The 'Pause Life
S2, E14
March 20, 2024

Dr. Mary Claire Haver is a board-certified OBGYN, a Certified Menopause Practitioner, a Certified Culinary Medicine Specialist, a passionate entrepreneur and best-selling author with a focus on women's health. She’s also a prolific menopause expert who shares her insight, wisdom, and practical tips for managing the midlife transition on social media, helping women around the world reach their best-feeling selves.

Mary Claire joins Stacy for a robust discussion about the reality of menopause, and shares her top exercise and nutrition tips, as well as her toolkit philosophy - techniques that she’s incorporated into her own life that she can apply as she ages to maintain a healthy lifestyle.

Follow Dr. Mary Claire Haver: Mary Claire Wellness and The Pause Life

Her latest book is The New Menopause, available for pre-order.

Follow Stacy London @stacylondonreal

Hello Menopause is a podcast from the national nonprofit Let’s Talk Menopause Produced in partnership with Studio Kairos. Supervising Producer: Kirsten Cluthe. Edited and mixed by Justin Thomas. Artwork by Stacey Geller.

Thank you to Always Discreet for sponsoring this episode of Hello Menopause. Always Discreet, because we deserve better. Available at Target.

Please rate and review the show on Apple, Spotify, or wherever you get your podcasts.

S2EP13 Dr Mary Claire Haver

Stacy: Hey friends, the views of our guests do not necessarily reflect the views of Let's Talk Menopause. Let's Talk Menopause does not provide medical advice. The content in this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions that you may have.

Hello Menopause is changing the conversation around menopause and in every episode we Floor, the physical, emotional, and mental changes that women experience during this transformative stage in life. Menopause has 34 symptoms, and we cover all of them from brain fog to panic attacks, to heart palpitations, and urinary issues.

For that last one, we're thankful that this episode is sponsored by Always Discreet, makers of liners, pads, and underwear for bladder leaks, Always Discreet is available at Target.

Welcome to Hello Menopause. I'm Stacy London, your host, a stylist, and a menopause advocate. Dr. Mary Claire Haver is a board certified OBGYN, a certified menopause practitioner, a certified culinary medicine specialist, a passionate entrepreneur, and best selling author with a focus on women's health.

She's the author of The Galveston Diet and the book The New Menopause, navigating your path through hormonal change with purpose, power, and the facts. Please welcome. Dr. Mary Claire Haver to hello menopause

Dr. Haver, I know that you have a new book coming out in April. It is called The New Menopause: Navigating Through Your Hormonal Change with Purpose Power and Facts.

It's described as the empowering approach to self advocacy, which I love, that women need as they go through hormonal change. So let's talk a little bit about the book. What was the impetus to write it?

Mary Claire: Really, it was my following on social media. I had written the Nutrition and Lifestyle book, Galveston Diet, published early last year and had a really great response to that, but so many more questions were unanswered.

People wanted to know all about HRT. What about all the symptoms? Is my frozen shoulder related to menopause? What about my tinnitus or my vertigo or what's going on with my itchy ears? And I just thought. This is a bigger book. This is a bigger conversation. And I'm all day long. I answer questions.

And I'm like, if I could just compile this into a book as a reference guide for women, this would be way more effective than 9, 000 videos on social media.

Stacy: Exactly. Then, even with 9,000 videos, even when they go viral, it doesn't necessarily get to everybody. Having a Bible and a reference book, I think, is always so essential.

And you're known for the Galveston diet, and you're known for nutrition and exercise and weight gain and stress reduction, which I do want to talk to you about, but I think it is interesting that you realize that there were [00:03:00] So many people asking other questions about what is related to menopause, right?

Because if I understand correctly, there are 34 common symptoms, but over a hundred potential issues that can happen during this phase. And nobody knows that frozen shoulder might be related to some sort of hormonal change. Is that really what you found?

Mary Claire: Yes. In my research for the new book, every single organ system In our bodies has estrogen, progesterone, and testosterone receptors.

And when those levels start tanking, we can see changes in each of our expressions of our perimenopause and menopause are individual. So where you would, might've had mental health changes and, frozen shoulder, I had hot flashes, night sweats. And skin changes that affected me and it's really hard for medical providers to know all of these things because we're not taught, there's just such a lack of education and focus around menopause care outside of the hot flash.

And we just, women are feeling. But they're crazy. They don't understand what's happening to their bodies. And this book is meant to be a tool of validation and a way for you to advocate for yourself with actionable items for you to go, informed into your physician's office.

Stacy: Let's talk a little bit about actionable items.

I understand obviously that it's such a varied range of experiences, as you've said. So one person's menopause is not going to be the same as another person's, but you did notice, and I think this is again why your first book came out, right? Was this idea that without any changes in diet and exercise, you were seeing that people in menopause and perimenopause gain about three to five pounds.

Is that three to five pounds just a solid three to five pounds or is that every year? Cause I, I feel like there, I've seen a lot of people with more weight gain than even that.

Mary Claire: So that's on average pretty much a year, about three pounds a year is the average weight gain. And a lot of the older studies just said it probably has more to do with aging because the trajectory of the weight gain doesn't seem to change with menopause transition.

You just take 50 year old, 55, 60 year old and the way it's going up. What is changing? I think what is important for people to understand is your body composition. And so where and how you deposit fat, how much muscle you have starts changing dramatically with the menopause transition. And that correlates more than just annoying weight gain that is cosmetically distressing, but a health risk.

Having a few extra curves or a little bit of an inch that you can pinch may not be something that you're happy with, but it really isn't that dangerous. What's dangerous is the new fat that gets deposited around our internal organs. That fat in medicine we call visceral fat, but in layman's terms, it's usually called belly fat, is the fat that is driven by hormone change, cortisol, lack of sleep, decreasing estrogen levels having more activity of testosterone in some women due to steroid hormone binding, globulin, there's a lot of different reasons and all of it is related to menopause.

Stacy: And it's interesting to me because, as a stylist, I have seen this in many people that I have spoken to who are in perimenopause, have even postmenopause. They talked to me about, when did I get this belly? I have a shelf, how do I disassemble it? Even their boobs get bigger, or, there's something that makes them feel like they have muffin top, and they did not change their diet, they did not change their exercise, and you have said that the idea of calories in, calories out is not what we should be focusing on here.

Let's talk a little bit about that. Why does that shift need to happen? Because when we're younger, that seems to work, right? But as we age, why does that not help us in the same way?

Mary Claire: It's mostly due to hormones and I don't say this lightly. I hate the term hormone balancing because we have dozens and dozens of hormones in our body, but the ones specifically that drive where and how we store fat and our metabolism, our hunger, our satiety, our things like leptin and ghrelin, insulin, cortisol, our estrogen, our progesterone, All of this works together and when you start pulling the rug out from under our sex hormones, we see differences in leptin and ghrelin, which controls, are you hungry?

Are you full? Did that meal satiate you or not? It's really fascinating when I did a deep dive into all of this. So even with zero changes in diet and exercise, the menopausal woman can expect to have at minimum. body composition changes and new onset of visceral fat deposition. But good news, there are a few studies that have looked at this and have some really concrete nutritional and exercise ways that we can combat this.

Stacy: Let's talk about nutrition. How can we leverage nutrition really at this stage of our life? Because I really do feel a little bit like menopause is the last exit on the highway, right? For us to really safeguard our health for the rest of our lives, what our health span and longevity is going to look like.

So I see this as a real opportunity. So let's talk about some of those action items. What can we do when we think about nutrition in order to safeguard against some of these changes in our hormones?

Mary Claire: All those years that we were counting calories, and I did it too, we weren't looking at nutrition.

And in medical school, nutrition was like porn. You know it when you see it. I did not have a nutrition class. We learned about calories, protein, fat, carbohydrates, and some really extreme nutrition deficiencies like that. Wash York or scurvy, but nothing about day to day nutrition and what is healthy.

Stacy: And really the lowest man on the totem pole is the registered dietician and healthcare team. And this is probably the most educated, the most informed, the best person in your corner, because they have the education and training, an undergraduate degree, and usually 18 months of postgraduate training to be able to be a registered dietician. And they're literally treated like the cafeteria lunch lady. And, I know this only because my sister is a registered dietitian.

Mary Claire: And so my daughter has an undergrad in nutrition science, was going to go the RD route, but took the MCAT and went to medical school instead. So talk about holding me accountable through all of the diet and picking apart everything.

So an answer, leaving calories on the side for a minute, calories are important. If you eat too many, you're going to put on excess fat. That's not working for you anymore. Let's take a look at your nutrition. Are you getting enough fiber? Fiber is one of the highest quality, most underrated nutrients out there.

The average American woman is getting about 12 grams of fiber in her diet per day, and she needs a minimum of 25. And when you get that adequate fiber, a combination of soluble and insoluble fiber, perfectly able to get that through diet. If you hustle, you are going to feed your gut microbiome because that's soluble fiber.

You're going to slow the absorption of sugars out of your gut into the blood stream. You're going to decrease your insulin levels. You're going to decrease your fasting insulin levels, and you are going to have decreased inflammation.

Stacy: So let's just talk a little bit about that. Just, I don't know the difference between soluble and insoluble fiber, and what would be some examples so that like literally when somebody listens to this podcast, they can go grocery shopping afterwards.

Mary Claire: So most foods naturally have a combination of soluble and insoluble fiber. Some of the supplements are one versus the other. So soluble fiber is what dissolves in water, okay? When you stir it up, you don't get that precipitation at the bottom. It's dissolvable, and that is the food for our gut microbiome.

That is the prebiotics. When you see it has a prebiotic, it's just fiber. Insoluble fiber is the fiber that bulks the stool that pulls the water in and adds volume to our stool. It helps move things quickly through the gut. And it's important. They each have jobs in our gut that are important. So if you choose a fiber supplement to get you over the edge, if you can't get it through food, then you want to choose a supplement that has both.

Stacy: Okay, and a supplement like that, so is Metamucil a soluble fiber, insoluble, like I'm, and then when we talk about like actual foods, are we talking about vegetables, are we talking about, yeah, things like that.

Mary Claire: Legumes tend to have some of the highest, legumes, nuts and seeds have some of the highest levels of fiber, so legumes are going to be your beans, we all know.

Tons and tons of fiber in our beans. Great source. I try to get some kind of a bean or a legume in my diet every day. Chia seeds, fabulous. Avocado, fabulous. Those are my top three. If you're going to hit it though, and those are things you should incorporate in your diet if you love them and can tolerate them on a regular basis to help get now fruit, nuts, seeds, leafy greens, anything with a crunch.

The crunch is fiber has lots of fiber in it as well.

Stacy: That is wonderful. Thank you. Because that's like a really easy rule of thumb if we can think about those things. And I love the idea of beans being in my diet every day. Beans, chia seeds, and what was your third top one? Avocado. Okay, so great. Two out of three I already got going for me, so I'm excited.

Let's shift gears a little bit and talk about the shift in exercise. Now, I know specifically for me, one of the things that I started to do, especially when I was younger, was like punishment. For me, going to the gym or going to see a trainer was, I've got to lose 10 pounds.

I've got to get thinner. That's the Gen X mindset in some ways, I think, but there was a point where I started to realize this was not going to be about aesthetics anymore that it was really going to be about. I want to be able to walk when I'm 85. I want to be stable enough not to fall when I'm older.

And a lot of bone density changes after menopause. So talk to us a little bit about exercise and why it can be so important. What sort of the top three things you would do to really help us, as we're moving through perimenopause and postmenopause.

Mary Claire: So in my clinic, my patients aren't coming to me wanting to rock a bikini. It would be wonderful. They would not say no to that. Nobody would say no. They are really looking at their mothers, their aunts, the older women in their family, and they're like, hey, I don't want that. I'm scared. I want to be functional at 85. I want to be the fun grandma. I want to climb the mountains. And if I stay on the path I'm on then that's not gonna happen for me. And I'm like, okay. Let's take a look at what you're doing now. So if you're on the couch and you're sedentary, we got to get you up and walking on a regular basis. If you're walking, let's pick up some weights. If you're going to the gym every day and you feel like you're not getting the maximum, what you can do, you really should be doing resistance training, strength training, at least two to three times a week, hitting your upper body, lower body and core.

We should be doing balance work as well as stretching. All of these are so important. And then of course, there's cardio. So forever, I was a Gen X-er. I did cardio to punish myself, to undo eating a cookie or, to get to a certain weight. And that, strong over skinny. Strength is the goal of exercise. Cardio keeps your heart strong. That's important, but we have to do way less than probably we thought we had to do in order to keep that heart pumping and, keep it, keep our longevity going for our cardiovascular health.

Stacy: And when you say that the patients that you're seeing now are saying they don't want to be like their grandparents, that really is Gen X, right?I feel like we are the generation that is propelling this conversation in a different direction. Because even boomers that are older than us, weren't necessarily talking about health the same way that we were talking about it. Now, this idea of not skinny, it's strength really feels like it's the first time that we've legitimately stopped talking about exercise as another form of beauty and really now talking about it as fitness and heart health and bone health and brain health.

Mary Claire: One thing about our generation that I love is that we are recognizing the choices we're making today are going to affect our health and longevity and functionality as we get older. Our parents, my parents, my husband's parents, don't think that way. They think they did everything they could and the chronic disease that they're suffering from is just bad luck.

Or the way that it goes. You get old and you get sick. And I'm like frailty is optional. It is not required, and if we don't rethink how we're doing this as a culture, as a generation, as a population of females, we are going to fall and break at 85, and that's totally avoidable. And when you break that hip, you have a 30 percent chance of death in one year, and that year is marked with a horrific decline in your health.

Stacy: I remembered this because I saw this happen to my grandmother and, from the time that she fell, she was in a nursing home. It was the beginning of the end and this idea that, once you fall, there is this 30 percent chance that you won't make it past a year. She made it well past a year, but she was in a bed. And that those are the things that I think we recognize particularly because we're this funny generation. I think that we benefited from cosmetic dermatology like no other generation. And we understand health so much better. Not much sitting, no smoking, stop drinking. Like we've learned 10, 000 steps. That's all happened in our lifetime. And I think that's really set us up in some ways for much stronger health outcomes and longevity that is going to be productive rather than sadly, being in a nursing home or sitting in a bed.

I'm curious also about when you talk about stretching, This is something that I don't hear people talk about often enough when it comes to exercise. Can you explain a little bit why stretching is so important? Obviously, we know stability for balance is so that we don't fall.

Strength training is for bone density. Cardio is for cardiac health. But stretching, I don't know that everybody understands the benefit of that.

Mary Claire: Sure. One of the things we're discovering is more and more about the musculoskeletal syndrome of menopause. And estrogen receptors in the joint tissue and the joint capsules are highly regulated in our premenopausal years.

And when we take that estrogen away, it seems like we are extremely affected. So when we look at the data, The musculoskeletal syndrome of menopause affects probably 85 percent of women where they are having pain where they never had it. They have no injury. They're having new joint pain and for 20 percent of those women, it is the worst symptom of their menopause. Absolutely devastating to them. And we don't just take menopause hormone therapy and think it's going to fix everything. Everything's a toolkit. And part of the toolkit for MHT is going to be stretching those joints and ligaments because they are shortening, they are tightening. And we have to get in there and keep them limber. Or they're, the lack of estrogen, even with HRT, there's no guarantee, is going to affect it. And I've just seen women who are devastated by this. Not just in terms of pain, but in terms of stiffness, right? It really does affect mobility. It keeps them awake at night. They can't sleep.

Stacy: I'm going to switch gears again because this is something, it's interesting. I'm such a big stretcher and I believe so much in it. And one of the reasons that I wanted to talk about it is that like somebody like me, I had psoriatic arthritis. I had psoriatic arthritis before menopause. During perimenopause, I started to notice a huge difference in the amount of flares that I was getting, in my mobility, and when I started to stretch, I got some of that back. Now, granted, having an autoimmune disease on top of menopause is probably a little bit more difficult and I think a lot of people may realize that, but.

I did not realize how important stretching was until I got to that stage. So thank you so much for explaining it. The other part of this before, we talk about the toolkit. The kind of big toolkit is stress reduction. And for me, I read years ago in Scientific American the lowest point of happiness in a woman's life is 45 to 55. And that's because it's the highest rate of depression, divorce, and decreased earning potential. And I'm like, Looking back on it, I'm like, duh, of course these things are happening, right? We are dealing with empty nest syndrome or childcare, dying parents or elder care. We're potentially being replaced by younger people in our jobs or jobs becoming redundant.

There is a lot of actual external realistic stress happening at this moment. And then a doctor once said to me, All this stuff is being thrown on you when you're at your physiologically weakest to handle it.

How do we manage the, really the external stressors that may be real in our life, right? Looking at our partner after 25 years and being like, who are you? I don't want to be with you. Or, having painful sex or loss of libido and struggling in that relationship. Those things are real. So how do we take that plus this physiological And when we're least physiologically able to handle it and manage it in a way that really benefits us.

Mary Claire: So I think first we have to educate that it is the time that we are most physiologically vulnerable to mental health and that this is your hormone. So without hormone therapy, we see a higher risk of new mental health disorders or worsening. So you were well managed, your therapy, whatever your therapeutic management was, stops working as well as it did.

Once women know, okay, this isn't me, this is partly my hormones. What I see in my clinic is yes, I've always had this stress but I had it managed. I had it down and now I can't, but one of the beautiful things about what I see in my patient population on social media is people are able to circle the wagons around themselves.

They are like they're putting up boundaries for the first time. They are prioritizing their own health and mental health because they are realizing if I don't do this, I'm not going to function and I don't want to be like that. I want to be happy Mary Claire. I want to be functional Mary Claire. And prioritizing my family comes first. The family I created or, whatever your inner circle is, they are my priority and everybody else falls on the side. So it's really cool that people's give a heck factor, give a shit factor, they don't care. If I don't take care of me, no one else is doing it.

Stacy: I think that's so interesting. I recently did an interview where I was saying that everything has become less or fewer as I've gotten older. For me, it's important to get rid of things. It's important to get rid of people. This idea that I want my circle of friends to be smaller. I'm not actually interested. I feel like I'm too old to go out and make all these new friends. It's exhausting. I want to know who my people are. I want to spend my time with my family. I'm not in that stage of acquisition anymore that I think I was, when I was younger or when a lot of us were younger, it was like, are we buying the house or are we buying the furniture or is it the clothes or is it the high heels? It's tough. It's tough. And you get to this stage of life and you have to re-evaluate your priorities. Just as you said, this idea of boundaries is maybe the first time that we've ever thought about doing this for us, for ourselves. We've been taking care of other people or making our lives look the way we want it to look. And now we have to focus really on what's going on internally and externally.

Mary Claire: I see it time and time again, my own life, my patients and I just constantly draw inspiration from other women in this menopause journey who are prioritizing themselves and just reaping the benefits and no guilt, no shame, no, if I don't put on my own oxygen mask, I'm not going to be able to put it on my children my spouse, my, partners, my parents.

Stacy: Would you say that your new book, it sounds like this is really also about agency, right? One of the things that I really believe is that we can't help ourselves if we don't have a baseline of knowledge about what's going on in order to do something about it. So when you talk about this kind of tool kit in your book, what does that mean and how should we interpret that?

Mary Claire: So when we approach, how am I going to live my healthiest, longest, best life? It's not, health is not operating in a vacuum, that we have to approach multiple facets and they all work together to keep us healthier. So in the book, we look at each organ system and each symptom profile and how we can manage that.

And you just. so much overlap. If we increase fiber this is going to get your metabolic syndrome and diabetes control and your hypertension. You know all that gets better. So in the toolkit we look at nutrition. Are you maximizing your nutrition and what does that look like for you? What supplements might help with some of the symptoms that you're having?

We look at exercise, both cardiovascular strength training, stretching, and balance. We look at pharmacology, so menopause hormone therapy or other pharmaceuticals that might. Get you to the next level of function. We look at supplementation where there are gaps in your nutrition or are there certain supplements that might aid your already good nutrition?

We look at sleep optimization and we look at stress reduction and the community, where are your people? Who is going to support you through this journey? How are you going to educate them so that they can be a better partner to you? And that's where the book comes in.

Stacy: That's why the book is so good for everybody. You don't need to be going through perimenopause or be postmenopausal to get something from this book. You can help somebody who is going through it. I just want to go back to MHT for a second. Because we know that there has been such a shift in the way that we think about hormones. They really are the gold standard for care during menopause, but the SWAN study, I think it was 2002, freaked everybody out and said everybody was going to get cancer and so nobody got hormones, nobody got menopause training. It was, all of a sudden, a real shift, a detriment to women. And I think it has done so much damage to women in the way that they think about menopause. But what I do find interesting is what is coming up and this is what I wanted to ask you about, pharmaceutically.

What do you see about the future of pharmaceutical non hormonal options? Because the only other options so far have really been naturopathic, right? Which may or may not help, you take them for three months and see and if they don't work Well, then what are you gonna do? So I'm very curious what you're seeing and the pharma side of things in terms of what can help us that isn't hormonal, if we really can't or don't want to take hormones.

Mary Claire: You know, everything unfortunately – and I'm not a conspiracy theorist - is about Making money. Pharmaceutical companies are in it to be profitable, and I respect that. I have to work within those boundaries. But if you choose not to or can't, the only thing that I am going to help with in your menopause are your hot flashes, which are one tiny sliver of what is going on in your body. And what upsets me about me is it kind of defines menopause by the presence or option absence of hot flashes. If you look at their language and we have got to leave that behind, you can't leave behind mental health, bone health, genital urinary health, all of that is important. So a lot of doctors will be like, here - treat your hot flashes and leave - and I'm like, wait, what about the rest of her body?

All of it is going through menopause with her, not just her thermoregulatory center. We're more and her ability to have children or not. Medicine has got to prioritize menopause in order for us to live our best lives. Other medications that seem to be coming down the pipe, looking at, I know Lisa Mascone is working on a CIRM.

So there are these things in, that we have that, and there's several SERMs on the market now. One is tamoxifen. So it's a selective estrogen reuptake modulator. And so basically it's an estrogen-esque compound that selectively binds to certain receptors in certain areas of the body so that you can avoid the uterus or the breast.

Dr. Mosconi's lab is working on one that binds to the brain to decrease the effects, the pro-inflammatory effects of the lack of estrogen on the brain that spares the breast. So for a breast cancer patient, this may be huge for her who's at risk for dementia or Alzheimer's disease.

I think there's some niches developing that are pretty exciting. One of the most exciting things that I've read about, I've actually met a PhD, is a new compound that's in the AMH, mullerian hormone. And so it is basically going to try to extend the shelf life of the ovary outside of reproduction.

And so it's Oviva is the name of it. They don't pay me to say this, I read all these things and I get so excited. So they're working on medication that would basically slow down the process of how fast we lose our eggs and how much estrogen is being produced by the ovary so that we can enjoy, delay menopause basically for as long as possible, which is going to be huge. They've got more testing to do, but that's what they're working on.

Stacy: Wow. I had heard that there was one scientist who was working on something about, making menopause optional. And I thought, Oh my God, if that happens, who's going to choose menopause?

Mary Claire: For the next generation, you can't revive a dead ovary, mine are gone, but this would be something like in the next generation.

Stacy: Dr. Haver, thank you so much for your insight and so much for your time. But I want to go back through some of these things just to remind people what they can do when they leave this podcast.

So first of all, in terms of nutrition, we talked about fiber being really important, right? And the top things are legumes, beans, chia seeds, avocado - put more of those into your diet. That is a good way to go. In terms of exercise, we really want to strength train. We also want to do things that are going to help our stability so that we don't fall, right?

And cardio for cardiac health, but it doesn't have to be as much as we once thought it had to be. And that we are stretching so that our joints stay lubed and we don't get that stiffness that happens during peri and postmenopause. And then in terms of stress reduction, We really have to look at how we are going to prioritize ourselves for maybe the first time in our lives around all of these true stressors that are happening in our lives.

And what are some of the things that you use as tools to reduce stress? Do you recommend Meditation cognitive behavioral therapy, are there things that you have found that have been truly effective in that kind of stress reduction?

Mary Claire: For me, and I, I practice meditation, which I never did before menopause. I thought that was woo woo and I don't have time for this, I can't sit there. And so I do guided meditation with Headspace at, there's other apps that are amazing, but that's just the one I stumbled upon and I like it. I do practice gratitude journaling. So I try to visualize the things that I'm grateful for, the wins in my life, the health of my children, the things that are going good in my life.

So I can focus on that. And then visually. let go of the things that are negative in my life. Like I put them in a balloon and I imagine them floating away so that they can't affect me, but that doesn't work for everyone. And it's, I try to implore each person to experiment with that and find out what's going to work for you. It might be prayer. It might be baking. It might be, what is the thing where your mind, you can just let go.

Stacy: I love that. That time for you and however that looks for you. Prioritize you taking five, ten minutes a day to do that every single day. You mentioned Headspace. I have to say I'm a big fan of Calm, another app. I'm not paid to say this at all. It's just that Harry Styles does read you a good night story. And I'm really into that. So again, with stress reduction, Let's talk about this, guys. Think about what is giving you the most sense of relaxation that lets you let go of some of the concerns and worries that we are going to have to face every day.

And whether, as Dr. Haver said, that is baking or prayer or meditation or whatever, maybe even exercise is a part of that. Something that you can do even five to ten minutes a day is really going to help in the way that your menopause is impacted.

Dr. Haver, I know that we have been the beneficiaries in our lifetime of a lot of health information that has helped our longevity, our health span.

We know not to sit all day long or smoke or walk 10, 000 steps that we didn't know before. So we're not going to have the same health outcomes as generations before us. We know that alcohol isn't great for us and, I know that, It's funny, especially living in a city, I feel like almost all of my meetings wind up being like, let's meet for a drink. If it's not coffee, we're meeting for a drink. And I have noticed that menopause sort of filters out some of our unhealthy behaviors. How does that affect us in terms of alcohol?

Mary Claire: So what I'm seeing in my patient population for sure, and definitely sentiments across, social media is our ability to tolerate alcohol is really decreased. One drink and you're giving up sleep. If you have a drink in the evening. Sleep disruption is already an issue in menopause and when you add alcohol onto it, it seems to amplify and magnify that effect. So many of my patients and followers are spontaneously cutting back on the amount of alcohol that they're drinking and the, how much and how often because they know they're sacrificing sleep to have that drink. And they're not willing to do it anymore.

Stacy: And they're not willing to do it anymore, right? I know, but I am one of those people who's there are days where if I don't have a filthy martini, I'm not going to make it through. I'm wondering if now I should be thinking about it as day drinking instead of night drinking

Mary Claire: I can do brunch, but not dinner. And so it's not, it's that six hour window. If you go to bed within six hours of that last drink, you really are running the risk of decreasing your sleep quality and quantity. But day drinking seems to fare well for most.

Stacy: So I have to switch from filthy martinis to a Bloody Mary. Okay. Whatever. I'll do it. Whatever it takes. But I noticed that, with many of my friends that it's not like we make this conscious decision to stop drinking alcohol. It really just becomes our tolerance is lower and lower as we go through the stage of menopause. I also wanted to ask you about are they called semaglutides? Because I'm not sure I've got them right.

Mary Claire: Semaglutide is one of the categories. So we usually call them GLP1 agonists.

Stacy: Wow, okay, so yes, so GLP 1 agonists which, for those of us who don't know what that means I wanted to ask about things like Ozempic, Wigovi, Monjaro, these are all these new miracle weight loss drugs. How do you think that's going to impact people who are going through menopause, particularly if we're talking about three to five pounds a year? Are those drugs that will be helpful to them or harmful to them or neutral?

Mary Claire: I think like any medication, there are risks and benefits. that you have to understand. What I see in my own practice, people coming in who've been given it are not getting adequate counseling that it can be a lifesaver for some patients. If your weight, your amount of visceral fat is running a health risk and you've done everything in your power, and we know it's not because you're not trying, we know this can be a lifesaver and extend the quality of your life. There are patients who I've seen who've been put on it who were only maybe five to ten pounds over what an ideal body weight and their goal was to be ultra thin for cosmetic reasons. Here is where I worry, is that what we're seeing in some of the patients, not all, if you're not eating adequate protein and you are not doing resistance training, your loss of skeletal muscle mass is going to be accelerated and this is going to put you at higher risk for Osteopenia, osteoporosis and sarcopenia.

You will be the frail little old lady, okay? But you are thin, and so you're trading being thin for other health long term down the road. I think we're going to see a rat, an epidemic of Frailty because of these drugs if we're not careful, I have patients who are on them, who are doing beautifully, they're doing the work, they're eating the protein, it's all making sense. They're not having horrible side effects and they are getting the fat off. And I'm applauding that a hundred percent because it is extending the quality and the quantity of their life, but that's not the same for everyone. And I think people who are going to uninformed healthcare providers to get these medications just to be thin are not paying attention to the long term side effects, and I think that's where we're going.

Stacy: And particularly postmenopause, right? When bone density is such a concern.

Mary Claire: We're already suffering. We're losing bone and muscle in our 30s, well before the hormones take a hit. And as those hormone levels begin to decline, we accelerate in bone and muscle loss. And we're just, you're robbing Peter to pay Paul, for your health.

Stacy: I think that's so helpful because I can't tell you how many people who I have heard talk, oh, now I've got, now that I've gained this 10 pounds or whatever it is post menopause, now I can just get it off, right? Instead of understanding the implications of what that means for our longevity and healthspan, which this is the opportune time for us to learn from you.

Also, I know you have your clinic. Is it possible to make an appointment with you or a nurse practitioner? And what is the waiting list for something like that?

Mary Claire: For me, it's two years. But my, I have two nurse practitioners, but listen, on our website, we have a list of providers who we have testimonials from our followers who give great menopause care. That's an option that the menopause society has a list of certified providers on their website. Thanks so much. That's another place to look.

Ask your friends, look on social media. It really is like finding a needle in a haystack to find a good menopause provider, but it is possible.

Stacy: Dr. Haber, thank you so much for your time. I appreciate it so much. And thank you for giving us so many tips and being able to get through this stage of life in a way that is like joyful and meaningful for all of us.

Mary Claire: You're so welcome

Stacy: Let's Talk Menopause, a national nonprofit organization is changing the conversation around menopause to make sure women get the information They need and the health care they deserve. Please visit for a wealth of menopause information, including a symptoms checklist, information about long term health risks, how to navigate menopause at work, interviews with health experts, and so much more.

This episode of Hello Menopause is sponsored by Always Discreet, makers of liners, pads, and underwear for bladder leaks. Always Discreet, because we deserve better. And you can find Always Discreet at Target, in store, and online. Hello Menopause is a production from Let's Talk Menopause. Produced in partnership with Studio Kairos, I'm your host Stacy London.

Kirsten Cluthe is our supervising producer, editing, and mixing by Revoice Media. Hello Menopause is available on Spotify, Apple, Google, and wherever you get your podcasts.