Aging Is a Privilege With Dr. Mary Claire Haver  🔗 **Source:** [Aging Is a Privilege With Dr. Mary Claire Haver](https://share.snipd.com/episode/79e96185-6160-4fe7-bb03-2ca5fe09b0db) ## Highlights - **The Fish Freezer Hot Flash** - Kate Bowler’s friend suddenly felt so hot while grocery shopping that she crawled into a fish freezer and waited for emergency help. - Mary Claire Haver compares the first overwhelming hot flash to realizing a major contraction means labor has truly begun. Transcript: Kate Bowler Like my friend, Christy Watson, she had this moment where she was grocery shopping and all of a sudden she just felt like enormously warm. She thought she was going to die. She like crawled into the fish freezer and just stayed there. Just be like, someone needs to call 911. Is that kind of experience where someone's like, what the hell is happening to me? Mary Claire Haver You know, did you have children? I have a 12-year Okay. Did you go into labor? Okay. So, you know, I had delivered, I don't know, 5,000 babies by the time I had my own. And no one could have prepared me for what that, like, I know I'm in labor feeling was. I thought I was in labor several times. I had a lot of Braxton Hicks and stuff, but then when you're like, Oh, this is, this is what's happening. Like, I think the vasomotor symptoms, the menopausal hot flashes like that. Like you have a couple of like, is this, I don't know. Ah, it's probably nothing. And then you're like, Oh my God. Like, like a page has turned. Like when you get that one big contraction, you're like, I'm having a baby. This is going to happen. Yes. So I feel like that, you know, when you turn the quarter and you have that hellacious hot flash, you're like, this is happening. ([Time 0:05:49](https://share.snipd.com/snip/0977efd2-cbaa-48d0-b2f9-f0e5678409da)) - **Perimenopause Starts In The Brain** - Perimenopause begins before periods stop, as declining ovarian function makes brain-to-ovary hormone signals increasingly erratic. - Early symptoms often appear as sleep disruption, brain fog, anxiety, rage, and lost resilience before cycles become visibly irregular. Transcript: Mary Claire Haver Is defined as one year after the final menstrual period. Okay. We know that statistically, if you go one year without a period over the age of 45, that that most likely is due to your ovaries have shut down. There's no more eggs left that are going to be able to ovulate. You're not going to produce those hormones anymore. But basically, if you think of why a woman ovulates or a girl ovulates, it comes from the brain. So the ovaries are really just clumps of cells. So we have our germ cells, which are where the genetic material is, right? And in utero, they get frozen in something called meiosis one, if you remember that word meiosis from biology. So they start splitting in the first split and they freeze and they're just hanging out there until they ovulate. And then the division occurs fully. And then we end up with like half your DNA in one, you know, and then that your, your partner's DNA, hopefully infiltrates the other side and you make a human, right? That's half mom, half dad. That's very simple. Okay. In order for that process to happen, um, signals have to come from the brain. And so our brain is always looking for estrogen, estradiol, looking for these hormones and progesterone. And when those levels drop off, it starts saying, wait a minute, I need those. Why? Well, biologically, we need to ovulate to propagate the species. But also like our brain works better with estrogen on board. So when it naturally dips in the cycle, the brain is like glitching a little bit. That's why we have more PMS. That's why we have more emotional symptoms like post-ovulation when those estrogen levels decline and the progesterone comes up. And so LH and FSH start pulsing. The signals go to the cells around those germ cells called the follicular and granulosa cells and start pumping out hormones and the whole system restarts. So that process in a healthy woman is very predictable, right? Month after month after month in a healthy woman, she should know on day 28 or day 32, she's going to have a period and the whole system restarts. And if you look back and we track through all the hormone levels, they're very consistent. On day one, it looks like this. On day eight, it looks like that. On day 14, on and on and on. We're born with all of our eggs. That's what makes us very different than men. Men have a factory in their testicles where they create fresh DNA that gets encapsulated into sperm every day. Every day, every day, every day. And I forget if it's thousands, millions, whatever. I don't study men. So, you know, they're a mystery. I just have the vaguest notion of what happens in a testicle. You know, I'm only in charge of two and that's my husband. So, you know, and I have daughters, so, you know, um, but they make their stuff fresh every day and they can keep making it until they die. Right. It gets harder and I wouldn't recommend it, but they can father children until death. Okay. So women, however, very different. We're born with a set amount of eggs. By the time we're born, we're already down from the original four to five million to one to two million through this process called atresia. And we don't really understand, go figure, how atresia actually happens, you know, but it's more kind of think of the survival of the fittest. We want the healthiest eggs left behind. So we're born with one to two million. They lay dormant until puberty. Then we start the ovulation process. It kind of goes wonky for the first year or so, and then things go into stride. And then, so by the time we're 30, we're down to about 10% of that original egg supply. So we lose about a thousand through the process of ovulation each month. And then we're also doing that atresia thing in the background. So we're just losing, losing, losing. By the time we're 40, we're roughly down to 3% of the original egg supply. Okay. Okay. And then by the time menopause hits, no more functional eggs. We're done. Okay. We've, and then we live the next 30 to 40 years without that process happening. Perimenopause. What happens in peri? Every woman has a different threshold, but we reach a critical egg level where the signals from the brain don't work as well as they used to. They can't recruit enough eggs to get out of the vault. And so the eggs try, but they can't quite get it going. And the brain is like, where's the estrogen? I'm looking like it should be here. You know, it's 430. Where is my estrogen surge? Like I'm used to it. And the ovaries are like, bro, we did what we could. And so the brain flips out and starts sending higher and higher levels of those stimulating hormones, LH and FSH, to the ovaries to basically force some ovulations to happen. So we have delayed. So it kind of delays. We'll have a double ovulation. That's called a loop cycle in some months. Progesterone really struggles to keep up. So what used to look like the EKG is now I take spaghetti and throw it at the wall. Yes. And so cycle irregularity happens towards the end of perimenopause. But what happens in the beginning is happening in the brain. So sleep disruption, brain fog, and mental health changes. So we see about a 40% increase in mental health diagnoses. Now imagine the woman who don't go to the doctor and get the diagnosis. How many women are struggling with like, oh, I'm just going to white knuckle it with their anxiety and depression. It it takes a huge our brains take a huge hit during this so the brain's basically rewiring to learn how to live and adjust without this predictable hormone level so perimenopause represents What i've coined the zone and i actually stole it from a doctor in new york and i give her credit in the book. The zone of chaos. Right? Because it's not predictable. You're ovulating whenever. And so your periods can be heavier, lighter, more creepy, less creepy. Like you can't predict it anymore. 80% of us will have dysfunctional uterine bleeding. But that's really towards the end. And so we just, I was never taught to look for the i don't feel like myself there's a whole paper on that presented at the menopause society of this like and they they really connected it To the hormone changes of perimenopause that our levels of serotonin dopamin norepinephrine all are dependent on estrogen levels and also like how we utilize glucose changes you Look at lisa mosconi's you know, in the menopause brain and how glucose is utilized in the brain changes. And we have a much harder time in the amygdala that controls our emotions and in the frontal cortex for memory. That is the brain fog in mental health. And so that the mental health stuff does tend to get better as the hormone levels drop and we get a more of a steady state. ([Time 0:07:27](https://share.snipd.com/snip/8e390fa9-d781-4be2-a81e-f537fabf638e)) - **Menopause Is More Than Hot Flashes** - Menopause can affect joints, muscles, sleep, body composition, palpitations, cognition, and workplace performance—not merely temperature regulation. - Estrogen loss may help explain frozen shoulder and some previously unexplained musculoskeletal pain through increased inflammation. Transcript: Kate Bowler What symptoms do you think surprise people the most? Mary Claire Haver You know, we all know about hot flashes, which are the vasomotor symptoms, but the things that blew up the internet, right, when I wore frozen shoulder. What? Yes. No. Yes. I have friends who are already getting frozen shoulder. Frozen shoulder. Great work done. Jocelyn Whitstein, Duke, she's an orthopedic surgeon, and Vonda Wright, another orthopedic surgeon,'re like, oh, these 40 or something year old women are coming in with frozen shoulder. What is going on? And what Jocelyn saw, Dr. Whitstein saw, was they were on aromatase inhibitors. So not only were they in this menopausal phase, their estrogen was taken completely away due to treatment for breast cancer. And this huge percentage of patients were coming in with adhesive capsulitis. So she started, you know, combing that she's just a brilliant scientist. And what do we do? We start looking through the data to see and found the correlations between, you know, aromatase inhibitors, just being fully menopausal and the incidence of frozen shoulder, and Then looking at women who happen to be on HRT and they had a lower incidence of it. So there's something really protective about estrogen in the musculoskeletal system. So a lot of fibromyalgia might be undiagnosed musculoskeletal syndrome of menopause. And doctors just didn't know the connection between estrogen loss and what's happening in our bones, muscles, and joints with increased inflammation. Can you give me one of those horrifying, just saying horrifying, where it's like 80% of people likely experience this? So when we pull, you have to remember, in the menopause literature, in academia, really the only thing that's been studied for the most part has been vasomotor symptoms. I see. HRT was developed to stop a hot flash. No other reason, right? It turns out it also helped bones and there were some-term benefits with, you know, longer lifespan, you know, to a certain degree and lower cardiovascular disease if you started it Early, right? Versus not being on it. So, but it was literally developed to just stop hot flashes and women would stop complaining and sleep, you know, and it works great for that. Yeah. When we pulled, so when you look at actual symptoms, so some of the big telemedicine companies are doing, they're cranking out tons of data, you know, the Oura Ring and all these wearables Are doing all this data collection. Turns out the top symptoms, like hot flashes are usually fifth. Weight gain, so body composition change, so increasing fat deposits among your abdomen. And if you're listening, yes, it's not your fault. This is completely hormonally driven. Hi. It's, you know, do you feel better now? Doesn't fix it just knowing it's there, but it makes you feel better that you're not lazy. Sleeplessness, so disrupted sleep. And so we weren't taught early on that these are direct, like the musculoskeletal stuff. Other things I blow up the internet, itchy ears, so common. They drive people crazy. Palpitations, 45% of patients will have palpitations, but it's really the mental health, the brain fog really lead, loss of resilience, not knowing who you are. When we look at the data around jobs, and so women who are employed are having more absenteeism and in the menopause phase. And so we, it was about one, I think, it was like in the billions of dollars, Mayo looked at this, like, what is the cost of women who are missing work due to untreated menopause? And what is the economic cost of that and then there's something dr malone talked about called presenteeism you make it to work but you're not functioning at the same level yeah and that's Mostly because of brain fog sometimes hot flashes where you're just stuck or your period's so heavy you're stuck in the bathroom you know and and not being able to like go sit at your desk Or do whatever because you're just you know bleeding through all the protection that you have. ([Time 0:17:24](https://share.snipd.com/snip/03fc87d0-3507-46a0-954d-7c14023ee506)) - **Do Not Buy A Menopause Cure** - Treat supplements as additions to a nutritious diet, not as cures for menopause or ways to restore ovarian function. - Be skeptical of products promising menopause belly cures, dramatic weight loss, or a return to youth. Transcript: Kate Bowler We just have to manage this. This has to be brought to the forefront. There's so much. I don't know if it's just my algorithm, but my algorithm really wants to sell me supplements about brain fog. Mary Claire Haver Okay. This is coming from a doctor with a supplement company. And let me be clear. There is no supplement in the world that will resuscitate your ovaries. Zero, nothing. So, um, that, that is not, you know, supplements should supplement a good, healthy, nutritious diet. And the supplements in my world are things that help me get more fiber or more protein or more building blocks of the nutrition things that I'm struggling to get through food. There is no supplement that is going to cure your menopause. You're going to go through this. Now, you may have slight relief of a few symptoms and good for you if that's what you want to do as long as it's not harmful. ([Time 0:21:20](https://share.snipd.com/snip/96073cc5-a90b-4402-81cd-e8b7dc5f3b04)) - **How The WHI Derailed Menopause Care** - The 2002 Women’s Health Initiative studied women averaging 63, not the typical 51-year-old beginning menopause treatment, yet its alarming publicity reshaped care. - Mary Claire Haver argues that age differences and later evidence were overshadowed by the claim that estrogen caused breast cancer. Transcript: Mary Claire Haver Yeah, because WHI was 2002, and that just threw an axe, you know, into conversation, into education, and basically nothing happened in menopause, you know, that really would move The needle. Lots of research was being done, incredible stuff that was just getting buried in academic journals that, you know, I think in medicine it just got easier not to deal with it because Somehow it got labeled as dangerous, so we're just not going to talk about it, you know, like, well, there's nothing we can do. You just have to get over it. So tell me again about like, cause previously there was a very well established. So yeah, like, like almost every medical board that dealt with women, right. Recommended hormone therapy. Okay. So about what we look at the data on FDA approved, cause that we can't really track non-FDA stuff, like compounded materials. So at least for FDA, 40% of eligible women were on HRT before the WHI. And so everybody thought that was a reasonable number. And from observational studies, we knew that women who are on HRT tended to have less heart disease, tended to, you know, we knew their bones were stronger. There was no debate there, right? Estrogen makes your bones stronger forever. But they tended to live a little bit longer and have less chronic disease. You know, they kind of slowed the rate of those things happening. So, you know, if you're a good researcher, as you know, how do we prove that? Observation is just correlation, not causation. We have a randomized placebo-controlled trial, and that's what the WHI was. The whole purpose of it was, does estrogen prevent heart disease? Okay. So they start collecting data. They have two arms. They have estrogen and progestin, or if you had a hysterectomy, estrogen only, because we need that progestin to protect the lining of the uterus. It's not negotiable. And then estrogen only arm, and then each of those had a placebo arm. And off they go collecting data. They noticed a signal in the estrogen plus progestin arm. It wasn't statistically significant, but it approached it, that estrogen, the estrogen and progestin arm had a slight increased risk of breast cancer. Now, remember, the average age in the study was 63, not 51, the average age of menopause. Why did they start with an older population? Because heart disease takes years. You know, they couldn't afford, it was already a billion-dollar study, they couldn't afford to run it for 20 years when a woman would start HRT and then when she would have a heart attack, Right? And so to cut costs, they pulled in older women. They had some women in their 70s who were starting HRT for the first time as part of the trial. And so they see this signal. They didn't see it in the estrogen-only arm. They saw a 30% decreased risk reduction. And like one guy decides we're going to call a press conference and stop the trial. Remember, there are multiple centers doing this trial. They called them all and said, hey, we're going to publish this paper. Basically, at the end of the day, saying that this estrogen plus progestin increases the risk of breast cancer. Like, wait, we didn't reach statistical significance. What about this? Let's age match the groups. You know, we're not looking at young versus old. They did have 50 year olds in the trial. They call a press conference, tell the world estrogen causes breast cancer. And the paper wasn't even published till 10 days later. So no one could read it. So like phones are blowing up. There's no internet back then, right? You know, 2002. Everyone's calling the doctor's offices. Oh my God, I'm going to, am I going to die of breast cancer? They're throwing their HRT in the trash. What have we done? And that was the genie we could not get back in the bottle. And other medical societies heard it like no HRT. We're not even going to think about it, talk about it, look at it, you know, and that stayed that way for 23 years. Wow. Yeah. The black box warning went on all estrogen containing products, you know, for menopause of vaginal estrogen plus systemic saying it caused heart disease saying you will have a stroke Saying your risk of death black box is for like cyanide, you know, like things that are really, really, really going to hurt you chemotherapy, you know, like that and not for vaginal Estrogen. It should have never been on there so multiple papers have been published but they just never got that virality that you know it wasn't picked up you know this was sexy estrogen and breast Cancer and so you would think that okay everyone stopped taking their estrogen literally almost everyone wow a whole generation of physicians never was trained in like reasonable Menopause care you know in proactive preventative menopause care. And then finally this whole menopause wave, I think it's Gen X who was like, F this, I am not standing for this. I'm not going to suffer. I'm not going to, I watched my mom like help me. And more papers started getting written and you know, menopause society was doing a great job. They changed their recommendations in 2022. And so, but like ACOG, who covers, you know, ACOG is American College of OBGYN, American Council of OBGYN, has not changed their menopause hormone therapy guidelines since 2014. Oh, my gosh. So, you know, there's a lot of politics involved here, a lot of, you know, but at the end of the day, the majority of women, their benefits are going to outweigh the risks for MHT. Yeah. And they're not having that conversation because they're walking into a doctor who's not trained. ([Time 0:25:27](https://share.snipd.com/snip/9ae6123d-2598-476f-b311-3517ed92aa7d)) - **Build A Prevention Plan Around Basics** - Protect long-term health with sleep, stress reduction, plants, adequate protein, fiber, blood-pressure control, no smoking, and therapy when needed. - These prevention strategies address heart disease, cancer, osteoporosis, and muscle loss together rather than treating menopause symptoms in isolation. Transcript: Mary Claire Haver We have much lower risk of like heart disease than men until menopause. And it turns out the lifestyle preventative things are almost all the same. Okay. For heart disease, for any cancers, for osteoporosis, for muscle, you know, sleep, stress reduction, good nutrition, lots of plants lean you know and enough protein however you want To get that in your body um avoiding ultra processed foods yeah um getting therapy when you need it yeah you know keeping your blood pressure down not ([Time 0:31:30](https://share.snipd.com/snip/081f596b-42bf-44e8-9854-039396c9cea4)) - **Get A Bone Baseline Earlier** - Ask for a baseline bone-density and body-composition assessment around perimenopause instead of automatically waiting until insurance coverage at 65. - Estrogen loss accelerates bone loss during perimenopause, while protein and resistance training can help rebuild the physical reserve. Transcript: Kate Bowler Is one of the first things you can do to just go get a bone density scan? Yeah. Most people haven't done that. Most people have not done that. Mary Claire Haver And this is where I'm going to be very clear. This is off of the guidelines. Okay. So we're going to step away on where I think the guidelines need to be rejushed. Okay. To have jushed. So remember, this guideline was more about insurance and payments than knowledge, right? So right now, without risk factors, you're not going to have insurance be able to pay for your bone density without risk factors until the age of 65. Kate Bowler That's way too long. Mary Claire Haver Cow is out the barn. That's crazy. Because i know from my patients so again this is just my experience and in our clinic with our two three doctors and four nice practitioners when our patients see that bone density and Go oh shit uh-huh they are motivated yeah they start doing they start lifting the weights eating the protein making sure they're getting calcium and vitamin d like they are doing the Things to build that bank of bone back up. Yeah. And it is nice to know that you really can build bone density. It's harder as we get older, but you can do it. Kate Bowler Because when I, I mean, it was only a couple of years ago, I got my first bone density scan, but it was like $130. I didn't realize that there was a person nearby. Yeah. You just have to like Google bone density scan and it'll be. Was it good? It was just like, actually it was a really sweet person whose wife had died of the same cancer I had. And the reason why he was doing these scans was he just liked being part of preventative medicine. Yeah. I thought, anyway, I just, I liked going. I liked feeling like I had a non on the scale related like just benchmark yeah and i do it once a year is that ish they say two years that's more to track loss and gain bone grows very slowly Mary Claire Haver Okay and bone right so when we go through menopause like we have a bone bank that we develop in childhood in like our early 20s and we max out on our bone density, probably somewhere mid Twenties ish. There's some debate on that. So twenties to thirties and then age and stuff just starts taking that away. And then when we take estrogen away, it wraps. So we have the biggest acceleration of bone loss and perimenopause, not menopause. Kate Bowler Yeah. Mary Claire Haver So I'm like, I get them. I recommend them as soon as they hit my door, they're coming in for menopause, right? For perimenopause. So I'm like, everyone should get a baseline. I think it's really critical to do a body composition, bone density and body composition before you start a GLP one. Do you want to know what is your bone bank? What is your muscle bank before you start that med? Because if you're not getting counsel correctly, you might under eat the protein and not do the lifting required for you to slow that lean mass loss. And when you lose lean mass, muscle bone goes to. ([Time 0:34:21](https://share.snipd.com/snip/d63ba05a-226b-4d8b-92eb-40b386e6d9be)) - **Train For Muscle And Bone** - Progress toward strength training at least twice weekly, gradually using heavier resistance as your capacity improves. - Pair roughly 150 minutes of moderate cardio with 60–90 minutes of weight training, such as brisk walks and short lifting sessions. Transcript: Kate Bowler I suppose a lot of women have to reconsider that storytelling, particularly around. I mean, I just remember it was all cardio. Totally. Just abs. Yeah. It wasn't heavyweights. Mary Claire Haver Heavyweights were going to give you big muscles. I can tell you I am the first female in my bloodline to lift weights. I like your bloodline. Like there's no Cajuns out in the swamps or in Nova Scotia or back in France who were lifting weights. And they may have been doing heavy, you know, my people were farmers and fishermen, you know, they may have been lifting some heavy kids, but like they were not purposefully trying to Maintain their bone density or their muscle mass. Kate Bowler I really like that. Cause everybody, I mean, I think, I think a lot of people get stuck on the like five to 10 pound. These are the intermittent, like just every now and then when they think of it, it's better. Mary Claire Haver Like any movement is better than none. Any weight is better than that. I don't want to say that it nothing's worse than sedentary for bones and muscle. But if you were going to magically pick, you'd be like maybe twice a week, straight training, at least twice a week, if not three. Yeah. If you can get it all in right. You know, push day, a pull day, and then cardio. All right. When we look at the data, 150 minutes a week of cardio. So getting that heart rate up moderately, where you can walk and talking's a little bit of a struggle, but you can do it. Okay? If you do that 150 minutes a week from sedentary, I will cut your risk of diabetes and heart disease and, you know, 50%. Just do that. Can you give me 150 minutes a week? If you do the math, that's, you know, five 30-minute walks, brisk walks a week. And they're like, I can do that. Okay. Weightlifting, how much? So it's somewhere 60 to 90 minutes a week. And it has to be not the Namby Pamby five-pound weight. But if she's starting from nothing, we start with body weight. Hollow bone disease. Then five pounds. But the goal is you just want to get stronger and to get stronger you have to lift heavier weights now again we're going to get sick we're going to travel we're going to have to back up so It's not like i'm all i'm not benching 200 pounds you know so i'm benching about 75 pounds for this little framed woman and you know like i didn't do any lifting on this trip i have to drive Back to tellide. I'll get back in the gym. But like life happens. We get sick. We get injured, whatever. So you just have to remember it's OK to go backwards as long as you keep moving forwards. You know, you just need to get stronger. So when you add that all up together, it's about 250 minutes a week. So to keep the math super simple, if you can give me a 20 minute walk a day and about 15 minutes of weight training, you're doing really, really good. That's amazing. So, and that should be minimum. ([Time 0:37:48](https://share.snipd.com/snip/c77eabd7-f8c4-484e-bb35-102953b91b13)) - **Information Replaces Menopause Shame** - Education turns menopause from a frightening personal failure into a recognizable biological transition with practical options. - Understanding the pattern can prevent women from blaming themselves or visiting multiple specialists for symptoms with one hormonal cause. Transcript: Kate Bowler It was just a block, like a mental block. I like did not want to face this topic. I did not want to read about it. I did not want to listen to other people talk about it. I have fully blocked out being a compassionate friend about other people. Mary Claire Haver I, in my precious thirties, when I was doing my training, we had six hours of menopause in a four-year curriculum. We had six one-hour lectures and I would roll my eyes and think, oh my God, I don't want to be dealing. Want to deliver babies I want to do surgery like if you would have told me you know like I didn't want to think about it yeah because my mom it was this dark ugly place that she hid in the room And yelled at us and and then they put her on sedatives so my mom was like on a derivative of phenobarbital for the treatment of her menopause yeah called Budisol and it you know but then Kate Bowler When it was my turn I was like holy fucking shit this is my life yes like this is my purpose yeah so I get it yeah I think I felt like I this is not how it works but I guess I was secretly hoping For cosmic math on like I've been through a lot yeah you've been through a lot so like I felt like I was in the hospital so much in my thirties. I felt like I lost most of my youth already. And everybody else is kind of having like a moment where they feel like summer. And I was just feeling like haggard and wizened and like a million years old. So then getting into forties and I've had a couple years in a row of good health, then I'm like, great, now is my time. Let nothing take it away from me. When I was like, surprise, there's a horrifying. But I think like what I've realized is like, every moment of reality is an opportunity to figure out what has happened and what is still possible. And I just really like the concreteness of like, there's very little that you're saying that really costs a lot of money. Mary Claire Haver Right. Or, and you know, why do we demonize menopause so much? This is a natural phase of life and we're going to go through it. But I think not allowing women the education around it, which is why I wrote the book. Like, I don't want any woman to go through this alone or not like have a clue what's happening and gaslight herself and like hop around and multiple doctors who haven't been trained who Can't connect the dots or see 10 specialists for 10 different problems ([Time 0:40:24](https://share.snipd.com/snip/ade7c21d-a2cc-4ba9-a1e6-9eb26ae7ae60)) - **Advocate Beyond Normal Labs** - Prepare for medical appointments by learning the evidence, tracking symptoms, and asking directly about menopause-trained care. - If a clinician says your labs are normal without explaining persistent symptoms, seek a provider who can connect them across specialties. Transcript: Kate Bowler Like being just aware that there is an enormous gap between best practices and when it might show up in your average primary care doctor's office. Mary Claire Haver So that's a huge problem is we have this gap between educating the population and then being, okay, I've got my resources, my tools. Now I'm ready to go have an informed conversation. And then you hit a closed door. So what do you do? Okay. Well, we have some stop gaps. So one of my big initiatives is we need legislation around mandatory menopause education in all of our clinical training programs. Like, it's ridiculous. Menopause shows up in the ER. Menopause shows up in orthopedic surgery. Menopause shows up in cardiology. Like, none of them are getting any menopause education. Yeah. Right? And how this loss of estrogen affects these different specialties. This has got to stop. Like, menopause is a longevity event. I really think we need legislation that will mandate that our training programs or any clinician who touches a female after reproduction ends, this has to be part of the curriculum. So then there's these great telemedicine companies, who I'm not being paid, who are developing menopause care, evidence-based menopause care. So, you know, they are speed educating their providers to make sure they have all the necessary knowledge in order to do menopause care. So I think we have some stopgaps, you know, to help us, you know, and then hopefully by the time, like, my daughter's 25, she's a fourth-year med student, you know, hopefully by the time She's out and practicing this, like in her ER rotation, this will be part of her training. Like how to recognize when, no one's going to expect her to treat menopause, but at least say, wow, this panic attack and these palpitations and these hot flashes you're having are probably Your menopause. Like go see your menopause certified clinician, you know, instead of, yeah, your labs are normal. Kate Bowler Yes. Bye. Yes. People usually get stuck after the, your labs are normal dot, dot, dot conversation. I just, thanks so much for the encouragement to like fill in the gaps about like just wanting to educate yourself, doing this kind of reading, being willing to start a conversation if Mary Claire Haver You haven't had one already? We're seeing this across so many aspects of women's health. Endometriosis, a woman will go almost a decade before she's diagnosed. Polycystic ovarian syndrome can look like so many other things like autoimmune disease. We're just missing the boat in women's health. And thank God for the internet because that's where women are educating themselves, some good, some bad, right? And, but I think it's so important that whatever, you should never suffer. Yeah, right. ([Time 0:43:00](https://share.snipd.com/snip/b04a6096-ead1-448b-b7af-966081f70b18)) - **Aging Deserves Curiosity Not Criticism** - Accepting reality does not mean giving up; information can guide the next right choice and support care for a finite, changing body. - Kate Bowler reframes aging as a privilege while encouraging curiosity, gratitude, and compassion instead of criticism. Transcript: Kate Bowler I feel like this was, um, this was an intervention and I think you, I think you handled it. You handled my deep secret reluctance very well. Mary Claire Haver It's coming, but it doesn't have to be. Well, one of my things is menopause is inevitable. Suffering is not. Yeah. So yeah. Kate Bowler Thanks for doing this with me. You're so welcome. If there's one thing I'm taking away from this conversation, it's that every time I allow reality to actually sink in instead of ignoring it, I feel better. Information is just that. Information. It's not a verdict. It's not a license to panic. It's just something that we can use to make the next right choice, to ask better questions, to advocate for ourselves, to take care of our fragile, normal, finite bodies that are carrying Us through this very normal, finite, fragile season of life. So if you're looking for practical help, Dr. Mary Claire Aver's book on paramenopause is full of very evidence-based guidelines, including really helpful scripts on like talking to your doctor, figuring out what questions To ask. So we're going to link to all of her work in our show notes. And here's just a little blessing for you if you're just feeling like your body is not what you would have picked if you were putting bodies together it's just a little blessing for accepting Our finitude our strangeness our aging as a very normal and you know god-made. May you remember that aging is a privilege, even on the days when it doesn't feel like it. May you meet your changing body with more curiosity than criticism. May you find people who listen when you say something's not right. ([Time 0:46:13](https://share.snipd.com/snip/ff6f179b-9b8e-4ba8-8dca-325657eb1e0e))