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Dr. Mary Claire Haver: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality

Andrew Huberman・2 minutes read

Perimenopause and menopause impact women psychologically, biologically, and socially, requiring preparation and proactive health strategies for optimal well-being. Hormone replacement therapy, nutritional practices, and lifestyle adjustments play vital roles in managing menopausal symptoms, with a need for increased research and education in women's health.

Insights

Preparation for perimenopause and menopause is essential for effective navigation of these stages, involving specific nutritional practices, supplementation, and conversations with healthcare providers.
Hormone replacement therapy, particularly estrogen and testosterone, is a crucial yet controversial topic that significantly impacts women's health during perimenopause and menopause.
The timing of hormone therapy initiation plays a vital role in determining its benefits for women, emphasizing the importance of strategic intervention.
Perimenopause involves hormonal chaos with unpredictable estrogen and progesterone levels, leading to diagnostic symptoms, highlighting the need for further research in this area.
Lifestyle factors such as diet, exercise, and sleep habits can significantly influence the course of perimenopause and menopause, underscoring the importance of holistic health management strategies.

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Recent questions

What are the common symptoms of perimenopause and menopause?
Symptoms include hot flashes, sleep issues, and inflammation.
How can women prepare for perimenopause and menopause?
Preparation involves nutritional practices, supplementation, and conversations with healthcare providers.
What role do hormones play in perimenopause and menopause?
Hormones like estrogen and testosterone decline, impacting health and symptoms.
What are some strategies to address common menopausal difficulties?
Strategies include managing sleep issues, hot flashes, and inflammation.
What is the average age for menopause, and when does perimenopause typically start?
Menopause occurs around 51-52, with perimenopause starting 7-10 years earlier.

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Summary

00:00

Navigating Perimenopause and Menopause for Women

Dr. Mary Clair Haver, an OBGYN expert, discusses perimenopause and menopause in terms of psychology, biology, and actions for optimal health.
Women should prepare for perimenopause and menopause before they arrive to navigate these stages effectively.
Specific nutritional practices, supplementation, and conversations with OBGYNs and mothers are crucial for women's health during perimenopause and menopause.
Hormone replacement therapy, including estrogen and testosterone, is a key topic with misconceptions and controversies.
The timing of hormone therapy initiation significantly impacts its benefits for women.
Strategies to address common menopausal difficulties like sleep issues, hot flashes, and inflammation are discussed.
Menopause signifies the end of ovarian function and a decline in sex hormone production.
Menopause is not just one day but represents the depletion of eggs and sex hormone levels.
The average age for menopause is around 51-52, with perimenopause starting 7-10 years earlier.
Perimenopause involves hormonal chaos with unpredictable estrogen and progesterone levels, leading to symptoms used for diagnosis.

14:50

Perimenopause: Research Gaps and Health Implications

Research on perimenopause is limited compared to pregnancy and menopause, with only 6,400 articles found on PubMed.
Resistance of cells and receptor changes during perimenopause require more research.
Mental health changes, including increased mental health disorders and SSRI use, are common during perimenopause.
Hormones play a crucial role in brain health, affecting neurotransmitters like serotonin and dopamine.
Symptoms of perimenopause include anxiety, cognitive issues, and loss of executive functioning.
Lifestyle factors like diet, exercise, and sleep habits can impact the course of perimenopause.
Factors like smoking, hysterectomy, and tubal ligation can affect the lifespan of the ovary.
Premature ovarian failure can lead to early menopause, with risks like cardiovascular disease and stroke.
Estrogen therapy doses vary based on the purpose, with menopause therapy aiming to alleviate hot flashes.
Birth control and menopause hormone therapy have similarities in estrogen use, but differences in dosage and effects on ovulation.

29:21

"Nutritional Supplements, Birth Control, and Menopause Research"

Suppression of ovulation can be used to alleviate acne, cramps, or other symptoms, while menopause hormone therapy can provide estrogen to calm the brain and stabilize hormone levels.
The speaker has been taking AG1 for over 10 years, emphasizing its importance for foundational nutrition and overall well-being.
Regardless of dietary preferences, it is recommended to consume unprocessed or minimally processed foods to meet nutritional needs adequately.
AG1 is highlighted as a comprehensive nutritional supplement that includes vitamins, minerals, probiotics, and adaptogens to support stress management and overall health.
Various forms of birth control, such as IUDs, pills, patches, and rings, are discussed, each with their own benefits and risks.
The speaker advocates for a vasectomy as a preferred form of birth control and highlights the importance of shared responsibility in contraception.
Hormonal contraception works by suppressing ovulation to prevent pregnancy, with different methods affecting the body in various ways.
Prolonged use of birth control that suppresses ovulation may slightly delay menopause onset by about 9 months.
Freezing eggs does not impact the onset of menopause, as only a small number of eggs are harvested compared to the natural monthly loss.
The lack of research and education in women's health, particularly in menopause and chronic diseases, is highlighted, with a call for increased funding and dedicated institutes for women's health research.

43:35

"Research Funding, Nutrition, and Menopause Health"

Advocating for increased research funding involves contacting Congress or Senators to express the importance of specific research areas.
Support for bills related to research funding can lead to increased budgets for initiatives like the brain initiative.
Nutrition plays a crucial role in managing inflammation during perimenopause, with fiber intake being a key factor.
A Mediterranean or Galveston diet, rich in fiber and diverse in colors, can aid in reducing inflammation and promoting overall health.
Protein intake is essential, especially for women, to combat visceral fat gain and maintain muscle mass.
Monitoring visceral fat levels can be done through methods like waist-to-hip ratio measurements or body scanners.
Symptoms of menopause include fatigue, sleep disruptions, psychological changes, menstrual irregularities, skin issues, and gut changes.
Changes in the gut microbiome during menopause can impact overall health, emphasizing the importance of fiber-rich and fermented foods.
Understanding family history of menopause age can provide insights into one's own menopausal timeline.
Regular monitoring of body composition changes, like waist-to-hip ratio, can help track progress and health improvements during menopause.

57:29

Menopause Management: Gut Health, Diet, and Therapy

Supporting the gut microbiome can potentially alleviate menopausal symptoms, with studies often using supplements like lactobacillus and bifidobacterium to show improvements in obese and hypertensive menopausal women.
Retrospective studies indicate that women following Mediterranean diets rich in fermented foods and yogurt experience better menopausal symptom management.
Culinary medicine certification helped in understanding nutrition better, leading to the creation of the Galveston diet, a more Americanized version of the Mediterranean diet with a focus on fasting and anti-inflammatory principles.
Fasting can potentially aid in reducing inflammation during menopause, although challenges like protein intake adequacy have been noted, leading to a shift towards spreading protein intake throughout the day.
Protein intake's importance for muscle health was previously underestimated, with resistance training now recommended for all individuals, including women, to maintain muscle strength and overall health.
Hot flashes, a common menopausal symptom, result from a hypothalamic thermo-regulatory center dysfunction, causing vasodilation and profuse sweating, often disrupting daily activities and sleep.
Hormone therapy is considered the gold standard for managing menopausal symptoms, particularly hot flashes, by restoring estrogen levels and regulating serotonin levels.
The demonization of hormone therapy stemmed from misinterpretations of large-scale trials, with estrogen-only therapy showing benefits in reducing cardiovascular disease risk in aging women.
Hormone therapy trials faced flaws in design and interpretation, leading to misconceptions about its risks and benefits, despite its potential in improving women's health during menopause.
Hormone therapy, particularly estrogen-only therapy, can be beneficial in managing menopausal symptoms and reducing cardiovascular disease risk, challenging the negative perceptions surrounding its use.

01:10:43

Hormone Therapy Study: Cardiovascular and Breast Cancer

The main estrogen in the compound is estradiol.
Two groups were given either Prim Pro (primin plus progestin) or Placebo.
A study recruited 11,000 participants in one arm and 15,000 in the other.
Women with hot flashes were excluded from the study.
The study aimed to measure cardiovascular disease outcomes.
The average age of participants was 63, despite menopause typically starting at 51.
In the estrogen plus progestin arm, there was a non-statistically significant increased risk of breast cancer.
The estrogen-only arm showed a 30% decreased risk of breast cancer.
Starting hormone therapy between ages 50-59 led to a 50% decreased risk of cardiovascular disease.
Estrogen is neuroprotective and exposure to estrogen correlates with higher cognition scores.

01:25:21

Optimizing Hormone Therapy for Women's Health

Hormone replacement therapy typically starts when patients are very symptomatic, especially in perimenopausal or postmenopausal women.
Dosages for hormone replacement therapy are tailored, with blood drawn to measure estradiol levels and titrate based on symptoms.
Therapeutic ranges for estradiol are not established, with dosages adjusted based on individual symptoms and responses.
Testosterone replacement therapy is often used to optimize well-being rather than strictly for low levels, with dosimenot strictly based on established ranges.
Hormone replacement therapy can be used to optimize health and reduce symptoms, not just for those out of range, with opportunities for further research.
Monitoring cholesterol and cardiovascular disease effects of hormone replacement therapy is crucial, with dosages adjusted based on individual responses.
Testosterone levels are checked more frequently in women due to lack of FDA-approved options, with transdermal options preferred.
Peak testosterone levels for women are around 35 to 70, with levels above 90 indicating potential issues like tumors or PCOS.
Hormone therapy focuses on replacing estrogens, androgens, and progesterone, with bioidentical formulations preferred for closer alignment with natural hormone levels.
Local hormone treatments, like vaginal estrogen and DHEA, have specific benefits for tissue health and can be used safely for various conditions like osteoporosis and sexual dysfunction.

01:39:14

Advancements in Menopause Care and Research

Menopause information is being systematically presented, with the Menopause Society not being acknowledged as a recognized entity.
The Menop Posi is now being recognized, leading to potential bans from certain platforms.
The speaker expresses pride in their expertise in delivering babies, caring for pregnant patients, pediatric gynecology, and adolescent care.
The speaker admits failure in post-reproductive care for women outside of surgical needs.
Exciting findings on hormone replacement therapy and flaws in previous studies are discussed, with European and Scandinavian studies showing protective benefits.
Forward-thinking studies are noted to come from Asia, particularly China, where gender equality in research is highlighted.
Non-hormonal therapies for menopause support are discussed, including nutrition, resistance training, and specific supplements like turmeric for hot flashes.
Recommendations for vitamin D, creatine, and bioactive collagen for muscle and bone health are made.
The use of a weighted vest for bone density improvement and muscle strength is recommended, with specific weight suggestions and practical applications.
The speaker discusses the development of a female-specific weighted vest for better comfort and effectiveness in bone density improvement.

01:52:44

Menopause, HRT, and Health Implications Explained

Research focuses on tenus and vertigo, with menopause accelerating crystal break-off rates in the ear.
Estrogen decline in menopause leads to increased tenus, while hormone replacement therapy (HRT) reduces vertigo incidents.
Dry eye, often underestimated, is a significant issue with a multi-billion-dollar treatment industry.
HRT appears to improve dry eye conditions, reducing occurrence and easing treatment.
Hormone therapy is not advisable for those with hormone-sensitive cancers or severe liver disease.
PCOS prevalence rises due to obesity, insulin resistance, and increased awareness, with birth control often used for treatment.
GLP1 medications aid in weight loss, with HRT enhancing weight loss effects by 30%.
GLP1 medications may reduce alcohol cravings and impulsive behaviors by affecting brain reward centers.
HRT benefits postmenopausal women for bone, genital, urinary, and skin health, with individual risk assessments necessary.
Estrogen therapy stabilizes mental health during perimenopause, while postmenopausal mental health often improves due to estrogen level stabilization.

02:06:51

Managing Menopause: Sleep, Sex, and Solutions

Hormone replacement therapy (HRT) can be continued as long as one is healthy, regardless of age.
Sleep disruptions during menopause can be caused by vasomotor symptoms, leading to middle-of-the-night awakenings.
Progestin, taken before bed, can calm the brain and improve sleep quality, even with HRT.
Alcohol tolerance decreases with age, affecting sleep quality significantly, with many women reporting sleep disturbances after consuming alcohol.
Men can support women going through menopause by acknowledging the transition, educating themselves, and being present during appointments.
Sexual dysfunction is common during menopause, with various issues like orgasmic disorder, arousal disorders, and hypoactive sexual desire disorder (HSDD) affecting women.
Testosterone therapy, Viagra, and Addyi are options to address sexual dysfunction, with testosterone being a popular choice due to its benefits and affordability.
Side effects from estrogen hormone replacement therapy (HRT) can include skin rashes and hives, potentially due to the adhesive in patches, prompting a switch to alternative forms of HRT.

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