30% of them, it's their worst menopause symptom. It's debilitating. They're not able to work out and exercise and do the things that they used to do because of this. All of this could be preventable. And what I think of cortisol levels, of what we've put a whole generation of women through, gaslighting them, not recognizing the constellation of symptoms that could be related to menopause, and what that has done to their shame and their guilt and their worry and all the things that drive up our cortisol levels because we weren't advocates in their care. We weren't holding their hands through the process.

Even if she chooses not to have hormone therapy, wouldn't it be nice to know? To know. Because that this would happen?

I just don't have willpower. Exactly. Oh, I've let myself go.

Oh, all those things. The shame and the change in libido and how the guilt she feels around that, especially for a woman who enjoyed what she felt was a healthy relationship and a healthy libido, that that is suddenly gone. And she doesn't care that it's gone. And it's dramatically affecting some relationships. All of this is treatable. All of this is part of this what's happening in our bodies and in our brains from this transition. And yes, it's natural, but it doesn't mean it's not pathologic and that you have to live with it.

I want to call out that of all those symptoms you just listed, you didn't even say hot flashes, right? No. And so many of us, that's the only thing we ever hear.

One of the greatest things about these telemedicine companies is women go to their sites to get information, and they'll take a little quiz. Could I be a menopausal? They are collecting data by the hundreds of thousands. So EverNow, one of the companies, and my daughter actually interned for them last year, which is why I know this. Over 100,000 women, and they said, What are your worst symptoms? And they went through the... They included all the ones in the book, right? And Hot Flashes was like number six or seven on severity and frequency and how much it affected their lives. I mean, my hot flashes were debilitating, which is what drug me reluctantly to take hormone therapy. But, oh my gosh, it was fatigue, sleep disturbance, depression, loss of libido, relationship issues, all of this stuff that no one was teaching. Very few are still being taught that this could be a symptom of her menopause, especially a woman who had it. She was great. She was living her life. She had stress, but she had it managed. It was all good. She was living her best life. And then all of a sudden, it gets pulled out from under her, and no one is helping her through this.

Can you share, Dr. Marie-claire Haver, what is hormone replacement therapy? What is bioidentical hormone replacement therapy? We're We're going to go deep on all the forms of it, the perceived risks, right? Sure. There are risks. And there has been this thing that's been out there in the universe since... I remember this as a teenager, right? A long time ago, I remember people saying, Oh, hormone replacement therapy can cause cancer. I mean, all of that. So can you talk about what's a myth? What's the truth? What is it?

Who needs it? Myth number one, it's dangerous for most women. Absolutely untrue. Myth number two, it's only for hot flashes, and severe hot flashes at that. By the way, who gets to determine if they're severe? Not me. That's you, the patient, right? Number Number three, there's so many that you have to do compounded to get bioidentical. We have wonderful, safe, efficacious, affordable bioidentical hormone therapy for 25, 30 bucks a month. Number 4, it's expensive. Very, very, very affordable for most women. If you go to a clinician who's willing to help you find the right pharmacy. I spend a lot of time shopping pharmacies with my patients to get the best deal, but pharmacy benefit managers is a whole other. But we do a lot of work in our clinic to help patients find affordable hormone therapy. That it's just estrogen or just progesterone or just testosterone and not some mixture of the three that you can't talk about one without the other. I think that's another big myth.

And hormone replacement therapy is basically supplementing your body's hormones that are deficient.

Supplementing or replacing.

Or replacing. Can you explain the difference between bioidentical hormone replacement therapy?

Yeah. Let's go back in history. When estrogen compounds were first being developed, they were mostly synthetic. They were made in labs. Chemists in white coats cooking up things and cleaving different compounds to create these products. And so the number one ingredient in birth control pills on the estrogen side of things. So let's go high level. We have estrogens, we have progestegens, which includes progesterone, and then we have androgens, which include testosterone. And for each of those, we have body identical, meaning pretty much looks like exactly what we have in the body, or then we have other options that are non-identical but still bind to the receptor. The body identical ones tend to be plant-based. And the chemical ones tend to be synthetically made. That's high level. For what we have commercially available in the US for birth control, and this is a big pharma problem, and I hate to demonize the pharmaceutical industry, but this is one place I'm not that happy, is that the only thing really commercially available, and I took them for years, is synthetic options. Why don't we have a bioidentical option? Why don't we have an estradiol and progesterone-containing dose for suppressing ovulation so that you don't get pregnant?

Because when we suppress ovulation, we also suppress heavy bleeding, acne, a lot of other things. Why do we have to go with a synthetic option for that? But then when we move over to menopause hormone therapy dosing, it's much lower than what's in a birth control pill. When we think about birth control pills were developed to stop not get pregnant, and you need a high dose to do that. The only reason why hormone therapy was developed was to stop a hop flash. We need to stop hop flashes. That is menopause. How much do we need to stop a hot flash? Then those formulations now, modern formulations, tend to be estradiol and progesterone. Now, that doesn't work for everyone. What I want to make clear to your audience is not every woman will choose hormone therapy or is a candidate, to be clear. But she's not getting the choice. No one's having the conversation with her by and large. She has to literally go through incredible mazes and hoops to find someone who will even talk to her about it. And that is the She needs to be able to make that decision for herself after consultation with a clinician who's educated.

And that's where we're feeling, women.

Right now, when a woman walks into her doctor, what does she need to ask?

Before you even hit the door, don't make the appointment until you have asked these questions. Is this clinician willing to discuss hormone therapy with me? What percentage of patients receive hormone therapy? If it's 100%, that's a red flag. If it's less than 25%, that's probably another big red flag. Okay? Wow. And are you going to offer me all of my options, or are you going to steer me towards one product? That's a red flag. So one of the commercially available products that is compounded is something called pellets. And in my world, in clinicians I trust, we have our little Menopause. It's a cute name for just a group of docs who we're constantly chatting all all day on WhatsApp across the world. What are you doing with this? We're a think tank. And by and large, we are not fans of pellets because one, I think we can do better for our patients. But a lot of clinicians, that is all they're offering. And I think that's an ethical red flag. I think that if you decide that pellets are best for you, that's your choice. But if you're not given all of your options, remember that your clinician is profiting off of the sale of those pellets, and they have a financial financial drive to push that towards you.

Is the clinician profiting off all the different options? No. Or just some? No.

Just some.

Is that why they only recommend some in some cases?

I mean, think about the economics of it. They're going to make a lot more money by giving them something that they're going to insert in the office.

Those three questions you listed are huge. I want everyone to pause the episode, rewind it, write those questions down, share this episode with every girl and woman right now. Ask her to write those three questions down. Call ahead.

Ask those I have questions. Yes.

Now, I want to ask you this because I want to get just really specific here. Do you call your regular doctor? Meaning your doctor that does your physical every year. Or which doctor do you ask for a referral to?

I wish I could tell you that you could walk into every OB/GYN's office. It's not happening. Go to the Menopause Society, look on their website for someone who's certified. It's not perfect, but it is a place to start. Then ask those questions. On our website, I have a crowd-source database of women who've had fabulous experiences with their clinicians, and we organize their testimonials by city and state. That's another place to start. It's getting bigger and it's getting faster. Telemedicine options, we're getting there.

Yeah, and we're going to link to all of those. I want to make sure everyone knows that in the show notes, we're going to link to all those as well as Dr. Marie Claire Havers' sites and books and all the stuff. I'm thinking about the woman right now who maybe her And insurance covers very few doctors. And she's trying to figure out, what do I do? Would it be wise to first call? Let's say you only see one doctor a year, and maybe you also go and get your pap smear done from a gynecologist. Would it be wise to call those to you first?

Call ahead first. Another trick which has worked. Two things. One is on our website, we have the Menopause Society guidelines for hormone therapy in a PDF that you can just print Print it out, bring it to your doctor. Bring it to your doctor. You may be able to teach them. It's not guaranteed, but it has worked. The second is say, Hey, let me try this for three months. I'll come back and tell you how I'm doing. These poor physicians, clinicians, nurse practitioners are so overwhelmed, so overworked. Their situations are not great. They have no time. I tell you, they'll be like, Okay, try it. Now you're going to educate them. You're going to come back in three months, and I promise I wish you, the vast majority of you are going to feel amazing. You're going to tell them, This works so beautifully for me. Thank you so much. And they're going to remember that and maybe read that guideline or take five minutes to educate themselves or get inspired to go and take the... Go get educated by the Menopause Society.

Should you ask for a referral to an endocrineologist?

Maybe. Those are getting better as well. But a lot of endocrineologists tend to work in niches of thyroid or whatever their area of specialty is. You would think Dr. Rocio Salas-Waelin, one of my dear friends, who is a triple boarded in obesity medicine and endocrinology and internal medicine, she did three fellowships on top of her residency. Said she learned very... She's the expert in how little clinically relevant information that she got and how we've all had to bring ourselves up to speed to be able to really give the best advice for a woman in menopause.

When you say nine out of 10 doctors aren't trained and don't have the knowledge or get hormone replacement therapy wrong, I just want to call that out because for everyone listening, there's a very good chance you're going to call your doctor, you're going to proactively ask these questions.

No, it's dangerous or no, etc. Or Another friend was on a plane. She's an OB-GYN, and she's not practicing anymore, but she was flying home. She ran into her former program director. So I was a program director for residents for 10 years, and they were just chatting on the plane. He talked about his wife, and she said, Oh, is she on hormone therapy? He goes, I don't believe in that. Like, it's Santa Claus. This is that generation of mindset of somehow you're weak or I don't believe in it, and you're just giving a woman permission to be whiny. Do you recommend the bioidentical? I do, but you have to be careful. Bioidentical, originally, that term was really a marketing term, not a medical term. We don't go into medical textbooks and read the word bioidentical. But it is an easy way to explain to a patient the difference between synthetic and something that is chemically identical to what your body made, and it makes sense to people. So I have adopted using it always with a caveat. Remember, you're not going to pull up the American College of OB/GYN or any medical textbook and read the word bioidentical, right?

But I do tend to stick to those formulations because they have the greatest safety and efficacy. Well, everything's efficacious, actually. Synthetic is efficacious. But when we start really teasing out risk, blood clots and the biggest risks are the blood clots and the potential for tumors, cancers, etc. Nothing is risk-free. That the bioidentical formulations seem to have the best safety profile.

Is there a blood test that we can do in general or any type of test that can give us the best sense of if our hormones are imbalanced? 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.

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Not in perimenopause, not a single one-time blood test. Remember, it is a constant level of fluctuation. So what we tend to do in our clinic, if a patient is still cycling regularly, we will have her come in on day three of her cycle for blood work. Fertility docs do this all the time. We're going to check an estradiol to FSH ratio to give us some an idea. We know from the Straff staging, which is very medical, that if a woman has FSH level is She's constantly above 25. On at least three occasions, she probably has about two years left until her period's in. There are some things we can do, but they're very nuanced and very complicated. There's new studies been doing on AMH, again, used in the fertility world, but give you an idea of ovarian reserve. It's not great, but it is something that can help tease out the information, especially if she's had a hysterectomy or she's had a IUD place that has stopped her periods or had an ablation. To give us a better clue because we can't use her cycles to help us line up what's most likely happening with her.

So everyone pause the episode, rewind, write that down, bring it into your doctor. Now, is there a blood test or other test to tell if we are in menopause? Yes.

It's So easy. It's FSH and usually estradiol together. Fsh is above 50 or pretty much pathognomonic for you are fully menopausal. You might see occasional ovarian activity, but for most women... And that's basically FSH is consistently above 50. She's not to be able to get pregnant again, is what that means. And then estradiol level that's below 20 is pretty much that's it.

You're done. You're in menopause. For perimenopause, what about the Dutch urine test that's like a 30 day in a row? Yeah. You pee on the paper for 30 days.

To be honest, that is so far outside of traditional medical training. That is very much in the functional world. I've scooted toward functional in my clinical practice, but I promise you, I don't need a Dutch test I can't be able to tell if a woman's in perimenopause- Will it help other doctors who are less educated and less tuned in? No, it's too confusing. There's nothing in our medical training if you went the traditional route that says anything about the Dutch test. They fascinate me. I looked at one yesterday for- I love It's all the preventative stuff.

I love it.

I love it. Remember, we have reactive medical knowledge, right? So we're there to fix what's broken. We don't learn much about prevention in medical school. So this whole new functional preventative world is very exciting to But it's not being policed and managed by the same groups that are controlling medical education right now. I think there's got to be some a bridge. There's got to be a consensus. Dutch, what I don't love about Dutch is it's not recognized by CLEA, which is the national standard of laboratory testing. It's only offered by one lab, and it's very, very expensive. I feel like I can give good high-quality perimenopause care, and I can pretty much tell if she's in it without needing to resort to the expense of a Dutch test.

Can you share? Because this is going to be a big aha for, I bet you, right now, I'm just waiting for the DMs on Instagram and the emails that are going to come in about this, that there's going to be women saying, Wait, I did go to my doctor and they offered pellets. I didn't know there was something else. Can you share, Dr. Marie Claire Haver, can you share what options are there exactly for hormone replacement therapy? We have so many. I'm going to ask you what ones you use right now. And I want to ask how you apply the certain one, break it down. You mentioned risk, and I'm going to go there because how you describe, and I want to encourage everyone to grab your book, The New Metapause, your future book, The New Perimenopause, but you go granular on this. But I want to ask you now also just the risks associated with each one, how you apply them, all of it. Who's a candidate? Who's not? We're going to go there. Okay.

So we break it down into the big three, the estrogens, the progestegens, and then the androgens. Okay, so let's start with estrogen because most conversations around hormone replacement start with estrogen. Estrogen is available in systemic, meaning we're treating the brains, the bones, the whole body, the uterus, everything. It's going into the blood. It's going everywhere. And then we have local. So local is topical. So it's either skincare for here or skincare for down there.

Like you put a cream in your vagina. Yes.

So as far as formulations, we have creams, we have gels, we have suppositories. So we have multiple ways to get it there. And thank God, because not everybody reacts the same way. Alcohols can be drying. Some people have reactions to them. But pretty standard where we start is a vaginal estrogen cream for the genital urinary syndrome of menopause. Now, right now, it's only FDA-approved for when you have symptoms. But why would you wait? Why would you wait to be miserable? Isn't there a place for prevention when almost 100% of us will develop GSM eventually if we live long enough? The loss of estrogen is not benign in the vagina, in the bladder. It's the best treatment for recurrent UTIs, for vaginal dryness, for painful intercourse. Now, again, It doesn't fix everything. There's a lot of things that can cause problems in the area. It's important that if you've gotten your prescription for vaginal estrogen and things aren't getting better quickly, that you see something like Jill Kraft or someone who specializes in the pelvic floor to be able to help you. We have pelvic floor physical therapy. Most women have no idea it even exists.

And it is literally the best thing that we should be talking about after childbirth because we just pushed a bowling ball out of our vaginas or carried one around for nine months. And to expect that it's just going to bounce all back, you're not going to have any problems after that. Women deserve that conversation. So that's systemic. The good news about systemic topical therapy, because I put it on my face as well, is that- Is estrogen cream on your face for collagen appearance Yes, for the health of your skin. Thinning skin, thickening the collagen in your skin. And we actually have several great studies. We had some really good studies before WHI. Then the whole world freaked out and nobody would ever talk. And then 20 years later, people got brave enough and started doing... So we have a gap in our studies, but we have great studies showing safety and efficacy of topical estrogen for the skin.

Just really high level while we go through all these options, vaginal estrogen cream or topical estrogen cream.

It doesn't absorb systemically, right? Not It's not clinically, it's considered local. It's considered local. Even with breast cancer, you can use vaginal estrogen.

Is it covered by insurance?

Yes, typically with regular normal insurance, vaginal estrogen is covered. Even out of pocket, the generic estradiol cream can run $10-$15 a month.

And what about for your face?

So for your face, those are compounded only. So you can take the vaginal estrogen cream. If patients want to try it, it's alcohol-based, so it can be, you know more about this than anyone, it can be a little bit drying. So you can mix it with something topically, like a pea-sized amount, a couple of times a week, no more than that. Or you can buy a compounded version, which is what I do that has a moisturizing base in it. To use on your face. Just to use on my face.

And for your face, is it ever covered by insurance, or is that more of a- No.

Things have to be FDA-approved to be covered by insurance. Now, you can get it for the vagina, and some women are choosing to put a little on their face.

On their face.

Dr. Gendler recommends the backs of your hands as well because we have a lot of thinning skin here as well.

Yeah. And so you're saying a pea-size amount a couple of times a week on your face? Right.

Now be careful. There was one sweet woman who was using the equivalent of a tube a day or something and covering all over her skin. Of course, if you're using that much, she ended up having some systemic absorption because she was using it well more. So I always make very clear, this is a prescription. You need to talk to your doctor and make clear it with them and be very clear on how little we need to see efficacy.

To get a prescription for it, and let's say someone wants to do it because they know it's going to happen to them 100% of the time, they don't want to ever end up suffering, but you want to get it covered. Yeah.

Is that- So it'll be covered for genital urinary. Yeah. So vaginal dryness for recurrent urinary tract infections. And it's actually wonderful for women who have urgency and frequency. So they have to pee a lot. This is a new thing. Or they all of a sudden have to pee and the urge is coming really quick.

Or they laugh and cough and they pee.

Well, that's stress incontinence. So estrogen can be a little bit helpful for that, but that's more of an anatomic problem. So don't go in with that. And so pelvic floor physical therapy. If you're going in with I just feel like I have to pee all the time. I'm getting up in the middle of the night with this urge to pee. Cough, laugh, sneeze is more stress incontinence, and that's a different treatment protocol. Okay. But yeah.

Do you personally use vaginal estrogen?

I do. It took me about seven years in on my menopause. This is such a funny story, physician treat that self. And I started having delayed orgasms. I'm like, What's going on? Everything's working. I'm on testosterone. My brain's in it. And it was taking forever. And that was new for me. And then I started having to get up to pee again in the middle of the night. Now, I never had any GSM.

Delayed orgasm, meaning it just wasn't a long time. It was taking forever compared to normal.

It was taking forever. You know, beautiful healthy relationship with my husband. You finally get in the mood, all the planets line up. Yay. And then you're like, and this was new for me. So I called Karen Mann, one of my menopausey girlfriends. I'm like, I'm so frustrated. She goes, Well, how much vaginal estrogen are you using? And I go, What? She goes, Marie Claire, you You're not treating? And I said, Well, I just wasn't having any symptoms. She said, Yes, you are. And so I tell that story, not to embarrass myself, but to be like, I didn't even realize it was still too taboo. And I happened to tell my girlfriend, and she said, Clearly, Really, this is your GSM. You're losing blood flow to the area. Let's get you a little vaginal estrogen because I was on systemic, but I wasn't getting enough penetration. Interesting. So a lot of my patients have to use both, and it happened to me, too. And now everything's working back again.

Is there something you can use that speeds up orgasm?

There are some topical, mostly compounded, out there that have things like sildenafil, like Viagra in them. They also have other compounds that will increase blood flow to the area. So And a lot of women find that it helps. It's not a problem here. They're having an arousal issue, and so it can help with that as well. But those are compounded and can be a little bit tough to find.

So you use that personally daily. And I've heard you share this before. You're talking about the topical estrogen, vaginal or on your face.

So vaginal, for me, it's twice a week because it's a stronger dose. And then my topical skin, which is formulated for skin, is daily.

Is daily. And I've heard you share that you can also to do topical while also doing systemic? Absolutely. At the same time. So what are the systemic options for estrogen?

So let's go through systemic. So systemic means you're putting it into your bloodstream. So there's two classes there. We have oral and we have non-oral. Oral is pills for the most part. Non-oral, meaning you swallow it, it goes through the stomach, gets picked up by the hepatic system. Like anything we ingest orally gets processed in the liver first. That is the natural way of doing things. When we ingest estrogen orally, it goes to the liver, and we can see two things happen that don't happen with a non-oral formulation. Our steroid hormone binding globulin increases, and our clotting factors can very slightly increase. For a woman with a predisposition to having blood clots, either through clotting disorder, she's had a history of a blood clot, then you want to avoid the oral estrogen formulation. By switching to a non-oral, like a patch, a cream, a gel, a spray, a Trokei, a pellet, I I don't want to demonize pellets. It's just a method of delivery. It's just how they're ethically sourced. It's just a problem. So we have lots of ways to get things into our bloodstream that are FDA commercially available and covered by insurance.

So I use a patch.

You use the patch. So when you talk about systemic forms of estrogen, if you put it in your mouth and swallow it and it goes through your liver, that is when the increase you're seeing of blood clot.

We can, and it's not for everyone, and it's very, very low, but we can remove that risk by using a non-oral formulation.

That's the patch, the cream.

That's patch cream gel. Gel. And where we need more research is all the data on cardiovascular protection that came out of the WHI was with oral estrogen, was with p remarin. And we saw cardiovascular protection. And so some of the people who like really using oral formulations are like, We don't have data on the transdermal saying that it's cardioprotective. We need so much more research. But I know that my cholesterol went down, way down. Now, I did change my diet and how I move my body and stuff when I went through menopause. But my cholesterol was tracking way up. Just from being menopausal and by using hormone therapy, changing my diet, increasing my fiber, doing all the things in the toolkit, then I was able to bring that... My LDL is down to 108, and I was doing a victory dance. I just got I literally just got it this morning. I had it drawn on Friday or whenever we flew out, and I was so happy. So knowing that all the work- You attribute that to the estrogen.

So you use the patch?

I do. As your systemic form. For my estrogen, for my systemic form.

In addition to the local, which is the vaginal cream, and then on your face. Just real quick before we move on to other forms, I just want to ask for everyone listening, because I'm telling you right now, we are not getting this info from our doctor. We are getting it from You who are our doctor today, which I'm so grateful for. Thank you so much. But for women that say, okay, I don't want to swallow a pill. I don't want the... Even though small, the increased clotting risk or the other things that when it goes through your liver. So I want to do a systemic form that is coming from the outside, like a patch or a cream or a pellet. You use the patch. What do all of those typically cost, and are they covered by All right.

Anything that's FDA approved. So there's a Estra gel. There's a couple of gels out there. There's a spray called even miss. There's the patch, which has multiple generic options. There's a vaginal ring, actually, that has a big dose that gets absorbed systemically. So the cheapest option is oral estrogen. That's like $2 a month. $2. That's what you swallow. That's what you swallow. So for patients who are low-risk for clots, and really, really, this is a budgetary thing, Then the pill, sometimes the pill option is great for them. Then we have the patch, which with a good Rx coupon or a little bit of hustle, we can get for about $20 to $25 a month for a box of patches. Then the sprays and gels don't have a generic option. I've seen anywhere from $75 to over $200 a month. And the ring, over $200. But the ring lasts for three months. So that's wonderful in that. If the ring is the best option for you as far as your lifestyle and how you want to do things because you get systemic and vaginal all in one with the ring being in the vagina, and they could afford it.

A lot of women really like the ring option.

Do you insert the ring yourself?

Yeah, it's a little flexible ring. There's a birth control option of it as far as what it looks like. I don't know if you put your finger and thumb together, it's about that big around. It's super flexible, so you just have to have the dexterity to fold it like a taco and insert it into the vagina. It's a tampon, you know when it's in the right place because you don't feel it anymore. And for some patients who struggle, we tell them to get an empty tampon holder and shove the ring in there and then just insert it that way. Just insert it. It's a little trick.

I'm going to go into how we find coupons, all the things because that's a big thing when it comes to some of these drugs. But I want to ask you who listening right now is a candidate for HRT and who's not?

So most of the candidacy is around estrogen. We don't talk about candidacy for testosterone or progesterone, but it's estrogen. And so progesterone can be a little tricky because of breast cancer. But who is not a candidate is easier to talk about. If you have a tumor right now that is being fed by estrogen or progesterone, you are not a candidate. If you have severe liver disease, I'm not talking mild fatty liver. I mean, severe liver disease where you have constantly elevated liver function tests. This is where estrogen is processed in our bodies. This is going to be tricky to keep you therapeutic because your body is not able to break it down. That's a very nuanced conversation with liver disease. If you are being treated for a blood clot right now, most people would steer away from estrogen. Once your blood clot treatment is over and we get all your levels back and we've done all the evaluation, you need to avoid oral estrogen at all costs. But you will be a candidate for transdermal estrogen. If you've We had a recent stroke, and we're not sure why. There's two kinds of stroke. One is hemorrhagic, meaning you popped a blood vessel, and then another is a blood clot in the brain.

If you've had a blood clot in the brain, that's going to be another very nuanced, tricky conversation around if you're going to be a candidate for hormone therapy moving forward. If you simply don't want it, some people are very concerned about putting anything in their body that their body didn't make naturally, that's okay, too. Let me be clear, you can be healthy without hormone therapy, but it is harder, and it's going to take a lot of hustle, and you may end up on multiple other medications to control certain conditions that are impacting your life.

That's a really fascinating point, is that there's a lot of people that maybe are scared, or they've heard things over the years, and now they're on all these other medications.

The people who are demonizing hormone therapy, by and large on social media, are women who haven't gone through it yet, men, and people who aren't allowed to prescribe it in the health space. So they're trying to sell you their supplement or their program because you don't need this. There's somehow you're weak or your body's not detoxing or processing. And I'm like, wait a minute. Simply, it's as she said, her thyroid removed. No one would tell a woman, and let me tell you, if men's testicles shriveled up and died at 51, we would not even be having this conversation. There would be no question we would replace this to sosterone and probably a little bit of this estrogen because it's protective.

Progesterone, testosterone. We're talking so much of the last two.

The last two. If you have a uterus, progesterone is mandatory if you get estrogen to protect the lining of the uterus. You don't want to just feed the utering cavity estrogen by itself, that lining will grow and could become cancerous. So we give you a progesterone, you're fine. If you don't have a uterus or if you have the progesterone in your uterus with an IUD, but if you have an ablation, you still need it. But say you don't have a uterus. Progesterone is an option. It is fantastic for sleep. Fantastic. Few things work better. Estrogen will stop the hot flashes so that you can sleep without the hot flash waking you up. But when I tell you I have to protect my sleep with my life now as a menopausal person more than I ever did. In my 20s, I just put my head in the pillow at the end, right? It's like I have a sage and a shaman in the bedroom I'm like, I have my progesterone, my magnesium, my L-theanine. You have all these potions and magic, and I can't have alcohol if I expect to sleep well, at least 6 hours before I go to bed.

It is like life-changing, the progesterone, for my patients to help with their sleep. So even if they've had a hysterectomy and they don't absolutely need it for protection, I am talking to them about their sleep and recommending it for that.

So if you're on estrogen right now and you're not on progesterone, that's a big red flag.

That's a big red flag. That is someone who doesn't understand endocrinology and what happens to the uterus. I could save someone's life right now. The topical progesterones, if you're doing bioidentical, oral is the only way. The molecule is humongous and has a horrible time going through the skin. We really struggle to get endometrial protection. Most of us who know what we're doing, we're using oral micronized progesterone, and that is $10 a month. Now, if you're allergic to peanut oil, we have options. Thank God we have compounded options for a non-peanout oil containing. Some people, the formulation, they feel groggy or hung over when they get up in the morning. So it's wonderful that we have different options.

This is huge because I just want to call that out again in case someone is running an errand, doing something else right now, and they're listening to this, you're saying if you are on estrogen right now, but you're not also on progesterone- Huge red flag.

Big red flag. Stop immediately and call your doctor. If you have a uterus, you need progesterone. Now, if you have a progesterone containing IUD, you're covered. But if you don't, this is a red flag.

And then testosterone.

Testosterone. So we know beyond the shadow of a doubt that it can be extraordinarily helpful for hypoactive sexual desire disorder or what in layman's terms, you would call low libido. We know it works. We also have two FDA-approved medications that work pretty well, too. I always discuss all three with my patients. Where the controversy around testosterone lies, Most people in the menopause world agree. If she's suffering from HSTD, let's give her a trial of testosterone and see how she does. Where we're seeing the backlash is that we know libido is a mood. It's in the brain. We know anecdotally and some from older studies that testosterone looks like it's helpful for maybe depression. I'm recommending it off-label for my patients with low muscle mass. In my clinic, I have a body scanner, so I'm able to check their muscle mass and visceral fat, and I can measure those things for them. If they're working out, we know that women with higher testosterone levels have higher muscle mass. And so if I supplement her a little bit, then I can help with her muscle mass and decrease her risk of osteoporosis and frailty as she gets older.

But any conversation of testosterone right now outside of libido, some people in the medical world go a little bit crazy. But I'm telling you, my patients who I'm using it for desire are telling me it's helping with mental clarity, stamina, mood. They are really, really We loving it. And how do we put it in your body? You want to avoid an oral formulation, again, because of what it does to the liver. So we have, most of my patients are using Androgel, which is an FDA approved for men version, but we're using it off label through the skin, on the shoulder or here daily, to give them a nice, steady-state. I'm just trying to get them back to their 30-year-old levels, right? Because female testosterone just gently declines throughout life. It does not fall off a cliff in menopause, okay? It gently declines. And then what we're trying to do is get them back up the hill a little bit to where they felt better and their bodies seem to be healthier at that level.

For testosterone, for a woman, is that ever covered by insurance?

No. Never It's not FDA approved for women for anything, even though we have great data. It is in Australia. It's approved by their version of the FDA. They have commercially available preparations, but it has been removed from approval for women. And it's also a controlled substance like a narcotic. There's a lot of hoops we have to jump through to get it for our patients because it's been abused, not by women, typically. But because of that, it's controlled, and it's really hard to get for a lot of women.

How much is it out of pocket?

So once you get it with the GoodRx coupon or through something like HRT Club, we have workarounds for everything. I can get a six-month supply for about $60.

So about $10 a month. When you say, we're going to dive into, I'm so excited about this, how do we find coupons? How do we build our menopause toolkit? Everyone listening right now, you're going to build your own menopause toolkit right with us. I just want to clarify one question on compounded versus non-compounded. So there's going to be a lot of people listening right now that maybe even missed that we just said that word. But there's compounded, non-compounded forms of medication, and then there's pharmacies that do compounding. Can you explain what both of those who things are? And do either of them freak you out ever? Because as a consumer, I think like, Wait, is there human error involved? Is someone is compounding?

There tends to be more human error.

Share with us what this is.

We have large scale... A pharmacy is just a room that makes medication, regardless of how they do it. We have FDA-approved, and they tend to be these really large pharmacies that are cranking out the patches and the pills. Most pharmaceuticals we use in the US, most people use non-compounded options. Compounding was originally how we got medicine. There was a guy in a lab coat with a bucket somewhere who was mixing up some potion for you to take. And that evolved. So not everything works for everybody in the FDA approved world. So a few guys still stayed back compounding special things or things that people needed because they didn't fit the mold. Compounding is done on a case by case basis, typically. But it became there's a loophole there. And so now these giant compounding pharmacies have been made that are making things like pellets, and they're not subject to FDA oversight. So there's no one going in on a regular basis from the government that are testing to make sure what they say is in the box is in the box. And it gets even tougher when you have the smaller local guy, I love these guys who are mixing up things.

No one's going to check him, and we just have to trust that what he's doing is doing. And some of these places are excellent. But it's really hard to tell, is this a good compounding pharmacy or not. In the hormone therapy world, there wasn't a lot of commercially available stuff after the WHI available that people felt comfortable using. In the functional world, they started leaning heavily on the compounding pharmacist to make things for them. And then those pharmacies were getting bigger and bigger and bigger. So about five years ago, the FDA went into the top 12 compounding pharmacies and pulled their hormone therapy options. And what they found, so we know that when the FDA goes to check the FDA approved ones, 98% of what they say is in there. We had about a 30% discrepancy of formulation and amount in the top 12 compounding pharmacy. I don't know their names. So it gives you an idea I'm sorry.

What year was that?

I think it was about five years ago.

So basically, when the FDA went into FDA approved labs that are not compounded.

Yeah, they said, Let's do a side by side comparison. It's okay, we know this is 98 percent- They're 98 % accurate.

What they said is in that medication is in that medication. When they went into the compounding, which is when inside the pharmacy- They just ordered it like they were Jane Doe and ordered it and had it shipped to wherever they were, and then they went to the lab and tested them.

And tested it. They saw up to a 30 % discrepancy.

So the compounding is when someone's actually compounding the medication or making it for you, putting it together. They tested and found about- That tends to be more human error, and we're not getting consistency with each compounding dose. So about 30% wasn't what they said it was. So that's the risk right there. Yeah.

So that's really the big risk. Do I use compounding Yes. I'm so grateful to have options for my patients who need something out of the box. I have a couple of compounders in the Houston area who I've actually driven up, loved everything that they're doing. Trust them. One of my nurse practitioners is married to a PhD pharmacist. Their daughter is a PhD pharmacist. They lean in heavily on what they think are the most reliable company. For my little small clinic in Texas, it's great to have these options. But on a large scale shipping out all over the US, I worry. And I think we don't need to do that for everyone, that I can get them safe, high quality, efficacious, FDA-approved, bioidentical hormone therapy. That's very, very affordable.

We're going to talk about GLP-1s in a minute, which is such a big thing right Now, when it comes to... We're going to talk about belly fat, and what do we do about it? We're going to talk about GLP-1s. Are they safe? Are they not safe? And there's such a huge area of GLP-1s from compounded pharmacies right now. So I'm going to ask you about that in a minute. But this is really good to know because I think a lot of people... When we're in our doctor's office, and if we get two minutes of their time and they just say that we're compounded really fast, it's hard to even process what that is for a lot of us because we're just worried, Am I going to get my question out? Am I going to leave the doctor's office with more questions than answers still? And this is happening over and over for so many people. So I think you breaking down, I'm going to call it a master class here today, of why are our hormones changing? What are they? What are all the symptoms that maybe we thought was something else? And then this idea of hormone replacement therapy.

I want to ask you because you talk about the women's health initiative, women's initiative of health. For a long time, there was this moment where a study came out linking cancer to hormone replacement therapy. And then just I feel like decades went by where everyone was just scared of it. Two decades. Two decades. As someone who is called the top menopause doctor in the world, now by millions of people, tell me about the risk in a nutshell. Does it scare you at all? And what should women be thinking about right now when it comes to HRT?

So we know that there are certain windows of opportunity where the benefits are going to outweigh the risk. So if we look at... It's always It's not going to stop a hot flash, no matter your age. If you have hot flashes, it will probably get rid of it if it's due to menopause. Not all hot flashes are menopause, by the way. Most are, though. It will always protect your bones. It is FDA-approved for the protection, for you to protect your bones against osteoporosis. We can cut osteoporotic fracture probably by 50% with the use of hormone therapy. Cardiovascular benefit, we have a window of opportunity. And thank God for Howard Hotis and Wendy Mac and Roger Lobo and all these incredible clinicians who have been studying this. So the WHI data, they went back and looked and said, let's break it down by age, because the average age in the WHI was 63 years old. We don't start women on hormone therapy, generally at 63. We start them when they're most symptomatic, late perimenopause, early menopause. So it wasn't a representative sample of the typical patient. They started women who probably had early pre-existing breast cancer or were getting very close, put them on hormone therapy, and the estrogen-only arm, they saw a 30% decrease at all ages for breast cancer.

It was the estrogen and progestogen. It was a very specific progestogen called Provera or medroxyprogesterone acetate that saw the slight but not statistically significant increased risk. It never reached statistical significance. Yet they shouted it from the rooftops of this incredible... They vastly over-exaggerated the risks and barely talked about the benefits of All-cause mortality decrease. If starting in the first 10 years of menopause, 50% per year decrease in cardiovascular disease. That's how protective estrogen is of our endothelium, of the vessels around the heart. We can decrease your risk of having a heart attack, not 100% and not forever, but we can delay it. That's the data we're talking about. When a patient comes in, and she's early, she's young, young, 50s, and she's like, What's the benefit to me? I'll just lay out what the studies Now, the US Preventive Task Force has not gotten around to saying these things, but we can decrease the risk of all-cause mortality, of a heart attack. If you have no pre-existing heart disease, it's probably going to delay the formation of clots and plaques and calcified plaques in your endothelium. We know this clearly, but we have a window.

Once those things start, it's better at prevention than cure. But it will always protect your bones. It will always protect your vagina and your bladder. And keep you from getting your sepsis and incontinence and all these things that are plaguing women. Because here's the biggest thing I want everyone to realize. We have a huge gender health cap in this company. When I hear the wellness bros who I adore, I'm going to one today, who talk about living forever and living longer and living to 120, I'm like, yay. Women live longer than men doing nothing, just existing. We live 4-5 years longer than men. We don't live healthier than men. We spend 25 of that life in poor health than our male counterparts. We spend much longer time with loss of independence, usually due to dementia and frailty and osteoporotic fracture. This is avoidable. This is what we do in our clinic when we talk about the toolkit. This is why we talk about hormone therapy is what is its place in the prevention of these diseases so that you can age better and longer and stay healthier longer. Right now, my mother, terrible Alzheimer's and just fell broke her hip.

How can I... It's a privilege to be able to do it, but the communication and the drama and the stress and what these diseases are doing to American families and what the prevention of these or the delay of shortening that time of mom losing her independence and all the things that have to go into place to take care of her. If my mother truly knew what was happening, I think she'd jump off a roof. And so my husband and I's conversation are around, what are we going to do to not do this to the girls? Know, how do we live healthier longer so that we're not as much of a burden for so long? And not that I feel like my mother's a burden, but she wouldn't want this if she knew it was coming. And no one talked to her in her life about preventing what has happened to her. What could she have done to prevent her dementia and to prevent her osteoporosis? And leaving menopause out of that conversation is a mistake.

You say that the study from a few decades ago was statistically insignificant. And a few decades ago, there was still just a few news channels that everyone had to watch. And so when something like that got broadcast, it just became so dominant.

It was viral, in how you define viral back then. It was the number one medical news story of 2002. Every newspaper, ABC, CBS, MBC, cover of Time magazine.

So right now, you utilize hormone therapy in your life. I do. And you clearly say for you, and You've been very definitive about who's a candidate, who's not, but that the rewards can far outweigh the risks.

I'm living my best life. I get up every morning excited. I feel better than I did in my 30s and 40s. I have better relationships. I have better boundaries. I'm a better businesswoman. I'm a better doctor. I'm a better mother. I'm a better wife. I'm having better sex. I want everyone to have this, and I'm really looking forward to the next 30 years. I'm not scared.

Can we be on hormone therapy forever?

Potentially. As long as for you, the benefits outweigh the risks. There's no reason to stop as long as you want to keep going.

Remember, this episode is not just for you and me. Please share this 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. We're continuing this conversation and diving even deeper. I'm so excited that you are not going to want to miss part three of our conversation with Dr. Mary Claire Haver, where we're giving you your menopause toolkit, including the tests you need to ask your doctor for, how to prep for your next appointment, what resources are available for free, and so much more. 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 Before you go, I want to share some words with you. Could 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. 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. And I can't wait to join you on the next 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.

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