Mary Claire Haver  ## Metadata - Author: [[Armchair Expert with Dax Shepard]] - Full Title: Mary Claire Haver - Category: #podcasts - URL: https://share.snipd.com/episode/3514768f-9bf5-45d6-8ebc-660f296478a2 ## Document Notes ## Highlights - **Misinterpreted Menopause** - Mary Claire Haver initially misinterpreted her own menopause symptoms as grief after her brother's death. - She realized she was in menopause only after the grief subsided and her symptoms persisted. Transcript: Mary Claire Haver Was, you know, I had an endocrine condition. I didn't ovulate regularly. Why I had fertility treatments for my kids. You had PCOS? PCOS. I had the two kids, finally got that done. I don't want to go through another miscarriage. We're done. So I go on birth control pills to manage my condition, which I did great on. That was fine for me. And then I get to about 48 and I'm like, okay, I think we're getting close to where we're going to be. And I'm totally suppressing my period. So I'm not taking the inactive pill. So I'm totally replaced all my hormones and shut it down. I felt better that way than PCOS. I was like, probably time to get off, see where we're at. So I talked to my nurse practitioner who took care of me and was like, I'm going to get off the pill. We're going to get some blood work in a month and see where I'm at. She's like, cool. Very same time, my brother dies. So I have six brothers from the same parents. My oldest brother died when I was nine from leukemia. So I was a kid when that happened. And then my next brother, Bob had HIV and hepatitis. The HIV is actually really under control, but it was his liver just tanking, tanking, tanking. So I've stopped the pill, see where Mary Claire's at. And I'm in the OR, the phone's ringing, ringing, ringing. I'm like, get the phone. And they put it to my ear. And they're like, Bob's in a coma. You probably should start heading home. Dax Shepard Did you know that was coming? Mary Claire Haver Eventually. I'd sat the kids down and say, you know, Uncle Bob's getting sicker, but not like today. Dax Shepard It kind of was abrupt despite knowing it was coming. Mary Claire Haver Yeah. I thought we had a year or two years. Anyway, my partner comes down. We get to a good part in the case, scrubs me out. And I go and prepare to go home and figure all this out. So here I am grieving this horrible thing and I am in full on menopause, but I don't know it. I'm gaslighting myself. I'm attributing all the things to grief and certainly grief was a part of it. But after like month six, I realized the grief is lifting. I'm not crying all the time on the way home. I'm like, when was your last period? Shit. ([Time 0:10:42](https://share.snipd.com/snip/9870e53a-bf46-4cfd-8c58-5842d17b8a65)) - **Menopause Detection** - Menopause is detectable through blood work by checking estrogen and FSH levels. - Perimenopause, however, lacks a reliable blood test for diagnosis. Transcript: Mary Claire Haver Perimenopause, no, we don't have blood work for that. Okay, that's what I was going to ask. Because I think I'm in it. Dax Shepard I know. Everyone your age does. Mary Claire Haver I looked up all the stats for Southeast Asia. Oh Oh, you did? Yes, I did. Thank you. Yeah, so we'll go over that. But I reluctantly go on hormone therapy because I'm like, I cannot live like this. I was still in the impression I would get breast cancer and die. It was going to kill me. Dax Shepard Well, let's address that right now because I happen to know way more about this than I should because I love... Women. Well, I do love women. But Dr. Atiyah, I love Peter Atiyah. And he's been such a vocal supporter of this. ([Time 0:12:52](https://share.snipd.com/snip/6a6cfd45-a33c-47cb-8fb0-b04ee4055bae)) - **HRT Hysteria** - The hysteria surrounding HRT and breast cancer stems from a flawed interpretation of the WHI study. - The study used older formulations and the results were misrepresented, causing widespread fear. Transcript: Dax Shepard So all of this, the hysteria that you probably received was based on the work of two people virtually. Mary Claire Haver So the WHI study was a large multi-center trial. It was one of the biggest projects the NIH had ever taken on. And for the first time, they were studying women. We were so fucking happy. We knew from anecdotal evidence that women who were on HRT before the WHI, hormone replacement therapy, 40% of women were utilizing HRT and menopause. So that was kind of the baseline rate. It was recommended by the American College of Physicians. I mean, it was like, everybody should consider this. We knew that women who chose it had lower heart disease, had lower certain risks, but that's not That's an observational study. Yeah, correlation. If you follow a TIA, you need a randomized controlled, blinded. So NIH, billion dollar study. Wow. Let's study women. They got 37,000 women recruited. Half were placebo versus estrogen or estrogen and progesterone if they had a uterus. Which is a huge issue already right there. Dax Shepard Right. If you're not combining the two. Mary Claire Haver Particular estrogen that they were on was Primarin, which we don't use today very often. And then a very specific progesterone. It wasn't using modern HRT formulations. It was just looking at this one. But at the time, in the 2000s, that was the most common formulations used. Nothing weird there. Because they were looking for heart disease as the outcome, is this really protective for heart disease? Or are just wealthier, healthier women on HRT and we're getting an artifact? The average age was 63 in the study. A little late. We know it works for hot flashes. We know it'll take care of menopause symptoms, but does it really help with heart disease? So they wanted to start later because it's expensive to go 20 years. So if we start later, then we'll start seeing the heart attacks in a quicker timeframe. They did have younger and they had some women in their seventies start, they went up to 79. Off they go with the trial. The women on estrogen only had a 30% decreased risk of breast cancer. And that was statistically significant. The women on the combo saw a slight increased risk, but it never reached statistical significance. Dax Shepard Really quick. The reason it was kind of irrelevant statistically is that the control group had an abnormally low rate. That's it. Which was not even considered. Mary Claire Haver So when you compare the two groups, whoa, this is really causing. It was four guys. Dax Shepard Chlebowski, Aragowski. I can't even pronounce their names. Yeah, the rough names. And they still stand by it. It's crazy. Just recently, they're back at it. Mary Claire Haver There were 17 centers involved in the study. There were multiple PIs, primary investigators. And these two or three guys wrote this paper and said, estrogen causes breast cancer, HRT causes breast cancer. And they called everybody in a room and said, take a look at it. You have one hour to make changes. They rejected all the changes. And then they went to the press. Speaker 3 There's no peer review. Yeah, no. Mary Claire Haver They just said it. And it was like letting a genie out of a bottle. Flawed interpretation and hysteria. There was no viral for internet back then, but it was the number one medical news story of 2002. ([Time 0:13:24](https://share.snipd.com/snip/a207eeec-d1bc-4acd-9d09-3c2d42ffb0cd)) - **Research Disparity** - There's a significant disparity in medical research focusing on pregnancy versus menopause. - Despite menopause affecting all women for a third of their lives, research is disproportionately skewed toward pregnancy. Transcript: Dax Shepard If you look at menopause at that same period,,000 articles were written. Mary Claire Haver Do you know how much brain power we're talking about? How much NIH funding, how much private funding, how many labs? That's 10 to 1. And more women will go through menopause than bear children. Exactly. Dax Shepard Yes, and the bearing children process will last them however long you want to say that window is. Mary Claire Haver Average of two kids, nine months each. Dax Shepard 30 years? No. So pretty nuts. And maybe now's a fun time because I actually want you to explain menopause, but I think now would be a fun time to just talk about men versus women here. ([Time 0:17:21](https://share.snipd.com/snip/b3c425f3-c5c3-4ade-a2e2-c1c765a886c4)) - **Sexism in Menopause Care** - Menopause is a natural biological process affecting a significant portion of a woman's life. - The lack of attention and research surrounding it reflects layers of sexism in healthcare. Transcript: Dax Shepard You can't underestimate the layers of sexism that exist within the fact that it would take however many years before we would acknowledge, oh yeah, women are really suffering from This and they have a bunch of symptoms from a bunch of different issues arising from this and better to treat those than to get to the core of what's going on. Mary Claire Haver When you look at why menopause hormone therapy was developed, it was to treat a hot flash and And forever, the pathognomonic, the poster child symptom was hot flashes, what we call medicine Vasomotor symptoms. What was never taught to me ever, and I learned like three years ago, was we have estrogen receptors in every single organ system in this body. And what I also was taught is in perimenopause, it's a slow, gentle decline. That's all I learned. One sentence, decline until full menopause when you lose function. It is a rocking roller coaster and your worst symptoms tend to be the mental challenges, the brain fog, the cognitive disorders, the frozen shoulder. All of it is peri and late peri and early menopause. That's when you're accelerating your loss of... Bone and muscle. And the eggs, right? We were born with all of our eggs. A million, though. That was a shocker to me. So one to two million at birth. One to two million eggs. But isn't this weird? It's like that thing where you're born with all your eggs, so really your grandma's eggs are your eggs. Yes. When your grandmother was pregnant with your mother, the egg that made you was inside of your mother, inside of your grandmother. In some ways, women have always existed. So there's all this knowledge, wisdom, and trauma. ([Time 0:19:02](https://share.snipd.com/snip/16ecca79-a005-4ec6-af35-c6f4659e5cfd)) - **Evolution of Menopause** - Human women are unique in experiencing menopause, likely for evolutionary reasons related to survival and wisdom sharing. - This natural process has become misaligned with modern lifestyles. Transcript: Mary Claire Haver There's a pod of certain whales that do it and elephants are very matriarchal. But when you look at like the anthropologists and they're like, why do women go through menopause? So from a survival standpoint, it behooves a woman to not keep being pregnant over and over again. You kind of have your batch of children and then you have better survival rates if you stop. The anthropologists also think that women served as the source of wisdom for the tribe. They were the passers-on of knowledge. The dudes tended to die younger because they're getting killed by saber-toothed tigers. The grandma stayed back. And I remember, these people were still very young compared to when we think of a grandmother now. We also died a lot sooner. Things that don't take people out now like vaccines and childhood diseases. We have a reason why we live longer. Right. Dax Shepard There was a very predictable role for the grandma. She was passing on all this wisdom, helping with children. Now we have all these things. We have childcare and we farm things out to strangers. And this whole role that once served our genetic fitness. Mary Claire Haver We've industrialized our way out of it. We've evolved past our genetics. Speaker 3 Yes. So we're saying the reason that human women didn't die is because of their... Mary Claire Haver Well, those who kind of ran the gauntlet of disease and being killed by accidents, if they survived, they seem to take on these very wisdom creating, teaching the next generation. You know, if you look at whales, they're teaching the babies to hunt while the moms are hunting, gathering with the dads. Dax Shepard Or grandma elephants. They're very involved in the ant system. And I guess, too, would I be wrong to say this? I'm assuming childbirth gets more dangerous as you're older. Mary Claire Haver Yeah. It's harder to do and it's harder to stay healthy doing it. In general, we would lose more women to cardiovascular issues, hypertension, preeclampsia, that kind of stuff. Before modern medicine, we had medications to help manage those conditions. ([Time 0:24:17](https://share.snipd.com/snip/1dfbb0dd-0560-47dc-9690-b50dc043b4e7)) - **HRT in Perimenopause** - Consider starting hormone replacement therapy (HRT) during perimenopause. - There's ongoing debate on the best approach: suppression and replacement or simply symptom management. Transcript: Mary Claire Haver We can but it's just how. Do we suppress and replace, like what's in a birth control pill, or do we just support, give you just enough to calm the brain down and make your symptoms better, but allow the process To proceed in the background? Right. There's tons of debate in my world about what's better. Dax Shepard Stay tuned for more Armchair Expert, if you We are supported by Addy. I know ([Time 0:30:46](https://share.snipd.com/snip/a3932b8d-0826-4568-b808-806af7cfd316)) - **Finding Menopause Experts** - Finding a menopause-trained doctor can be challenging due to inadequate medical training on this topic. - Use resources like menopause.org and telemedicine companies specializing in menopause. Transcript: Dax Shepard Okay, so 6,000 women reach menopause every single day in the United States. Every day. And there are only 2,300 providers certified in menopause medicine. So once this occurs to you and you're going through it and you start getting serious about your own reluctance to go through this, which is a great motivator, how do you approach it? What do you start looking at? How do you even begin assembling what becomes the toolkit? Mary Claire Haver I wish that I could tell you, you could confidently walk into your OBGYN, your family medicine, your internal medicine doctor, and have a reasonable, logical conversation about your Plan of care in perimenopause and menopause. That is not possible right now. It is not the fault of the individual doctor. They may have been excellent in your birth and your pregnancy, every aspect. But because of the six hours, so right now they surveyed residents coming out three years ago, only 30% felt barely adequately trained to treat menopause. It's awful. So at least they're honest. Call ahead. Look on the Menopause Society website, which is menopause.org, and see who has passed the test and is certified there. It's not perfect. There's always people out there who aren't great doctors who took the test, but it's somewhere to start. We crowdsourced with my followers. I've got thousands of testimonials, and we organize them by country, city, and state to help people. They don't pay me just to go find a provider who might be able to help you. And right now, it's pretty slick. There's some great telemedicine companies that have been developed, mostly female-founded, who saw a gap in care and they saw a need and they developed these telemedicine companies. I have women calling me from New York, LA, London, the most well-connected you would think, who have the same basic questions and the same worries and the same fears and cannot find help As the woman sitting on the couch in Iowa. Yeah. ([Time 0:35:07](https://share.snipd.com/snip/786def55-37e8-4e57-a08e-2f85a9d35616)) - **Learning from Followers** - Mary Claire Haver learned about the breadth of menopause symptoms through social media interactions with her followers. - This prompted her to create educational videos and eventually write her book. Transcript: Dax Shepard Okay, so as you start focusing on it and kind of pledging to get competent in it and start treating women, are you yourself even shocked with the amount of symptoms? Because I wrote down symptoms and it's about the longest list of symptoms I've ever written. Mary Claire Haver I was shocked and most of that was driven by questions I got on social. As my little social media platform was exploding, when 10,000 women ask you about frozen shoulder or palpitations or vertigo, you're like, they can't all be lying. Then I'm digging and I'm like, somebody who did the study, there's clear data here. So I go online and I make a little video talking about the correlation between menopause and vertigo, menopause and frozen shoulder, menopause and palpitations, and the world goes Crazy. I get 10,000 comments. Why didn't my doctor know? Again, we're doing a terrible job of teaching, but I was literally learning alongside my followers. As I learned, I'd make a video and teach. And that's what inspired me to write the book. And they're like, please write a book. I don't want to chase you all over social media. It's too complicated. Just put it all in one place. Frozen children, that is scaring me. My mom had it. My grandmother had it. Dax Shepard One of my mother-in has been dealing with it for the last six months. ([Time 0:36:49](https://share.snipd.com/snip/3128244e-7584-4428-be29-749315d18bf7)) - **Managing Vaginal Dryness** - Use lubricants proactively during every sexual encounter in menopause to combat vaginal dryness. - Don't wait for symptoms to use vaginal estrogen; it's safe and effective for reversing dryness. Transcript: Dax Shepard Common for sex to get more painful, right? Mary Claire Haver When we go through the menopause transition, 100% of us are going to lose the protective effect of estrogen in the vagina, the vulva, the bladder, that whole what we now call the genital Urinary system, pubic bone all the way back and up to the bladder. We lose elasticity. We lose the ability to produce mucus. So if you biopsy to pre- and post-menopausal vagina, pre-menopausal, it's this thick velvety full of mucus glands, very resilient. It'll take a beating and be fine. Baby comes through there. It's traumatic, but they'll make it. And then postmenopausal looks like a desert. You went from this gorgeous, thick, multi-layered tissue to six cells laying on top of each other with no mucus, no nothing like a desert. All we have to do for those women is give them back estrogen in the vagina and all that tissue will grow back even at 70. You can absolutely prevent and reverse this condition. So I recommend lubricants for all of my patients on every sexual encounter. Just get used to it, do it proactively, normalize this. And then I'm advising not to wait until you start having symptoms to use vaginal estrogen. It's very safe. It's like skincare. It doesn't absorb much. There's very much risk-free. If you have active breast cancer, you can still use it. It will save your life. I mean, it prevents UTIs. The best treatment for recurrent UTIs for a menopausal person is vaginal estrogen, not recurrent antibiotics. Dax Shepard And it's just a topical. Yeah. Mary Claire Haver They have creams, gels. They have a suppository. They have a ring. There's multiple ways. But generic and cheap, the cream works for most people. ([Time 0:45:47](https://share.snipd.com/snip/78989100-1764-4d36-a8a5-ea13752a3cd4)) - **Testosterone Pellets** - Be cautious with testosterone pellet therapy for menopause; it can be difficult to manage and some doctors may promote it for financial gain. - Explore other testosterone options like creams, gels, or injections. Transcript: Mary Claire Haver Interesting. You can also get a capsule. So there's trochees that dissolve that are submucosal. So you put them under your tongue. Oh, you mean the pellets. So pellets are commercially available. They're not FDA approved. There's a problem with pellets that we see kind of in the ethical realm. Two problems with pellets. If you go to a doctor and they are trying to talk you into pellets and they won't discuss any other form of hormone therapy, that is an ethical red fox. They are financially benefiting from the sale of the pellets. And I just think you can do better because pellets are very hard to manage. You have this rapid rise. And I've seen females with testosterone levels in the four and five hundreds. And I am not kidding. They never made a female level pellet. They just give females the low level and say, you're running 200. You're fine. You're not going to die. Dax Shepard They don't slowly dissolve at a predictable rate. Mary Claire Haver They're supposed to. I've never seen a decay curve. Have you? They don't publish them. They're not FDA approved, so they don't have the same regulation. So I'm like, listen, we don't need to be doing this. And I can take it away tomorrow. If you have a pellet, you are stuck until it's gone. Three months generally? Generally. I think we can do better for our patients. I don't need to make money putting pellets in people. It's a cash cow for a lot of practices. I'm just really hesitant. If your doctor is really railroading you, if they say I only do pellets, I would probably bounce. Interesting. ([Time 0:50:21](https://share.snipd.com/snip/c0556d61-7f75-4c16-a675-395aef5eefc2)) - **Diet and Exercise** - Prioritize limiting added sugars, increasing fiber and vitamin D intake for aging well. - Incorporate magnesium, collagen, and regular exercise tailored to your fitness level. Transcript: Dax Shepard Okay, so we have diet and I'm glad you're collecting protein. Mary Claire Haver Top nutrition tips for aging and longevity for women and menopause. Is she limiting added sugars? So the whole keto movement, sugars got demonized, but it turns out that sugars added to stuff are much worse than found naturally in fruits and vegetables because the sugar in a fruit Is wrapped in a fruit, which has fiber and vitamins and minerals. And this is a doctor who sells supplements, but I think everyone should be able to get everything they need from food. That just doesn't happen. That would be amazing if it happened. That's ideal. So I'm here to help you fill in the gaps where you need it. Fiber, vitamin D. 80% of my patients are deficient in vitamin D. We're checking everyone's levels. We're telling them to supplement. I'm giving prescription doses if they're super low. We're trying to give them loading doses. Magnesium is really great for a lot of patients. I have a specific collagen product that was studied in menopausal osteoporosis that seems to have some benefit. So we're talking about that. For movement, most of my patients are walking minimum. You have to meet her where she is. If she's sedentary, just walking 30 minutes a day will decrease her risk of diabetes by 50%. That's it. If she's walking, let's put on a weighted vest. If she's doing that, let's get in the gym. You have to meet them where they are. All the influencers, they're lifting and all that. I'm like, that scares the shit out of most women. Yeah, it seems insurmountable. So we're easing them into it. I love to run these challenges for my followers. We'll get 100,000 people who are lifting weights for the first time. And I'll have a fitness person in there. I didn't know either. I was injuring myself. Dax Shepard Of all the ologies, you didn't do kinesiology. Mary Claire Haver Kinesiology is not on my list. So I will hire someone to come in and show my followers how to do a squat. You don't have to do a lot of different exercises, just the really basic push, pull. Dax Shepard There's some real key ones that are super beneficial, particularly for osteoporosis. Mary Claire Haver Squats, lunges. For osteoporosis, good studies with walking with a weighted vest, doing yoga with a weighted vest, balance training with a weighted vest is super helpful. Vibratory plates. Again, you're stimulating that musculoskeletal unit. I tell patients to brush their teeth on one foot because you're working on balance to always be decreasing your risk of fall with balance training. And then lifting, they were putting 80-year ladies in the gym from nursing homes and they were seeing all these gains. Dax Shepard Hand grip strength's a big indicator. Mary Claire Haver So grip strength is a proxy for the rest of your body. Right. Dax Shepard If you do deadlifts, you will inadvertently get... Mary Claire Haver Yeah. So it's not the grip strength. That's an easy thing to measure. That's an indicator. I got it. That's an indicator. Dax Shepard Stay tuned for more Armchair Expert, if you dare. We are supported by ZipRecruiter. Oh, get recruiting. ([Time 1:02:01](https://share.snipd.com/snip/e17478cc-4cc1-4923-a212-a38d6d92c787)) - **GLP-1s and Menopause** - Consider GLP-1s for managing visceral fat in menopause if lifestyle changes are insufficient. - Careful monitoring of muscle mass is crucial when using these medications. Transcript: Dax Shepard So that's exercise, diet. Now, where do GLP-1s fit into this? Mary Claire Haver We do use them in our clinic and probably 20% of our patients end up on them. When they come to us, it's usually, hi, I'm in menopause, help me, I'm dying. Probably 50 to 60% of them now have a weight problem. I have either always had it or they have new weight gain. So the first thing we do is break down where their fat is, if they have it. Because some patients come in, they're just muscular and they've been told they're obese their whole life and they're crying their eyes out because, oh my God, I'm healthy. What? If they have a visceral fat problem, I really don't care about subcutaneous fat. It's not metabolically that active. It's just storage. It's the intra-abdominal fat that'll kill you. And so we are working on that number. And what do we know works for that? Starvation, but that's not why they're there. High fiber diets, low added sugar, diets rich in probiotics or a probiotic supplement, zone two training, all of that works. So we're focusing on that and we get her start in HRT. Across the menopause transition, a woman will go from 8% of her total body fat being visceral to 23 on average, just from becoming menopausal. No changes in diet and exercise. I have the unusual circumstance of most of these people follow me, have read the book. It's an investment to come and see me because I'm outside of the insurance model. Yeah. So they've done their homework. They're dedicated. Yeah. So they're like, okay, let's do this. We start HRT. We bring them back in three months. If her cardiometabolic risk factors are still there and she's like, I want to give it a try. I'm like, let's go for it. A GOP-1 needs a lot of counseling to be done well. Dax Shepard Yeah, because you're taking on a lot of risk of muscle mass loss, which is so important for your hospital. Although there's supposed to be a new one coming out. Mary Claire Haver Yeah, that's three. So there's semaglutide, which had just the GLP-1, and then terzepatide, which is what we usually start with now, which has the GLP-1 and the glucagon agonist. And then this new one has, I forget what the third ingredient is, but I'm excited to see when it comes out. Dax Shepard Reduce the loss of muscle mass. Mary Claire Haver In our clinic, if the patients eat the protein and do the resistance training, we are seeing some muscle loss expected, but not this massive loss. And they are able to maintain. And then it's like that first three months, if they lose 20 pounds, maybe five is muscle, maybe 20%. But then that just levels out and it's all fat loss after that. It is absolutely the coolest thing to watch because we bring them back every six weeks to check their muscle mass. We stay on top of it. We're checking in with them. They're doing this not to look great in a bikini. I mean, maybe that'll happen and that'll be great. But they're doing this to decrease their risk of all these diseases they don't want to die from. Dax Shepard Yeah. Or plague their children with. Protect the last 15 years of their life or 10 years of their life. Mary Claire Haver And be happy during those. They're so motivated to avoid the diseases that plague their elders. ([Time 1:07:34](https://share.snipd.com/snip/73956d15-7cde-4bce-afd4-07339b5c4108)) - **Accelerated Menopause** - Several factors can accelerate menopause onset including smoking, chemotherapy, and trauma. - Hysterectomies can shorten the lifespan of ovaries, leading to earlier menopause. Transcript: Dax Shepard As you might expect, my wife, knowing that I was interviewing you, had some specific questions. Fire away. Are there any ways to predict when onset will be? Kristen heard your mother's sister can be a guide. Mary Claire Haver There is a genetic component. So there's an ethnic genetic component. So I was telling Monica, for me, it's 51 is average. For her, it's 46.7. African-Americans is about 18 months behind Caucasian. Asians get a little bit longer. Okay. Does sexual activity impact that? Trauma does. So we know lots of things that speed it up. You were born with X amount of eggs and they're going to go before you die. If you live a normal lifespan. But what do we know speeds up the process of egg loss? Yeah. Smoking, chemotherapy, radiation, abdominal surgery. You have a hysterectomy, leave the ovaries behind, but we've cut a significant blood supply to the ovary. We're going to lose average of four years off the life of the ovary. A lot of women undergoing necessary hysterectomy aren't getting that counseling. Speaker 3 There's nothing they can do about it, but wouldn't that be nice to know? Yeah, I have a friend's friend who had to have a hysterectomy. She's like, I'm about to be in menopause. Dax Shepard My mom had one when she was 30. Speaker 3 My mom had one after baby number eight. Mary Claire Haver They were like, this is your Catholic birth control. Time for that uterus to come out. So does it instigate menopause? It cuts the blood flow. So you lose the shelf life of the ovary where you may have gone through a 51. Now you back that up four years on average. Okay. Speaker 3 But it's not like you have the hysterectomy and then- No, unless they remove the ovary, right? Mary Claire Haver Exactly. So that's surgical menopause and we have premature menopause and early menopause. So those are a little bit different animals. Premature ovarian insufficiency is usually with an autoimmune condition. So it has its own set of risks. And then surgical menopause, you don't get a trial period. It's like, boom. So whenever I had to take out ovaries for medical reasons, I was putting a patch on them in the OR. Dax Shepard Yeah, that makes sense. Okay. So ethnic is a predictor. Mary Claire Haver So ethnic and then family history. You look at the women in your family, when did they go through it? Dax Shepard But on your mom's side, is she right about that? Mary Claire Haver Mom's side and sometimes dad's side. I mean, you're half genetically. Dax Shepard She compared it to male pattern baldness, which we know comes from your mom. But I was saying, well, that's because it's on the 45th chromosome and you can only get an extra mom. Mary Claire Haver So this isn't a chromosomal thing. Yeah, so it's not like that, right? It's more of a general health and kind of how things are going to go. Certain tribes in Africa have a lot of twins or certain cultures are more prone to twins. That's more of a general than a chromosome thing. Dax Shepard There's a couple of things happening. A, it was completely understudied, as you pointed out. It's beginning to get studied, but also we're seeing an art. What do you think about the impact of all fours? ([Time 1:10:05](https://share.snipd.com/snip/266a5e37-94f4-49e5-a0cb-82596a56f281)) - **All Fours and Menopause** - Mary Claire Haver found it challenging to engage with the novel 'All Fours' initially. - She was instructed by her co-writer to understand its resonance with women experiencing menopause. Transcript: Mary Claire Haver I'm literally on 79% of the chapter. First of all, I hate the protagonist. Okay. Yeah. So she's not my girl. Yeah. Okay. But I'm researching and writing the new perimenopause. It's not coming out till 2026. I'm in the middle of it. And so Gretchen, who's my co-writer, I write like an asshole. I am so clinical. My collaborator will take my disgusting prose and spin it into something that sounds digestible. Like a human. Not a normal person could read, not geek. And Gretchen's like, it from the perspective this is resonating and that just flipped the switch for me I read for entertainment I read about fairies and dragons and lots of sex and my Daughter reads all the dystopian novels so I read to read with her and talk about stuff and then I read medical journal articles so to pick up a book that is outside of my usual and not have A 15 year old little girl who turns into a princess with magical powers was like hard. I'm trying to identify this. And she says, stop trying to identify, read it and figure out why the hell the world is resonating. And then I'm like, oh, so then the doctor in me is like, she's having palpitations. That's a panic attack. That's menopause. That's menopause. That's menopause. Now I have an affair and redo this room in this weird hotel. That's a whole nother thing, but I'm getting it now. It is so hard resonating. Movie rights are done. Oh yeah. All my friends read it. Did you love it? I loved it. I haven't read it. Dax Shepard I've been told what it's about from Monica who loved it. To me, it's like I was prescribed a role I don't want, or I want to test, or I want to shake up, or I want to break because I just prescribed it. And now I want to decide. I don't want it anymore. That's so perfectly paralleled to, hey, guess what? I don't want to live a third of my life in discomfort. Mary Claire Haver That. So what I'm finding, and I think why the divorce rate's so high, is that women and myself included, and thank God my relationship is better than it's ever been. And we're working together. We have a small business through the supplement company and he's now running it. I've never liked him more. But yeah, she's getting to choose the last third of her life. And so did I. I chose differently than her and that's okay. But women are circling the wagons around themselves. Menopause is fucking them so hard. They are giving themselves permission to put themselves first. Yes. To me, it's I've had enough on all the levels. And now it's a survival thing. If I don't do this, me, my journey was quit a job that didn't serve me, stop serving a system that was broken, absolutely get the hell out of Dodge, figure out what the fuck I wanted to do With my life, put my own oxygen mask on first. Speaker 3 It's time for you. Mary Claire Haver And I really didn't give a shit if the kids or my husband cared, but I had to do this. Thank God it all worked out. And look where I am now. But that's what it is. Speaker 3 It's I'm making choices for the first time that are for me that aren't just handed societally to you. But what's scary about that book is now is the time I get to make the choices and my body is disintegrating. That's the part that I think everyone was like, oh, my God, we have to wait till then. And it's coinciding with that. What do we do? ([Time 1:12:33](https://share.snipd.com/snip/9a9ccbb3-6c95-4efc-8782-72860ef122e8)) - **Menopause and Empowerment** - Women in menopause often make choices that prioritize their well-being, sometimes leading to significant life changes. - This empowerment can be challenging but ultimately positive. Transcript: Mary Claire Haver How do we prevent ourselves from getting to the too late exactly too late to celebrate well educate yourself as soon as possible yeah that's part of my mission is just vomiting all over Dax Shepard Social media i think a lot of people think of hrt as being what you do after you have all the symptoms that's the next wave i think is preventative where some of the hardcore old school menopause Mary Claire Haver People are like, don't say prevent, they come after me every time I talk. Look, FDA approved for the prevention of osteoporosis and that is enough for me. But let me tell you, the U.S. Preventative Services Task Force needs to get their shit together because you have a window of opportunity for cardiovascular disease prevention and the data coming out clearly For mental health. We can prevent the suicides, the job loss, the brain fog, unless you're on the dementia spectrum, with early and judicious hormone therapy. Not allowing your body to withdraw and go through that chaos. Why wait till you have all the symptoms? Dax Shepard Why wait till your vagina's broken? But there's no other condition that we don't think early detection and treatment is beneficial. Mary Claire Haver It's never been thought of like that. It's way too you're miserable. And then it was severe symptoms only. A doctor's going to tell me if my symptoms are severe enough? What does that even mean? What does that even mean? And why? Dax Shepard It's like some old vestigial Protestant suffering something. Mary Claire Haver Women have been taught to minimalize. Did you read the WW story? Dax Shepard Oh, yeah. Whiny women. Mary Claire Haver The whiny woman. This is just what women go through. They tend to whine a lot. Dax Shepard Early in her residency, they'd come to her and say, we got a WW in room 305. The ([Time 1:15:17](https://share.snipd.com/snip/e4ef1bc2-3aa0-47a5-82aa-5dcd78286a1e)) - **Dismissive Labels** - Medical professionals often dismiss women's menopause symptoms with dismissive labels like "whiny woman." - This reflects a lack of understanding and empathy towards women's health concerns. Transcript: Mary Claire Haver Woman with a laundry list of complaints, very vague, weight gain, brain fog, low libido. And they're like, check her thyroid. Get these tests. Make sure you're not missing anything, but you're not going to be able to help her. Dax Shepard It's just a whiny woman. Mary Claire Haver It's just one of those whiny women. So I talked to other doctors across the country. And in California, they called it whiny Guinness. Oh, nice. And on the East Coast, around New York, it was TBD, Total Body Dolores. And in Miami, it was Madame Dolores. Speaker 3 Oh, my God. What is that? Mary Claire Haver Pain. Oh, okay. Like, she's got a lot of pain. Women who come in and complain a lot, kind of vague. Libido, go have some wine. You'll be okay. Yeah, yeah, yeah. The answer. Oh, my gosh. This is wild. ([Time 1:16:47](https://share.snipd.com/snip/ca134118-b30b-47ee-867c-8589254d47e4))