Moment 160: Menopause Expert: They're Not Telling You The Full Truth! "No Ones Talking About This": Mary Claire Haver

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0:47For people that don't understand menopause, they might think that it's a small issue affecting a small group of people. But how many women are affected currently by parry menopause, menopause and postmenopause? Sure. So right now, about a third of the female population of the world is in parry full met our postmenopause. You do not, it's not optional. All of us go through it. And because we have such individual expressions of how it affects our bodies, what we know now is that there are estrogen receptors in every organ system of our body. And when those levels start declining, we see a very wide variety of a spectrum of syndrome where it used to just be thought it was a few hot flashes and some night sweats.

1:34Maybe your sleep's disrupted. Your genital urinary system is going to take a hit. Your bones are going to get weaker. But what we know now is how much it's affecting our mental health, our capabilities, our skin, our bones, our kidneys, you know, vertigo, tenitis, frozen shoulder. But any time I post about those on social media, the internet explodes. And women by the thousands are like, oh my god, I had no idea. You know, and just the validation piece was so huge for them to make, because they've been dismissed for so long and told it's all in their head. And if we think about from sort of parry to postmenopause, what is that sort of typical, I don't know, that's a tricky word to use.

2:11But what is the average typical age range? And then also what is the sort of more possible age range? So it could just start between this age and this age. So in the US and in most of Europe, the average age of menopause, which means one year after your last menstrual period, is 51. Parry menopause, which is when your body recognizing, recognizes there's some declining estrogen levels and you're beginning to be symptomatic, can start seven to ten years before that. So normal menopause is still 45 to 55. And so if you do the math and back that up seven to ten years, it is completely reasonable for a 35 year old woman to begin to experience some of the symptoms of parry menopause.

2:55So let's start with what is it? And I'd love you to explain this to me like a 10 year old. Okay. Because I'm sure there's some people that are both men and women that aren't flea. So we're going to talk about gonads, right? What's going on? So gonads are where our, so in men, it's the testes. And where you're making your genetic material to, you know, where you're making sperm, right? And in a female, it's going to be ovaries, her ovaries. So the difference, big differences between male and female and how that process happens is that males make their genetic material fresh constantly, the minute they go through puberty until basically they die, unless they have some medical issue.

3:36Females on the other hand, our eggs develop while we're in utero and our mothers. So while we're in the womb, where she's five months pregnant with us, we have our maximum eggs that we're ever going to have. And those are meant to last us until we go through menopause. And so they lay dormant until we go through puberty, and then they wake up again and we start ovulating. So we have this monthly and a healthy person, cyclical, you know, hormones rise and ebb and flow with our cycles each month. We have a period, you get pregnant, you don't get pregnant. And the whole process starts over again.

4:09Well, because we're born with that egg supply through time, we're decreasing the amount and the quality of those eggs. So when a woman hits the age of 30, she is down to about 10 % of the egg supply that she had a birth. And when she's 40, it's down to about 3%. And so, and it gets harder and harder for that ebb and flow of the natural hormones to do its job. And we start seeing fluctuations in her periods, and then organ systems that are beginning to notice the lack of estrogen. Estrogen is a really powerful anti -inflammatory hormone and most of our body systems. So the Muscle of Scyndra of menopause is really starting to be talked about quite a bit now.

4:54And we're looking at things like frozen shoulder or througes, generalized aches and pains. And most physicians aren't aware of this. You know, most know about hot flashes and night sweats and sleep disruption. But now that we're really opening the conversation as to how many organ systems are affected, we are seeing people coming out of the woodwork just so happy to know that they're not crazy and they're being validated. And what's happening at these sort of three stages? So we have the perimenopause stage, which is from what I've understood there when estrogen levels start to drop. Right. So we start seeing disruptions in the forest.

5:30So instead of that nice monthly estrogen surge with ovulation and then the progesterone goes up, we start the elongation sometimes, or they even get closer together. I call it the zone of chaos. What used to be a very reproducible dependable system starts failing. So some women will have irregular periods, meaning they're spacing out, they're skipping periods. Others will have really heavy periods like, you know, hemorrhagic almost. And again, individual, the way the body reacts to this is very individualized from patient to patient. Doctors love something that follows a list, a checklist, right?

6:08You know, we have all these complicated things we have to learn and we have these checklist. But menopause, it's like pinning the tail on a moving donkey. And in perimenopause, it's very, very chaotic. Estrogen surges, then it goes away for a while. Like a woman in perimenopause can feel completely fine for a few months. Everything goes haywire. Then she's fine again. You know, and not only is her estrogen declining, her testosterone is declining as well. So we're seeing loss of muscle mass, we're seeing changes in her sexual function, we're seeing decreased strength. You know, there's some really good studies showing how testosterone also affects our mental health and our cognition as well.

6:45Why does this happen from this sort of like an evolutionary? So the anthropologists have looked at this heavily and there's only a couple of species in the world that go through menopause. Humans are one. There's a couple of species of whales and I think they've now discovered one of the giraffes. Species of giraffes can do it. But the by and large most mammals will die while they're so ovulating. You know, like they're not going to go through a menopause. And so there's something called the grandmother hypothesis where there was an evolutionary advantage for women to survive if she stopped the ability to have children at some point.

7:25Now again, you have to temper this with humans have prolonged their lifespan and their health span because of modern medicine. So probably when we evolved, we weren't living this long. You know, a woman my age was pretty rare. I'm 55. And so, you know, it's hard to say I think we have outlived how we were genetically built. And so we're living longer and being forced to like deal with the consequences of that. So then the next stage is menopause. Mm -hmm. So menopause itself is really that it's just really one day in your life. It's when you can throw the hammer down and say, I'm never going to ovulate again.

8:04I'm done. And so if a woman's over the age of 45 and she hasn't had a period for a year, that's the definition. Okay. Now it gets confusing because what if she's had a hysterectomy or doesn't bleed because of a surgery or an IUD or something. Well, then we can't use her periods to help judge. And that's what we start doing blood work to see, you know, where she is in her menopause journey. And then post menopause is the rest of your life. You know, the hot flashes might go away, night sweats might go away, brain fog might get better. But pretty much everything else is going to continue to progress in a very linear fashion until you die without estrogen replacement.

8:42To put it lightly, you seem somewhat dissatisfied with the current set of answers that the medical field, but just society at large are offering for women in this sort of peri and post and menopause will phase of their life. And I've sat here with a lot of women who are experiencing menopause at one stage or the other. And they also seem to be at a loss for answers. I was sat here two days ago with a very, very successful woman who, you know, has all the resources in the world. And she basically came in and this is someone that has all the answers. People come to her because she has the answers.

9:21And the one thing she doesn't seem to have answers on in her own words in her life at the moment is menopause. She's rummaging around the internet, Googling things, finding contradictory information. And when you sat down, you had that same energy like you feel like women have been directly let down by a system. I think the medical system is letting them down. I think society is letting them down our value and our worth. And medicine, you know, I came through this wonderful training program. I'm very proud of what I learned. I'm very proud of the care that I gave except I was a horrible menopause provider for probably 15 years.

9:57I knew what I knew. I relied on my training and I didn't look outside of the traditional confines of training. This is such a systemic problem that, I mean, I'm going to tell you a story and this is true. And it's embarrassing, but I think it needs to be said because I think it really highlights how women are treated in medicine. When I was in training, we had these upper level residents. So we have a hierarchy where you have different years of training. So it was in the early years, maybe my first year, and we had these clinics that we would run to take care of patients. And so we have the Stutrix and we have gynecology as like divisions in our training.

10:38So in gynecology, everything gets lumped together. Pediatrics, menopause. We had no specific menopause clinic. I maybe got six hours of lecture in a four year curriculum. And so we'd have these women coming in in midlife and they had multiple complaints. They didn't feel good. They weren't sleeping. They were gaining some weight. They were, you know, aching that, you know, just this laundry list of things that were a little on the vague side. And my upper levels would say, oh gosh, good luck with that. You've got a WW on your hands. And that was code. We never wrote that in the chart. This was not taught to me by faculty.

11:18This was just kind of a handed down in the lure of training. And a WW was a whiny woman. And that was code. And now I know that she was paramedicoposal suffering from her list of symptoms of now which we've categorized about 70. And they were frustrated because they didn't think they could help her. Now remember the Women's Health Initiative, which was a study that was supposed to do a lot of good for women. It was originally designed. And it was stopped in 2002. That was the end of my training program was 2002. So I come from one of the last groups of physicians in the US that were ever trained in hormone replacement therapy.

11:58And then the rug was pulled out from under us. So the WHOI, there were mistakes. There was misinformation in the reporting. And there was misinterpretation of the results. All of that has been walked back, re -looked at. We know that for the vast majority of women, hormone replacement therapy is safe and effective. And can give a woman her life back.

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