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What Every Woman Needs to Know about Perimenopause and Menopause

For the most part, I consider myself a person who is well-informed and in tune with my body, so I never expected perimenopause to catch me off guard like it did! I quite literally found myself blindsided by the intensity of the symptoms and lack of awareness surrounding this topic.

For months, I dismissed these symptoms—I experienced hot flashes, mood swings, insomnia and brain fog. It wreaked havoc on my life.

It wasn’t until I realized that my monthly cycle was off that I began to wonder if I was entering perimenopause. “But I am only 44 years old,” I told myself. I felt too young (and too unprepared) for this transition.

As I realized what was happening to my body, I began to navigate this gravely opaque path on my own—doing research, seeking out advice from medical professionals and friends. Then, I discovered Dr. Mary Claire Haver’s book, The New Menopause. And everything changed!

In her book, Dr. Haver shares keen insights and essential information that is truly life-changing. It is crucial for women to educate themselves about perimenopause and menopause and become an advocate for their own health.

And, my friends, we need to talk about this… out loud. By having these conversations, raising awareness and sharing our own experiences, we can pull back the curtain, break the silence and create a much-needed support network.

As I continue on this journey, I find solace in knowing that I am not alone. By learning from experts like Dr. Haver and connecting with other women like myself, we can truly empower ourselves. Together, let’s change the narrative surrounding menopause and ensure that no woman feels isolated or uninformed during this inevitable and pivotal time of her life.

In this episode you’ll learn:

  • The symptoms of perimenopause and menopause—and the difference between them.
  • The importance of self-advocacy and finding an HRT-friendly provider.
  • The benefits of starting hormone therapy for heart health and brain function.
  • Tips for nutrition, exercise, sleep and stress reduction during this transition.
  • That relief is possible! Learn where to find help and how to support your body.
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  • Mary Clare Haver, MD, FACOG, CMP is a board-certified Obstetrician and Gynecologist and also a Menopause Society Certified Menopause Practitioner from The Menopause Society. In 2021, she established Mary Claire Wellness, a clinic dedicated to providing comprehensive care for menopausal patients. In 2023, she published her first book, The Galveston Diet, and launched ThePauseLife.com as a trusted resource for menopausal women worldwide. Dr. Haver is recognized as a thought leader and author who provides valuable advice for women going through different stages of menopause. She aims to “demystify menopause” and promote self-advocacy for women’s health. This led her to publish her second book, The New Menopause, which is now a #1 New York Times Bestseller.
  • If you feel you need additional support, please consult this list of safety, recovery and mental health resources.
disclaimer

This podcast is intended to educate, inspire, and support you on your personal journey towards inner peace. I am not a psychologist or a medical doctor and do not offer any professional health or medical advice. If you are suffering from any psychological or medical conditions, please seek help from a qualified health professional.

dear gabby #219 Aug 12, 2024 physical wellbeing

what every woman needs to know about menopause & perimenopause: big talk with dr. mary claire haver

[00:00:00] The following podcast is a Dear Media production. Hi there, Gaby here. This podcast is intended to educate, inspire, and support you on your personal journey towards inner peace. I am not a psychologist or a medical doctor, and do not offer any professional health or medical advice. If you are suffering from a psychological or medical condition, please seek help from a qualified health professional.

Hey there. Welcome to Dear Gabby. I'm your host, Gabby Bernstein. And if you landed here, it is absolutely no accident. It means that you're ready to feel good and manifest a life beyond your wildest dreams. Let's get started.[00:01:00]

Welcome back, my friends. Welcome back to Dear Gabby. Okay, so you're living through my life now, people. I, in the last four months, was hit over the head like a sucker punch with perimenopausal symptoms. But I didn't have any information. I'm 44 years old. I was like, this is too soon. This happens in your 50s.

Uh, no. It started happening so hardcore to me. Night sweats, hot flashes, brain fog, irritability, vaginal changes. I mean, it was just like one. I was like, it was so overwhelming. My whole entire internal system was in chaos. And thankfully it was so extreme because when you have extreme experiences, you want to get help faster.

And I started searching. I was like, where can I get this help? Where is the help? And Of course, you start searching menopause, you're going to get to Dr. Mary Claire Haver. She is the author of The New Menopause. It's been on the New York Times list for like months now. The woman is epic. I started [00:02:00] following her channel.

I started reading every blog, every podcast. Listen, I was obsessed. I've been listening to her forever. And I said to Josh, I was like, my dream is to have Mary Claire on the podcast because we need to spread this message. This audience, whether you're going through menopause or you're in your thirties and you're having some perimenopausal symptoms like irregular periods or dry vagina, like I said it people, dry vagina, or you're sweating or you're having night sweats or you're, it's not just hot flashes.

It's everything. Frozen shoulder. It's, uh, sometimes teeth issues. God, the list goes on my friends. You gotta get ahead of this. And today on the podcast, I'm going to give you the full picture with the expert, Dr. Mary Claire Haver. We talk about symptoms, treatment. We also talk about why the conversation about menopause has been so hidden and now why it's so in the zeitgeist and it's out in the world in such a big way.

The tables have turned. The support is available. You [00:03:00] get in there now, my friends. Let's get in there. Get support. Let's get help. Let's go. Also, I don't want you to forget guys that there's more help available, the self help that you need, no matter what you're going through. And that's coming through with my new book, self help out December 31st.

Yep. New Year's Eve. And here's the deal. You might be thinking, well, why would I order the book so early? Well, the answer is when you pre order the book, you get enrolled in a Live online full day masterclass with me, where I'm going to bring the book to life. And I'm going to teach you all the methods from this book before it even comes out.

It's a full day, totally free. Just have to pre order the book. So if you're out there, you're thinking, I think I'm going to order it when it comes out. Don't wait, go grab it. Now go to deargabby.com/selfhelp and enroll for the free live online masterclass. So, my friends, listen to my guru, Dr.Haber, share everything you need to know about menopause.

And now listen, if you're a man listening, you [00:04:00] better listen to this episode because you got a woman in your life who needs you to know what's up. Enjoy the show. All right. So, you're my hero. I just need to start by saying that you have been wonderful.

In my YouTube channel on my Instagram, I've listened to every single episode that you have been on every podcast. I've read the book cover to cover. I've listened to the book. It is almost like God was like, let's put you deep into hardcore perimenopause the minute that this book hits the world. I am hearing that message from so many and you know, I was like you, I kind of got hit.

Over the head in early menopause. My peri was was treated because I was on other medication but I got off that medication to kind of see where I was at and like Like a tree fell on me. So and I gaslit myself for probably six months. Like I did not [00:05:00] recognize my own menopause You know the aches and pains the brain fog that you know I was going through grief and depression which you know was understandable given like my brother had passed away sadly and But you know after the grief fog started to lift and I still felt so horrible Finally, I was like, wait, when was my last period?

And I've never had regular periods, so that wasn't abnormal for me. And I was like, I think I'm in menopause. You know, I'm too young. I was only 48. And I didn't even know these things and I was the expert. You know the supposed expert based on like what was taught to me And I really felt like I was a good menopause provider until I realized I didn't know anything Yeah, I thought I was pretty in tune with my body until I realized I didn't know anything And i've had such a hormonal journey.

My audience knows that Later in life, I did, I did an IUI for my first child at 39 [00:06:00] and then I did a tremendous amount of IVF and when I was turning, in my 40, early, when I just, when I just turned 40, I did about nine rounds of treatment to get one embryo and then carried that baby for five and a half months and then had to let him go.

And so that journey, not only of the grief of the loss, but also just the grief of what I put my body through. Mary Claire, nobody told me that when I was doing all this IVF that it was going to push me into this process sooner. No one talked about that. I would have probably like pulled back on some rounds.

I mean, I don't know what I would have done, but just correct me if I'm wrong, but did I just blow out all my eggs? Like would I just, you probably set up the process to some degree. Yeah. Yeah. Nine rounds of stimulation. Yeah. We're all born with all of our eggs and they're going to run out one day. And so we don't know what's teaching us outside of maybe smoking.

Most people know that, you know, that there are different, definitely [00:07:00] environmental things we can do to, to wipe out egg quality and egg supply throughout our lifetime. And I want to talk to that a little bit because my audience is 25 to 55 it's, it's, it's your, it's right in your sweet spot right now, which is about.

Really educating people on getting ahead of their hormonal health. And Mm hmm. So I'm running around, I'm literally like handing this book out. I gave it to my father in law who is a Yale physician and I was like, he's retired now, but I was like, read this book, tell all your OBGYNs. Like, I am just, I'm your biggest brand ambassador.

And if people listening that have not, that have been living under a rock and do not know Dr. Mary Claire Haver, we're talking about the new menopause. And it is, It is my Bible. And so I think that my audience, you know, the 30 somethings that, you know, just had their babies or maybe they've gone through some IVF, they might be rolling their eyes just like I did when I, you know, I was 41 and I was having symptoms, but I didn't realize that [00:08:00] there were symptoms.

So I was talking to Dr. Mindy and I was getting some feedback from her and she's like, so are you in perimenopause? Are you still getting your periods? And I was like, offended. I was like, what do you mean? Of course I'm not in perimenopause. Of course I was. I was, and I was just like, I'm not like, I thought that was just something that happened in your fifties.

Meanwhile, I was sweating through the sheets, brain fog, irritability. Yeah. So average age of menopause in the U S roughly is about 51 years of age. That is no more eggs. You're done. No more periods. Fertility is out the door. Okay, that's average. So 45 to 55 is normal for full menopause.

Perimenopause is the transition between You have a stone cold, normal reproductive cycle, meaning the ebb and flow of your hormones is predictable month to month to month in a healthy patient, right?
So that on day 14, you know this is going to happen. On day 16, this is going to happen. [00:09:00] On day 21, estrogen is rising and falling, progesterone is rising and falling, your FSH and LSH are going up and down. That's the way God made us, okay? Perimenopause is when we reach a critical egg threshold. Okay.

Remember, we're running out where the signals from the brain that tell the ovary to ovulate don't work anymore. It's like insulin resistance. This is now stimulating hormone resistance because we're running out of eggs. So the hypothalamus, which is a gland in our brain is sensing the blood all the time for us for dial levels.

When it senses that they're low and it like in a normal cycle, it will say, Hey, to a Terry, make that FSH and LH so that we can ovulate. So it does that every month. And all of a sudden one month. No estradiol rise and the hypothalamus is like, Hey, what happened? And the material is like, I don't know. I sent the signal, but the ovaries can't respond.

So the hypothalamus sends more stimulating hormone, more, you know, gonadotropin releasing hormone. And so we end up with these big bumps in [00:10:00] our FSH really. Okay. Which is one of the blood tests we use to test for menopause. And then we finally get an ovulation, which is typically delayed. The estradiol levels are much higher.

So we're instead of this very predictable rise now we have chaos the timing's off the levels are off We have much higher raises. We have this is perimenopause and the brain hates chaos The brain is very used to day 14. This is going to happen on day 16 This is going to happen and now everything is all over the place and our neurotransmitters Are heavily relied rely on our sex hormones for levels It affects that and gaba which makes us sleep and all these things.

So We see in perimenopause and then transition Which very few people understand because we're not taught in our medical schools and training programs for clinicians We are seeing now that we're looking at the data a 40 percent increase for increase in mental health disorders. That [00:11:00] means, you know um All the people who are experiencing changes and aren't going to the doctor to complain about it are experiencing it too.

The brain becomes almost chaotic between brain fog and the mental health changes. And then the anxiety, the depression, and you, you go to your doctor, you get, you know, they don't understand what's going on. Oh, you're just stressed out. Oh, this is just time of your life. Oh, get some more sleep. Oh, lose some weight.

And no one is pointing to this is your perimenopause. And It is dramatically affecting your life, your sleep, your relationships, your weight, your, you know, all the things that kept you normal and homeostatic and you could handle and roll with the punches, suddenly the resilience is gone. Resilience is gone.

Yeah. Resilience is gone. Your brain is gone. So I just want to share some of my symptoms with my audience so that they don't feel alone in it. And sometimes you've already sort of mentioned some of them, but I want to really just say it straight. So prior to my recognition of being in perimenopause, I always had [00:12:00] night sweats, but I wasn't, I was blowing that off and I had, brain fog and I was kind of blowing that off or just like taking a lot of fish oil or whatever.

Then like in the last six months or so my sweats got so extreme that I was literally like drenching the bed. And then I was just putting up with that. The brain fog was there putting up with it and not Just thinking they didn't have you and I didn't know that the treatment was possible before menopause.

I didn't even, I didn't know anything 'cause we didn't know until you got your megaphone, until others like yourself, . Some people knew they just didn't have megaphones. I learned from them. There's lots of people that knew. There's lots of people that knew and there's people that, but they were in like little isolated pockets and we couldn't get to them.

That's the beauty of social media. And there's a handful. You out there that are just really, really raising people's attention, which is just like the greatest gift in the world. And so then overnight, like in the last three months, I was just the [00:13:00] biggest bitch ever. Like, and Josh, who's on the call, my producer and Ria, they would hear me being like, guys, I just, just warning you, I don't have any tolerance for anything right now, but it's affected my marriage.

And then it was sleepless nights, hot flashes, like throughout the day. Like lots of hot flashes and then everything else that goes along with it brain fog. Yeah things that I will Stinky stinky stinky stinky Yeah, I wanted to just say it so that I can say it so others don't think it's just like this urban myth And that they're alone in it and to know that that i've been out there feeling this So here I was and I read your book and you're telling me and this is where I want to leave it to you to tee Up what why we want to start early and I honestly I haven't had a period since April, so I could be, I don't know where I'm at, like, am I peri?

Am I, I'm not menopause yet? Explain why I'm not menopause yet, just for the listener. Well, menopause is, and I have a huge problem with this, is stupidly [00:14:00] defined by the lack of a menstrual period. What if you have an IED? What if you've had a hysterectomy? What if, you know, do you not get to have a menopause?

And so what it represents is ovarian failure, basically. Our ovaries have run out of eggs and can no longer produce the levels of sex hormones, not even close, like less than 1 percent of estradiol that we used to make. And there are estrogen, testosterone, and progesterone receptors in almost every organ system of our body.

So kind of the old menopause way of thinking, that's why I called it the new menopause, was Menopause should be tolerated. We only give hormones if she's going to commit suicide, you know, like there's no other option. You only give tiny amounts for like the smallest time possible and she should just get on with it.

This is a natural process. You know, failure to recognize the protective preventive benefits of hormone therapy, the protective benefits for your mental health, the protective benefits for your brain fog and protection against Alzheimer's. [00:15:00] And so, and your bones, you know, decreasing the risk of fracture, you know, and decreasing the risk of frailty and nursing home admission.

This is what we're talking about because The gender health gap is real women live a little bit longer than men, but we don't have a long health span So 20 of our lives are spent in poorer health than our male counterparts Women are much more likely to end up with frailty and dementia Than their male counterparts and that's what's in menopause Two out of three are women that get dementia.
That's what you've been learning from you.

Ladies, you know how I feel about obstacles. They are detours in the right direction. I want to talk about an obstacle millions of women are dealing with. It's a condition called hypoactive sexual desire disorder. Or HSDD, which in regular people terms translate to frustrating low libido. HSDD impacts [00:16:00] 1 in 10 women.

Women who used to enjoy sex but suddenly don't anymore. And they can't figure out why. For women who are hearing this message, who are saying, Wait, that's me, your obstacle? It just became a detour in the right direction. That's because there is now an FDA approved option for certain pre menopausal women to address HSDD.

It's called ADDi, and it's the number one prescribed treatment for HSDD, aka frustrating low libido. During clinical trials, ADDi was shown to improve desire, reduce stress from low desire, and increase the number of satisfying sexual events. Now, if that isn't a detour in the right direction, I don't know what is.

Want to learn more? Head over to Addie's website, addyi. com, to see if Addie is right for you. That's addyi. com. Today's podcast is sponsored by Midi Health and I couldn't be happier about it. As you have heard me say, this conversation with [00:17:00] Dr. Haver is so important. Finding out about what happens during perimenopause is the most important information we could ever receive because we can get to it earlier.

Before I had all this Marie Claire information and the book and my other friends like Dr. Taz and all these other people in my life, I was really, really stuck. Doc, like I was so moody, super irritable, insane brain fog. I couldn't sleep. I was sweating to the oldies people. And I'm only 44 and menopause was not something that was on my radar.

I really didn't have the information. So please listen closely when I say say we all need to know about menopause, the symptoms, what to do when we begin to experience them and where to turn for options. And that's why I couldn't be more thrilled to have Midi Health as a sponsor today. The experts at Midi Health understand exactly what you are experiencing and even more importantly, they know how to help.

That's because Midi clinicians are menopause experts who are dedicated to providing safe, effective FDA approved solutions. So if you're like me and you're a woman [00:18:00] over 40, or honestly, Even in your 30s, it can happen, and you're having hot flashes, brain fog, mood swings, weight gain, you're not sleeping, you're feeling anxious, you're super moody, your periods are irregular, the list goes on, and by the way, we talk about it in the episode.

Then you want to check in and see if you're having a perimenopause or menopausal experience. You deserve to feel great. Book your virtual visit today with joinmidi.com. That's joinmidi.com.

There's so many things I want to get into, but for the listener who is very, very new to this, and they're having symptoms, but they haven't, but their peer and their periods are erratic. So they're having every two months, every three months. Is that better? Perimenopause, straight, you know, Um, especially if you had regular cycles before that were predictable and now they're erratic.

That's very menopause You know that that I wouldn't need to do blood testing. I know [00:19:00] you're there So for that I test for a lot of things thyroid inflammation markers nutrition stuff But rarely am I doing like these big hormone panels because I can just listen to the patient and believe her and And no, and then we start discussing treatment options before we get into some of the treatment options because I really want to give people hope and give people direction and let them know that, that I'm only actually a week and a half into HRT and I'm feeling the benefits of the progesterone already, just in terms of health.

The first few days I was knocked out. Like I was so tired in the morning, but I'm feeling the calmness from that and a very low dose. And then I'm on a low dose patch just because I'm very sensitive to hormones. I'm starting slowly. And yeah. Yeah. Perfect. But is it placebo, Dr. Haver, or is it that I'm actually feeling something because I'm having less hot flashes already, like almost none in a week and a half?

Some women may take longer, but I'm not surprised. Remember that when we go through menopause, [00:20:00] we up regulate the estrogen receptors, especially in the brain. The brain is starving for estrogen, and so it's going to try to grab on to anything that it can, so it's going to make more receptors so that it can capture any estrogen, anything estrogen like floating around your system.

So now we give you The hormone back and then flood the receptors. Of course it wiped you out for a couple of days. Your brain is like And for you fortunately the thermoregulatory center that controls the hot flash stuff just calmed down really quickly But i'll tell my patients let's give it four weeks before we Try a dose adjustment if you're still having hot flashes.

That's beautiful. Okay. So, the WHI study, correct? WHI? I'd like you to hear about that because I know, because I was getting a facial about two weeks ago. And I'm with a woman in her 50s, she's probably post menopausal. And I'm like, oh, you know, I just was in the sauna before the facial and I'm I, or I [00:21:00] was in like the steam room and I'm like, I'm just sweating and I shouldn't have done that 'cause I'm having fought flashes.

And she's like, oh yeah. Like, you know, I understand that. And I was like, yeah, I'm so excited. I'm reading this book, the New Menopause and I'm gonna go on HRT next week. And I was like, just so excited. She was like, oh no, that's terrible. You have to be careful with that. And that's the old mentality that God bless my mom and, and that generation she got so.

I'm going to say it. They got f ed. They really got screwed. And so I'm just trying to, I'm going to be really out and blunt about it. Like I want to debunk the myths of this study that was inaccurate. So the study is just a data set, okay? It's how the data was manipulated. And presented there's good information that came out of that study stuff I used today like protein intake and frailty and how to set a course for you not to end up in a nursing home But back up to hot flash So we knew in the 90s 80s and 90s that women on hrt Which about 40 percent of women menopausal women were on hrt at the time.

It was recommended by every medical [00:22:00] society We knew that they had lower incidence of heart disease heart attacks, right? And so versus women who chose not to take it But that was observational data, which is not proof. And so in order to have proof we need randomized controlled studies versus placebo because they felt that well the women on hrt Tend to be healthier and wealthier And is that just an artifact of something socio economic versus does this really prevent heart disease?

So that was the focus of the study So they recruited like 37 000 patients and at the time the number the two top prescriptions given were premarin and prempro And so they studied only those two formulations You And they didn't study the modern HRT we give now, okay, which is bioidentical. And so they use this Premarin, which is natural, but it comes from horse urine, fine.

And then they did medroxyprogesterone acetate, which is a synthetic progestin. And then only for women who had hysterectomies. So they do these two groups. The [00:23:00] average age of the study was 63. Why? Because the outcome they were looking for was heart disease, and you don't get heart disease typically till you're older.

They did have younger women in the study, but they went up to 79, 79 years old. Okay. So they enroll, they start, you know, and they notice in the estrogen and the pro prim pro group, a very slight, slight increase in breast cancer for the women who were taking from pro, but a massive decrease in breast cancer in the women who were taking primarines, they call a press conference, they do not release the data.

It ended up being the biggest misinformation campaign probably in the history of medicine. And. It was the it was the number one news story of 2002 Remember newspapers have to sell newspapers and controversy cells. This is happening all over the internet today clickbait This is the original clickbait and They talked about the relative risk, which most people don't understand versus absolute risk so the risk the absolute risk of breast [00:24:00] cancer was about four out of a thousand women per year and it went up to seven out of a thousand women per year and that was all ages Okay.

So three extra cases per a thousand women per year. That's the relative risk. So if you look at the math, that's like a 25 percent relative risk, but the absolute risk was less than 1 percent per year. Okay. But that's not what people heard. All they heard was the headlines. Estrogen causes breast cancer.

Estrogen is not helpful. And that at that point, the earth stopped all, all hormone therapy education stopped, all research stopped. And that was it for an entire generation. We know now they've looked at that data again, that if you even believe that slight increased risk, like no one's given all of the options.

That estrogen alone is actually protective for breast cancer, that if you look at the younger population, estrogen is better at prevention than cure from a lot of diseases. So you start early in your menopause or in [00:25:00] perimenopause, you're going to decrease by 50 percent per year, your risk of a heart attack and death from a heart attack, your all cause mortality or risk of colon cancer, you know, your risk of osteoporosis, of general urinary syndrome of menopause, and you're going to feel better.

A lot better like ignoring the fact that sex hormones walk out the door And that that's not supposed to affect us in any way I think is ridiculous And that is the old menopause and so The whi is just the data set and there were some very self important people who stick by these claims today They're still publishing that estrogen is dangerous and women really shouldn't be taking it You know what?

They say about me that I am putting ideas in women's heads Making them think they have symptoms they don't have to ask for hormones they don't need. That was quoted about me. And I'm like, that's the problem. My Instagram feed, because you have millions of women raising their hands saying me [00:26:00] too. And they think that women should shut up and get over it and just deal with it.

And guess what? Gen X and below were saying, no, thank you. That's right. Bye bye. We're going to go over here. We're going to go over here and, you know, when I was reading some of what you wrote in the book about how when you were in residency, they would refer to women in menopause as WWs, as whiny women.

It made me cry. WW. Yeah. It makes me so outraged. I was crying. I was, I was. It was like a trauma response, you know, I just felt so activated and outraged, which is why I'm just going to take my megaphone and just blast this book out to the world because it's heartbreaking to, I've dealt with mental illness.

I'd had extreme postpartum depression and then realizing like this perimenopausal period was another form of mental illness. People are not getting the help they need. And so that's the question for my listeners who are like 35, you know, [00:27:00] feeling symptoms, early forties, feeling symptoms. That's sort of my sweet spot right now.

What should they do? Because they might be thinking, oh, it's too soon to get any hormonal health and blah, blah, blah. I'm like, don't go get it, but I want to hear it from you. So. Educate yourself, you know, number one, don't go into this blindly and don't Realize that there are wonderful fabulous incredible clinicians out there who just aren't trained Okay, and we're probably a generation away from like my daughter's in medical school.

I'm confident that her Generation is going to be menopause competent. Okay, but what are we doing? We're with everybody else in the middle. So Educate yourself. You're going to have to advocate for yourself. And I have lots of tools in the book, how to talk to your doctor, questions to ask labs to ask for, but like just knowing and being aware and know yourself and don't gaslight yourself.

These things are real. These things are happening and that you don't have to suffer. It may take some hustle to find a provider who's going to listen to you [00:28:00] while we get everyone trained and get this train moving, you know, in the metaverse. But. There is good help out there and don't be afraid of hormones.

We're simply replacing what your body can't make anymore and your body with your natural hormones is never going to function better. And pretending that we are going to be absolutely as functional as you were in any aspect post menopause, I think it's a mistake. Now you can be healthy without hormone therapy.

It's just harder. And some people don't have symptoms. I mean, I have friends that just, and that's real too. So don't like go over, you know, over complicate things if you're not having symptoms, but I will say that here I am and I have got real line on speed dial and I like had immediate access to you and Dr.
Taz and I just have all these incredible. People in my world that have done so much are obviously the, at the forefront of this. And I just want to make this very clear to my listeners, with all those privileges and resources that I've had, I have a Google [00:29:00] Drive in my computer that says hormones. And it is six pages long.

And it's notes from your book and it's notes from conversations with Gabrielle and it's notes from from listening to podcasts and it's just talking to a few different doctors before I chose my doctor and even talking to my OBGYN and getting his take even though he wasn't on the same exact path, right?

And talking to my GP and and looking at my bloods and the whole thing, it's all in there. And now I feel like I'm this like expert on my hormones, on my hormones, right? And well, yeah, I want to emphasize that, look, you may not have the experts on speed dial, but even with that, I could have just been like, Oh, I'll just let somebody tell me what to do.

No, no, no, no, no. I wanted to get, yeah, don't outsource your menopause because you have to be as active as a participant just because medicine has not caught up with what women are. Meeting now or what they're [00:30:00] not willing to put up with anymore. And so, you know, you, what you're doing is perfect. No one's going to know your body better than you.

No one. I'm just the captain of a ship, but I'm not building the engine. So I'm here to facilitate your goals, your needs, and help us figure out what soup is going to work best for you at this phase of your life. And that may change as you get older. Right. And so setting you on a course that you can live a happy, healthy life.

I mean, I'm 55. I've been menopausal for at least eight years and I am truly living my best life. Yeah. I am healthier. I'm wealthier. I have better relationships, better boundaries. I'm helping more people. I'm absolutely where I want to be. I get up every day excited about the world, what I can teach, what I can learn.

And I want that for everyone. I literally want everyone to get up and feel the way I do. And had I not changed everything I knew about my health, my hormones, my nutrition, my movement, and [00:31:00] restructured everything for my old lady body, then I wouldn't be here today.

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So I want to get into a bit of the what to do next, right? Because the, and this is for people of all, look, you don't have to be Gabby Bernstein with Dr. Haver. Now on her podcast, you can have limited resources and get this help. And so First thing is like go buy this book tomorrow or today or right now.

And then, because you give it all, like I really want to emphasize it, the whole journey is in the book. But I do want to give people the overview of the fitness, the protein, the fiber, the supplemental, and then your thoughts on the HRT. Sure, just like how to hand mental of things to focus on nutrition wise Make sure you're getting at [00:35:00] least 25 grams of fiber in your diet per day Clearly study showing studies done in women men of all the women Women with more fiber in their diets have less insulin resistance, which goes up independently of age through the menopause transition Less visceral fat deposition.

So all these body composition changes that we're seeing weight goes up with age. Okay, we can't deny that But the, where you're gaining fat, the inter abdominal cavity fat that goes from 7 percent in a premenopausal woman to 23 percent in a postmenopausal woman. And so we can attenuate that with good fiber intake.

So getting all that fiber in it also feeds your gut microbiome and does a million other fabulous things. Try to limit those added sugars, sugars added in cooking and processing, not fruits and vegetables. Those are fine in dairy if you can handle it, but Those sugars added in alcohol and drinks and beverages and condiments to less than 25 grams per day Not to say you're not going to ever have it but women who do that consistently Do better.

They have better health profile and they have less menopause symptoms. [00:36:00] Typically, make sure you're getting plenty of foods rich in magnesium Or do a magnesium supplement. I found that really helpful for sleep as well. Calcium Make sure you're getting calcium from food. Calcium supplements have never been shown to decrease the risk of osteoporotic fracture and they cause kidney stones and they Have all you know, the cardiologists hate them because they think that they calcify the plaques in our coronary arteries So those are just some simple nutritional things make sure you're getting enough vitamin d Most of my patients are extremely deficient in vitamin d.

It's such an important hormone in multiple aspects of our body for movement I grew up in the cardio generation. Everything I did was to be skinny. I worked out to be skinny I ate to be skinny and now I realized I chipped away at my bone and muscle strength and the effort to be thin and now I weigh more than I have forever like before I started gavelson diet when I thought I was fat and Now I have more muscle like I eat and work out to be strong And that's what's going to keep me healthy, you know It's so fun to look at food and be like what's going to make me [00:37:00] strong instead of how am I going to be skinny?

It's such a different mindset and so movement Now I'm doing much, much, much more resistance training, lower impact cardio. You know, I'm doing a few sprints here and there for my VO2 max, but I am literally three to four days a week doing resistance training. I wear weighted vests all the time. I walk in it.

I hike in it. I, Did you get one? I'll do anything you tell me to do. So I'm actually in talks with QVC to make one because I don't like the way they fit over our breasts. You my love, they would, they would be honored to have you on QVC because literally we are hanging on your every word. And so yeah, biggest hack ever, go, go to Amazon and get a weighted vest and just wear it around the house.

I mean, It will save your bones. Do some yoga with a weighted vest on. It'll increase your balance, will decrease your risk of falls. And so all this stuff's so important and stress reduction. This is our [00:38:00] time. I've had to get good with boundaries. I've had to start down some toxic relationships. I've had to really learn how to love people from a distance.

Who's personalities are not making me a better person and so my own family members and so and that has just made my life healthier and really prioritizing my sleep. I've really had to watch alcohol. It is really disruptive. So for me and so many of my patients. More than a glass of wine at night, I know I'm not going to sleep that night.

I'm getting up at three. And so if I ever choose to drink that, I'm choosing not to sleep. That is my choice. And so, and if I don't prioritize my sleep, the wheels come off the bus, right? And so everything is harder. So really, I had to turn the air AC down in my room, get some different sheets, really focus on making my sleep environment the best.

That I need it to be and a chili uler I have it all going. Yeah, some of my patients get the chill pads and stuff. I'm not haven't gone that [00:39:00] far yet But I have like the mattress. That's a cooling mattress the squishy thing. So whatever works for you, but invest in that it's so worth it Right. And, and then we move into, so we've got the nutritional side.

What is it about saw palmetto that helps us? So saw palmetto can block some of the receptors. If you're saw palmetto has been used like for acne and oily skin and some of the changes for some women through perimenopause. They will see the activity of their androgens rise. So even though their actual testosterone levels are not higher, because they're more of it is free and active due to changes in menopause.

Some women will have menopausal acne, menopausal changes in their body odor. They'll have like weird smells and stuff. And so solid palmetto can block the dihydrotestosterone receptor and limit the action of that testosterone on those cells. skin and like sweat glands and stuff. And you have a whole, there's a whole chapter about the why's for each one.

So that's. So my next big thing is to start a training [00:40:00] program so I can just get more Mary Claire's out in the world. That's exactly it. That is the most important thing you could do at this time is to create the training. So as we close the conversation, HRT, we don't, you go over it all in the book, but you have like a simple entry point and obviously this all depends on the person's individual history and their three family history, all of that.

If they have their ovaries dot, dot, dot. So just broad strokes over you just to give people a taste of what they would. Sure. No one's so I have drugs of choice, right? So when we look at the broad categories of sex hormones, we have estrogens, we have progestogens, and then we have androgens, which are like testosterone.

And when we talk about. Therapy, it depends on what stage you are. Sometimes just progesterone is what will start in early period menopause. Sometimes if they're really having the mental health issues, I'm going to add estrogen early, right? Because I see where this is going, especially if they have a history like you of having really severe issues, postpartum that was from estrogen [00:41:00] withdrawal, and I don't want to go there again, so we're going to go ahead and I didn't know that right on Zoloft, by the way, I really am grateful because it did save my life.
 
But like. You're part of an estrogen support as well and so I'm just going to say that loud and proud for everybody listening who's, I just want to make sure people hear that if you're going through postpartum, make sure people are testing your estrogen, your TSH, right? It's the most important thing.

Right. Like we don't want to miss anything and Some estrogen support might be helpful for her, you know, through this transition, not to say you won't need an SSRI. Many of my patients did, but this is a key thing that we're missing. And if you have a history of that, I'm asking you every single visit.

How's your mental health? How's your mental health through the transition? So my kind of go to with estrogen is going to be a transdermal option. Usually the patch, we have five strengths. So I have wiggle room. They're very inexpensive in the scope of things. They 20, 25 bucks a month with coupons or whatever, and they're generic.

So most people have access to them. They're FDA [00:42:00] approved. I'm 98 percent certain what they say is in that patch is in it. For progesterone, almost everyone in my metaverse is an oral micronized progesterone. It's bioidentical. It has the highest safety profile. It does not have an increased association with breast cancer.

So any of us are using that one. And then for testosterone, it's tougher because we don't have an FDA approved option for women. So we have, we go two routes. Depending on the state because there's different laws. One, it's a controlled substance. So we're trying to get the FDA to take that down. Like Kelly Kaspersen and other people in, in the menopause are fighting the FDA, like meeting with the FDA to have testosterone taking off.

Like it's like a narcotic. I'm like, no, no, no, no. It's testosterone. It's a natural human hormone. And then the next battle is getting an FDA approved option for women. But until then, you can either use the men's version if you can get it. Or we'll have it compounded for patients in a cream, but we are all doing pretty much transdermal options for that.

What about vaginal cream? [00:43:00] If you're, oh, and vaginal estrogen should be in a vending machine. It is over the counter in Europe. Okay. It is so safe. Even if you have active breast cancer, you can use vaginal estrogen. There's no systemic absorption in that strength because it is so mild. Okay. It is a lifesaver.

Like if you're having vaginal dryness, decreasing lubrication, pain, loss of elasticity, anything, recurrent UTIs, the best treatment, better than antibiotics for prevention of UTIs. If you are having irritable bladder, getting up in the middle of the night to pee all the time, all that, if you're having delayed orgasm through your menopause, giving yourself natural estrogen to increase the blood flow to the area can really help.

I'm just such a fan. I think everyone should be on it. Okay. Okay. And what is that product? It's usually a cream. So they have for vaginal estrogen, it's local, right? So it's much lower dose than systemic. They have creams, which are usually how we prescribe it because there's a generic option. It's cheap, but there are also pills.

And then [00:44:00] there's a ring, a really cool ring you throw up there and it lasts for 90 days, but they tend to be expensive and not covered by insurance. So I love a ring, but I don't even use it because the cream's so cheap and I don't mind it. Yeah. And I, that's what I love about you is you're really speaking to what people can access and what people have access to.

So if you're talking to this, the last sort of roundup question, because this is so needed and it's the whole guide, it's all in one place. It is, I trust it. I trust you. I'm going to cry because you've meant a lot to me because I was so alone in this, even though I had these friends, even if you have those resources, you don't use them often because you're in shame or whatever it is.

And I just hearing you was like, Holy there's hope. And. And then I just acted on it quickly. And I think that's the other thing is don't wait, act on it quickly, get educated, but you can get into motion. So any sort of last words other than me saying, [00:45:00] go buy the book, everybody, any last words for, for folks listening that you're just like, this is the most important thing I could say to a woman ever.

Menopause is inevitable. Inevitable. It's happening. If we're lucky to live long enough, it's happening to all of us. But suffering is not. And don't let yourself suffer and please share your experiences with everyone who will listen we need to de stigmatize normalize Make this as this sisterhood of guiding everyone through it, you know Like we do with puberty like we do with childbirth We should all be supporting each other and please do not use your personal experience to judge that of another woman Hmm.

Do not. It's just like postpartum or pregnancy, right? It's all that shaming. Like that woman that did my facial, she was shaming me privately without realizing it. She's like, I didn't have any symptoms. I was fine. I didn't take it. Exactly. I didn't need any of that. I'm like, okay, how's that osteoporosis working for you?

Exactly. And white knuckling it is so unnecessary. So I just, [00:46:00] on behalf of all the women out there that are following you and reading you, I want to just speak for them and just say, thank you so deeply. You are a hero. And I, I just, I can't wait to hug you in person one day. And literally we weren't recording any more podcasts like for a while, like months.

And I was like, get her on, please. And here we are. So tell your COO, we love her. We'll send her some books as well. And, um, I'm just, I'm really proud of you. And I want it from a woman out of you and it's a big deal. And I know you know that, but I wanted to reflect it back to you. So thank you so very much.

Thank you. It's still unbelievable to me that I was a basic OB GYN, nothing fancy, really hardworking, really great with my patients. And now I'm here, teaching millions. And how'd this happen? Like, how did I get here? But it's where I'm meant to be. Yeah. And it is the best thing I've ever done with my life.

Yeah. [00:47:00] No, you're doing God's work and I'm really proud of you and I, I'm really behind you in creating the training. So if you need any guidance on that, we'd be happy to share any information you need on that and support you because they train the doctors and the practitioners and the nurses and, and everybody.

So thank you. Awesome. All right, everybody, go buy the new menopause and go save yourself and feel better. I love you. I love you. Thank you so much. Thank you for having me. I'm so excited. And you're on the road and you're on your tour. So good luck with all of that. But Mary Claire, I just want to say thank you. I just, I love you. Thank you.

Make sure to subscribe so you don't miss any of the guidance or special bonus [00:48:00] episodes. Your experience of this show means a lot to me, so I really want to welcome you to leave an honest review. And you can follow me on social media at Gabby Bernstein. And if you want to get in on the action, sign up for a chance to be Dear Gabby'd live at DearGabby.com. See you next week.

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