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Meet Your Menopause Expert
Today, Dr. Thais Aliabadi and Mary Alice Haney of the SheMD podcast are diving into the world of menopause with a true expert in the field. Dr. Mary Claire Haver brings a wealth of knowledge as a board-certified OB/GYN and certified culinary medicine specialist. She’s the bestselling author of the Galveston Diet and has a new book coming out called “The New Menopause.”
A Journey from Doctor to Advocate
Dr. Haver’s story began during her tenure as a professor and residency program director. While managing a thriving practice, she noticed a consistent pattern emerging among her patients – women she knew personally from church, marathon training, and daily life. These weren’t just random patients; they were members of her community who kept sharing eerily similar struggles. They described unexplained weight gain, persistent sleep problems, unexpected body changes, and an overall sense of not feeling like themselves anymore. Their experiences would soon become the catalyst for a significant shift in her medical focus.
Personal Experience Shapes Professional Focus
Everything changed when Dr. Haver reached age 48 and decided to stop taking birth control pills. Her transition into menopause was sudden and intense, marked by severe hot flashes and night sweats. Despite her medical background, even she initially struggled to connect these symptoms to menopause. This personal experience opened her eyes to the gaps in traditional medical training about women’s health during this crucial life stage.
From Curiosity to Mission
Her personal journey through menopause sparked an intense curiosity that would transform her career. Dr. Haver discovered that her medical training had provided minimal coverage of menopause care, a gap made worse by the cautious approach many doctors took following the Women’s Health Initiative study’s findings about hormone therapy. Determined to find answers, she pursued additional education in nutrition, immersed herself in the latest menopause research, and developed a deep understanding of how hormonal changes affect the entire body. This knowledge led her to create comprehensive resources for women seeking help during their menopause journey. Today, with a following of over 3 million on social media, Dr. Haver leads the conversation about menopause care, helping women understand that this transition affects far more than just hot flashes – it impacts everything from cognitive function to emotional well-being.
Note: This podcast is for educational and entertainment purposes only. Always consult your healthcare provider for medical advice.
From Curiosity to Clinical Focus — Menopause & Nutrition
I wrote a book called The Galveston Diet on how a menopausal person could approach nutrition. -Dr. Haver
Understanding Our Bodies’ Timeline
Let’s talk about something that affects every woman – menopause. Unlike men, who can make fresh genetic material their whole lives, women are born with all their eggs. This biological fact shapes our entire reproductive journey. At birth, we start with an impressive 1-2 million eggs. By the time we reach age 30, this number drops dramatically to just 10% of our original supply. The decline continues, and by age 40, only 3% of our initial egg count remains.
What Makes Women Different from Men
The fundamental difference between male and female reproductive systems lies in their operating principles. Men’s bodies function like a continuous factory, producing new genetic material daily throughout their lives. Women’s bodies, however, operate more like a storage system. We’re born with our full egg supply, just as we’re born with all our brain cells. What’s particularly noteworthy is that our ovaries age twice as fast as any other organ in our body, making this system even more remarkable.
When Does Menopause Happen?
The medical definition of menopause is straightforward: it occurs when you’ve had no periods for one year after age 45. However, this definition has its limitations, as it doesn’t account for women with IUDs or those who’ve had hysterectomies. In the United States, the average age for menopause is 51 years, though the normal range spans from 45 to 55 years, encompassing 95% of women. The transition period, known as perimenopause, typically lasts 7-10 years and usually begins between ages 35 and 45.
The Journey Through Perimenopause
During perimenopause, your body undergoes significant changes as your hormone levels become increasingly erratic. The once-predictable monthly hormone pattern transforms into a more extreme version of itself. Your brain must work harder than ever to trigger egg release, resulting in a cascade of hormonal events. This period is characterized by delayed ovulation, dramatic hormone surges, and sudden drops in hormone levels, creating a roller coaster of physiological changes.
What Can We Do About It?
While the market is flooded with supplements and treatments claiming to delay menopause, the scientific reality is more modest. We currently have limited ability to significantly alter this natural timeline. The most effective approach remains focusing on overall good health and wellness. Scientists are actively working on innovative solutions, such as developing continuous hormone monitoring systems similar to glucose monitors, but this technology isn’t available yet. The most important thing to remember is that every woman’s experience with menopause is unique – even sisters can have vastly different journeys. Success lies in understanding your body’s changes and seeking appropriate support when needed.
Ovarian Biology — Defining Perimenopause & Menopause
The Fundamental Difference Between Male and Female Aging
When it comes to reproductive aging, men and women follow very different paths. Men continue to produce fresh sperm throughout their lives, but women are born with their complete lifetime supply of eggs. This fundamental difference shapes how women experience reproductive aging and menopause.
The Timeline of Ovarian Aging
Our ovaries age more rapidly than any other organ in our body, following a predictable yet dramatic timeline.
By the time we’re 30 we’re down to 10% of our egg supply, and by the time we’re 40 we’re down to 3% of our egg supply. -Dr. Haver
Defining Menopause
The clinical definition of menopause is straightforward: no menstrual period for one full year. However, this definition has limitations, particularly for women who have had a hysterectomy or use an IUD. In the United States, the average age for reaching menopause is 51, though the normal range spans from 45 to 55 years old.
The Perimenopause Journey
Perimenopause represents a significant transitional period that typically spans 7 to 10 years. This phase usually begins in a woman’s mid-30s to mid-40s and brings substantial changes to the body’s hormonal patterns. During this time, women experience irregular ovulation accompanied by fluctuating hormone surges. The body’s ovulation timing becomes less predictable, leading to variations in both estrogen and progesterone levels.
Understanding Hormone Testing
Current methods for tracking hormonal changes during menopause have limitations. Single-point measurements from blood, urine, or saliva tests cannot fully capture the dynamic nature of hormonal fluctuations. Medical researchers are working toward developing continuous monitoring systems, similar to continuous glucose monitors, to better understand and track these hormonal changes. This technology could revolutionize how we monitor and manage menopausal transitions in the future.
Symptoms Beyond Hot Flashes — Systemic Effects
I didn’t know that menopause could affect every organ system of our bodies. -Dr. Haver
Understanding the Full Impact
Many people think menopause just means hot flashes and night sweats. The truth is far more complex – menopause can affect nearly every system in your body. This widespread impact often surprises both patients and healthcare providers, leading to missed opportunities for treatment and support.
The Many Faces of Menopause
During menopause, mental health changes become notably common. Women often experience new-onset depression and anxiety, while many struggle with cognition issues and brain fog. These mental health shifts aren’t minor – studies show a four-fold increase in these symptoms during the menopausal transition.
The cardiovascular system faces its own challenges. Many women notice changes in their heart’s behavior, experiencing more palpitations and increased sensitivity to heart rhythms. Estrogen plays a crucial role as an anti-inflammatory agent, so its decline affects the entire body’s inflammatory response.
The musculoskeletal system undergoes significant changes too. What doctors now call the “musculoskeletal syndrome of menopause” can include joint pain, conditions similar to frozen shoulder, and new chronic pain patterns that might resemble fibromyalgia. These symptoms often appear suddenly and can be quite distressing for women who’ve never experienced such issues before.
Genitourinary health faces particular challenges during menopause. The condition known as genitourinary syndrome of menopause (GSM) brings multiple issues: vaginal atrophy, decreased lubrication, increased irritation, more frequent UTIs, and changes in urinary patterns. The good news is that these symptoms respond well to treatment when properly diagnosed.
Bone health becomes increasingly important during this time. The rate of bone loss accelerates significantly, raising the risk of osteoporosis. However, hormone therapy has shown remarkable protective effects, potentially lowering fracture risk by about 50%. This makes early intervention and proper treatment crucial for long-term bone health.
Body composition changes in distinct ways during menopause. Women often notice a shift in fat distribution from peripheral areas (the “pear” shape) to more visceral fat (the “apple” shape). This change isn’t just cosmetic – it carries important implications for cardiometabolic health.
The skin and hair undergo noticeable changes too. Women can lose up to 30% of their collagen, leading to drier, itchier skin. Some experience unusual sensations like formication (feeling like ants are crawling on the skin). Hair thinning becomes more common, and some women notice new patterns of hair growth related to hormonal changes.
Taking Action
Understanding these wide-ranging effects helps women better prepare for and manage their menopausal transition. Working with healthcare providers who understand the full scope of menopausal changes is crucial. Through proper medical support, lifestyle adjustments, and appropriate interventions, women can navigate this natural life transition more successfully. The key is recognizing that these changes are normal, treatable, and worthy of attention and care.
Hormone Replacement — Symptom-Driven, Individualized Care
I usually treat symptoms not blood levels. -Dr. Haver
A Patient-Centered Philosophy
The cornerstone of modern hormone replacement therapy lies in treating the patient’s symptoms rather than focusing solely on hormone lab values. This approach recognizes that each woman’s experience is unique and requires individualized attention. Through careful shared decision-making, healthcare providers discuss risks and benefits based on various factors including age, symptoms, existing health conditions, and personal cancer history.
Beyond Hormones
For some symptoms, particularly mood-related issues, non-hormonal options serve as the first line of treatment when hormones are contraindicated. This comprehensive approach ensures that women receive appropriate care tailored to their specific needs and medical history. The treatment strategy extends beyond just managing symptoms to include vital aspects of overall health.
Comprehensive Care Approach
Lifestyle modifications and preventive measures form integral parts of the treatment plan. This includes detailed nutrition counseling, structured resistance training programs, and regular body-composition monitoring through tools like DEXA scans and body scanners. These elements work together to create a holistic approach to menopause care that addresses both immediate symptoms and long-term health.
Long-Term Health Goals
The focus extends well beyond immediate symptom relief to encompass crucial long-term health objectives. By implementing early interventions and targeted hormone replacement therapy where appropriate, the aim is to reduce the risk of several age-related health concerns. These include sarcopenia (muscle loss), frailty, osteoporosis, and cognitive decline. This forward-thinking approach helps ensure better health outcomes as women age.
Monitoring and Adjustment
Success in hormone replacement therapy is primarily measured through symptom tracking, with objective testing such as bone density scans and laboratory work used selectively to guide treatment decisions. This balanced approach allows for ongoing adjustment of treatment plans based on both subjective improvement and measurable health outcomes. Regular monitoring ensures that the therapy remains effective and appropriate as a woman’s needs change over time.
Testosterone — Benefits, Monitoring & Pellet Controversy
They’re recommending giving super physiologic doses of testosterone. -Dr. Haver
Understanding the Biology
In women’s bodies, the ovaries produce testosterone as a key precursor to estradiol. During menopause, androgen production drops by about half, though the adrenal glands continue to contribute some testosterone. This natural process affects various aspects of women’s health and well-being.
Clinical Applications
Testosterone therapy can play a valuable role in treating hypoactive sexual desire disorder. When combined with proper nutrition and resistance training, it can also help support muscle and bone health in cases of sarcopenia. These benefits make testosterone an important consideration in menopause care.
Treatment Options
Several formulations are available for testosterone therapy. These include compounded topical creams that deliver small daily doses, modified male formulations used at lower doses (though this is considered off-label), and in some cases, pellets. Each option has its own benefits and considerations that need careful evaluation.
The Pellet Debate
A significant controversy surrounds testosterone pellets, which were originally designed for men. Many compounding protocols target male-normal ranges of 150-250 ng/dL, which can lead to unwanted virilizing effects including facial hair growth, acne, and hair loss. This approach often delivers supraphysiologic testosterone levels that aren’t appropriate for women.
Safety and Ethical Concerns
The marketing of pellets has become increasingly aggressive, raising ethical concerns about their use. Some practitioners may be overusing them for revenue purposes. Once inserted, pellets cannot be easily removed if problems arise. The high serum testosterone levels they produce can cause significant side effects.
Practical Treatment Approach
Many experienced clinicians prefer to start with low doses, typically around 5 mg/day in topical form. They carefully monitor symptoms and aim to maintain levels within the high-normal female range, well below male norms. This conservative approach prioritizes safety while still providing therapeutic benefits.
Formulations, Progesterone, Safety & Duration of HRT
If you start hormone therapy within 10 years of your menopause or before the age of 60, you will have a lower risk of death from cardiovascular disease. -Dr. Haver
Understanding Treatment Goals
Hormone replacement therapy serves two important purposes: it helps relieve immediate symptoms while also offering long-term health benefits. When appropriate, it can protect your bones, support brain health, and maintain cardiovascular wellness. The timing of when you start HRT makes a big difference. Research shows that beginning treatment within about 10 years of menopause or before age 60 provides the strongest protection against cardiovascular problems and dementia.
Choosing the Right Delivery Method
When it comes to taking estrogen, non-oral routes like patches and other transdermal methods are often the best choice. These options help reduce the risk of blood clots. While oral estradiol does work well, it comes with a higher risk of venous thromboembolism (VTE). For women who still have their uterus, adding progesterone is crucial. This can be done either cyclically or continuously to prevent endometrial problems that might arise from using estrogen alone.
The Role of Progesterone
For progesterone treatment, oral micronized progesterone has shown excellent safety results. Many patients find it helps improve their sleep and reduces nighttime anxiety. Doctors typically start with about 100 mg and can increase the dose up to 300 mg as needed. The duration of hormone therapy isn’t limited by a specific age cutoff anymore. Instead, doctors and patients have ongoing conversations about risks and benefits. As long as no new health issues develop that would make HRT unsafe, the benefits can continue throughout treatment.
Monitoring and Follow-up Care
Regular monitoring is an essential part of hormone therapy. This includes screening for cardiovascular risk factors, checking cognitive function, and assessing bone density when needed. Your healthcare provider will regularly review whether you still need hormone therapy and look for any new health conditions that might affect treatment. This ongoing assessment helps ensure that hormone therapy remains safe and effective for each individual patient.
Bioidentical Hormones, Compounding Myths & Closing Advice
Understanding Bioidentical Hormones
When we talk about bioidentical hormones, we’re referring to those that are chemically identical to what your body naturally produces. The primary focus is on estradiol, which perfectly matches the hormone your ovaries once produced. While other types of estrogen exist in the body, estradiol remains the most crucial for treatment purposes.
The Truth About Compounded Hormones
The world of compounded hormones is surrounded by misconceptions that need addressing. Despite marketing claims, compound pharmacies don’t necessarily offer superior products compared to standard pharmaceutical options. Popular combinations like “biest” and “triest” lack robust scientific evidence to support their claimed benefits. Wild yam cream, often promoted as a natural solution, simply doesn’t work and should be avoided. It’s essential to approach any marketing claims with healthy skepticism, especially when they seem too promising to be true.
Taking Control of Your Care
Getting the best menopause care requires an informed and proactive approach. Education about available options forms the foundation of good decision-making. Finding a healthcare provider who specializes in and takes menopause seriously can make a significant difference in your treatment journey. The focus should always be on addressing your specific symptoms rather than just chasing lab numbers. Being prepared to discuss both risks and benefits with your healthcare provider ensures you’ll make well-informed decisions. Staying current with new research developments helps you participate actively in your care decisions.
Moving Forward
The field of menopause care continues to evolve with ongoing research bringing new insights and understanding. Rather than accepting outdated information or unproven treatments, women deserve care that’s firmly grounded in scientific evidence. Effective menopause treatment should be tailored to individual needs, with a clear focus on symptom management. The approach should prioritize safety and rely on well-researched methods, with regular reviews and adjustments as needed. For additional information and resources about menopause care, SHEMD.com offers comprehensive guidance and support.
