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

Andrew Huberman2 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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