The #1 Menopause Doctor: How to Lose Belly Fat, Sleep Better, & Stop Suffering Now
- Guest
- Dr. Mary Claire Haver
- Read time
- ~5 min
- Uploaded
- 21 Mar 2024
- Duration
- 1:14:32
- Views
- 2.6M
KEYPOINTS
- 01
Menopause is badly under-researched and under-taught
Dr. Mary Claire Haver is a board-certified OB-GYN, a certified menopause practitioner and the author of The New Menopause. She says a PubMed search for 'pregnancy' returns about 1.1 million articles, compared with about 94,000 for 'menopause.' She estimates menopause gets roughly 10% of the funding and attention, even though it covers the last third of a woman's life. Women live a bit longer than men, she notes, but spend about 20% of their lives in poor health.
- 02
Ovarian aging starts at birth
Women are born with roughly a million eggs and lose them throughout life, faster with age. By 30 about 10% remain, and by 40 about 3%. Mel, 55 at the time, was stunned she'd never heard this. When the eggs run out, periods stop, and estrogen, progesterone and testosterone fall with them. Haver says a postmenopausal woman's estradiol is under 1% of what it was at 25. 'You will not die without it,' she says. 'You'll just die faster and less healthy.'
- 03
Estrogen receptors are in every organ system, so symptoms show up everywhere
Each woman experiences menopause differently. One may get palpitations, frozen shoulder and vaginal dryness, while another gets hot flashes, night sweats and rage. Haver lists joint pain, frozen shoulder, constipation or diarrhea, new or worsening asthma, new autoimmune disease, tinnitus, and dry skin, eyes, mouth and vagina. Doctors trained to spot a single checklist 'duck' miss many of these.
- 04
Perimenopause is a 'zone of chaos' that can start at 35
Perimenopause typically begins 7 to 10 years before the final period, so roughly 35 to 45. It's more than irregular periods. The brain pushes hard to squeeze out an occasional egg, causing estrogen surges Haver compares to being 'pregnant with triplets,' followed by crashes. She thinks that's why moods swing. Some women do well with progesterone alone, others need estrogen too, and Haver admits good studies on the best approach are limited.
- 05
Falling estrogen affects the brain
Dropping estrogen can narrow blood vessels in parts of the brain and trigger menstrual migraines. Haver says it's associated with low mood, anxiety and brain fog. Women with known ADHD often get noticeably worse during the transition. She says it's unclear whether that's new ADHD or someone who 'was kind of making it' until losing estrogen took away her resilience.
- 06
Estrogen is anti-inflammatory, and losing it fuels chronic inflammation
Haver separates helpful acute inflammation from chronic, low-grade inflammation, the 'something's not right in my body' feeling. Estrogen calms inflammation in bones and joints, which is why aches and stiffness flare without any injury. Mel recognized herself in having to 'pry' herself over in bed.
- 07
Osteoporosis is largely preventable but usually caught too late
Bone is constantly broken down and rebuilt, and in menopause breakdown outpaces rebuilding. Osteoporosis is often diagnosed only after a fracture, and Haver says 50% of women will have an osteoporotic fracture before they die. After 65, a broken hip carries about a 29% risk of death within a year even with surgery, about 79% without. Survivors often live with chronic disability.
- 08
The WHI scare came from a flawed study and alarmist reporting
The major hormone study enrolled women averaging 62, with some in their 70s, rather than women around 51 at menopause. It also tested only one older formulation, conjugated equine estrogens. By then many likely already had heart disease. Haver says most of the frightening findings have since been walked back, and one remains debated. She cites data that women starting HRT between 50 and 59, or within 10 years of menopause, have lower cardiovascular and all-cause death rates.
- 09
Most women are candidates for hormone therapy
Haver's absolute no's are undiagnosed vaginal bleeding (get it checked first), active breast cancer, an active blood clot and an active stroke. A family history of breast cancer isn't a contraindication. Clotting risks such as MTHFR can be handled by avoiding oral estrogen. Some breast cancer survivors may qualify after a nuanced risk-benefit talk, since cardiovascular disease, not breast cancer, is what such women most often die of. She doesn't expect every woman to choose HRT but says 'every woman deserves the conversation.'
EXAMPLES
- 01
The 'WW in room 12'
In residency in Texas, senior doctors in cowboy boots would say 'you got a WW in room 12, good luck,' meaning 'whiny woman.' These were women who couldn't sleep, were gaining weight, unhappy and getting headaches, but still had periods. They were told it was just aging. Haver now hears the same story from almost every patient: 'my pants don't fit, I'm grouchy, I feel like I have ADHD or dementia.'
- 02
Duke's frozen-shoulder finding
After a woman who chaired an orthopedics department compared notes with a woman who chaired an OB-GYN department, a Duke analysis found that women on hormone therapy had lower rates of frozen shoulder (adhesive capsulitis). Haver uses it as an example of research only now linking estrogen to joints.
- 03
Heart drugs tested on men
Haver says ACE inhibitors and baby aspirin are often recommended to women for primary prevention despite benefits shown only in men. Being menopausal is itself a risk factor for worse cholesterol, and women on HRT tend to have higher HDL and lower LDL.
- 04
Probiotics and belly fat
Losing estrogen shifts the gut microbiome toward a male profile and encourages visceral fat around the organs, which is linked to heart disease, diabetes and stroke. In a study Haver cites of postmenopausal women with obesity and hypertension, those taking probiotics had lower blood pressure and less visceral fat, though their weight didn't change.
- 05
80% vitamin D deficient
Haver checks vitamin D in every patient who will allow it and says about 80% are deficient, not just low. She points to weaker gut absorption and sun protection as reasons.
OTHER RELEVANT
- 01
Haver's menopause toolkit, in order
Nutrition, then movement, stress reduction and sleep, then medication such as hormone therapy (or alternatives if you aren't a candidate), then targeted supplements. She prefers getting nutrients from food and supplementing only where there's a gap.
- 02
Her top three: fiber, magnesium, omega-3s
Track your fiber for a couple of weeks, using beans, legumes, berries, nuts, seeds and avocado. For magnesium she favors glycinate, citrate or threonate (Magtein) and food sources like pumpkin seeds and leafy greens. For omega-3s, eat fatty fish or flax, or supplement. Her go-to is yogurt topped with flax, hemp and chia seeds, plus something probiotic daily such as yogurt, miso or kimchi.
- 03
Train to be strong, not skinny
Haver was an '80s step-aerobics instructor exercising to stay thin. She didn't lift weights until her 40s and says it's never too late. Mel now does resistance training three days a week.
- 04
Sleep: progesterone, estrogen and hard truths about alcohol
Progesterone can deepen sleep, has an anti-anxiety effect, and Haver says it can be taken daily even before menopause. Estrogen addresses the hot flashes and night sweats that wake you up. Don't neglect phone and light habits. On alcohol, she says even one glass now wakes her at around 3 a.m.: 'If you're choosing to drink, you're choosing not to sleep.' Track your cycle too, so you notice mid-month fog, irritability and headaches.