Dr. Mary Claire Haver: Menopause, Belly Fat, HRT, Frozen Shoulder and societies acceptance of women’s suffering.

Dr. Sameena Rahman [: 00:00:01

Hey y'all, it's doctor Samina Rahman, Gyno girl. I'm a board certified gynecologist, a clinical assistant professor of Ob GYN at Northwestern Feinberg School of Medicine, and owner of a private practice for almost a decade that specializes in menopause and sexual medicine. I'm a south asian american muslim woman who is here to empower, educate, and help you advocate for health issues that have been stigmatized, shamed, and perhaps even prevented you from living your best life. I'm better than your best girlfriend and more open than most of your doctors. I'm here to educate so you can advocate. Welcome to Gyno girl presents sex, drugs and hormones.

Dr. Sameena Rahman [: 00:00:47

Let's go. Hey y'all, it's me, doctor Smita Raman, Gyno girl. I'm super excited today to be on this podcast with the amazing, amazing doctor Mary Claire Haver. I don't like football. She is. Most everyone knows her. She is a board certified ob GYN and a certified culinary medicine specialist from the American College of Culinary Medicine. She's a Louisiana state University Medical center graduate and completed her Ob GYN residency at the University of Texas Medical Branch.

Dr. Sameena Rahman [: 00:01:22

She's also a certified menopause specialist through the Menopause Society. She was a clinical professor at UTMB in the University of Texas Health center in Houston for a very long time. She has now amassed over 5 million followers through all her social media platforms and understands that menopause healthcare is in dire need of change. She's here to demystify and change the narrative around menopause. She's also a New York Times best selling author for her amazing book, the New Menopause.

Dr. Mary Claire Haver [: 00:01:53

Woohoo.

Dr. Sameena Rahman [: 00:01:55

So awesome. So I if I had an audience, I'd have them all clap for you to welcome you to Gynell girl presents sex, drugs and hormones. I'm super excited that you're here today, Marie Claire. I love everything you're doing and I love part of the menopause with you. So thank you for joining me.

Dr. Mary Claire Haver [: 00:02:13

I'm so happy to be here, especially with another member of the menopause, when I tell you it is so wonderful to have this community of like minded providers from diverse backgrounds all focused on changing the narrative and the woman's healthcare prospects about her, you know, the last third of her life. It just means everything to me.

Dr. Sameena Rahman [: 00:02:32

Absolutely. And I really like, I have to commend you so much because, you know, we have obviously a lot in common. We're both ob gyns. We both are from the south. I started my own practice about ten years ago, and at that time, I was, like, trying to talk about, you know, general urinary syndrome, menopause, and menopause and everything, but it never really picked up the momentum. And I just really love what you've done. You've really spearheaded this movement, honestly. Like, you know, you've amassed so many people following you.

Dr. Sameena Rahman [: 00:03:01

I mean, just tell us. Tell my listeners. Cause I'm gonna talk to you about your menopause story, too, but just tell my listeners, like, how. I mean, 5 million followers over so many social media platforms. Like, you've just done such an amazing job of reaching out to people. Right? Like, I think when we talk about really making a change in people's lives, as doctors, we tend to do it, like, on a one on one basis, but to do it on such a global level is really just wow. And so that's. I commend you for that, number one.

Dr. Sameena Rahman [: 00:03:30

But tell us how, you know, how you came to this and how it happened.

Dr. Mary Claire Haver [: 00:03:33

I mean, I wish I could tell you that there was this, like, grand Machiavellian plan to, like, take over the menopause, but, you know, my daughter is interning for a menopause telemedicine company right now in their marketing and pr departments. So she's having to do a breakdown of what's working in the menopause world, and she hashtag menopause. And she's studying everything. She's like, mom, you know, the post, you're. She goes, you're one of the people that's, like, getting a lot of the menopause tags. I'm like, okay, yeah, all right. And she said, but it's like, they're. You entertain.

Dr. Sameena Rahman [: 00:04:04

Yeah.

Dr. Mary Claire Haver [: 00:04:05

And then you educate and you advocate and you validate, and I go, that's about it. You know, I'm. I've gotten good at listening to people on social media, getting curious about what they were complaining about, digging through the research, educating them about it, and then making them feel like they were normal, and then giving them tools on how to manage it. And so that's what the book is, is a compilation of all of that that I've been doing on social media for years.

Dr. Sameena Rahman [: 00:04:30

That's amazing. And the book is amazing. I'm sure most of my listeners have it by now, but because I talk about it all the time, but I want to say, like, you know, so the other day, I was at dysfunction for Liberty, Liberty Road. Have you heard of, like, nada Jones? And she's started this sort of group where she talks to a lot of midlife women on the middle third of their life and changing their narratives and everything. And, you know, one of the. One of the topics that just kept coming up about midlife women is how much noise there is out there, right? There's a lot of noise on social media. There's a lot of discussion around, you know, wellness for the midlife woman, what? Trying to navigate that. And some of the people there were like, I just, you know, sometimes I just get frustrated, and I don't know how to navigate this, and they just walk away.

Dr. Sameena Rahman [: 00:05:13

They don't do anything about it. But, like, you know, for the people listening, like, what advice do you have for them to how to navigate through all this noise? Because obviously, when something has gotten to this kind of force, people are trying to monetize off of it. And we know that midlife women are in a vulnerable situation where they. There's so much predatory work, very vulnerable.

Dr. Mary Claire Haver [: 00:05:34

So it's like, I'm seeing it just as you are with so much you, you know, people trying to take advantage of the confusion and the misunderstanding. And, you know, so here's what I would go back and tell my 35 year old self, who was looking forward at menopause, as this kind of scary, weird thing that would make me an old woman, that I wouldn't be expected to thrive, and that I would probably not have any hot flashes because I was thin. That's what I really thought. So, number one, educate yourself about menopause. This is coming. It's inevitable. It's a way bigger deal than we thought, and it's going to affect you in ways you never imagined. And so, as much as you can do, my book, other people's books, podcasts, whatever, to make sure that you know what's going on, you understand the basic endocrinology of it, and that how it can affect different organ systems is only going to make this less scary and therefore lower your cortisol levels through this process.

Dr. Mary Claire Haver [: 00:06:28

Number two, nutrition over calories. Like so much, many of us are so motivated to be thin, be thin, be thin. And everything I ate was to be skinny, and everything I moved my body, exercise was to be skinny for 25 years, and that was a mistake. And so learning about muscle fitness, health, wellness, eating more protein, eating good nutrients, trying to change your habits so that it is supporting you to be a healthy old baby is very, very different than what it looks like in your twenties. So the things that we get away with, and so starting those habits now really think of aging as a privilege that is denied to so many of us and that this can be the best part of your life, literally. I am living my best life. If you would have told me. I mean, I am healthier, I am wealthier.

Dr. Mary Claire Haver [: 00:07:13

I have better connections with my family. I have better boundaries. I have better. I'm helping more people. I've reached 5 million people, and all of that is just. I want that for everyone so that they can look at you, me at 56, and say, I have charted a course for the best third of my life. Like, this is it. This is my time.

Dr. Mary Claire Haver [: 00:07:34

I've got this covered. Rather than being plagued with poor health and frailty and cognition trouble and not being able to keep your job and then suffering from the fallout, you know, the financial issues from that.

Dr. Sameena Rahman [: 00:07:46

Yeah, no, absolutely. And you and I know that, you know, when we graduated residency, you know, I want to just talk about how both of us came to the menopause space, and I. And, you know, our journeys in this space as of now. But we both know that we didn't get much menopause training in residency. Like, that was like, I think I saw, like, I had an REI doc that taught me, that showed me a couple menopausal patients. And I remember I was an intern when the whi came out, and I remember the journal club around it, and we were like, well, why are they making such a big deal of it doesn't seem like it's. That's, you know, it's like, you know, that's not that big of a deal about this breast cancer increase. And, you know, we were, like, very baffled by sort of, like, the media noise around it.

Dr. Sameena Rahman [: 00:08:30

But the reality is, you know, most obgyns don't get a training. Most pcps don't. Most internists, I think. What is it? It's like 7% of graduating residents out of those three professions have an idea of how to take care of menopausal patients.

Dr. Mary Claire Haver [: 00:08:42

Feel. Feel confident, right?

Dr. Sameena Rahman [: 00:08:44

So, yeah. So let's talk about how you.

Dr. Mary Claire Haver [: 00:08:48

So here's. Here's what scares me is that when I finished my residency, I felt like I was a great menopause provider. That's the problem. I didn't know what I didn't know exactly. And so what I'm hoping all this noise we're making is to have clinicians realize, yeah, something ain't right. But they are saying, well, how much menopause training did I actually get right?

Dr. Sameena Rahman [: 00:09:10

It's true. So what did you, like, how did you come to your, like, your journey through menopause and what was, what did you feel when you were, when you were going through it?

Dr. Mary Claire Haver [: 00:09:20

You know, sadly, it was my own menopause. And rather than, you know, I was aging with my patients, so I kind of stayed in the same practice for most of my career. And you start out, you're having babies, they're having babies. That was kind of the path. And then I was aging with everyone. Certainly. I had menopausal patients before, but I was getting a bigger percentage of my patient population as menopausal. And I was seeing the same things, you know, like weight gain, not sleeping, depression, anxiety, like all these things where these were like, women I was in the community with.

Dr. Mary Claire Haver [: 00:09:48

I went to church with them, kids went to school together, I worked out with them, and they're all like, what the hell is happening to me? And I started realizing, is this menopause? Is this part of it? Is that this was never taught to me. And then I got the rug pulled out from under me. It was horrible because I was on birth control, got off and figured out I was immediately menopausal somewhere. I had gone through menopause probably at 48 and had no idea. And so I didn't have a transition. I just woke up. It's like coming off of therapy and was like, this is for the birds. I can't function.

Dr. Mary Claire Haver [: 00:10:21

And wait, you know, I felt like I was throwing in the towel by going to HRT, like, like the epidural, you know, oh, I'll see how I do with my attitude about an epidural. And I got one at 3 cm because I was nine, so, you know, but then I felt like a failure, you know, you're kind of like, oh, I'm not tough enough or I'm not strong enough. And that I realized that is faulty mentality. Then as I started digging, I was learning about the cardio protective benefits and the neuro protective benefits and, you know, and what the actual risk of osteoporotic fracture is and what that will do to a woman. And I was like, wait a minute. And sexual dysfunction in general, urinary syndrome and all the things. I was like, what are we doing? We're ending up with an aging population of women who are miserable, miserable by and large and can't take care of themselves and are in needing long term care facilities and, and suffering years and years of disability when they don't have to.

Dr. Sameena Rahman [: 00:11:13

Right?

Dr. Mary Claire Haver [: 00:11:14

Right.

Dr. Sameena Rahman [: 00:11:14

Absolutely. I mean, it's so interesting how, like, I think when at the menopause conference last year, sue dominance was talking about how she came up with her article about, you know, misled about menopause in the New York Times, and she said that, you know, one of the underlying themes she kept hearing was that, like, women had just come accustomed to suffering, and as a society, we're accustomed to women suffering. Right? Like, we've just accepted it. I mean, how many times do you have a patient who's told you that when she complained about something, a doctor told her that, you know, this is just what women have to do, or, like, you know, you need to try x, y, or z, drink alcohol, whatever. You know, do something that you just. On. The underlying tone is that, like, you know, your body was made to suffer, you know? And it just shocks me that, like, we accept this as a society, right?

Dr. Mary Claire Haver [: 00:12:03

Yeah. It is 100% the biggest crock of shit that has ever been fed to women. And, you know, we don't have to. You want to suffer, that's your jam. Go for it. But you don't have to. And we have ways to mitigate this suffering where you can be a fully functional, able to give everything you've got to the world human being, you know, with some intervention, and suffering is not acceptable.

Dr. Sameena Rahman [: 00:12:28

And it's funny because, you know, as ob gyns, do we not hear about, like, these stories all the time? Well, you know, when I remember when I was pregnant, they were like, well, when I was pregnant, I was contracting while I was delivering someone. Like, it was a badge of honor to suffer. You know what I'm saying? Like, we just perpetuate it, right? Oh, yeah.

Dr. Mary Claire Haver [: 00:12:44

Or to labor in the middle of laboring the patient. I mean, that. That was, you know, I finished my l and d shift and laid down in the bed and had a baby.

Dr. Sameena Rahman [: 00:12:53

Yeah, exactly. And it's supposed to be like, oh, you know, you're a badass because you suffered through it. Like, no, it's not okay. Like, we shouldn't, like, reward that. I mean, if that's something you really want, that's up to you. But you. There are options to not do that, too. So I think that's something we.

Dr. Sameena Rahman [: 00:13:08

I'm glad that narrative is sort of changing now, too. True fact. I used to follow you way back in the day when you were just, you know, like, doing the Galveston diet and all that stuff. And I used to.

Dr. Mary Claire Haver [: 00:13:17

Galveston diet, order your fiber.

Dr. Sameena Rahman [: 00:13:19

And I'm like, this is the best fiber in the world. I love it. It was really good.

Dr. Mary Claire Haver [: 00:13:23

But I was there, you know, and.

Dr. Sameena Rahman [: 00:13:25

The collagen, and I haven't looked at your turmeric yet. But I was like, oh, this very clear. She's onto something. You know, like, I remember, like, looking at your recipes online, but tell me how you came to culinary medicine. That's very amazing, too. Like, that's pretty cool.

Dr. Mary Claire Haver [: 00:13:42

So my kind of toe in the water here in the menopause space was, you know, my, like, what brought me to the trough? And this is embarrassing, but damn true. And most of my patients complain of this was my weight gain. And I was so frustrated with the weight gain with menopause because, remember, my social currency, how I felt about myself every day was based on that number on the scale. And it's an embarrassing thing to say. I was an almond mom, whole nine yards. I had thin privilege my whole life. But it was work, you know? And all of a sudden, the work wasn't working exactly. And I was like, I was getting obsessed, weighing myself multiple times a day, doing two days in the gym, starving myself, and it was not working.

Dr. Mary Claire Haver [: 00:14:19

And, you know, I was that whole, like, calories in, calories out. Like, am I crazy? And my husband was like, girl, first of all, my teenage daughters were watching all this, like, disruptive behavior. And. Yeah, I know. And he's like, uh uh, no, no, no. You look great. Like, he's like, you're beautiful. I don't care.

Dr. Mary Claire Haver [: 00:14:36

Da da da. You know? And then that motivated me to look outside the box, okay? And then I called the PhD nutritionist at the university I was at and was like, what the hell is going on in menopause? And they started sending me articles about inflammation and nutrition and estrogen's role in anti inflammation and how it's all connected and visceral fat. I knew nothing about visceral fat. And then, like, Pandora's box opened for me. And so I start sharing about that part of it. Create a little nutrition program for my patients and myself. It's going well. Start sharing that on social Galveston.

Dr. Mary Claire Haver [: 00:15:07

Diet explodes. I make a book. I make a program out of it. But then as I'm conversing about nutrition and menopause, people are asking, what menopause? What about frozen shoulder? What about my this? What about my that? And that's where the conversation got bigger and bigger. And so I decided I don't want to be in this box of a diet doctor. Like, you know, the nutrition culinary medicine certification was to give me credentials and learn because they didn't teach us anything in med school, and it was awesome, and I highly recommend it. But I knew that my mission was bigger. Like, I'd conquered the nutrition thing.

Dr. Mary Claire Haver [: 00:15:36

Now I want to, like, take on all of menopause. And so that's where I just broadened, broaden my conversation online and was sharing everything I would learn. So that resonated with people and it just kept growing.

Dr. Sameena Rahman [: 00:15:49

Oh, that's great. Yeah. And I think one of the big things, you know, that we all need to just accept is that we do have a genetic impact on how we age and everything like that, but it doesn't have to own us. Right? Like, that's. I think that's the one big thing that I've come to realize, is that I have very bad genetics when it comes to cardiovascular. I mean, I'm south asian, we have like, such cancer, high rates of cardiovascular disease. Yeah. And so, like, I feel like I'm constantly fighting my genetics.

Dr. Sameena Rahman [: 00:16:15

Like, I'm just like, you know, but I. But I'm not going to just lay down and let it happen to me either, you know? So I think that's an important message. You always say too, right?

Dr. Mary Claire Haver [: 00:16:24

Right. I mean, genetics is a loaded gun, and then our lifestyle is what tends to pull the trigger. I mean, again, that's kind of a blanket statement. But, you know, you don't. If we go with the status quo of what western medicine is really offering women right now, as we age, you are going to die of a heart attack way before me and I'm going to get cancer way before you. And we're not willing to accept that. And so we are trying to use every tool in the toolkit to put those ads back in our favor. And so, and menopause is a huge part of both of those things, you know?

Dr. Sameena Rahman [: 00:16:57

Absolutely. Let's talk about your toolkit. Actually, I love that. You know, in your book, you talk about a little bit. I mean, basically, you give like a whole toolkit for all the, you know, issues surrounding menopause and tell, let's tell the listeners about this toolkit that we have here. I, and also your website, Paul.

Dr. Mary Claire Haver [: 00:17:16

So the toolkit theory is that health is not in a vacuum. So it's not like I'd give my patients HRT and send them out the door, right? We're plotting a course for the next 30 years, and it includes nutrition, exercise, stress reduction, sleep optimization, supplementation, whatever. Okay. And that looks different for every patient. It really is precision medicine. So the toolkit was a way to approach each symptom in menopause, not just the hot flashes. I'm talking the brain fog, the musculoskeletal disorders, the skin changes, the hair, nails, gut everything. And what do we know that nutrition does like, what specific nutrients might be helpful here? What supplements have been shown to be helpful, what exercise tends to work better here if you have these certain things so that a woman felt empowered and that you realize it's not just HRT.

Dr. Mary Claire Haver [: 00:18:03

That's just one small part of your toolkit, if you even choose it, it's not for everyone, but that we have all these other things, other pharmacology that might be helpful outside of HRT. And so I just wanted her to have as much information to advocate for herself because I can't be everyone's doctor and, you know, so that she could have, at least on her end, an informed decision formed, you know, informed choice on the feet on her, the future of her health, right.

Dr. Sameena Rahman [: 00:18:26

No, absolutely. And I think all those are important. And just understanding that it's not, you know, everyone always says, oh, you menopause doctors are just pushing hormone therapy on everyone and this and that. And it's not, it's like we just want to destigmatize hormone therapy because of the, you know, whi, everyone knows. Yeah. And so, you know, we want to destigmatize, but we also want to just like, you know, give everyone the tools they need. You're right. Absolutely.

Dr. Sameena Rahman [: 00:18:53

I think that's a great combination of things that you're, you've given. You know, when you talk, when we talk about this menopause, like movement that's happening right now, there are a lot of new tech companies that have come up, right? Where do you think that intersects with what we're doing as, like, on the ground clinicians?

Dr. Mary Claire Haver [: 00:19:12

So I think the best of two areas I see where we can intervene, you know, where I'm excited, one is in testing and doing more, you know, figuring out ways to diagnose perimenopause because we don't have a great blood, urine, or saliva test for that. And people are spending thousands of dollars on NSS testing. And so really putting some data and science behind. How are we going to diagnose perimenopause if that's with some kind of a continuous monitor or, you know, what that's going to look like? So that's one area. The other is there's a couple of pretty good biotech companies, at least two, if not three, that are figuring out ways to extend the shelf life of the ovary beyond our, what we're genetically programmed to be. So using AMH derivatives, anti mullerian hormone derivatives, to slow down the aging of the ovaries because our ovaries age twice as fast as any other organ in our body, and therefore we become menopausal. And so could we extend that shelf life, not for reproduction, but just enough estrogen being produced to keep us healthy, to not live with the estrogen deprivation syndrome that affects our liver and our bones and our general nervous system? So I'm really excited about that.

Dr. Sameena Rahman [: 00:20:26

Yeah, I think that's what I'm waiting to see, what comes out of that, because we all know when patients enter menopause too early, it's such a dramatic health risk. Can you talk to the viewers about that?

Dr. Mary Claire Haver [: 00:20:38

Yeah. So the longer our bodies are forced to live without estrogen, the less healthy you are on multiple cardiometabolic and neuro disease states. So in premature menopause or premature, that's 40 to 45, that's early menopause, they have risks. So the longer your body is forced to live without estrogen, the higher your risk of cardiovascular disease, diabetes, stroke, hypertension, osteoporosis, etcetera. So then when you get into the pre premature ovarian failure, premature ovarian insufficiency years, it's even worse. Surgical menopause is worse, you know, and so those things aren't being addressed. So iatrogenic surgical menopause, you know, for good reasons, but then no one's addressing their health risks as we age. The studies are coming out just showing that it is criminal what is happening to women who go into early menopause for whatever reason, especially surgical, that are not being counseled adequately or treated so that they can optimize their health.

Dr. Mary Claire Haver [: 00:21:39

Ovaries need to be removed sometimes for disease, and we need to do that. But then they're just being thrown out into the wind as menopausal humans being forced to live not 30, 50 years, 40 years without the benefit of estrogen, which speeds up this race. It speeds up their aging in every other organ. So now they're dying earlier of stroke, diabetes, hypertension, dementia, Alzheimer's. And it's less to do with putting labels on. It's everything to do with how long your body lives with that estrogen.

Dr. Sameena Rahman [: 00:22:08

Absolutely, because it's such an important hormone for us. And how do you see some of the other, there's a lot of platforms that are now coming out when we talk about tech, there's all the good menopause platforms. Some clinicians, yeah, telemedicine, some of them really get threatened by them. But I'm always like, are you going to be able to treat this billion women that are going to be in menopause. Like, there's an access issue, right?

Dr. Mary Claire Haver [: 00:22:32

Yeah. So, look, study came out in 2023, and, you know, we've seen the data of self reported residents saying, I don't feel comfortable. So we only have 7% graduating today who, like, feel confident, whatever that means. Okay. When a woman in 2023 walked into her doctor's office and complained of the cliche menopause symptoms, so God forbid she didn't have hot flashes and had palpitations or something else, you know, she has no periods and hot flashes. It is undeniable. She's menopausal. She only has a 10% chance of being offered any treatment at all.

Dr. Mary Claire Haver [: 00:23:03

90% of clinicians will deny her anything. Just say, this is normal. There's nothing we can do. Bye bye. Of the 10% who were offering her something, four to one, it is an antidepressant. This is the problem. So savvy tech companies see this need, understand these statistics, and know that women are needing help. They are developing telemedicine companies specific to take care of this need.

Dr. Mary Claire Haver [: 00:23:29

Look, I have a waiting list of two years for menopause, and this is cash. You know, this is not insured. I can't afford to run a practice with insurance because I don't do surgery anymore, which would pay the bills. And so, yeah, there is a need why they're getting upset, because we cannot handle the menopause burden. We don't have enough providers.

Dr. Sameena Rahman [: 00:23:50

And, you know, when we talk about, you know, these telemedicine companies, I mean, some of them are really practicing amazing medicine, and some are great. So you have to do your research and try to get under that. And so I think it's, like, one of these things where, like, you know, it's even, like, direct to consumer marketing right there. Those. Some of the direct to consumer products that are out there, a lot of people are threatened to buy. But again, you know, we don't have the capacity to treat all these patients. So I think that it's actually a good thing the majority of the time. Tell me, like, what do you think? Because obviously, you do a deep dive into every potential symptom of menopause.

Dr. Sameena Rahman [: 00:24:28

What do you think is the weirdest symptom you've ever heard of for menopause or perimenopause?

Dr. Mary Claire Haver [: 00:24:32

Oh, the ones that blow up the Internet are, at least on my stuff, are the frozen shoulder. Frozen shoulder. Like, people go nuts over frozen shoulder. Bonda Wright is built in Empire, you know, on the Internet because she's, like, probably the world. She's probably the world's expert on mescal skeletal syndrome of menopause. It's amazing.

Dr. Sameena Rahman [: 00:24:51

I gotta have her.

Dr. Mary Claire Haver [: 00:24:52

I think Candida says vertigo, like, you know, vertigo and the, the ringing in the ears that people are like, itchy ears, that drives people crazy.

Dr. Sameena Rahman [: 00:25:01

Yeah, I was, my mind three years ago, I had a patient with severe vertigo, and I was like, well, I mean, you need hormones. Let's try it. And I did a deep dive and I saw it, of course. She's like, what?

Dr. Mary Claire Haver [: 00:25:11

Doctor Martin, this is a miracle, because.

Dr. Sameena Rahman [: 00:25:14

The vertigo is very debilitating.

Dr. Mary Claire Haver [: 00:25:17

The taste still. So change in taste, change in smell, change in taste. The burning tongue syndrome, that those, those really get people's attention, you know, because they were dismissed and told there's nothing we can do, or put some capsaicin on your tongue, which is like, you know, peppers, which does seem to work a little bit for burning tongue, but, you know, it's like. Or just HRT, you know, or to the poor woman who presents to the ER with palpitations, sweating, anxiety, you know, and gets a full cardiac workup, all this stuff. And literally, she was menopausal. That's all it was, you know, and no one being trained to connect the dots there for her. And she gets, she goes to multiple doctors for multiple problems, ends up on polypharmacy, when all that probably would have taken care of, 90% of it was replacing her hormones.

Dr. Sameena Rahman [: 00:26:06

Absolutely. I have to say, my husband is a physiatrist, so he does PM and r, but he does interventional pain, sports medicine, and he's always sending me patients with joint pain. Like, he was like, I'll do the injection, but I think she's perimenopausal. Or he was like, the frozen shoulder thing. So it's very interesting. Yeah, I think that whole finding has been very, like, transformative for patients to realize, like, when I wake up and I can't walk or, you know, not being able to lift your shoulder above a certain point, it's pretty amazing, actually, that, that the hormones can make that much of a difference. So what do you think? Some of the biggest myths that we still should bust, I mean, I'm busting myths all the time around here, but, you know, with whi stuff and everything else, but, you know, you never can.

Dr. Mary Claire Haver [: 00:26:45

Hear it too much, that hormones are dangerous. One very popular gynecologist said, and this one just, I was like, why would she even do that? But, okay, that somehow, like, you're less if you're not taking hormones, like, you know that those of us who have open discussions about hormone therapy are considering that women who don't choose HRT are less of a woman or something like that. I think that kind of. I think that kind of talk is just harmful and not helpful, especially coming from a clinician in this space with a big following that bio identical and synthetic and all the misinformation around that. Yeah, that pellets are the way to go. I think that's a big misunderstanding. I think you have better options out there for your hormone therapy and probably much less expensive and incredibly efficacious and safe. That is not the way to go.

Dr. Mary Claire Haver [: 00:27:37

I mean, no doubt somebody gets a.

Dr. Sameena Rahman [: 00:27:39

Load of testosterone, they're gonna feel amazing. But, like, is it. Can you talk a little bit about that, Anna?

Dr. Mary Claire Haver [: 00:27:46

Yeah, so, so there's a certain company that makes a certain brand of injectable pellet, what we call pellets, which are little dissolvable tubes that have the medicine embedded in it. And so I don't demonize a pellet. It's just one way to put stuff in your body. But this certain company never made a female dose. And so to treat females, they give them the lowest male dose, which gets a woman physiologically, typically above 200 in nanogram per Picolita, whatever the measurement scale is. And a female level is 45 to 70 is healthy, young 25 year old female. They're super physiologically dosing routinely every single woman. So they get this initial burst, and they turned into teenage boys.

Dr. Mary Claire Haver [: 00:28:28

They feel great. Their libido is restored, yada, yada, yada. But then, you know, the higher you go, the more side effects you have, and then it stops working. You develop technical access. And so, you know, I think you have better options, and there's no reason to go super physiologic on a patient that we know of that that would be at all beneficial. So you could get her libido, you know, working back in the right direction. You can get her bone and muscle moving back in the right direction with the resistance training and the protein intake, you know, with physiologic female doses, without the barrage of side effects that we see at the higher doses.

Dr. Sameena Rahman [: 00:29:03

Absolutely. I mean, we all understand why this industry of bio, bio identical marketing existed, because nobody was giving women the hormones. So obviously, it was another predatory way. So, I mean, you know, that's why I don't, I don't villainize patients who go that route, because I'm like, well.

Dr. Mary Claire Haver [: 00:29:19

You know, oh, they were desperate and they tried.

Dr. Sameena Rahman [: 00:29:21

You didn't get it when. Yeah, right. But I think that, you know, just educate, because it is hard to. I mean, it's really hard to convince someone who loves their pellets so much to come off the pellets. I mean, unless you tell them, you need to tell them every respect, and sometimes they're willing to take it. So, you know, that's, again, a personal decision, and neither of us practice patriarchal medicine.

Dr. Mary Claire Haver [: 00:29:44

Yeah, if it's her clinical choice. And what happens is these clinicians are not offering them all the options. They're just only offering pellets, which is a huge red flag, and that should never happen. There's no reason you shouldn't be able to prescribe FDA approved options for your patient, allow for insurance to cover it. It's a huge moneymaker. And I just think the way that they're being utilized tends to be unethical, and patients are suffering because of.

Dr. Sameena Rahman [: 00:30:07

Absolutely. I mean, we have these people knocking at our offices all the time, like, hey, you want to? And I'm just like, no, you're not coming in this. And so. Okay, well, let's talk about. Also. So this book has really exploded. It's been amazing. Tell me, what.

Dr. Sameena Rahman [: 00:30:24

When did you decide to write this book? After the Galveston diet. You said that. When was it with the research? Tell me about.

Dr. Mary Claire Haver [: 00:30:33

So we turned in the manuscript for Galveston diet. So Galveston diet was published in January of 2023. And I think I turned in the manuscript the summer before. You know, it takes months from when you turn it into and it's published. It's a very long process. And so we were up here in college. So I'm in Colorado right now. We were hiking, and my husband and I did this, like, two hour hike, and we were talking, talking, talking, and he's like, it sounds like you need to write a book about menopause.

Dr. Mary Claire Haver [: 00:31:01

You know? And I was wanting to get away from the diet nomenclature and the diet culture. And, you know, I knew I had a bigger message. And he's like, you need to write this book. And I remember as soon as we got home, I got on the phone with my editor and said, I really want to write a bigger book about menopause. She says, well, how would it be different than Galveston diet? I'm like, oh, my God, you have no idea. And so that began the process two years ago this summer. And so I wrote the book here in Colorado. I took three months off last summer doing the research and working with the editors and my collaborator, really refining it.

Dr. Mary Claire Haver [: 00:31:33

And so just the best thing I've ever done, just the hardest I've ever worked. You know, all the hundreds, thousands of articles I read, you know, trying to make sure I fully grasp what was, what was in the literature so I could share it with the world.

Dr. Sameena Rahman [: 00:31:47

Yeah, no, and it's so nicely put together and it's like, you know, very, I think everyone's that I've spoken to that's read it because I have a lot of patients that come in with this book and like, well, I've read Doctor Mary Claire's book and I'm like, oh, okay. So you know exactly what you want. I mean, it makes life a lot easier as a clinician because they're already like, well, yeah, look at my symptom list, Doctor Ravon, you know, like, because you have the little area where you can write your symptoms. And I'm like, oh, very nice. Okay. So I think that, you know, in that respect, it's been wonderful. You've gotten a lot of good feedback from people doing it in clubs, like book clubs and everything, right?

Dr. Mary Claire Haver [: 00:32:22

Yeah, it's been, it's been really amazing. We've, we've hit the best at the, you know, the big one, the New York Times bestseller lists for six weeks now. You know, we haven't missed it yet. And that, you know, that's kind of a marker of how you're doing. We're always in the top 50 on Amazon, you know, and some days I have to pinch myself, like, wow, it's beyond, like, my social media presence now. Like, the book is being shared and people are telling their girlfriends and they're having book clubs and they're, you know, it's got legs, as they say, so. And that's really what I wanted. I wanted this to be a tool that women, you know, females could use to advocate for themselves and educate themselves to have a better, healthier life.

Dr. Sameena Rahman [: 00:33:00

Absolutely. Are you going to do into different languages? Because I'm sure it's like, you know, internationally needed as well.

Dr. Mary Claire Haver [: 00:33:07

Yeah. So the editor does all that. Like, I don't own the book, the publisher does. So they've sold it. Oh, God. Lithuanian, Croatian. We're waiting on Spanish. We have German and we're waiting on Japanese.

Dr. Mary Claire Haver [: 00:33:18

We have, I think we did Chinese. So, yeah, it's. So it'll be like 18 languages so far.

Dr. Sameena Rahman [: 00:33:23

Wonderful. Wow, that's amazing. What are the things that you offer your, like, when a patient. Cause are you still seeing patients right now or are you kind of taking a break?

Dr. Mary Claire Haver [: 00:33:31

Well, right now I'm taking a break, but my clinic's still running. I have two nurse practitioners, so we communicate. So they're seeing patients right now.

Dr. Sameena Rahman [: 00:33:38

What you tell your patients, like, when they come and see you, and you and I practice precision medicine, so everything we do is geared toward that specific patient. But how do you approach your patients in the office?

Dr. Mary Claire Haver [: 00:33:50

So, luckily, I have a body scanner in my office where I can measure visceral fat, muscle mass, you know, and her, you know, besides just weight or bmi. So a lot of the discussion we have is around her body composition and what that means to her health and future. So if they have low muscle mass, we're talking about ways to improve that. That will also improve her bone density. If she's got high visceral fat, then we're looking at certain nutritional exercise, you know, tools to get that down to decrease her risk of high hypertension, diabetes, and stroke. And then, of course, we have a conversation around hormone therapy and other pharmacology. So I have an hour with my patients, and we really. I give her a comprehensive, you know, plan, nutrition, exercise, stress reduction, sleep optimization community.

Dr. Mary Claire Haver [: 00:34:34

You know, how important it is to talk about this as well as their pharmacology.

Dr. Sameena Rahman [: 00:34:38

No, that's great. Do you think you're going to do another book after this? I don't know what you'd write on.

Dr. Mary Claire Haver [: 00:34:43

But, yeah, I've already negotiated for the new periwise, so really, really, really blowing out the new perimenopause. And then in my dream, I have a third one, which is the post menopause, like, really honing in on the behaviors and things like, once your symptoms are gone, that are going to keep you healthy and out of a nursing home.

Dr. Sameena Rahman [: 00:35:03

You know, I've been asking all the other people I interview as well, because, you know, now most of us get, like, those, you know, mid 60 or close to 70 year old patients who, like, for instance, I've been seeing for GSM or, you know, whatever, urinary stuff. And they're like, we feel left out of this equation because, you know, 20 years ago, when I entered menopause, the doctor told me I couldn't be on systemic hormones. Like, is there a chance for me? So tell me, tell us how you approach those patients.

Dr. Mary Claire Haver [: 00:35:30

100%, she needs vaginal estrogen. If she has a vagina and she's over the age of 60, you know, like, that is a non negotiable. So, yeah, hormones are for her. As far as systemic. If she's gone without hormones for more than ten years and she's over 60, she's a probably lost most of the cardiovascular protective benefits, and it won't hurt her. But, you know, so we start talking about cardiovascular risks and symptoms. I sometimes get a calcium cardiac score to check for atherosclerotic disease, because if they do have severe atherosclerotic disease, HRT estrogen might make it worse. Again, there's some controversy there, but I'm wanting to get the fuller picture of what we're looking at down the road.

Dr. Mary Claire Haver [: 00:36:09

And there is a window of opportunity for brain protection as well. So I can't tell her. This is going to decrease your risk of dementia, Alzheimer's, you know, only when she's young or earlier in her menopause journey would that appear to be protective. So estrogen is better at prevention than cure. 100% is going to protect her bone. 100%. Always every day for the red cell, you know, always protecting her general urinary system. And I'm giving it to her both ways, you know, systemically and vaginally.

Dr. Mary Claire Haver [: 00:36:33

I want to hit it from both ends because, you know, the data, you know, how many women end up in long term care facilities or in hospitals from you, urosepsis. And that is 50% preventable with just vaginal estrogen, you know, prophylactic vaginal estrogen. It should be in the water. So those are the, those are the things I counsel about.

Dr. Sameena Rahman [: 00:36:52

Yeah, that's what, that's what my favorite thing to say is that vaginal estrogen is life saving because of that, the ural sepsis leading to 6% of them die from uricepsis when they're hospitalized. So, I mean, it is. It's life. It's life saving. So most of my listeners have heard me say that many times. Okay, so you're going to do your next book, probably. Let's talk about, when you talk about just a little bit more about the weight management portion, because I haven't had that many people discuss the best ways that they introduce weight management for their patients. So you do this.

Dr. Sameena Rahman [: 00:37:28

Bonding scanners tell me where you talk about what things that you would bring into the equation for your patients.

Dr. Mary Claire Haver [: 00:37:34

So we try to make sure she's getting adequate protein to support her muscle mass, you know, or if she needs to grow muscle, I'm recommending more. So I'm giving her grams per day of protein, fats, and carbohydrates. Just rough, you know, within 10% goals, I do put them, you know, knowing what her basal metabolic rate is. Because I have that scanner, I am putting her in a slight poor deficit, but nothing crazy, because I want her to get adequate nutrition, and we're going to lie on movement to try to, you know, keep that calorie deficit going. If she's on the couch, we talk about walking. If she's walking, we're going to put on a weighted vest. You know, if she's already weighted vesting or doing light weights, we're going to go for heavier weights. You have to meet the patients where they are and not so much focusing on that number on the scale.

Dr. Mary Claire Haver [: 00:38:14

We're focusing on hanging on to this muscle mass while we lose the fat. The most difficult patients are the ones who are skinny fat, who have low muscle mass and high fat levels, because it's hard to do that both at the same time to build muscle while you lose the fat. You know, it just. The two are just diametrically opposed, and people freak out on the scale. So we kind of pick one and fix that first, then we go to the other. Unfortunately, the pressure from our, you know, cosmetic society is to look a certain way and whatever, that doesn't necessarily line up with her living a long, healthy life. So, you know, I try to keep them focused on that. So we talk about nutrition, anti inflammatory nutrition.

Dr. Mary Claire Haver [: 00:38:54

We have meal plans and things that we've developed through Galveston diet that we send them home with, and then we bring them back to measure their body composition when they come back.

Dr. Sameena Rahman [: 00:39:02

Well, that's wonderful because you have all those good recipes, too, on your website, I think. Right. And so then you'll just assist them through that process, which is wonderful. Tell me what you're going to do in the next two years. You think, other than write this, is there anything else that you're.

Dr. Mary Claire Haver [: 00:39:24

So I'd like to expand our clinic a little bit, you know, hire a couple more practitioners. Cause we're just booked out forever. I'd like to write the new book. So in 2026, I want to publish the new peri memocause I'll be 58. So, you know, before 60, I, you know, we've developed, you know, I'm an entrepreneur, and we've developed our supplement company and our, you know, we have meals throughout. Like, we've done really well with our ancillary products associated with what we do. I really want my website to be the go to website, like the goop of menopause with evidence, you know, without the. Whatever the problems.

Dr. Mary Claire Haver [: 00:40:01

And she's an incredible business woman, so I have to respect her for that. But I want this to be where people go to find information, to find a doctor, to find, and then the other. The last thing I'm doing at the end of this year is I'm developing a training program for clinicians to do menopause care. I just feel so I want to be part of the solution, which is getting boots on the ground.

Dr. Sameena Rahman [: 00:40:22

I want you to do that, too. I was gonna say, I want you to do that, too. Absolutely.

Dr. Mary Claire Haver [: 00:40:26

So, yeah, I've gotten. We've hired a CEO for that company. It's a whole separate company. And we're, you know, I've gotten. Actually the first time I've ever used funding. Like, we built everything from scratch on our own. My husband and I have just used our personal finances to fund everything. This is the first time I'm bringing in help in the form of venture capital to launch that business.

Dr. Sameena Rahman [: 00:40:45

So that's amazing. Yeah.

Dr. Mary Claire Haver [: 00:40:47

And it takes a lot of the work off of me. My team is going 100 miles an hour just trying to keep my balls in the air.

Dr. Sameena Rahman [: 00:40:53

That's awesome. I love what you're doing. Okay. So when you have a patient who, like, you know, a lot of my listeners, you know, will say that, you know, they've been gaslit by their clinician. They're, you know, not getting what they need. My tagline for my. For my podcast, I'm here to educate. So you can advocate.

Dr. Sameena Rahman [: 00:41:10

But how would you tell a patient to advocate for themselves other than, you know, knowing the information you've given, or, you know, how do you. How do you tell a patient to talk to a clinician that's not listening to them?

Dr. Mary Claire Haver [: 00:41:21

So I can't fix an asshole. And so. And a lot of these doctors just don't have time in their busy schedules to get up to speed on menopause. So before you hit the door, call ahead. Are they willing to have a conversation with me about menopause? Does he or she even prescribe HRT? And if the answer is a categorical no, then this is nothing. That appointment you want to have, you know, try to find someone who's certified by the menopause society, which isn't perfect. Exactly. Or, you know, we have lists.

Dr. Mary Claire Haver [: 00:41:53

Or go to telemedicine so that you know, that there are people here who have less. You have to step out of the box to be an informed menopause provider. Yeah.

Dr. Sameena Rahman [: 00:42:02

I mean, I always say to patients, too, like, if you're. If you go to a. If you're going to an Ob Gyn, for instance, and there's only pregnant women in the room, it's less likely because, I mean, when I don't. I don't know if you ever worked for, like, a big. But when I used to work for a big academic center and I was doing both Ob and gyn, like, you're seeing 30 plus patients a day, right? You don't want to, like, oh, yeah.

Dr. Mary Claire Haver [: 00:42:22

Oh, yeah. And running back and forth to labor and delivery in the middle of the day.

Dr. Sameena Rahman [: 00:42:27

So you're going to come in there and tell your doctor all these problems, and they're going to be like, they want to stab themselves in the eye because they can't. Number one, they don't have the time to help you. They're under a crunch. So I don't, you know, like, I don't, I don't know, speak negatively about them in that respect because. But at least tell the patient, like, hey, you know what? This is not my area. Let me tell you who can help you or, like, give them the tools they need. Right. Because it's not, it's not fair to the patient.

Dr. Sameena Rahman [: 00:42:53

But I've been in that clinical scenario where, like. And I still feel bad about it. Like, this was like 15 years ago when I'd see a patient in a 30 patient a day practice and someone complained to me about, you know, sexual pain or, you know, some sort of thing as I'm leaving the door and.

Dr. Mary Claire Haver [: 00:43:07

I'd be like, like, right.

Dr. Sameena Rahman [: 00:43:10

And I still feel so sad that I did that. But I was in a, you know, you're in a situation where you couldn't, like, you know, it's not built for that. Our medical system is broken in many ways.

Dr. Mary Claire Haver [: 00:43:19

Right. It's not built for that.

Dr. Sameena Rahman [: 00:43:20

Yeah. Especially, you know, for midlife women, for women who have sexual pain or, you know, complicated histories. You know, you need the time. You need that hour with them. You need to, you need to be able to do a full examined. But so what else do you want to tell the viewers? I mean, the listeners, I say viewers because I have a YouTube channel, too. What else do you want to tell the listeners before we kind of, my.

Dr. Mary Claire Haver [: 00:43:42

You know, menopause is inevitable, but suffering is not. And expecting to suffer and accepting suffering is just not anything you have to do. But it is going to take some legwork, and you're going to need to educate yourself in order to have the best outcome.

Dr. Sameena Rahman [: 00:43:54

And I like what you say all the time, that you have a nursing home prevention program. I think doctor Malone, Sharon Malone says that she wants to be a benefactor, not a burden, but it's the same concept. Right. Your nursing home prevention program.

Dr. Mary Claire Haver [: 00:44:07

Right. And I love the way Sharon phrases that and I've borrowed that phrase several times. You know, I have two daughters, 20 and 23, and I'm, you know, I can't tell you the drama in my family group chat over my mother right now and her end of life stuff. And I want to limit that as much as possible for my kids know, again, I want to be a benefactor of them and not a burden or for as little as possible. I don't expect to live forever and I know I'm going to have illness, but as much the impact taking that away from them as I can.

Dr. Sameena Rahman [: 00:44:36

And I think that, you know, we want to live good quality lives. We want to live, you know, if we were to live a long life, we want to live it in a good way. We don't want to be, like you.

Dr. Mary Claire Haver [: 00:44:44

Said, the nursing home to 100 with ten of that being in a bed.

Dr. Sameena Rahman [: 00:44:49

Yeah, exactly.

Dr. Mary Claire Haver [: 00:44:49

No, thank you.

Dr. Sameena Rahman [: 00:44:50

No, thanks. Exactly. Exactly. And we've all, I think at some point. Cause we're in that life period where you had enough family members with dementia or something and you see the toll it has on the family too, right? Like a lot of times dementia patients don't know what they're doing, but like, it plays a role. It puts a toll on a lot of family members too, just because their personalities change and, you know, they have frontal lobe disease, all this stuff. But I think that's a good ending point for us is that we should all work to be like really preventing our own or just encouraging our own healthy lifestyle so that we live very healthy and good lives without being like you. Like you said, like in the, in the bed, peeing on ourselves, not knowing where we are.

Dr. Mary Claire Haver [: 00:45:33

Yeah, absolutely.

Dr. Sameena Rahman [: 00:45:34

Well, I think.

Dr. Mary Claire Haver [: 00:45:35

Exactly, yeah.

Dr. Sameena Rahman [: 00:45:36

Thanks so much, Mary Claire. I appreciate you being here today. You are amazing. You are a force to reckon with. I love being part of the menopause. Thank you for all that you're doing to help the world, really. I mean, I think it's amazing. So I'm going to put all your stuff in the show notes and how people can get in touch with you.

Dr. Sameena Rahman [: 00:45:56

And the new menopause, if you haven't bought it, is available on many platforms, but you can get it in bookstores and Amazon and anywhere you get books pretty much. And you can find Doctor Mary King on many platforms these days. But this ends.

Dr. Mary Claire Haver [: 00:46:11

Thank you.

Dr. Sameena Rahman [: 00:46:12

Thank you so much. This ends. Another great podcast for Gyne or girl presents, sex, drugs and hormones. I'm here to educate so you can advocate for yourself. Please join me for my next podcast and enjoy your day. Thank you. So much. If you have a second, please subscribe to this podcast.

Dr. Sameena Rahman [: 00:46:26

I'd love for you to be a follower and learn as much as you can about the things that we're going to talk about with all the people on our journey. Please review us on Apple or Spotify or wherever you listen to podcasts.

Dr. Sameena Rahman [: 00:46:38

These reviews really help review us.

Dr. Sameena Rahman [: 00:46:40

Comment tell me what else you want to hear to get more information. My practice website is www.cgchicago.com my website for Gynel Girl is www.gynegirltv.com. my Instagram is Gynell Girl so please follow me for some good content. Additionally, I have a YouTube YouTube channel, Gynel Girl TV where I love to talk about all these things on YouTube. And please subscribe to my newsletter, Gyno Girl News which will be available on my website. I will see you next time.