The Perimenopause Masterclass: Anxiety, Brain Fog, Broken Sleep, Weight Gain & GLP-1s

26:57Dr. Mary Claire Haver:But this is actually a severe systemic problem. We have not prioritized women's health after reproduction ends. We are not teaching on a large-scale basis, all of these doctors who are charged with your health care, how menopause affects a woman. Maybe your OBGYN will understand what's going on with your cycle irregularity and hot flashes. Most docs will get that. A bunch of hot flashes, your cycle's becoming irregular. Most doctors will be able to say, okay, menopause. However, your cholesterol, your anxiety, your joint pain, your sleep disruption, your weight changes, your new belly fat. We're not teaching that by and large.

27:38Dr. Mary Claire Haver:Now we're working on it. We need a robust menopause curriculum, which is not available in most programs. So it is really sadly up to us to educate ourselves. Sometimes we'll know more than the doctor. And one thing we've tried to do at The Pause Life, if you go to our website and you look at the menopause empowerment guide. It's free. It's what, 15 pages now. We keep dumping more stuff in it. It is a set of resources with tons of links available for you to educate yourself and resources for you to take into your clinician so that hopefully you can maybe educate them some and be able to get what you need.

28:18Dr. Mary Claire Haver:Also, we have resources on how to find doctors who are menopause certified. You can go to menopause.org for the Menopause Society and try to find a menopause-educated clinician there as well. I thought perimenopause was just about periods and hot flashes. Why do I feel like my entire body is breaking down? That's a great question because we have estrogen receptors and those on video. We're going to fly in an image here. There's a great study. It was the first time I saw this. It absolutely just stopped me in my tracks. It was the location of the G-coupled estrogen receptors throughout the human body.

28:57Dr. Mary Claire Haver:And they're everywhere, guys. They're in the brain. They're in our skin. They are in our bones. They're in our gut. They're in our epithelium. They're in our vagina. They're in all of the tissues in our body. And it just was so validating for me to see that scientifically. And then they listed all of the disease states, including things like fatty liver, including, you know, I'd never thought about before and really was what happened metabolically, how estrogen affects the liver and how you make cholesterol, how estrogen is an anti-inflammatory hormone. So when it goes away, we lose some of the protection against inflammatory processes in our body.

29:34Dr. Mary Claire Haver:So please, nothing else. Go to our website at thepawslife.com. Look up the Menopause Empowerment Guide. Download it for yourself so you have some resources for you. My cholesterol is suddenly high. And my doctor is talking about heart disease risk. What does that have to do with perimenopause? So remember, estrogen affects the liver and affects how we make cholesterol. So it drives up our ApoB. It can actually drive up LP little a. In men, LP little a appears to be more genetic, but we see an increase in LP little a. These are specific, very small cholesterol particles that have a much higher association to the risk of atherosclerotic disease and cardiovascular disease than just your total cholesterol.

30:23Dr. Mary Claire Haver:So in our clinic, we are doing deeper dives into lipid panels on patients, not getting just the standard lipid panel. We're getting all these extra markers so we can counsel our patients appropriately. Also, there's something called vascular flexibility. So your blood vessels in the presence of estrogen are more flexible. They're more squishy. They're more able to handle the blood passing through. However, when estrogen levels decline, we lose that flexibility and the arteries actually become stiffer, which makes our blood pressure rise. So those of you, including myself, who have seen a rise in your blood pressure, you enjoyed this nice, normal blood pressure most of your life, and then all of a sudden you're going through menopause and you see it rise, it's not because you did anything wrong.

31:08Dr. Mary Claire Haver:This is a predictable biological consequence of this fluctuation and decline of estrogen levels. And it is not fair to you that you did not know this and that this is blindsiding you at this time if you're seeing it happen.

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32:15Dr. Mary Claire Haver:These are prescription strength formulas made with estriol, the gold standard hormone your body stops producing naturally, and they are backed by clinical research. Women are seeking smoother looking skin, improved firmness, and a brighter, more even tone. If your skin is changing, your skin care should change too. With Alloy, you consult with a doctor and receive expert guidance and have your treatment delivered right to your door. Head to myalloy.com and use code MCH20. That's MCH20 to get$20 off your first order. perimenopause is not early menopause it is its own distinct biological phase and it has been largely ignored my new book the new perimenopause is about the seven to ten years before your period stopped a transition that is anything but gentle hormones fluctuate wildly and for many women this is when the anxiety brain fog sleep disruption weight changes mood shifts joint pain, and that unsettling feeling of, I don't feel like myself anymore, begin.

33:26Dr. Mary Claire Haver:Long before anyone says the word menopause. Perimenopause often starts quietly. It shows up in the brain first, then the body, then everywhere else. And too often, women are told, nothing is wrong. I wrote the new perimenopause because you deserve answers before things spiral. You deserve care before burnout. and you deserve a clear roadmap for a transition that medicine has ignored for far too long. The new perimenopause is now available for pre-order everywhere books are sold. Learn more and pre-order your copy at thepawselife.com. If your skin or your nervous system feels a little overwhelmed lately, this may be your sign to simplify.

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35:12Dr. Mary Claire Haver:I've always been strong. but now I feel weaker and my joints ache constantly. Plus my doctor is worried about bone density. Is this connected to hormones? It absolutely can be. So there are estrogen receptors in our muscle, in our bones, in our tendons, in our joints, okay? We know that. There's also testosterone receptors and probably a few progesterone receptors in there. And what has been defined is something called the musculoskeletal syndrome of menopause. We now think that a lot of fibromyalgia, which is a condition that occurs in mostly women between the ages of 35 to 60, what else is happening during that time?

35:54Dr. Mary Claire Haver:You have to start thinking. And so we think that a lot of women who are being diagnosed with fibromyalgia may actually just have the musculoskeletal syndrome of menopause and are having increasing inflammation in their joints, bones, and muscles. Osteoporosis is something different. osteoporosis, so the rate at which we are chewing up bone and the rate at which we lay down bones. So up until we were not sure age somewhere between 20 and 30, we are laying down more bone naturally than we chew up. Bone is always remodeling, right? You're always chewing some up and laying down new bone behind it, like Pac-Man, right?

36:31Dr. Mary Claire Haver:Coming out with new bone. when we go through perimenopause, we see the greatest level of rate of bone loss, okay, than we even postmenopausal women. So the biggest acceleration in your loss of bone actually starts happening in perimenopause. For that reason, my patients are very interested in having their bone density evaluated at the beginning of perimenopause. So we know what their baseline is. Sadly, insurance will not cover this unless you have a kind of an extraordinary risk factors. So a lot of patients will have to fight to get that covered or they're choosing to pay out of pocket to get a baseline bone density scan so they can understand, you know, where do I need to focus here?

37:19Dr. Mary Claire Haver:What are my goals? And if your goal is not to have a vertebral fracture and have horrible back pain like your mom did or have a hip fracture and end up with a horrible quality of life, you know, or have long bone fracture in the arm because you just kind of tripped and fell one day. If you want to limit those risks, you know, you need to know what your baseline bone density is because we can start making changes in perimenopause to support your bone and muscle strength so that you don't have as high a risk as you age. You can actually grow bone at any age, but it does take work and it takes understanding what your starting baseline is.

37:57Dr. Mary Claire Haver:So estrogen plays so many roles in the body, but I want to focus on kind of what I call my top five. And this is what I talked about a lot in the new perimenopause. We're going to talk about brain. We're going to talk about heart, muscle and bone, liver, and our immune system. So in our brain, the sex hormones or the progesterone, estrogen, and testosterone have direct effects on our neurotransmitters. How we produce things like dopamine and serotonin, these chemical messengers that hop from neuron to neuron in the brain and is why we have memory, why we have mood, why we have anxiety is directly related to these chemical messengers.

38:36Dr. Mary Claire Haver:And when we lose estrogen and lose progesterone, we see changes that quite often will be severe mood changes. Anxiety and depression are the top two. We see changes in the processing speed in certain areas of our brain. The way we process glucose changes, amazing work done by Dr. Lisa Moscone, looking at energy metabolism in the brain across the menopause transition. And there are certain areas of the brain to do with memory and cognition that change dramatically across the menopause transition. Estrogen is involved in our strength, like we talked about in our bone, and in energy use in both, and in our liver, in fat and glucose metabolism.

39:19Dr. Mary Claire Haver:And then our immune system, it's directly tied to inflammation control. These estrogen receptors, both alpha and beta receptors are everywhere, but really where we're seeing the metabolic consequences and where we're seeing the hardest hits for women in perimenopause are going to be in fat cells, in the brain, in the liver, and in our muscle. So it's not just fertility that changes. It definitely changes, right? But it is so much more than that. It is your metabolism, is your energy stores, and it is your resilience. So another common question we get, seeing this question right here, I'm eating the same way as I always have, but I am suddenly gaining weight around my middle and my blood sugar is creeping up.

40:05Dr. Mary Claire Haver:I feel more inflamed than ever. What's happening? Another similar question. I've gained 15 pounds around my middle despite eating well and exercising. My doctor says I need to eat less and move more, but is something else going on? Yes, yes, yes, yes, yes, yes, yes. Okay. Let me break it down for you the best I can. So the best way to explain this is something I like to call, you know, we talked about earlier, the musculoskeletal syndrome of menopause. Well, I wrote a paper with a couple of medical students and Dr. Rocio Salas-Waylan, where we coined the term the metabolic syndrome of menopause, specifically to look at a cluster of what's happening of increasing abdominal obesity or what you would call belly fat.

40:51Dr. Mary Claire Haver:Now, this is the fat not under the skin. This is the fat that is inside of our abdomen that wraps around our internal organs. Also, it could be leading to high triglycerides, a lower HDL, that's the good cholesterol, and elevated fasting glucose and increasing insulin resistance. Those two go together and high blood pressure. This happens due to estrogen loss and not because you're letting yourself go. Okay. Specifically, when we talk about what's happening with the increasing intra-abdominal fat, there's several kind of factors. if you think of a traffic circle, right? And there's several entries into this circle that's spinning into a woman getting more and more visceral fat or abdominal fat.

41:35Dr. Mary Claire Haver:One, your insulin resistance is getting worse. So your ability to take in a glucose load, so eat a sandwich, eat a salad, eat whatever that has glucose, eat a cookie, and how much insulin it takes to drive that blood glucose into the cells. So when you become more insulin resistant, it takes more and more insulin levels, okay? Higher insulin levels are linked to more inflammation and more visceral fat. So the higher your insulin levels are, really after you eat. So when you don't see those insulin levels decline, you don't see blood sugar going back as quickly as it used to, back to a normal level after a glucose load, we are seeing increasing levels of inflammation and more and more fat being driven to the intra-abdominal cavity.

42:26Dr. Mary Claire Haver:Once that fat gets to the intra-abdominal cavity, it kind of acts on its own. Subcutaneous fat doesn't produce as many inflammatory cytokines. These are inflammatory chemical messengers that can go and inflame other parts of your body, your brain, your gut, your joints. But the intra-abdominal fat does do that. And that is new for many women. So when we look at the data, they did scans looking at premenopausal women and then perimenopausal women and postmenopausal women. And they measured with either a DEXA scan or an MRI how much visceral fat they had, how much intra-abdominal fat. And you take age out of the equation because remember, women go through menopause at different ages.

43:09Dr. Mary Claire Haver:So if you match them to their menopausal status and not their age, we see a pattern forming. Somewhere between 8 to 10 percent of a woman's total body fat is intra-abdominal in a pre-menopausal woman, okay? However, you take her through the menopause transition and that can increase 18, I've seen as high as 30 percent. So I like to like round it off at about somewhere in the 23, 24 percent range. So you can basically double to triple the amount of visceral fat that you have simply by going through menopause. No other reason, okay? But There's several factors leading to that. Inflammation levels are getting higher.

43:45Dr. Mary Claire Haver:Insulin resistance is increasing. That makes your blood sugar levels stay up higher longer, which also increases inflammation. And you're losing the protection of estrogen, which in itself is an anti-inflammatory hormone. And all of those things are driving more and more fat to the abdomen. Also, we're seeing sleep disruption. Women who don't sleep, who are having trouble falling asleep or staying asleep, who aren't getting the good quality sleep, have higher levels of visceral fat, which is leading to more inflammation, right? Which is leading to also changes in their diet. You crave more things that are unhealthy, like simple carbohydrates when you don't sleep, right?

44:21Dr. Mary Claire Haver:You're tired, you're exhausted, you start reaching for comfort food, you start reaching for things. These are all psychological changes that happen throughout the menopause transition. Next question, what are the actual health risks if these metabolic changes go unaddressed? we see some pretty scary statistics. Cardiovascular risk doubles across the menopause transition. So premenopausal women enjoy a lower risk of cardiovascular disease than their male counterparts. And one of the key factors we think that is leading to being healthier in a premenopausal woman versus her male twin, right? Is that she has more estrogen on board, which is giving her that level of protection.

45:05Dr. Mary Claire Haver:It's lowering her inflammation levels. It's keeping her blood vessels more flexible, and it's decreasing the rate at which she can develop atherosclerosis. Once that estrogen protection goes away, we see her quickly meet the risk of amends by the time she's 60 and then surpass him. We see increasing rates of diabetes, which again is another risk factor for heart disease. We see insulin resistance really start increasing across the menopause transition. we've really treated menopause like a footnote instead of a pivot point for metabolic health. So a lot of you are asking, okay, well, do I just need to get on hormone therapy and that's gonna fix everything?

45:44Dr. Mary Claire Haver:No, no. I wish I could tell you just take your HRT and everything's gonna be fine for most of you. That is, it's gonna be helpful, but it's not gonna be everything. You are going to have to double down on your lifestyle in order to avoid some of these risks and stay as healthy as possible for as long as you possibly can. And fortunately, when we adopt a lot of these behaviors, it affects multiple disease risk states. So when we look at women who don't have heart disease and what their habits are, women who don't have dementia and what their habits are, women who don't have osteoporosis and what their habits are, many of those habits are the same.

46:21Dr. Mary Claire Haver:They eat adequate protein. They limit their processed foods. They exercise on a very regular basis to include strength training and some cardiovascular training. they are social. They stay connected to their communities. They have lower stress levels because they have friends. All of this is important. So I wish that I could just wave a magic wand and tell you get on hormone therapy and it will solve all of your problems. But that is not what happens at all. It is unlikely that if you eat the standard Western diet and live a sedentary life and take hormone therapy, that it is going to dramatically improve your lifespan or your health span.

47:06Dr. Mary Claire Haver:It most likely will have minimal effect. It will definitely help your hot flashes and probably help you. It will help your bones as long as you take it. But without the package, the toolkit, right, of the lifestyle changes, of prioritizing yourself, of staying metabolically healthy, you are not going to be able to live your best life in that last decade. We're going to get into some nitty gritty stuff here. And I don't mean for this to sound political at all. It's not really political. It's like the powerful versus the powerless. That's how I like to think about it. So pick your side of politics, whatever that is.

47:43Dr. Mary Claire Haver:Everyone talks about cardio for weight loss, but all I talk about is weightlifting. Okay. Your basal metabolic rate, all right, Your BMR, how many calories you burn at rest, okay, not moving, is determined by how much muscle you have. So we have a body scanner in our clinic that measures muscle mass. It measures your body fat. It tells you if the fat is visceral or subcutaneous. It tells you how much body water you have if you're dehydrated or, you know. So that number on the scale is so much more than just how much fat you have, which is all women tend to think about, right? Your muscles weigh, your bones weigh.

48:20Dr. Mary Claire Haver:You want heavy muscles and you want heavy bones. you want to gain weight. You want to gain weight in those areas, okay? But everyone's fixated on fat. So calories are important. No one can deny that, right? You eat in a consistent caloric excess, you are probably going to store fat. That's just how biology works. However, how many calories you're burning at rest is determined by how much muscle you have. And your aging process and menopause is chipping away at that muscle strain. So you have to work to keep it. And if you didn't start out with much like me, naturally, you know, a thinner person with low muscle mass, I'm working really, really hard so that I can keep my basal metabolic rate high.

49:01Dr. Mary Claire Haver:Also, that muscle is a big, juicy organ that soaks up glucose and lowers my risk of diabetes, lowers my insulin level. Okay. The most geroprotective organs that we have in our bodies, geroprotective, Do you know what that word means? It means protecting you in the gerontological ages, 65 plus, are your ovaries which go away and your muscle mass. They seem to be the most protective, geroprotective. And so we have the opportunity to build muscle at any age. It takes work. I just saw a study that was done with 80-year-olds, taking them into the gym, putting them through resistance training protocols, and they improve their muscle strength and muscle mass, okay?

49:45Dr. Mary Claire Haver:making sure you're getting enough protein to provide enough substrate amino acids to build those muscles, to grow muscle. You must have the building blocks of protein, which are amino acids. So really rethinking this whole like workout more, eat less, be thin, be thin, be thin is the only way to be healthy is not going to be your best bet. What tests should I be asking my doctor for? When should I start? And should I wait until my symptoms are really bad? Okay. You should not wait until your symptoms are really bad. So here's the quick and dirty. Here's kind of five things I think you should know about yourself at any age, right?

50:22Dr. Mary Claire Haver:If you're premenopausal, perimenopausal, postmenopausal. These for women in midlife, these are five lab tests I really, really think you should know. This is part of our lab checklist that is free to download 100%. Go to the website at The Pause Life. You can find it. But if I was going to give you top five, So you guys get your pencils out. You can take notes. Number one would be you should know what your fasting insulin and fasting glucose are. Those are so important. Why? Because we have no diabetes, pre-diabetes, diabetes, right? It's a continuum of blood sugar. We all start out with how our body is, how much insulin is secreted in relation to a glucose load.

51:09Dr. Mary Claire Haver:So your fasting insulin and glucose level, you can run it through something called the HOMA, H-O-M-A-I-R, insulin resistance calculator. They're free online. You put in those two numbers and it will tell you, and you want it to be less than two, just FYI. You want that HOMA-I-R score to be less than two. Anything above two is insulin resistant. You may have totally normal blood sugars. This is a red flag early warning system, okay? A marker to tell you, hey, I need to work on this. I need to make some changes because I am insulin resistant. I'm not pre-diabetic yet, but over time I have much more likely to be.

51:46Dr. Mary Claire Haver:So that would be one thing to get an early warning system. So fasting insulin, fasting glucose. Number two, you need to know what your ferritin level is. Why? Ferritin is our iron storage hormone. It is the first thing to go when our iron levels are low. Your blood iron may look totally normal, but what is stored in the bone marrow is what's important. And they've changed it. It used to be 30 was the cutoff. In the last few years, they moved it up to 60 for a ferritin level. So it can pick up low iron stores way, way, way, way, way earlier before you ever become anemic. Again, it's an early warning system, right?

52:25Dr. Mary Claire Haver:And this is one of the things we see aging and menopause chip away at. Low ferritin levels are related to fatigue, hair loss, brain fog, anxiety, all things that happen in perimenopause, right? So it is one of the critical labs that we get to try to differentiate. Is this perimenopause or does she also have a low ferritin level that we can treat, right? By giving her iron, either through an iron transfusion or oral iron supplementation, iron-rich foods. Number three, vitamin D. You need to know your vitamin D level. And remember there is low, which is less than 30. there is optimal, which is 60 to 100, okay?

53:03Dr. Mary Claire Haver:So you don't want to be low or deficient. You want to be optimal, which is in the way we measure in the US, 60 or above, super easy to supplement if you have low levels. We have vitamin D supports bone density and muscle strength, plays a role in immune function and inflammation. It influences mood and insulin sensitivity and low levels are associated with fracture risk. hello, because vitamin D, calcium all come in at the same. Okay. Number four, you should know what your LP little a is. Lipoprotein A can be genetically determined, but we do see an uptick in levels for as you go through menopause.

53:41Dr. Mary Claire Haver:So if you had it done in your 30s and you've been told, oh, you don't need to check it again. It was normal. Not if you're a woman. You really should check it in postmenopause as well. So once you go through the menopause transition, we don't see it increase more in the data that I've seen, but it's not something it's a one and done. For men, it's a one and done. But for women, you should recheck it after menopause if you've had it checked before. Why? Because heart disease is the leading cause of death in women and LP little a is significantly associated with the risk of cardiovascular disease.

54:12Dr. Mary Claire Haver:And you can get in there and get early before you could pick that up before your total cholesterol increases and know what that is. Number five, and this one is controversial, but we do do it in our clinic and I'll explain right. This is a high sensitivity C-reactive protein. I was always taught, don't measure something if you're not going to treat it, right? And so high sensitivity C-reactive protein is a general marker of inflammation. I can't tell you where the inflammation is coming from, only that you have it with the CRP. We can have guesses as to where it comes, but it is associated with metabolic dysfunction, cognitive decline, and accelerated aging.

54:49Dr. Mary Claire Haver:So it often can tell us there's some inflammatory in our clinic where like something is causing you to have inflammation. We are going to start doing things we know that can lower inflammation. That's going to be exercise, stress reduction, monitoring your sleep, increasing your protein, increasing your fiber intake, increasing your fruit and vegetable intake. Like we're going to hit it with all the things and monitor that and see what's going to help it come down. Remember that your symptoms are data. Brain fog is data. Chronic fatigue is data. Weight gain, especially in your med section, is data.

55:21Dr. Mary Claire Haver:Poor sleep is data. These translate symptoms into physiology. And the blood work just kind of helps complete the picture. And so, again, our lab checklist has these and many, many more tons of resources available to you. If you go to pauslife.com and just go in the little search bar and type in checklist, and you can get it downloaded to your inbox for free. And then you can take that to your clinician or just Get the labs ordered on your own.

55:54Dr. Mary Claire Haver:Many of you know I've spent my career pushing for better medical standards for women. MidiHealth is on that same mission, delivering the kind of care women have always deserved. For too long, women have been told to just deal with perimenopause and menopause symptoms. Your labs are normal. This is just a part of aging. Eat less. Work out more. That approach failed us, and it's exactly why both my work and Midi's exist. Midlife and menopause aren't the beginning of the end. They're a critical window of opportunity. But education is only half the battle. Women need access to clinicians who actually understand the science of female aging.

56:35Dr. Mary Claire Haver:That's the gap Midi was built to close. Midi is focused on healthspan, not just lifespan. That means looking at your metabolic health, bone density, cardiovascular risk, and cognitive function. It's the kind of proactive, evidence-based care I've always believed women deserve. And it's exactly what Mitty delivers. And here's what matters most. Women in all 50 states can access this care, covered by insurance, with clinicians trained in the latest menopause and longevity science. because your zip code should never determine your access to quality menopause care. Book your virtual visit today at joinmidi.com.

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58:56Dr. Mary Claire Haver:Dr. Haver, do you believe in GLP-1 therapy? okay it's not Santa Claus it's not as if I believe in it or not you know asking for my opinion means we're going to leave science off the table and I'm not willing to do that we utilize GLP-1 therapy appropriately in our clinic for our patients and I have literally seen it work miracles for our patients, especially those who have struggled with lifelong issues with weight or obesity or insulin resistance. We have two hours of podcasts, two separate podcasts done with Rocio Salas-Waylan. If you want a deeper dive from an actual expert, she wrote the book Weightless.

59:46Dr. Mary Claire Haver:I'm not going to lie. I was skeptical when they first came out. I did not know all of the research that had been done over the last 20 years. Remember, I didn't treat diabetes. And if I had gestational diabetics, we used insulin or something like metformin to treat them in pregnancy. I did not manage this at all outside of a pregnancy. So when I started utilizing my menopause clinic, I just thought those medications were only indication was to treat diabetes. And I would send them back to their endocrinologist to have that done. But when the indications for obesity started surfacing, again, you have to imagine my background of me being a little bit skeptical because I was seeing what everyone else was seeing was all of a sudden these dramatic and sometimes scary weight transformations on looking across social media of some of the people I followed to the point where I was guessing based on their physical appearance, and this is a little bit of judgment, that they were likely losing muscle mass along with fat loss.

1:00:51Dr. Mary Claire Haver:Now, I can't prove that, but just looking at, you know, their facial structure and how their bodies were, it would be, it looks really difficult that they would have been able to lose weight that quickly without suffering from muscle mass loss. And that's going off the data we had from gastric bypass patients and knowing what their muscle loss is with rapid weight loss after surgery. And here we are looking at the, playing the long game with patients looking at muscle mass and bone strength. So I was really skeptical until I started following Dr. Jenna Siwak and Dr. Rocio Salas-Walent on social and looking at the medical research journal articles they were presenting and then pulling them myself and reading them myself and realizing, wait a minute, I am allowing my own bias to stand in the way of what could be potentially best for a patient, especially when Dr.

1:01:43Dr. Mary Claire Haver:Rocio was really focusing and showing the body composition scans on her patients who were not losing any or significant muscle mass because of the way she was counseling them. And I was like, oh, so I got educated. And then we started on a very limited basis trying this medication on some of our patients who were struggling with obesity with the caveat that we were making sure that they knew how much protein that they would need and that they were committed to resistance training in order to, as they lost weight through this, how the mechanism of the medication worked, but they were getting adequate protein and adequate stimulation for the muscle and bones so that we would not put them in a position where they would have such significant muscle loss and bone loss, where they would be at risk for sarcopenia or frailty as they aged.

1:02:36Keeping that in context, we've done really well

1:02:40Dr. Mary Claire Haver:with this medication. A, we do body scan everyone. We know what their body composition is. We know how much muscle mass they have. And if they are losing muscle mass more than 10%, we are counseling them to come off the medications and adjust the dosing and really recommit to what the end goal is, is a healthier body, less visceral fat, less inflammation, and maintaining their bone and muscle strength. We're very aggressive at recommending getting a baseline bone density before starting a GLP-1 so that you know what your bone density is before we start and how we need to focus on that as well.

1:03:21Dr. Mary Claire Haver:Turns out pretty much the same thing that helps grow muscle grows bone. And so those two things can usually go together. But, you know, we take an hour with our patients on a new patient visit. And then if they decide that, you know, if we decide as a clinician they're a good candidate, we bring them back for another hour to counsel them on the GLP-1 usage and how to do it in the safest way possible. Every medication comes with risks and benefits. Every medication will have pros and cons. These medications are not for everyone. These, you know, And so, yes, we use them. Our patients are doing extremely well, but it is not, here's your shots and go home and go be skinny.

1:03:59Dr. Mary Claire Haver:That is not the way we counsel our patients. We are very, very specific as to how we manage them, how we monitor them, and how we help them stay healthy through the process. So to wrap up the GLP-1 conversation and people struggling with weight who've had a lifelong struggle or struggle in menopause and perimenopause, look, you are not broken. This body composition change you are experiencing is a, remember this, say this over and over, this is a predictable biological consequence of my hormone change. This is a predictable biological consequence of my hormone change. So what that usually means for most of us is you cannot keep going with the same lifestyle that you had and enjoy the same health benefits.

1:04:45Dr. Mary Claire Haver:Things are going to have to change. The GLP-1 is simply a tool in the toolkit. There are multiple tools in the toolkit. Adequate resistance training, adequate cardio, you know, exercising your body, lowering your stress, focusing on your sleep, doing all the things that are going to make a healthier body and help these medications help you. There are tools available. GOP-1 is just one of them. But the most important tool is information, education, and a clinician who believes in you and just believes that menopause is part of this process. And you deserve that. perimenopause can be hard, but it's also really full of possibility.

1:05:24Dr. Mary Claire Haver:It's okay for both things to be true at the same time. If you look at it as a window of opportunity, which is how I look at it with our patients, you can get ahead of so many things that can be affecting you long-term. You can feel bad today, but still believe that tomorrow will be better. You can be struggling and still be very, very strong. You are not declining. You are transitioning, and this transition is going to affect 100 % of us who are lucky enough to live long enough to go through this process. And where you end up really, really, really is up to you. I want you to know this. The tools exist.

1:06:04Dr. Mary Claire Haver:The knowledge exists. And a community exists for you. What you need to thrive through this and then get you through the next 30 to 40 years is available. you just need to know where to look and what to ask for. And now you do. This is the beginning of a new chapter and it should be the best third of your life. That's how it is for me. And I really believe that the last third of your life should be the best third of your life. So what are my top takeaways? Find a menopause educated or menopause trained provider. We have a list of resources on our website. It is in the Menopause Empowerment Guide.

1:06:44Dr. Mary Claire Haver:There are great online resources. Join a community online or in person. I welcome you to join our community at The Pause Life. We are in there answering questions, providing resources, but the best part really is the community and them sharing all of their stories, their resources, their struggles, and just oftentimes the question is answered before we can get to it by someone in the community who went through the same thing, found the resources, and fixed the problem. If you are not starting resistance training, I want you to get curious about it. There are so many resources online. You don't have to just jump into a gym and spend lots of money.

1:07:22Dr. Mary Claire Haver:You can do very simple things at home, you know, with your own body weight that can be effective. I like to meet my patients where they are. So if you are sedentary, just start walking. A one 30-minute walk after dinner every day can lower your risk of diabetes, I think, by 50 % in some patients, okay, if you're sedentary. So don't feel like you have to suddenly train for a triathlon or a marathon. Just going for a walk every day can lower your stress, improve your sleep, and decrease your risk of diabetes and insulin resistance. Track your protein intake for a few days. Download a free nutrition tracker.

1:08:00Dr. Mary Claire Haver:My favorite is Chronometer. It's free. It was developed for nutrition scientists. And it can just help you get an idea of how much fiber are you getting? How much vitamin D are you getting? How much magnesium are you getting from your food? If you purchase, pre-order the new perimenopause, this is pretty cool. We have a symptom tracker. So you get a whole guide. You get the whole first chapter to read for free. We'll just give you the PDF. And in the back of it is like a three-page symptom tracker that you can actually take to your doctor and share with them to help you explain what your symptoms are.

1:08:33Dr. Mary Claire Haver:Decide on one intervention you're gonna try and commit to it for three months. Is it going for that 30-minute walk a day? Is it upping your fiber intake by 10 grams a day? Is it monitoring your protein intake? Is it, you know, checking your vitamin D level and enjoying a vitamin D supplement? Just commit to one intervention. Do one small thing. Is it finding a menopause-educated provider and making an appointment to discuss your symptoms and what hormone therapy could possibly do for you? Also, share this podcast. Share this information with a woman who needs it. That is how we grow. that is how we maintain that is how more and more and more women how we get to normalize this so that the demand increases and that our institutions our teaching institutions our training institutions will be forced to keep up with us and the demand that we are providing and the most important thing is believe that better is possible because it is believe that you deserve this.

1:09:34Dr. Mary Claire Haver:Believe that this, your life after reproduction ends should be your time of wisdom, your time of thriving, and your time to have the best third of your life. You can find full episodes of Unpaused on YouTube at Dr. Mary Claire. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepawselife.com. My new book, The New Perimenopause, is available on Amazon and everywhere you buy your books. If you're loving this podcast, I have an important request.

1:10:15Dr. Mary Claire Haver:Please take a moment to follow Unpaused on your favorite podcast app. Following and listening is what pushes this information to more women who need it. So if this podcast has helped you feel seen, understood, or supported, hit follow right now so you never miss an episode. Thank you for being here with me. Let's keep going. Unpaused. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.