Train Your Brain To Thrive Through Menopause

22:51That's the big thing I'm hearing is like the glucose spikes.

22:54Dr. Mary Claire Haver:The data around a 30 minute walk after dinner is like astounding. Start there. Because you will then be the walker in your mind. And that is so important because again, that identity formation. So when I was talking about that, we want to take it out of the prefrontal cortex, which is, oh my God, there are a hundred steps involved. I got to find out about the cancellation policy of the gym. And if I go on vacation, you know, all of those micro details, it is too much expenditure. You want to make it in the simpler, more reptilian part of the brain, which is, let's just get this done. There's no thinking involved.

23:26And every time you take a step, there's a little bit of a dopamine surge. And that dopamine surge says, starts to facilitate and lay down tracks, you know, in the neural pathways so that it becomes automatic. There's no thinking involved. So we do get a little boost of dopamine. People are thinking, I need to wait for motivation to strike me like lightning, right? And what we don't realize is this concept in therapy called behavioral activation. You put the cart before the horse. You know when motivation comes? After you act. Action begets more action. We found that people who exercise regularly have a greater sense of purpose in life, and people who have a sense of purpose in life are more likely to exercise.

24:08So if you don't feel a sense of purpose today, go for a walk, go for a 15 minute walk. You're going to come back energized. You're going to have a sense of agency. I'm a capable person. I get stuff done. What did you do? I went for a walk. That was the most important thing. That's all you did. Yeah. And when I tell this to patients the first time, they laugh at me. They're like, Dr.

24:26Dr. Mary Claire Haver:I mean, the mentality is like, what's the point? It's a 15 minute walk. It's not going to burn any calories and all that, but like, it's not the point. You know, I think we're missing the point of exercise. Yes. And of agency and making you believe that you're a capable person and making it a part of your identity. Because one thing I should say is there's this whole idea of the default mode network, and maybe we can talk about that. And that is the ruminating part of the brain.

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25:25Dr. Mary Claire Haver:So you had mentioned the ostrich optimist, the person who buries their head in the sand. And I see a version of this in clinic, a woman who's been told nothing is wrong so many times. You know, she's seen six, eight, ten providers and they're all like, you're fine. Your labs are normal. And then she accepts that that's that's her. You know, is that an ostrich optimist as well? I mean, they can become that. I mean, to me, that feels like gaslighting, right? Like being told you're fine and you're minimizing and dismissing a person. So that's more like an I understand that the doctors are well-intentioned.

26:01They weren't trained. Yeah. And it's limited. Right. So they're just going off of the knowledge I have. And for some people, that can be reassuring to say, OK, at least I know it's not something that's within your domain. These are the five doctors I went to, and there's nothing in their domain that they can fix because that's that's what I would say. But I would tell this woman to to not be the ostrich optimist. Right. Because you clearly know that there is a disconnect between how you feel and how you want to feel. And that, to me, is where motivation comes in. I don't think women feel like they have permission to want to feel differently than what they've been given.

26:36Yes. I'm going to say something which sounds contradictory to what I want to say. On one hand, I think a sense of acceptance in life is important, right? Like, change what you can and accept what you can't. I remember one of the things that came out of my work with 9-11 survivors was telling somebody like, you know, just go back to work. And they're like, but the world is not a safe place, you know, and how do you argue with that, right? Like there could be another attack tomorrow. How do I know? And I realized that as a therapist, like I also have to create room for acceptance. That one of the things I learned in my Eastern upbringing is a question to ask yourself when you feel super, super frustrated and you feel like there's nothing else you can do.

27:17ask yourself, is this a problem to be solved or a truth to be accepted? So if you've lost someone, a loved one, and you're grieving, you can't bring them back, right? You can't undo a tragedy or a horrific situation. So in those circumstances, when I feel, I say when a person feels completely helpless and they have tried every which way, I think in those moments, sometimes acceptance is useful. But at the same time, that's where the practical optimism comes in. It's like acceptance for now, right? So let's say I've come back from my fifth doctor's appointment and everybody is saying to me, there's nothing.

27:52And that's happened to me. I've shared that with you. I had a problem and doctors are telling me, you're fine. But I knew that something was not fine. But for that day, I was like, I just need to go home and sleep, right? I have been through a lot. So it's okay to have micro buckets of acceptance, right? In that one day, you've come back from your fifth doctor's appointment. And on one hand, you feel reassured, okay, it's nothing. I'm not dying. I'm not dying, yeah. And then on the other hand, you're like, I will come back to this tomorrow, which is, but I'm not and I need to continue my search.

28:21So I think a lot of times, for example, with therapy, people dismiss therapy and they're just like, I'm done with it because they had one bad experience or two or three. And I say, keep looking, right? Like it's, keep looking for that provider that can see you, that has the expertise, that is trained, watch videos, get recommendations and referrals from other people, but don't give up. So yes, there is an element of the ostrich, but I also just feel like this woman is also being gaslit.

28:48Dr. Mary Claire Haver:Yeah, which I guess makes it worse. Yeah. You know, there's a cycle that you described that I want to make sure we cover clearly for everybody listening. The woman who cannot follow through on her commitments to herself and that failure, like she just, the shame starts. You know, and what society is telling her she should be doing and God forbid she gets on social media and looks at these unrealistic expectations. How do you break that cycle? So I think first recognizing what that emotion is, which is the shame. Shame is very toxic. And you've internalized other people's values, and they're not necessarily even your own.

29:26And I was mentioning the idea of the default mode network, which is it's a part of your brain that's active when nothing is happening, when you're just sitting there and you're daydreaming. And it's meant for you to sort of have some introspection and, you know, self-referential thinking, what we call like thinking about yourself and your habits and awareness of the self. It's what's happening in your brain when you're not doing an activity. But in these negative loops, it can go down and you can start ruminating. And you can say, I'm hopeless. I am helpless. What's wrong with me?

29:58Dr. Mary Claire Haver:I mean, I see it in clinic. And that's the main reason I'm pulling out tissue for patients. is there is so much shame and they feel like failures. Their body's failing them. They're not able to, you know, commit to the nutrition, the exercise, but like also they're struggling in every relationship as well with their children, with their parents, you know, and all of this is being stacked on top of them. And they keep taking on more and more and they just can't manage it. So, you know, it's not something, especially I think if you've been conditioned to think that you must be a high performer in every aspect of your life.

30:37So some of it is these narratives and these scripts that we've been given. I know I grew up with that. You have to serve everyone else. So it's like you're dismantling and deconstructing an entire worldview, right? And it's collapsing. And it is an opportunity, I think, for a rebirth of sorts. To say, once something collapses, it's like, imagine, I would hate for this to happen to anybody, right? But let's say your house just, I mean, that's a tragedy, right? But like, I'm using it as a metaphor. It collapses. And they're like, okay, here's some insurance money to build your dream house. What do you want to do?

31:15We're going to put you up somewhere temporarily. We're reconstructing this house. We're rebuilding it. And I look at therapy as an opportunity for that. Like a person may come to see me because of a job loss, because of a divorce, because of a relationship problem. They come in from one specific problem. But then I say, let's look at the rest of your house. Let's look at the foundation. What is the foundation on which this house, your whole self-esteem, your whole sense of self and character is built on? and self-compassion is not woo-woo. There is so much science behind it. When we look at self-compassion involves saying to yourself, I'm aware of these negative thoughts.

31:50I'm just going to be aware of them. No one is saying that they're true. I'm just going to be aware of all of the negative things I'm saying to myself. Then on some level, there's going to be a certain amount of acceptance that I think I'm a shitty person. All right, now what? What are you going to do? It's like, imagine you're talking to somebody else. You're like, all right, bring it on. say what you have to say about me. Once there's a certain amount of acceptance of the negative self-talk, but also a desire to want to rewrite this, you then start to say, you have to say to yourself some form of self-compassionate, like rewriting the scripts.

32:23I have been dealt too many cards. I am going through a lot of changes in my body right now. It is not my fault. This is very unfair. I say this to my husband. I'm like, you are lucky that you get to keep a lot of your testosterone or whatever, you know, like until your God knows how old. Like I have said to him, I feel like this is very unfair to me. Why are the hormones that are not just for reproduction, right? I'm done with that aspect of my life. I have kids, but I need my estrogen and my progesterone to function. I want to function at my maximum capacity. I feel like this is the stage when you're in your forties and your fifties, when you have maximum regenerative capacity, They talk about IQ.

33:00They talk about empathy. They talk about resilience, worldview. We know that there's a dip in our happiness. There's like a U-shaped curve where 47, they say, 48 is the lowest point of that happiness. And it's only going up from there afterwards because we do an audit.

33:16Dr. Mary Claire Haver:Well, let's go back to that. Hold on, hold on. Where is this from? What, the graph? Like, I see this clinically, but I've never heard anybody talk about this is the nadir for women. And that is the age of peak perimenopause. Yeah. So the maximum zone of chaos. So go back to that graph. Yes. So looking at populations and happiness, like, you know, of course it's subjective ratings, but 47, 48 is the lowest point. I mean, when you're younger, you think your whole life is ahead of you, you're in your 20s. And by your 40s, whatever plans that you started out with, sometimes they don't work out. Sometimes the plans that you had, like I'm gonna have this marriage or this children or this job or financially.

33:52So some of it is what's happening in your life outside. And some of it is also the changes hormonally. but it's with men and women, right? So it's more than that. It's sort of like midlife. I think you're taking an audit of this house and this foundation and do I like it? Do I like me? Who am I? We become the sandwich generations. We're not really in touch with our friends. Like, you know, I think about when kids are in college, that's the time, high school, college, when you are in your peers' company and that's the most amount of time you'll ever spend with people your own age. And then it's like, when it comes to friendships, it's kind of downhill from there.

34:26I hate to say it. And we do know that if you want to look at somebody's health in their 80s, look at what their friendships and their relationships are like in their 50s. And that is going to project peak health. And this whole midlife period, I feel like this is such an opportunity for us to revisit all of these values that have been handed to us and reconstruct and rebuild. And there is a rebuilding. So from 47 to 48, from this nadir, the you goes back up because the people that you do take, I don't want to say take back, but that you invite back into your life. Yeah.

34:58Dr. Mary Claire Haver:You choose. I mean, boundaries. Yeah. Yes. I've done this exact thing. I was at my absolute lowest, I think at 47 to 48 and had to rebuild. And now I'm a menopause specialist. And now I have built this incredible life. I've put up boundaries. I've cut people out of my life that didn't make me happy, you know, and my own family members. And it's okay. And I've given myself permission to stop asking for permission for every single thing that I do. I love that. Do you know, do you remember what it was? Was it a single moment or a decision? Or how did you feel empowered to be like, I'm now living?

35:35My brother's deaths.

35:36Dr. Mary Claire Haver:So I lost, I've lost three brothers. One when I was nine and he had leukemia. And then in 2015, I lost my brother Bob due to HIV and hepatitis. And then in 2020, I lost my brother Jude. I'm sorry. And to esophageal cancer, stage four. And those were like watershed. Plus, I was like coming out of the fog of menopause, like taking back control back of my life, you know, and I may not get these years. I'm like, you know, so Bob was nine years older than me and I just turned 57 and will outlive both of them. So all three of my brothers. So this is the year. And I I was on a mountain in Norway hiking with my husband and our two of our closest friends on my birthday.

36:23Dr. Mary Claire Haver:And I remember climbing up this mountain and being like, this is the year. Wow. This is it. And like, look at where I'm at. Look at where I am versus 10 years ago. I built a huge community. I've, you know, conquered this social media thing. I've, you know, practicing the medicine I was born to practice. And I made up the rules myself, you know, and wow, built a company, you know, after age 50. it was just like this incredible moment for me totally that's so beautiful you took the time to like they say like enjoying the view like yeah at that moment to be able to take in a perspective and also gratitude that like i have my therapist you know which i got way too late but i have learned gratitude to practice gratitude and like get up in the morning that's what i do first thing it's like what am i grateful for today i used to write it down i can do it in my head and it's usually the same thing every day that I have a job that I love.

37:16Dr. Mary Claire Haver:I don't feel trapped. I don't feel stuck in my life that I have a beautiful family. My kids are healthy and thriving. You know, I have a 33 year relationship that's still thriving. I have, you know, financially stable. Thank God I'm healthy. I'm healthier than I've ever been in my whole life. And beautiful thing is like you, you built it. Right. So like, I always struggle with this idea of gratitude in the sense that like, okay, I can be grateful. People gave you things. Yeah. But it's like, if you built this, you can still be grateful, right? Because you have the means, the resources, the mental wherewithal, the emotional capacity to create the life and the support, that combination.

37:55So it's like very much something that you created, you envisioned, but you can still be grateful for it.

38:00Dr. Mary Claire Haver:Yeah. Oh, I totally am. I know it can be taken away. My health could go. My family's health could go. You know, we've lived through that. And so I'm just, I'm grateful for what I have today. But it's interesting, for the listeners, I'm thinking about trauma and tragedy, right? And that when I asked you, how are you so happy, right? And how have you built and how did you give yourself permission? I think it's helpful for people to hear that sometimes it comes from the darkest moments and that you build a new foundation. I totally did. I'd never thought about it that way. But yeah, I was like, I'm giving a gift that they weren't given.

38:35Dr. Mary Claire Haver:I'm getting lives, years, that my brother's never had. What am I going to do with that? And it just becomes so easy to start cutting away the things that don't matter or aren't making me a better person and really putting myself first, taking care of my own needs, and so that I can be a better support to the life that I built. I mean, there's a big reframe, right? Like I think when you, when you, what you're talking about, what you've asked me before is there's a lot of like victim mentality, like in terms of how do I, how do I not get in my own way? I think one of the things that happens in pessimism, so this is built on the work of Dr.

39:11Martin Seligman, positive psychologist. And he said that when we're, when we're bathing in pessimism, we tend to take things personally. He calls them the three Ps, right? And we think that the negative thing is pervasive. It's in all aspects of our life. And we think that it's - We certainly get caught in that trap. And we think that it's permanent. And I added a fourth P, which is that all of that makes us passive. So the bad things that are happening in my life are my fault. They're never going to go away. And it sucks all around. How do we break that cycle?

39:42Dr. Mary Claire Haver:Because I get trapped there and I have a panic attack. Yeah. So one thing I say is, I talk about this in the pillar of emotional processing. It's a four-step plan. So whether it's a big problem, whether it's a small problem, first identify the trigger. We know time and time again that people that are more granular about the problems in their life that can very specifically pinpoint to the shift in their day, this was the incident that pissed me off. This was the antecedent. This was the trigger. So I call it name it, name the problem, name the antecedent, claim it. Where in the body are you experiencing this?

40:16Because for a lot of us, we're holding tension in our jaws, in our shoulders, insomnia, in our bellies. So name it, claim it, tame it. So this is where the actionable items of what helps self-soothe you. And I think a lot of us as adults, when we were kids, we would suck our thumb, we would cry. What is your self-soothing go-to technique? right? For some people, for me, it's like, I call them oasis moments, 60 minute, 60 second meditations. If you can do five minutes, great. But you know, I had to learn this like on our 36 hour shifts in the hospital in a utility closet, not sexy, not glamorous.

40:52Now I call it a little Zen den. It's like a pillow on the floor, but where can you just in your car before you get home, don't enter the house before to the chaos of the rest of your life and the rest of your day in your family without giving yourself 60 seconds to do a deep breathing exercise. Progressive muscle relaxation. It's like tensing and releasing muscle group by muscle group. So what's happening in the

41:15Dr. Mary Claire Haver:brain when you do that? So you're basically allowing for vagal parasympathetic flow. And there was a book written in the, I think, 70s called The Relaxation Response. And I feel like there's so many different roads that can help, like basically dampening the sympathetic fight or flight, noropinephrine. Our bodies are constantly in feelings of threat. And I don't know why. I can definitely see in the peripenopause phase I'm going through, I'm on edge and I can't even tell you why. I don't know what the threat is, right? There's no bear coming after me, right? Like I'm not in school and I'll sometimes have dreams that I've missed the bus or there's an exam.

41:51We carry the certain sense of like, and also surveillance and self-surveillance, right? Like we start to internalize this idea. So when people, when we feel like we're being watched and people don't realize is it's something I'm thinking about and writing about now is this concept of open kitchen plan. And then now we have an open plan in our offices, right? So this idea that we're going to be productive and it all comes from, it's really funny, it was meant as a prison design where the prison guards are watching you and they could be watching you. Maybe they are, maybe they're not, but the idea is that you're going to internalize this surveillance and then you're just going to act and do the right thing because you feel like you're being watched.

42:27and I think that's what's happening to a lot of women because of social media because a lot of us have our brands online but even if we're meeting up with friends for brunch oh what's the cute outfit what I'm like so we're on and we're presenting and we're performing and I'm frankly sick of it and also I think when you get older like there's you know that there's the concept of the FOMO fear of missing out but then there's also JOMO you know and like the joy of missing out and it's like reclaiming back your time if you get invited to an event like I remember one time being on a show, it was with Kelly and Mark, Kelly Ripa.

42:58And I remember her, we were talking about friendships and, you know, not saying no to the invitation. And she made a joke. She's like, I love to say no to the invitation. I want to stay home and do nothing. And I remember not quite, I mean, this was a few years ago and I like didn't quite get it. And now I'm like, I get it now. I understand when you're so overworked and exposed and talking all the time, all you want to do is just, I don't know, be home in your, like, I don't know about you,

43:20Dr. Mary Claire Haver:Well, now, I mean, last year was my year of yes. You know, menopause was, I was riding this incredible wave. I was saying yes to every invitation, every talk, every, we started the podcast. Like, and then by the end of the year, I was completely burned out. I had gotten multiple back-to-back viral infections. I had pulled my back with a heavy suitcase and that was taking a long time to heal. I was just exhausted. And I remember waking up here in New York in the hotel at four in the morning and just being like, I can't. I can't do this. And having a come to come to Jesus with my team of like, I have pushed myself too far.

43:54Dr. Mary Claire Haver:We really need to cut back. And like 2026 is my year of no. Absolutely not. If it doesn't, you know, if it's not a hell yes, like a hell yes, it's a no for us. And it's been amazing. Yes. I like to stay home. There's something so beautiful in reclaiming your time. And I think for me, the through line with this, our conversation is so much about agency. And I love what you said about giving yourself permission to not need permission, right? And it's building that foundation. My whole career, I've asked someone permission to do anything. May I see this patient? May I ask for a promotion? May I, you know, and just being my own boss has been fantastic.

44:32I love that. You know, the last step of the, I said, name it, claim it, tame it, right? And the last step is reframe it, which is how can I look at this, whether it's finding the silver lining. And sometimes you're not going to be able to reframe. Like I said, in those cases, if something so horrific and tragic has happened, you ask yourself, is this a problem to be solved or a truth to be accepted? So that's really important. And not everything, because we talked about toxic positivity. You can't put a positive spin on everything. But, you know, I'm just thinking about what you're sharing. And I think everyone will have their version of it.

45:02Like even if they're not, you know, fabulous like you, like doing like, you know, companies and, you know, podcasts and Oprah specials and like all sorts. But they have their version of I have I broke. I have too much. And looking at that moment as the reframe, you can look at it as, holy shit, like I'm broken. Or you could say this is an opportunity for me to do an inventory and an audit of what brings me pure joy and pure pleasure. And I feel like that's kind of where I am right now, where I want to keep my focus and my interest very narrow. I want to focus on building muscle.

45:34Dr. Mary Claire Haver:How much do you think of that as menopause? Your realization of the need to have to do this is tied to what's going on hormonally. I think a big part of it. I think, you know, I remember my mom had once said to me that she thought she she called it the wisdom of menopause because, you know, she. Your mom talked about menopause. Yeah. Believe it or not. But was she a doctor, too? No, she was a Ph.D. in special education. But like nobody talked about menopause. Like it was not a thing. My mother. It was a dark closet. She went and hid in. Yeah. You know, and they gave her drugs. It was funny because we when we met, we met at a conference where Oprah was speaking.

46:11And I remember watching Oprah with my mom as a kid and she had some special, maybe like one or two about how, you know, menopause cracks. You know, my mom had a heart attack. And I think at that on the table, she she had anesthesia and she was not at all one of these people who believes in visions or superstition or anything like that. Very like scientific and fact based. But she was like, that surgery changed me. She's like, I came back a different person. And it was it was at menopause, right? Like when women are dismissed, it's not women don't die of heart disease. Women don't get heart disease.

46:41This is reflux. So she was minimized and dismissed and had like 90 % blockage in her LAD, quadruple bypass, came vegetarian, non-smoker, yoga, no like risks that, you know, other than being South Asian. We've later found out that South Asian women have small coronary arteries, but still. So just the typical being dismissed by the medical system. And she said that it allowed me whether it was the heart attack, whether it was menopause, They all happen at the same time. An opportunity to see that I don't have to live by other people's rules. The wisdom. She called it the wisdom of menopause. And we didn't talk much more about it, but I just do know that she went through a transition where her eyes were open.

47:22You know, she was very hyper-educated for her age and time. And my father and her very both supported each other. They were advocates with child mental health, with women's rights. She worked with the first and second prime minister of India to create this model school that started in her nursery, in her living room from a nursery school to four acres, 1 ,500 students over two campuses. And she just said, I always would do what was expected of me, the obedient, dutyful daughter helping her parents, flying back to India, back and forth to take care of them, us, my dad being an obedient wife, submissive, but at the same time, a very powerful woman.

47:58And I saw my parents really support each other. But I do know that at the end of the day, she played a very, like a deferential role and almost to her detriment with her health. So it makes me think of all the things of my dad is a super ager. He walks five miles a day, Peloton weights. And my mom could have done things differently, I think, if she had prioritized muscle health, metabolic health. So I learned from both of them. And I do think that something happens in midlife where you all of a sudden realize, I don't, I'm not immortal. And that sounds so silly, but I think when you're 20 or 30, it's not on your mind.

48:32Dr. Mary Claire Haver:I'm literally trying to teach my daughter these lessons, daughters, and it's really hard for them to hear it because they're 25 and 22, you know, and hopefully they'll hear it better in their 30s. Yeah. But this mortality thing, I'm seeing that with my patients. If they are, they come in for the fires of menopause, right? Like the hot flashes, you know, we give them back their resilience. And then they're like, keep me out of a nursing home. I don't want to be a burden on my children. I want to live independently as long as possible because we're watching the way our parents are aging in general, not all, of course.

49:08Dr. Mary Claire Haver:But like the women tend to have a very poor quality of life for those last 10 years versus the men. And I'm like, that's systemic. That doesn't have to happen. And so I love being able to counsel patients around that. And like you were saying, like the shift of, oh, I should probably be looking at my muscle mass. What is my bone density? Like, what is my cholesterol? What's my LPL? You know, what are my risk factors here? Because medically, we were, women don't have heart attacks. Women, turns out the number one killer of women is heart disease. Yes. And that feeling of like, I think midlife, what is my purpose now?

49:43I'm seeing a lot of women, friends who are early 50s and they are living their best life. Like, I love that. I love that. And so I feel like, you know, you know what's really interesting? your viewpoint on aging determines your lifespan.

49:59Dr. Mary Claire Haver:What do you mean by that? So people who have a positive view of aging on average are living five to seven years longer. And I'm going to check the stats and get back to you on that. But people, when they looked at them, do you think that aging is a good thing as opposed to, are you scared of it? Are you afraid that you're going to be a shriveled old person? People who say, I'm looking forward to it. So So even just like this is where the optimism comes in is having optimism really is just positive life expectation, right? That I do believe that the best outcome is going to be possible.

50:36Dr. Mary Claire Haver:What about the woman who goes to her doctor and they say, you're depressed, you're anxious. OK, here's your medication. Here's your SSRI, which is what I was trained to do. I didn't know anything about therapy or, you know, I'm not a psychiatrist. She gets her medication and it's working okay. And then it stops working. And that happens a lot in perimenopause. You know, you develop a mental health issue, you become medicated, and then the hormone changes. What should, you know, they go back to the doctor and they're like, add a second medication or increase the dose. But should she be doing something different?

51:13Dr. Mary Claire Haver:Like, what can she do for herself? So first thing is when a patient comes to see me, I always ask them to get labs or if they have labs from their primary care doctor. And what I'm looking at is vitamin D level, which all of us are deficient at living in the northern hemisphere, even if we are darker. 80 % of my patients. Yep. And I have patients whose vitamin D is in the 20s or 30s, or that may be normal, but it's low vitamin B12. So many of my patients are low in vitamin B12, or it might be right on the cusp. and their doctors will be like, it's fine, it's normal. But we know that neuropsychiatric symptoms, you can get jitteriness, anxiety, insomnia, depression, low motivation, all from even low normal, right?

51:50So if there's any room, you know, and pushing your primary care doctor, and sometimes I'll have to get on the phone to say, listen, I understand it's at the cost, but I do think, would it be worth it, whether it's like oral supplementation or if they're able to get monthly injections, I do see a big difference with the jitteriness and the mood. And I think for a lot of women, those are their symptoms.

52:07Dr. Mary Claire Haver:Okay, so vitamin D, B12. thyroid so tsh t324 and also um cbc a lot of women have anemia and they may have low ferritin for any amber reasons and like even diabetes chronic diabetes cholesterol a lot of the medications that they're on so beta blockers can cause depression so just getting a full profile of the labs the medications that they're on side effects of it anything like people who have untreated or undiagnosed ADHD. I see a lot of women midlife for the first time are realizing, oh, that's what that was my entire life. I thought it was brain fog for whatever. And sometimes a low dose stimulant could be helpful.

52:46Sometimes a low dose stimulant could be making them more anxious. So really just getting a full sense. So I do think that getting the labs checked, plus asking, you know, a lot of times people are only getting medications from a primary care doctor, but they're not also in therapy. And so therapy to me, even if it is six weeks, eight weeks, a short course, we find that even one brief psychotherapy intervention can be really helpful, but obviously six to eight weeks of cognitive behavioral therapy. And I went through this myself and I found this so helpful when I was in training, we were told, oh, everybody should go to therapy.

53:18And I'm like, okay, with what time and with what money? I was working at five different hospitals in New York City and a hundred hours a week. And therapy in Manhattan, nobody takes insurance, super expensive, right? So it wasn't until I had my own mini breakdown of sorts that I ended up seeing a therapist.

53:34Dr. Mary Claire Haver:Same. And it was a professor who had given a talk and I had this vision in my head of therapy is Freudian. You have to be on a couch. Half the time, the older male therapists are falling asleep on you and not listening and not paying attention and you're not - And you're a psychiatrist. Yes. And this is what you taught in therapy. And because that was a lot of like the psychoanalytically trained and nothing against it. There's some, there are different modalities of therapy and to each their own. And you have to go to what speaks to you. But we ended up having a lecture. Like I, this was like one of the lowest points in my life.

54:01my mom was diagnosed with stage three breast cancer because of her heart disease. Nobody wanted to give her chemo. They said she's going to put her on chemotoxicity and give her heart failure. So I was like, oh my God, she's going to die. Breast cancer is treatable, except she can't get any of the treatments. And I'm already working a hundred hours a week. And then I'm thinking, oh my God, she's going to die. Right. And I'm going to five different doctors and trying to find her someone that's going to treat her. And in the midst of all of this, my legs give out. I can't walk. Like, and there's nobody who can explain.

54:24I went to see the best neurologist. They're doing EMGs. They're like, you're totally fine. And I was like, but I'm not fine. Right. And that felt like just dismissive, like go figure it out. And I was like, how exactly am I supposed to be figuring it out? I'm not sleeping at all. And I was doing very well in residency. And then we had this professor give us a talk on cognitive behavioral therapy. And he's like, it's short term. It's time limited. It's very action oriented, problem solution focused. And eight to 10 weeks, it changes your life. And I literally was like, sign me up. I'm like, give me a referral today.

54:52And it did change my life because it put me in the driver's seat as opposed to bad things happening. I'm always, I feel one step ahead, right? Doesn't mean that I live life, you know, carefree, not at all. But what it taught me was number one, cognitive restructuring, which is really important. What we did was naming the antecedent and then keep - What's an antecedent? So like the trigger, like, so in my case, it's, oh my God, I got this, you know, diagnosis on my mom and she's going to die, right? So that all of a sudden that's your thought, the antecedent, the thought is she's going to die. I'm going to fall apart.

55:26I want her to meet my, you know, walk me down the aisle and see her grandkids. And, you know, I'm in my 20s, so I'm not married yet. And all of these future projections that I'm catastrophizing. And then you're writing down what are all the things that you're doing, which is I'm jumping to conclusions that she's not going to find a doctor. I'm fortune telling. I'm writing. I'm projecting all of my worries and fears. I mean, the list just could go on of and these are things that we all do. There's like 18 or 19 what we call cognitive distortions, mind reading. We assume we know what someone else is thinking, jumping to conclusions, right?

55:58Fortune telling, dismissing the positives. And so that was a big one, right? It's called negative filtering. You're looking at everything through this one negative lens and you're minimizing or what we call discounting the positives, which is I am a doctor. I am connected. I know a lot of people. I can get her help, right? So in those moments, we overestimate the magnitude of our problems. She's going to die versus underestimating the agency and the control and the power we did have, which is eventually problem solving. Okay, this is where we switch from unproductive worry. So when you're talking about the patient that comes in, what else can we give her?

56:32Tools. We want to give her tools. It's not just sending her with an SSRI prescription, which is very helpful. I do think that antidepressants, when you do a thorough behavioral health assessment, is this person depressed? It's not hormonal. Okay, can you send them, can you get them a referral to somebody as wise as you are, right, in their area? Can we rule out labs, but also let's get them skills so that they feel agency again. Because even if it is hormonal, even if they are dealing with vitamin deficiencies, how can we strengthen and beef up their own internal system so that they can respond to the challenge ahead?

57:04So the unproductive worry would be somebody spiraling and being like, I can't do anything. Five people said they can't help her. She's doomed. I'm doomed. We're fucked, right? Like, sorry. Or moving from unproductive worry, which is like your car stuck in the mud, wheels are spinning there's no translation rocking chair there's movement but there's no acceleration and then productive worry is now what who am I going to call and eventually we found a doctor who uh a lovely oncologist who's like I'm going to help her I'm going to reduce the dose instead of this treatment I'm going to give her like the smallest amount and let's see and I'm going to monitor her very very carefully so the problem is that most people give up before they get to the solution because they end up getting paralyzed by it.

57:48So I would say if I'm working with someone, I want to give them tools because the tools that you get in therapy, they stay with you for life. The medications, once you're off them, you're right back to where you began. So they have an important role in that for a lot of people who are like, I'm so depressed, I can't get out of bed. I'm so depressed. I don't even want to see you, doctor, in your office. I don't even want to get on Zoom to talk to you. So I say that kind of person who is not feeling a sense of meaning in their life. They have lost a sense of purpose. They have lost joy and pleasure in the things that they once used to love.

58:18That's called anhedonia. That to me is the hallmark of depression. If you told me, I love swimming. I love golfing. I love playing mashang. I love traveling with my husband. I love going out to dinner. I love getting dressed up. I don't do any of those things anymore. I can just tell you right there, that's depression, right? And you need skills. And this is called putting the cart before the horse, where we know like if when a person is depressed, they don't want to go to a party, they don't want to see a friend. But we do know that once they see that friend, that it is so rewarding for them that it is like, it's a form of an antidepressant.

58:53So I talk about this in like the four Ms of mental health, but putting the card before the horse, pushing yourself to do something before you feel ready, populating your calendar with activities that bring you pleasure and meaning and joy. So looking at your schedule for the week and putting those fun things in there. I think fun has always been the thing that I put last, always. Always. Like family, friends, health, patients, work probably is first and then everything else, right? But scheduling in joy as if your life depends on it because it does.

59:23Dr. Mary Claire Haver:Talk to me about the four M's. Yeah. So if I had to tell someone in less than five minutes, I was in a situation where it was the height of the pandemic. It was April, 2020, and New York City had reached its peak death toll. and I get a call that Global Citizen is doing a program and it's gonna be a one night live stream with all these famous Elton John and, you know, I don't know, Oprah and all sorts of J-Lo performing, like a benefit concert. And I was like, great, I'll be watching. And they're like, no, we want you on the show. And I was like, I don't sing and I don't dance and nobody wanna see that, right?

59:57Rolling Stones, like, you know, like one of those big performance benefits. And they're like, no, we want you to talk about mental health. And I was like, oh, like what specifically? And they're like, we want you to give people tools and calm them down. And like, you know, the whole world is scared and broken right now. And I was like, great. How long do we have? Like an hour? And they're like, no, you have 59 seconds. And I just started laughing. I was like, I'm supposed to give you hope and motivation and a toolkit in 59 seconds. So I call my dad, psychiatrist. And I was like, dad, what do you talk about in 59 seconds?

1:00:25He's like, it's okay. It only takes a minute to save somebody's life. And then he hangs up. And I was like, Yoda, where's the wisdom? I need some practical, tangible tips for my own anxiety here, right? But then I thought about what if I had to prescribe somebody in less than a minute, something that is evidence-based, that is science-backed, that could save their life, that I prescribe to my patients, that I do myself, that I see in my dad, this super healthy, super happy, optimistic, super ager. What are we doing every day? And I remember that years ago when we had those old school prescription pads, I used to write on them for my patients, a prescription.

1:01:01Yeah. And they would be like, they would laugh at me. They were like, I was hoping you would fill my lorazepam, my benzodiazepine. Where is my medication? And I would say, this is your medication. And I would write four things, right? And I was like, okay, I need to make it simpler. So I, for the purposes of this talk, I said, okay, we're going to talk movement, mindfulness, meaningful engagement, and mastery. and there's so many more things, sleep, diet. I don't wanna say that these are the only four habits, but these are the four habits that in and of themselves are good mental health, but then they beget any kind of new project that you want to start.

1:01:35This will help you do that. So when it comes to mastery, I say you don't have to be a master at something, but you have to do something that helps put your brain in a flow state. And in that flow state, it's this, your norepinephrine goes up, which helps you super focused, super concentrated. It improves your mood. And it's this delicate balance between an activity being challenging enough to sustain singular focus and concentration. And the beauty of that is it shuts out the default mode network. That is the part of the brain that is ruminating and you're not good enough and self-sabotage. So that is how you drown out those negative voices is focus on something 10 to 15 minutes a day and then do more of it.

1:02:12That really helps you be in the zone. Pottery, golfing, yoga, whatever it might be. Something that you want to get better at. It's challenging enough to keep you focused, but not enough where you get frustrated. So you don't want to get bored and you don't want to get frustrated. So it's this perfect, like it's like a U-shaped curve, like, I'm sorry, inverted U-shape, where at the peak of the height of this inverted U-shape is perfect. It's zen. Yeah, you're in the moment. So that's mastery. Take up something. And, you know, I do talks to a lot with a lot of young people, like I'll go to high schools and they'll have a keynote presentation about mental health and practical optimism.

1:02:43And one of the things I'm hearing a lot is teens don't have any time to do anything fun for themselves. They say everything I'm doing is for this college purposes. So doing something that has no benefit to social media, you're not showing off to anyone. It is just for yourself. If you want to post your whatever pie that you made, if that's your thing, do it later. But that's not why you're doing it. You're doing it for yourself for no other reason, just to get better at something. Languages, learning language, dancing. We know that there's so much health benefits and neuroplasticity with dancing and living longer.

1:03:12So mastery, movement, that's a whole other thing, but 10 minutes, lower the entry barrier, keep your sneakers next to your bed, keep your gym clothes next to your bed, keep that water bottle filled. I have a separate gym bag where I have a separate set of keys, just so I don't forget like any little thing, a separate set of AirPods, whatever it is. That will sabotage you. Yeah. So 10 minutes, you have weights and a yoga mat by your bed, strength training. We know you've talked a lot about that. Please invest in your muscle health. That is the organ of longevity. and meaningful engagement. This is by far my favorite pillar.

1:03:45I love talking to people, as you can tell, and connecting with people on a deep and meaningful level. But one of the things that gets scary for a lot of people is I don't have time, right? And I wanna connect, but I don't have time. I think of there's micro connections where you can connect with somebody. You're standing, talking to the barista, someone walking a dog, a neighbor, a bus driver, a doorman, these are micro connections. They don't have to be your best friends. You don't have to ever see them again. But think about when you move throughout your day, can you schedule a 10 or 15 minute buffer in your day so that you allow yourself to have these small moments?

1:04:22You're online, you're talking to someone. So anything from micro connections, which are small built in moments of connections with random strangers to activity partners. Don't minimize the person you get to go to yoga with, right? Or that you see them every day or at a class. Like, that has value overall. It doesn't have to be the deep and meaningful conversations. But that is really important. Having at least one or two authentic places in your life where the mask comes off, that mask of performance, we don't have to impress this person. And I call this concept, one of the things that I'm thinking about a lot is how we're expected to perform all the time and be visible all the time.

1:05:00These are areas where you can be held. And I say, as a society, we're seen, but we're not held. We don't have areas and protected spaces and places where we're not expected to be impressive or on or have our hair and makeup done. I don't know about you, but like.

1:05:17Dr. Mary Claire Haver:Well, my life has gotten more like that, you know, in this new iteration of Marie Claire is I'm performing a lot more than I used to. Yes. And that's exhausting. It is exhausting. And it takes up so much of like that executive functioning in the prefrontal cortex of having to be on. I was telling my husband, I'm like you and my dad last night, I was like, I came from a TV interview and I was saying, you don't understand how hard it is to be a woman when you have so much knowledge and information to give. It's not the depth. The number one question I get asked is, what was your lipstick color? I was like, I'm talking about suicide.

1:05:51Why are you looking at my lipstick? Where'd you get your pants? Yeah, exactly. So meaningful engagement is be vulnerable, be authentic, schedule an eight minute phone call. This was something that came from the New York Times. And I love this idea of they had a friend challenge and I was interviewed for an energy challenge. And then someone else did a friend challenge that week in the January, 2024. And I love the person who had offered this advice, which is in eight minutes, just pick up a call. You're on your way home. You're on your commute if it's safe enough. But that's how you create connection.

1:06:20You're stuck at the airport. Call a friend. So be very intentional about scheduling those connections in person as much as possible. Go to a place where you can drop the mask and the hat. But don't forget activity partners and micro connections because those are like the social snacking as well. And then mindfulness. Find your Zen Den. Create a Zen Den in your home. It could be a pillow and a blanket on the floor. It could be a yoga mat, but it's a place that you designate in your home, in your life. It could be in your car, but 60 seconds of deep breathing two to three times a day. It just creates these islands of this is my space, reclaiming space and reconnecting to your breath.

1:06:54And it also is lowering your heart rate and lowering the cortisol, lowering the norepinephrine that is constantly in the fight or flight mode.

1:07:04Dr. Mary Claire Haver:Welcome back to another Medipause. I'm Dr. Mary Claire Haver, host of Unpaused. Today we're talking about something that deserves far more open, honest conversation, sex and menopause. Sex is a cornerstone of intimacy and connection, but as life changes through stress, childbirth, aging, and menopause, so does our relationship with it. Somewhere along the way, there's been this narrative that menopause signals the end of a woman's sexuality, and that couldn't be further from the truth. What it can signal, though, is change. Hormones shift, and that can come with things like lower libido, discomfort, or just feeling off in your own body.

1:07:47Dr. Mary Claire Haver:Most clinicians were never taught how to evaluate libido, arousal, orgasm, or sexual pain. OBGYN training focused on pregnancy, surgery, and cancer screening. Sexual medicine was not part of the curriculum and still largely is not. So when women are dismissed, redirected to therapy alone, or told everything looked normal, it was not because their symptoms were imaginary. It was because the system failed to train clinicians to recognize and treat sexual dysfunction. Women internalized that failure. They assumed it was just aging, just stress, just marriage, just something to endure quietly. It is not.

1:08:32Dr. Mary Claire Haver:And here's what makes this even more challenging. So many women are experiencing these changes, yet too few are offered real education, validation, or solutions. That's where platforms like MidiHealth come in. Midi connects women with clinicians who specialize in midlife health, including menopause and sexual wellness. Instead of having symptoms brushed off or feeling dismissed, women can access personalized science-backed care, whether that include hormone therapy, non-hormonal options, or simply working with someone who truly listens. MidiHealth is built specifically to address the gaps in midlife care.

1:09:13Dr. Mary Claire Haver:It brings together clinicians with expertise in menopause and related health concerns, offering virtual care that is accessible, evidence-based, and centered on real patient experiences. Because this is not just about sex. It's about quality of life. It's about confidence, connection, and feeling at home in your body. If you are struggling with low libido, painful sex, or other concerns, know that help is available. Explore treatment options, and most importantly, give yourself grace. Intimacy is about more than just sex. It is about connection, pleasure, and feeling alive in your own skin. Menopause is not the end of anything.

1:09:58Dr. Mary Claire Haver:It is a transition, and with the right support, it can be a really empowering one. Go to joinmidi.com, join M-I-D-I dot com, and connect with one of their clinicians today.

1:10:14Dr. Mary Claire Haver:a lot of my patients are really struggling with sleep and you know if it's hot flashes and especially the wake-ups you know a lot of them you know if they're not lifelong anxiety and struggling to go to sleep you know hormones go do a lot for those patients but what i'm seeing even with adequate hormone therapy is these middle of the night wake-ups you know and we look if you have to get up to pee, then we talk about restricting fluids and stuff, or if that's being caused by an overactive bladder, you know, we can medicate that. But so everything's perfect. And she's not anxious when she goes to bed, she falls right asleep, but she's waking up.

1:10:51Dr. Mary Claire Haver:And this doesn't get better postmenopause. It starts in perimenopause and then kind of keeps going. What do you think is happening? Like if she wakes up and can't, you know, there's an anxiety loop that starts, you know, like how can we help her? So first, just the knowledge that it is normal that the 3 a.m. wake up is happening for any number of reasons. Cortisol is trying to get in action again in anticipation of the morning. Melatonin in this stage of our lives for all people in general, but women especially, is going down. So it's expected that you will wake up. But if you don't tie a negative association with it, that I am doomed because there's always anxiety, but then there's anxiety about the anxiety or the anticipatory anxiety.

1:11:32We call this metacognition thoughts about your thoughts. Don't label it as anything more. This happens to me a lot when I'll wake up and then I'm aware of the time. But here's the thing is don't be aware of the time. I think the biggest thing that we do is we first look at our...

1:11:44Dr. Mary Claire Haver:317. Yeah. That's the time. It's like the witching hour, you know? And so we look at the time, we're aware of it, but where are we looking at the time? We're looking at it on our phone because most of us don't have analog... A clock radio anymore. Yeah. And that's a problem because then you say to yourself, oh, I'm just going to scroll. I'm just going to check my messages. Did somebody email me or call me or whatever? And we do it as a form of distraction or we think that we're hatching up because we always want to be in the know what's happening in the world at this moment. And there's so many problems happening right there.

1:12:15Number one, you're getting activated just by knowing, by simply being aware of the time that's already activated. Then you have the blue light that's happening. Then you have the messages and the unfinished business loop. So that's really big. Like for a lot of women, our brains, I think it's a normal thing, but I think I see this a lot in high achievers, the desire to close the loop. I don't know about you, but I don't like unfinished business. I don't like if I have emails or if there are messages or people that are waiting, that sense of urgency of putting other people's needs, right? That feels uncomfortable to me because I feel like I need to close the loop on that.

1:12:50So do not introduce other people's problems into your own life. Do not introduce them. Do not invite them when you wake up at 3 a.m. So when you get out of bed, the whole thing with CBT insomnia is supposed to be the gold standard is that if after 20 minutes, you're not able to fall back asleep, you're supposed to get out of bed. And you're supposed to do something extremely passive and extremely boring. So have a wonderful history book that if you're assuming you're not interested, I find history interesting, but if you don't, find some subject that is either soothing or passive or boring or calming.

1:13:23For some people, it might be folding laundry, right? but it should be in a dark, cool area. Get out into the living room, sit for 20 minutes, but do not look at your phone. You will not be going back to sleep, I can guarantee you. It'll be two hours before you'll realize it.

1:13:36Dr. Mary Claire Haver:Someone on social media, this is a topic of conversation quite a bit on my social, and this woman commented one time, and it just made so much sense to me. She said, like, just imagine you're a cave person and you're just gonna throw another log on the fire. Like, it's your turn. Like, you woke up, you're gonna go take care of, you know, and you're meant to do this and it's part of your life and you're gonna throw the log on the fire and then go back to bed. Check on, you know, you're checking on the other cave people. Everybody's okay, everybody's asleep. And then you go lay back down, you know.

1:14:06Dr. Mary Claire Haver:Reframing it as, you know, I was anxious about being anxious. You know, I was like, oh my God, I'm up, I'm up. I can't believe I'm up again and I have to da-da-da-da-da today. And like, oh, it's my ancestor waking up to go take care of the fire that needs to keep going all night. It refreeze to death and it's her turn. Yes, yes. I love that, normalizing it. Yeah, totally. and I'll just go back to bed and it'll be fine. Yes, it'll be fine. I love the, because you're reframing it and I love the simplicity is it'll be fine because the minute you say to yourself, I've done this before, right? Like I have, I've been able to fall asleep before and I have, I have functioned the next day on little sleep because that's the biggest thing I think people are thinking, how am I going to get through the next day?

1:14:43And I would say, keep your routine wake time, even if you had trouble falling back asleep because I think a couple of things end up happening. Sometimes if a person has the luxury of sleeping in, if they didn't sleep well, they will. and then that destroys their sleep architecture for the next day. Yeah, their circadian rhythm. And then limiting the number of naps. If you still keep to that, whatever wake time you have, the next night you are passing out and most likely not waking up at 3 a.m.

1:15:06Dr. Mary Claire Haver:So I'm finding a lot of women in midlife are struggling with loneliness. The ties that bound them while their kids were younger, the friend groups, the families, people start going through divorce and those kind of friendships are breaking up, kids are growing up, moving away and the things that kind of kept you together in your friend groups. And my husband and I are seeing this, you know, right now in the relationships we kind of built when the kids were younger are now, you know, and I've found myself a little bit lonely sometimes and definitely my patients are seeing it. Can you talk about that?

1:15:39Yes. So, you know, this is kind of peak loneliness when we would expect it because you don't have those built-in layers. Like, so look at those opportunities. Where's the low-hanging fruit? So that's the first thing I would say, right? Like if you're in a city, like if you're traveling a lot to be intentional, like I have, I have a friend who does a lot of speaking all around the world and she has her lists of who is living in every city. And she tries to make it a point to say, I'm here. And I think letting people know very clearly what your limitations are and saying, I only, I'm so sorry, but I only have time for a 30 minute catch up, you know?

1:16:12And, and I think we create so much extra work for ourselves to be like, it needs to be a three hour dinner catch up. So one thing that I really loved is this idea of catch-up culture. It's not good for us. Catch-up culture says, let's meet once a year, twice a year, and we'll sit down for four hours, and you'll tell me everything, and word vomit, and I'll word vomit on you, and then we won't see each other for the next year. Instead, build like kids have parallel play, right? So I have to do an errand. Would you mind coming with me, right? Like I've got to go to the post office. It'll be our time to catch up.

1:16:43So build in opportunities where you can do shared activity together or do nothing together, right? So like, why do we have to get dressed up to go to brunch and make it this whole big thing? Come for a walk every, routinize, come for a walk 20 minutes with me every Sunday, right? Like, so make these kind of standing things. If you have one Sunday dinner a month that you can say, I'm gonna host, we're gonna meet at a restaurant to put things on the calendar in advance, planning trips. If you're in that like phase of life where you're lucky enough to be able to afford and have the health, we have like a standing ski trip that we take.

1:17:13Like we have a couple of standing, like one is like a couple of strip that just, you know, no kids. One is like a family ski trip with a bunch of other families. So if you can, and we have friends that are like crazy, they'll be planning 12 months in advance. And we're like, okay, that's too far. Let's do six months. So I think the number one thing is recognizing that you're lonely. Some people are biologically hardwired to be lonely. That default mode network that beats yourself up, it also has a tendency to say, you know, I feel like there's something wrong. But don't beat yourself up. Loneliness is like a biological drive.

1:17:43It's a cue, just the way hunger is. It's a signal that says, I am lacking in something that is nutritional and that is required for my sustenance. And that is human interaction. So planning it in the calendar as much as possible. And knowing that it's not going to drop out of the ceiling into your lap. So if I'm traveling and just say, okay, who do I know in this city? Who can I tell them in advance? Let's keep the plans loose. If I find myself having a 30 minute right before I go into a talk, do you mind? And most people are so happy that they'll, you'll think it's weird. Like I'm getting my makeup done.

1:18:13Can you sit next to me? They'll be like, why would I do that? Don't think about that. I would say most people would be so happy to see you. They'd be like, sure. What do you want me to do? Where do you want me to come?

1:18:21Dr. Mary Claire Haver:Before we wrap up, the sandwich generation, you mentioned a couple of times, but I really think it's hitting us really hard. and this seems to be unique to this generation, what would be your best advice for someone who is absolutely trapped between parents who won't listen and children who won't listen? Because you know best. Yeah, that's the best way to put it. Yep. Oh my God, it's so hard. It's like caring for the caregiver, recognizing that you are a caregiver. I think that people have this vision of caregiver means I'm glued to my 90-year-old mother's bed day and night and changing diapers type or pans or adult, whatever.

1:18:58That's not what caregiving necessarily looks like. It's different for everyone and recognizing that you're in that phase of life where you also get to be a human being. I think the biggest thing and the hardest thing for a lot of women is they hear me saying, so Dr. Farmer, you're saying me first. I'm not saying that. I'm saying me too. Just you get to pull up a chair. You get to eat at the table that you're serving other people at, right? Like that metaphor of you're so busy providing. And I'm saying reclaim your own joy and say to yourself, what would it mean if I didn't visit my mom four times this month?

1:19:30What would it look like if I visited her three times? What if I took back one of those times and went to an exercise class and met up with a friend for lunch or for coffee? I think the guilt is kind of the underneath underlying that I should be. There's this idea of shoulding on ourselves, like something shitting, right? Like I should, those should statements need to change to I can, I will, I may, right? Allow yourself variations on that theme of what is reclaiming my own joy, my own time, my own rest look like. And one thing I would say is if you do have siblings, a lot of times people, this idea of like weaponized incompetence, it's not just our partners, right?

1:20:04It's also sometimes our siblings.

1:20:06Dr. Mary Claire Haver:Oh gosh, yes. And to say, I'm not asking you for help. Let us put down in writing what each person is capable of doing and let's split the load. What are you good at? Are you good at finances? Are you good at looking at referrals from, you know, for the parents to suggest doctors, Can you go to some of the appointments? So I think looking at big picture and anticipating these end-of-life conversations that are so hard to have, like talking to your elderly parents, like, let's talk. Do you have money put aside? Because that's a big thing, that financial drain. The frustration I'm seeing with our friends and my patients is the parents are refusing to have the conversation.

1:20:41Dr. Mary Claire Haver:And then there's a lot of catastrophizing on the child's part in that when shit hits the fan, they have to drop everything to go tend. you know and it if it negatively affects their life yes and i i love and i have so much admiration for people when they're when they're in their 50s and 60s and they're downsizing and they're like i don't want my child they're getting rid of this my husband i talk about this all the time like we are going to make this so easy for them i love that you know yeah anything that you can whether it's like talking about even getting like long-term care even renewing like every year my dad will say this is my long-term care insurance this is my medicare card i want you to have this and this is who to call.

1:21:19These are my, like, where the bank is, the bank account, like giving somebody step-by-step instructions of what to do. Because in that moment, they're grieving. When your child is losing their parent, you know, the parent is like, I'm not going to be here, not my problem. And I'm like, no, you don't get to do that. And also, like, I do this a lot with my patients where they will tell me about their aging parents and I'll be like, get your parents this vest, you know, this exercise vest, get them dumbbells, help them invest, get them physical therapy, get a prescription for being deconditioned and get them head to toe, like training, like muscle mass training, resistance, but anything you can do to say, listen, I'm sorry, and have very clear conversations.

1:21:54Who do you think is going to take care of you? Like, let's say your parent is healthy enough to maybe move closer to you or to downsize or whatever. Just say, listen, you live across the country. I just want to understand what was your vision? Where did you want to go? Would you have someone living in your home? Like, were you expecting me to move back home? Like, it's so uncomfortable because I think there's all these implicit, not explicit expectations. Right. And it's not sexy. It's not glamorous. Parents want to think that, oh, my parents, my kids will come, but they have their own lives. So what are you doing to earmark money, care, insurance, end of life plans, advanced directives, healthcare proxy?

1:22:30What are your goals? Do you want burial? Do you want cremation? Do you want to be on a ventilator, feeding tubes? Like all of it, like schedule appointments with your parents and then distribute amongst siblings, aunts, uncles. and I think it's really important that our parents have community. Like I always tell, ask my dad, like often he'll stay with me, like my mom passed. So, but he has a really rich and robust friend network. All the friends that he went to med school with, they meet, they travel, he has neighbors. He goes out of his way to do things for other people and they're 10 times like able to reciprocate to him.

1:23:00So I think a lot of people become like old curmudgeons and they're just like - Well, yeah, you know, I've watched

1:23:04Dr. Mary Claire Haver:their social network get smaller and smaller and smaller. Yeah. You know, and my mother lost, once my dad died and three of her kids died, she just never left the house, really, other than to go to the doctor. And then was depending on all of us to like, you know, one of my brothers lived with her. But, you know, it doesn't have to be like that. And so, and I can see the beginning of her loss of independence. And she's got dementia and has fractured multiple bones, hasn't been walked on her own in over a year, was when she isolated herself. And often there's cognitive decline and like with the dementia, you know, it's hard to be, you know, I'm just thinking of prevention to me.

1:23:44It's like that whole saying of like an ounce of prevention worth a pound of gold that anything you can do, like I'm thinking in my mom, like microvascular changes, right? Like she had cardiovascular disease and we think of this as being limited to the heart, but we don't realize the same blood vessels go down to your toes, go to your head. And so later on, I realized while there was no stroke, but microinfarcts, microvascular dementia, not a lot of people think about or know about. So they have more personality changes that are subtle, that look like depression, that look like you're becoming difficult.

1:24:13You look like you have OCD. You've become more controlling, more rigid, more homebound, bedbound. And being that she was such a force of nature personality-wise, nobody could ever argue with her. So when she started shrinking and becoming isolated, we're like, okay, well, this is just who she is. She doesn't want to go out. She doesn't want to talk to people. And I don't know what we could have done other than now knowing in hindsight that cardiovascular disease also affects the brain. It changes you. It isolates you. It makes you depressed. And anything that you can do to get people when they're healthier to get plugged into volunteering.

1:24:44Prevention. Yeah. And I remember when my mom retired, her cardiologist said to her, are you sure you want to do this? He's like, the people who remain at work after the heart attack are the ones that are the healthy is because you're going to become isolated. She's like, no, no, no, I'm going to India. I'm helping my parents who live there and she did take good care of them. But this idea of you need to have your own purpose. So I feel like midlife, finding a new purpose. If it's not for your kids and if it's not for your career, I don't care if your business is profitable or not. If you can afford it, come up with something to do to put your energy because you are your sharpest and you're smartest.

1:25:22You have more agency. You have more capacity and more capability at this stage of your life. You are a wealth and treasure of resources. So don't let society make you feel invisible or less than. Like, I really do feel like this is our best years are still ahead. Yeah. So I please, I tell people, I understand you might be empty nesters. Find yourself a hobby or a job that will keep you busy out of the house at least 20 hours a week.

1:25:45Dr. Mary Claire Haver:So for our listeners, you know, what are the top three takeaways from practical optimism you want them to understand? So, you know, practical optimism is eight pillars. If I would ask you to do three, I would say the first one is starting with purpose, having very clear intention. I say to people, write your purpose in pen, but your path in pencil. And what I mean by that is be flexible of how you achieve it. Some people are like, oh, I have to be this. Like I have young patients who are like, I want to be a doctor. And I'm like, okay. And then they try to go to med school and it didn't work out.

1:26:15And I was like, what's underlying? You want to help people? There's a thousand ways to help people and it doesn't have to be this. So being flexible when door A doesn't work, try door B, C, D, E, all the way to Z, right? Don't take no for an answer when you want to accomplish something. So be very clear and intentional about what your purpose is. The second P is processing your emotions. If you don't manage your emotions, your emotions are going to manage you and they're going to show up in the form of physical illness. I always say that your body expresses what your mind cannot. So your body is going to become the stress manifestation.

1:26:45So your skin, your gut, all of that. So take care of the emotions by naming, claiming, taming, and reframing. And if you can't reframe, I said acceptance. It's huge. So there's eight, you know, having sense of agency and proficiency and self-compassion, being present, people is one of the pillars. And then the last one is about practicing healthy habits. So taken as a totality, these eight pillars help you go from intention to execution. And practicing healthy habits is really just a stand-in for fill-in-the-blank of what you want to accomplish in your life. And in order for you to accomplish it, you have to automate it.

1:27:19Take it out of the work of your frontal lobe, expensive CEO. We're not going to make them scrub the toilets. So automate it. And you do that by lowering the entry barrier, by having accountability, whether it's in the form of apps, doing things with friends. So those four M's of mental health, movement, mastery, meaningful engagement and mindfulness, you can do all four going to some sort of a movement class. Go to a movement class with friends and do it every week. All of a sudden you have mastery, right? If you're breathing and doing yoga, it's mindfulness, right? So if you take nothing else from this conversation, I would say the four Ms of mental health, put them in your phone in the notes section and start scheduling them this week.

1:27:57Dr. Mary Claire Haver:So you have mentioned a worry journal in your book. Is this something that would be helpful for that? And what is a worry journal? So the idea of worry journal is you spend about 10 minutes and just start worrying, right? All your worries on a piece of paper. And I know you're looking at me. Different than the, what I was told to do of everything you're happy about, you know, the gratitude journal. Yeah. So you're looking at me like you're crazy. Why? And I know, so my therapist had given me this homework and that's how I first got onto it. I said, why would I worry? Like, who does that? I'm trying to get away from my worries.

1:28:31I don't need more of them. I already have enough in my head. And she was like, trust me, the idea is that you're taking all of your negative thoughts or worries and you're putting them on paper. So number one, you're getting it out. And just that act in itself gives you a little bit of like agency. Yeah. And it gives you a little bit of control. And then what I realized is studies show that 85 % of the time, the things that we worry about, they never actually happen. And then the 15 % of the time that they do, we are more in control of the situation than we actually give ourselves credit for. The other thing is that when you start to worry, you realize that there are themes and it's the same theme over and over and over again.

1:29:05Oh my God, I'm going to make a fool of myself. Oh my God, no one's going to like me. And that's not the case. And then you get to write in your worry diary what actually happens. I have my patients write it. So if you're like, oh my God, I'm going to ask a girl out or I'm going to try to make new friends and I'm going to get rejected. I say write down. And the things that you're worrying about, vast majority of the time, you don't get rejected. You are able to make a friend. Somebody does go with you on that coffee date. So worry helps you park it out of, take it out of your head and park it on paper.

1:29:33And then I say the next step is that's the worry part. And if you wake up at 3 a.m. and you can't go back to sleep, write a worry journal. But the best thing you can do is schedule a worry sometime in the evening when you have time and do it preemptively. So you've already gotten right. It's like a cleanse. It's like a toxic cleanse, a free 10-minute toxic cleanse. Get everything that you're worried about out on paper. And it's not your responsibility.

1:29:55Dr. Mary Claire Haver:All right, Dr. Sue Varma, thank you so much for coming on Unposed. Thank you. So great to talk to you. You can find Dr. Varma on Instagram at Dr. Sue Varma or through her website, DrSueVarma.com. Her book, Practical Optimism, is available wherever you buy books. 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 now everywhere and anywhere you buy books and through our website.

1:30:35Dr. Mary Claire Haver:If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver.